Construction of a Questionnaire to Assess Parental Stress in Neonatal Intensive Care Unit

Document Type: Original Article


1 Faculty of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran

2 Pediatric and Neonatal Intensive Care Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

3 Fulbright Scholar and Professor at Florida State University, College of Nursing

4 Faculty of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Once an infant is hospitalized in the Neonatal Intensive Care Unit (NICU), the entire family dynamics is disrupted due to stressors such as interruption in maternal-infant bonding, abandonment of other siblings and financial burdens. Combination of multiple stressors often ends in divorce or other devastating results. In this study, a novel survey questionnaire has been developed to assess the level of parental stress in NICU and identify the warning signs, in order to provide assistance to young couples in need of help.
Methods: Qualitative content analysis was performed to survey 13couplesrecruited from various teaching hospitals in Isfahan, Iran.
Results: The initial part of the questionnaire was designed to assess parents’ stress level with an expected content validity index of 0.78 or above and to measure face validity of the questionnaire, all the items received a mean impact score of 1.5 or above, and the Cronbach’s alpha reliability of the 12-item questionnaