Journal of Neonatal Nursing xxx (2017) 1e7
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Journal of Neonatal Nursing
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Original Article
Ghanaian fathers' experiences of caring for preterm infants; a journey
of exclusion
Esther Abena Adama*, Deborah Sundin, Sara Bayes
School of Nursing and Midwifery, Edith Cowan University, Western Australia, Australia
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 5 March 2017
Received in revised form
19 May 2017
Accepted 26 May 2017
Available online xxx
Aim: To explore Ghanaian fathers' experiences of caring for preterm infants in the neonatal unit and
after discharge.
Method: Participants were part of a larger study to explore parents’ experiences of caring for preterm
infants after discharge. Narrative inquiry methodology was used to interview nine fathers of preterm
infants of gestational age 26e36 weeks at three stages-one week, one month and four months-after
discharge from four level II and III neonatal units in Ghana. Data was analysed using thematic analysis
guided by the three-dimensional narrative inquiry space. Ethical approval and consent from fathers were
obtained before interviewing them at their residence.
Result: Three themes emerged from the data showing the chronological journey of fathers from the
neonatal unit till four months after dischargee1. In the neonatal unit e “there's no room for me; 2. Predischarge preparation e “I was not involved in discharge education” and 3. Home care/post discharge e
“I'm scared of my preterm infant”. Fathers reported being continuously excluded from the care of their
preterm infants. This exclusion resulted in increased stress and lack of confidence in caring for their
preterm infants after discharge.
Conclusion: Fathers' experiences of caring for preterm infants is a journey characterized by exclusion and
lack of caring confidence after discharge. Recognising and addressing the needs of fathers of preterm
infants in the neonatal unit is essential in building their caring confidence after discharge.
© 2017 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.
Keywords:
Discharge
Experience
Fathers
Ghana
Neonatal unit
Introduction
Parents of preterm infants endure stress from birth of the infant
and admission to neonatal unit until discharge and beyond (Chang
et al., 2016; Cleveland, 2008). Numerous studies have explored how
parents experience this stressful period and their coping mechanisms in the neonatal unit (Carter et al., 2005; Turan et al., 2008).
Results suggest that due to the unexpected nature of preterm infants' birth, parents are initially shock. Fegran et al (2008)
compared the emotional bonding experience of parents of preterm infants in the neonatal unit and reported that, while mothers
experienced a feeling of powerlessness, fathers experienced shock
but were willing to be involved in the care of their preterm infants.
Involving fathers in infants' care decreases fathers' stress level,
increases emotional bonding and attachment and increases the
intelligent quotient of children (Huerta et al., 2013; O'Brien and
Warren, 2014).
Fathers' traditional role as the family's breadwinner has shifted
to include direct involvement in childcare which was traditionally
considered a feminine responsibility (Annor, 2014). Fathers'
involvement in childcare only became prominent in the mid 1980's
as more women joined the work force. Raley et al (2012) revealed
that fathers are more likely to be involved in direct childcare activities if their wives spend more time at work and contribute
financially to the upkeep of the household. Fathers who hitherto
would have been at work now spend time with their family caring
for newborns especially in the early days following birth
(Cunningham et al., 2008; Premberg et al., 2008). In countries such
as Sweden, both mothers and fathers are given equal paid parental
€m and Duvander, 2002). Evidence
leave for childcare (Sundstro
since the inception of this policy in Sweden has revealed increased
paternal participation, involvement and overall satisfaction in
childcare among families (Haas and Hwang, 2008).
Fatherhood in the Ghanaian setting
* Corresponding author.
E-mail address: estyadama@yahoo.com (E.A. Adama).
In Ghana, as in most cultures around the world, fathers are the
heads of households. They command respect from members of
http://dx.doi.org/10.1016/j.jnn.2017.05.003
1355-1841/© 2017 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Adama, E.A., et al., Ghanaian fathers' experiences of caring for preterm infants; a journey of exclusion, Journal
of Neonatal Nursing (2017), http://dx.doi.org/10.1016/j.jnn.2017.05.003
2
E.A. Adama et al. / Journal of Neonatal Nursing xxx (2017) 1e7
their household (Abass et al., 2012). Fathers' involvement in
childcare is mostly related to the provision of shelter, food and
other needs of the family (Dumbaugh et al., 2014). Direct childcare
activities such as feeding, bathing, grooming and nappy changing
are considered a woman's domain and if done by a man is regarded
as a favour or an “extra job” (Annor, 2014, p. 28). Fathers are
perceived as purveyors of discipline who must behave in a harsh
and masculine manner (Nyarko, 2014). Their involvement in
childcare is only recently becoming popular with educated African
fathers becoming ‘softer’, and actively participating in childcare
(Annor, 2014; Heaton et al., 2005).
As the breadwinner, Ghanaian fathers are expected to be
hardworking and spend more time at work to meet the family's
needs. Culturally, Ghanaian fathers are considered caring and loving if they are able to provide financially for their family (Coe, 2011).
Male dominance is also seen in employment as only 39.7% of the
Ghanaian workforce is made up of women (Ghana Statistical
Service, 2015). Child caring is perceived as a basic responsibility
of mothers (Ampofo et al., 2007). Fathers only provide economic
support and make major maternal and infant health decisions
(Dumbaugh et al., 2014). Although evidence suggest that as heads
of households, fathers' participation and involvement in preventive
healthcare services has the potential of improving maternal and
child health outcomes, socio-cultural expectations of males has
been cited as the main barrier to male involvement in childcare
(Adongo et al., 2013; Dumbaugh et al., 2014; Mullany et al., 2007).
Fathers' experiences in the neonatal unit
Previous studies on how fathers experience their care giving
role when a sick and/or preterm infant is in the neonatal unit have
been conducted in countries where paternal involvement in
childcare is a well-known phenomenon. The results indicate that
with all the support in the neonatal unit prior to discharge, fathers
report feeling anxious, lack of control and low confidence in caring
for their infants (Deeney et al., 2009; Hollywood and Hollywood,
2011; Provenzi and Santoro, 2015). This stress is apparently at its
peak in the first week of admission as fathers perform the role of a
supporter to both mothers and infants (Lindberg et al., 2007;
Lundqvist et al., 2007). There is also evidence, however, that the
stress response may be delayed and become pathological in some
cases. In a study to compare the relationship between acute stress
disorder and post-traumatic stress disorder among parents of
preterm infants, Shaw et al. (2009) found that more fathers than
mothers experience post-traumatic stress disorder and that fathers'
post-traumatic stress disorder surfaced up to four months after the
stressful event. Similarly, Olshtain-Mann and Auslander (2008)
reported higher level of stress among parents of preterm infants
compared to parents of term infants two months after discharge.
Fathers in Pohlman (2005, p. 209) study described this feeling as
“frightening ordeal…and walking on pins and needles the whole
time”.
Support for fathers in the neonatal unit
Considering the high level of stress among fathers of preterm
infants and its effect on family dynamics and parent-child relationship (Mackley et al., 2010), scholars have recommended support for parents in neonatal units (Lindberg et al., 2007). The most
appropriate support in most neonatal units is the Family Centred
Care (FCC) approach. FCC is a philosophy in which the institutional
care provider forms a partnership with patients and their families
to provide optimum care for patients (Griffin, 2006). Introduction
of FCC in neonatal units led to the re-design of many neonatal units
in order to accommodate families' unrestricted presence (Griffin,
2006). It is advocated that the design of neonatal units should
not affect the practice of FCC. The foundation of FCC is shared information between care providers and families (Lindberg et al.,
2007). The right communication by healthcare workers, inviting
and involving fathers in the care of their infants are essential in
et al.,
building their confidence to care for preterm infants (Mode
2014; O'Brien and Warren, 2014). Despite the benefits of FCC,
many challenges have been cited. Key among them are nurses'
unsupportive attitude towards families who wish to be partners in
the care of their infants, and the extremely busy nature of neonatal
units (Coyne et al., 2011).
Fathers' post neonatal unit experience
After discharge from neonatal unit, parents of preterm infants
may experience post-traumatic stress disorders (Shaw et al., 2006,
2009). Comparing the post-traumatic stress levels of mothers and
fathers, Shaw et al. (2009) reported that more fathers than mothers
experience high level of stress up to four months after neonatal unit
discharge. Although it may appear that the infant's discharge ends
the worry of fathers, major stress levels still exist and so does the
need to provide effective support after discharge.
Lindberg et al. (2008) explored the experiences of eight Swedish
fathers after discharge of their infants from neonatal unit, and reported increased father-child bonding and caring confidence after
discharge. This finding is however not surprising as Swedish fathers
enjoy all the benefits of FCC and paid parental leave in order to be
involved in the care of their preterm infants during hospitalisation.
The higher the level of support rendered to fathers, the higher their
confidence and bonding with their infants.
In Ghana, although there is no formal policy for including fathers in their preterm infants' care, fathers are increasingly
showing willingness to be involved in child healthcare (Dumbaugh
et al., 2014). With the expected and actual rise in paternal
involvement and participation in infants' care and its effect on
improving newborn outcomes (Moxon et al., 2015), it is imperative
to explore how Ghanaian fathers experience their involvement,
participation, and care of their preterm infants during hospitalisation and after discharge. The findings of this study, which aims to
address these issues, will inform nursing practice in the neonatal
unit and beyond.
Method
Design
This study was conducted using narrative inquiry approach
described by Clandinin and Connelly (2000). Narrative inquiry is a
qualitative research methodology that studies the lived experiences and the influence of sociocultural environment on a given
phenomenon using stories as data (Clandinin, 2006). As narrative
inquiry enables participants to share their lived experiences
through storytelling, it was deemed a good methodological fit for
this study. Narrative inquiry emphasis on the essence of a story
rather than the ‘truth or fact’. It aims to understand the meaning
the storyteller ascribes to his/her experience of a phenomenon
under study (Kim, 2015).
Study setting
Ghana is located in West Africa few degrees north of the
Equator. There are ten administrative regions in Ghana. It has a total
area of 238,538 sq km with a current population of 26, 908, 262
(Central Intelligence Agency, 2017; Ghana Statistical Service, 2016).
Ghana is well known for its natural resources such as Gold,
Please cite this article in press as: Adama, E.A., et al., Ghanaian fathers' experiences of caring for preterm infants; a journey of exclusion, Journal
of Neonatal Nursing (2017), http://dx.doi.org/10.1016/j.jnn.2017.05.003
E.A. Adama et al. / Journal of Neonatal Nursing xxx (2017) 1e7
diamond, bauxite and recently oil. Agriculture provides onequarter of Ghana's Gross Domestic Product (GDP). In 2016, Ghana's GPD real growth estimate declined from 3.9% in 2015 to 3.3%
(Central Intelligence Agency, 2017). Ghana's hospital bed density is
0.9 beds/1000 population with an infant mortality rate of 36.3
deaths/1000 live births (Central Intelligence Agency, 2017).
Recruitment of participants for this study was done in four
government hospitals (one tertiary and three district hospitals) in
two regions-Ashanti and Western. People in these regions belong
to the larger Akan ethnic group (Central Intelligence Agency, 2017).
The four neonatal units have characteristics similar to level II
and III neonatal units. There were between 15 and 40 cots in the
neonatal units of district hospitals and 100 cots in the tertiary
hospital. However, due to limited equipment and space, there is
overcrowding resulting in two or more neonates sharing cots and
incubators. The nurse to patient ratio is an average of one registered
nurse to 3e7 neonates. Due to the busy and crowded nature of the
facilities, early discharge of stable preterm infants is practised at
these facilities.
Ethical consideration
Edith Cowan University Human Research Ethics Committee
and Kwame Nkrumah University of Science and Technology
Ethics Committee granted ethical clearance for this study. In
addition, heads of various hospitals granted consent for recruitment. Consent form was signed or thumb-printed by all
participants before interviews. Participants were assured of
confidentiality and privacy, therefore names used in the narratives are pseudonyms and do not have any connection with participants' real identities.
Study participants
Participants for this study form part of a larger study that
explored parents' experiences of caring for preterm infants after
discharge. A total of nine fathers of preterm infants were interviewed after discharge. Four were recruited from a tertiary teaching
hospital which provides neonatal intensive care to approximately
4500 infants a year (Gold et al., 2013). The rest of the fathers were
recruited from the remaining three district hospitals. Their ages
ranged from 20 to 38 years and their preterm infants' gestational
ages ranged from 26 to 36 weeks. They were all in full time
employment. Length of stay in the neonatal unit ranged between
one to nine weeks. Participants were considered eligible if they
were above 18 years and their preterm infants had no disabilities.
Data collection
A total of 27 in-depth interviews were conducted at one week,
one month and four months after neonatal unit discharge
(February to June, 2015). All interviews were conducted face-toface in participants' homes lasting between 20 and 85 minutes. A
semi-structured interview guide was used to elicit responses. Interviews were conducted by one of the authors (EAA) who is
Ghanaian and a registered nurse with experience of working in
neonatal units. Eighteen of the interviews were conducted in Twi, a
local language widely spoken in Ghana. The rest were conducted in
English. Data was collected until saturation was reached. All interviews were audio recorded, translated to English and transcribed verbatim. Participants' observation and field notes were
recorded to support audio recordings.
3
Data analysis
Analysis of data was conducted using thematic analysis. Stories
that carried similar messages were grouped and a theme assigned.
Therefore, themes that followed the chronological journey of fathers were assigned to reflect how fathers experienced the phenomenon of caring for their preterm infants at the neonatal unit
and after discharge. Analysis was based on the three-dimensional
narrative space framework (Connelly and Clandinin, 2006). In
addition, re-storying and participants' confirmation of stories was
utilised to further increase the study's rigour.
Results
The aim of this study was to explore the experiences of caring for
preterm infants in the neonatal unit and after discharge. Results
have been presented in chronological order to reflect how fathers
journeyed from the neonatal unit till discharge and the accommodation of the preterm infant into their routines. Each stage of the
journey has been represented by a theme that described fathers'
experiences. As narrative inquiry's feature is chronology, culture and
location, this order caters for the three-dimensional narrative space.
In the neonatal unit e “there's no room for me”
Father's experiences in the neonatal unit was themed “there's no
room for me”. Despite the struggle by fathers for recognition and
involvement in their preterm infants' care, fathers felt they were
constantly sent away by healthcare workers. After a series of interviews, it was clear that although Ghanaian fathers may want to
be actively involved in the care of their preterm infants, they were
unlikely to be given the opportunity in the initial stages when their
preterm infants were hospitalised. This was evidenced in the
following interview extract:
I went to the unit every evening after work to spend time with
my child and wife but anytime I went there, I could not see and
hold my baby for long. I felt like I was not welcome but I kept on
asking questions. All the attention was given to the mother and I
was left out (Ben)
In another interview, a father narrated how excluded he felt
during one of his visits:
I understand the nurses were busy but a simple welcoming
attitude would have been good. I was only called when they
needed money for medicine or a consent for treatment. No one
seemed to care about fathers in the neonatal unit, so I asked my
wife for the baby's progress everyday (Evans).
Although fathers felt left out, they narrated that some of the
healthcare workers tried to include them but they felt there was no
room for fathers, which made it hard for them to be part of their
infant's care:
The charge nurse was very good. She took me to her office and
explained things to me but that was very brief. My wife had all
the attention. I do not envy her but at least they should accord us
[fathers] the same attention. After all, when we came home, it
was me, my wife and the baby so I should have been involved in
the hospital so that I can support her but that was so hard for the
healthcare workers to do (Isaac)
Having been thwarted in their efforts to get involved in their
infants' care, other fathers reverted to their traditional role of
Please cite this article in press as: Adama, E.A., et al., Ghanaian fathers' experiences of caring for preterm infants; a journey of exclusion, Journal
of Neonatal Nursing (2017), http://dx.doi.org/10.1016/j.jnn.2017.05.003
4
E.A. Adama et al. / Journal of Neonatal Nursing xxx (2017) 1e7
working and paying bills. Through their exclusion from the
neonatal unit, they came to believe that it was for mothers and
babies only. A father referred to the name of the neonatal unit to
confirm this assertion:
The name of the unit alone should tell you that you are not
welcomed. They call it MBU…Mother and Baby Unit. So where is
the father? That means I must stay away until my babies are
brought home (Bright, father of preterm twins)
Some fathers narrated that the routine of the neonatal unit was
not very accommodating for fathers:
I learnt that the neonatal unit had a strict feeding routine. This
routine coincided with the visiting hours. I entered there one
day hoping to have a good time with my baby and wife only to
see that all the women were breastfeeding their babies and I felt
so embarrassed so I left and vowed not to step in at that time
again (Justin).
These routines made it virtually impossible for fathers to spend
quality time with their preterm infants. Fathers therefore resorted
to being emotionally present all the time but physically absent most
of the time:
Although I couldn't spend more time in the neonatal unit, I
thought about my baby all the time and I prayed for her every
single minute (Kwame)
The fathers seem to have similar experience in the neonatal unit
e not one of the participants spoke positively about it e and all
reported that they struggled to feel comfortable around their infants after discharge.
Pre-discharge preparation e “I was not involved in discharge
education”
All the fathers in this study reported that they were not included
in discharge planning. Their experiences regarding pre-discharge
education included the following extracts:
They did not teach me anything or involve me. Probably my wife
would have benefitted from that. I went to visit them a day
before discharge and my wife said the doctors said if the baby is
well by tomorrow they will discharge them and so it happened
and they were discharged. They said nothing to me but I knew
where to send the baby if things go wrong at home (Simon).
I wasn't told anything by the doctors or nurses, my wife just
called me one day in a happy mood and said they have been
discharged…no discharge education whatsoever, but I trust my
wife may have been given some tips (Kwame).
No one said anything about home care of the babies to me. The
nurse said ‘your babies are discharged but you have to return in
three days to re-check their weight’ (Bright).
Realising that they have to support their partners to care for
their preterm infants, some fathers relied on the internet for information on preterm infants' care:
No one told me anything. As soon as I paid the hospital bills, my
baby and wife were released to me and no one said anything.
When I asked if there was something I should know, one of the
nurses said I should ask my wife. As if to say ‘your wife is more
important to us’ Well, I learnt a lot by reading online (Justin).
Some fathers received pre-discharge education on the care of
their infants, but only because they asked questions:
I used to ask a lot of questions so they told me all they had told
my wife. I was in the neonatal unit very often and the nurses got
to know me. I asked them questions regarding my baby's health.
I had no issues when my baby was discharged. My wife and I
never assume, we always ask (Ben).
Fathers lamented that healthcare workers involved mothers in
pre-discharge education and neglected them. They felt an equal
opportunity to teaching and learning in the neonatal unit should be
given to both parents:
I don't think I'll be asking for too much if I ask that they include
me in the dos and the don'ts of caring for my own preterm infant
at home but that never happened. Discharge is good but what is
the essence of it if you cannot continue the care at home? They
were busy teaching my wife stuff, but they never bordered
about me (Isaac).
Home care/post discharge e “I'm scared of my preterm infant”
The immediate effect of not involving fathers in the care of
preterm infants during hospitalization was felt during the initial
stages after discharge. Fathers reported varied emotional responses
such as fear, anxiety and absolute lack of confidence in caring for
preterm infants. Discharge presented as the best moment for fathers as one father narrated:
When my wife called to say, they've been discharged, I rushed to
take them home where I could feel like a father and not an
intruder (Kwame).
Fathers had problems relating to their preterm infants as they
were scared to hold and care for them:
In fact, when they finally came home, I was afraid to touch the
babies because that was my first time of holding them. They
appeared too tiny that I thought I would break him. When all the
two were crying at the same time, I felt sorry for my wife but I
was also scared of injuring them. In the end, I had to invite my
mother to come and help with their care (Bright).
Another father said.
I have only seen her twice out of the three weeks she and her
mother spent in the neonatal unit so when they came home, I
didn't even have the confidence to feed her but my wife taught
me and now I can do it with ease (Kwame).
Although fathers were happy that their babies were finally
discharged from the neonatal unit, most of them said the happiness
was short lived as they had to return to the neonatal unit:
I brought my wife and baby home feeling a bit of relief from the
constant travel to the hospital but that night was horrible. The
baby cried throughout the night and I was so confused not
knowing what to do. I finally took them back to the hospital. When
we got there, we were told there was nothing wrong with her, she
wanted a cuddle. A simple solution like a cuddle! But I didn't know
because my wife and I have never had a baby (Simon).
Please cite this article in press as: Adama, E.A., et al., Ghanaian fathers' experiences of caring for preterm infants; a journey of exclusion, Journal
of Neonatal Nursing (2017), http://dx.doi.org/10.1016/j.jnn.2017.05.003
E.A. Adama et al. / Journal of Neonatal Nursing xxx (2017) 1e7
Some fathers reported that their lack of confidence in providing
care led to some serious incidents after discharge:
I was never taught how to feed the baby so when my wife went
for shopping and the baby was crying, I was scared to feed her
with the expressed breast milk but I gathered courage and fed
her. Later, she started vomiting from the mouth and nose. I was
so scared. I took her to the hospital and they said I did not burp
her after feeding… I know it wasn't my fault because no one
taught me how to feed or burp (Don).
For some fathers, home was probably the best thing that
happened to them since the preterm infant was born:
This baby is very brave and so is my wife. I wanted to appreciate
their bravery but the hospital wasn't just conducive. At home, I
try to help my wife care for him. Initially, because of his smallish
body, I was uncomfortable, but now, I can bath, feed and change
his diapers. Sometimes I look after her all night so that my wife
can have a good night sleep (Ben).
Lack of adequate discharge preparation for fathers also resulted
in instances where fathers could not provide the best support for
their partners and preterm infants.
I never thought of bringing my mother-in-law to help with the
baby's care. I had always wanted to care for my baby independently but unfortunately, he was born preterm and I had no idea
what to do to support my wife so I brought my mother-in-law to
help (Kwame).
Home hasn't been easy at all, I was always scared of losing my
baby. I felt he should still be in the hospital where doctors are
constantly present to care for him. Maybe I am being too protective but I think I still have some fears. I feel my baby should
still be in the womb not here [home]. The incubator gives me the
assurance that the womb conditions are present but at home, I
am always scared that something bad will happen (Evans).
I wanted to help my wife but I felt very incompetent so I do the
house chores and she cares for the baby (Don).
Some father reported that they did not know who to call if
something went wrong with their babies because they were not
informed prior to discharge.
Right now, you don't really know who to call if something
happens. I asked my wife wasn't given any number to call for
help. When you're discharged, it's like you've to do everything
but I don't know anything about preterm infants (Kojo)
Discussion
We explored the experiences of fathers of preterm infants after
discharge from four level II and III neonatal units in Ghana. The
theme “there's no room for you” was considered the best fit for the
data describing fathers' experiences in the neonatal unit. Fathers
felt they were not involved in the care of their preterm infants e
they felt sidelined. Fathers perceived their presence in the neonatal
unit as a nuisance to healthcare workers and other patients. Due to
this feeling, some fathers switched to their previously ‘comfortable’
breadwinner role and stopped visiting the neonatal unit. This situation potentially undermined the principles of FCC in the neonatal
unit. Our finding is supported by Dumbaugh et al. (2014)’s work in
5
which fathers were sent away from labour rooms and immediate
infant care areas as these places were perceived as a woman's
space.
In the neonatal unit, fathers felt like aliens to their own infants
and partners as reported by Jackson et al. (2003). They struggled for
non-existing caring space until they turned to feeling more
emotionally present than being physically present. The only way
fathers felt involved in the care of their preterm infants was
through payment of bills and signing consent forms for clinical
procedures. For fathers, the caring space was dominated by
mothers leaving only a ‘financial space’ for them to occupy. A
possible explanation for the lack of inclusion of fathers in the care
of their preterm infants in the neonatal unit is the deeply rooted
cultural expectation that women are the sole carers of children
while men remain breadwinners (Adinkrah, 2012; Annor, 2014).
Similar findings have been reported by Hollywood and Hollywood
(2011) in which fathers reported feeling helpless because more
attention was given to mothers.
In our study, healthcare workers, the design and routine of the
neonatal units were cited as barriers for fathers' involvement in
their preterm infants' care. Fathers felt they were either intruding
or obstructing ward routines.This prevented fathers from fully
participating in the care of their infants' care. This finding is
consistent with the work of Feeley et al. (2013) in which fathers
reported the structure of the neonatal unit and attitude of healthcare workers as barriers for becoming involved in their preterm
infants' care. However, it is in contrast with the work of Lundqvist
et al. (2007) in which medical equipment such as incubator were
perceived as a barrier between fathers and preterm infants.
Although fathers of preterm infants have expressed willingness
to be involved immediately after the shocking birth of their preterm infants (Fegran et al., 2008), fathers in our study reported not
being involved in their preterm infants' care during hospitalisation
and immediately following discharge; they felt a sense of neglect
by healthcare workers. Our finding is similar to that of Lindberg
et al. (2007) but contrary to O'Brien and Warren (2014) and
Arockiasamy et al. (2008) in which fathers felt they have been
supported and encouraged to participate in the care of their preterm infants to the fullest. Father's lack of involvement in their
preterm infants' care can be attributed to nurses lack of appreciation of fathers' contemporary significant role in childcare and/or
nurses negative attitude towards patients and their family (Moyer
et al., 2014).
At the pre-discharge stage, most of the fathers reported that
they were not included in discharge education. They continued to
feel excluded and unrecognised even when their infants were being
prepared for discharge. One very outstanding explanation of this
result is that healthcare workers may also hold the same cultural
belief that ‘caring space’ is for mothers whereas fathers occupy the
‘financial space’. For this reasons, fathers leave the neonatal unit
with a lot of unanswered questions and doubts regarding their
preterm infants care. Similar finding has been reported by Sneath
(2009) whereby parents of neonatal unit infants go home with
unanswered questions due to lack of discharge education.
After discharge, the consequence of not involving fathers in
their preterm infants' care was evident in fathers' inability to
confidently provide care and unnecessary presentation to hospital.
Bonding issues were evident among fathers because the process of
bonding with their preterm infants during the early days after birth
was truncated by healthcare workers in the neonatal unit by
denying fathers unlimited access to their preterm infants. Our
finding supports the work of Olshtain-Mann and Auslander (2008)
who reported lack of caring confidence and higher level of stress
among parents of preterm infants two months after discharge but
contradicts the work of Jackson et al. (2003) who reported
Please cite this article in press as: Adama, E.A., et al., Ghanaian fathers' experiences of caring for preterm infants; a journey of exclusion, Journal
of Neonatal Nursing (2017), http://dx.doi.org/10.1016/j.jnn.2017.05.003
6
E.A. Adama et al. / Journal of Neonatal Nursing xxx (2017) 1e7
increased level of caring confidence among fathers of preterm infants after discharge.
Study strength and limitation
The current study which explored fathers' experiences of caring
for preterm infants in the neonatal units and post-discharge has
deepened our understanding of the phenomenon of caring for
preterm infants in the Ghanaian setting. However, it was limited by
the small number of participants making transferability of result an
issue to consider in practice. The small number of participants
however provided rich in-depth data to describe the phenomenon.
Also, as data was collected after discharge, there is a possibility
of recall bias. However, as the aim of narrative inquiry is to understand the value the participants' place on their experiences
rather than seeking the truth (Kim, 2015), the current study achieved its aim of exploring the phenomenon of caring among fathers
of preterm infants.
Conclusion
Fathers in this study felt they were excluded from the care of
their preterm infants; they were only recognised when a significant
medical decision or financial issue arose. The concept of family
centred care in neonatal units in Ghana is yet to be fully practised.
In addition, our study has revealed how attitude of healthcare
workers and the name of neonatal unit prevented fathers from
being fully involved in the care of their preterm infants. Excluding
fathers in the neonatal units and discharge planning resulted in
increased anxiety, confusion, and undue stress after discharge.
Further research is required to investigate the support needs of
fathers of preterm infants in the neonatal unit to serve as a foundation for practice change. Modalities for implementing family
centred care in resource poor regions like Ghana must also be
studied.
Conflict of interest statement
No conflict of interest has been declared by the authors.
Funding statement
This project was funded by the Edith Cowan University Postgraduate Research Scholarship (ECUPRS)
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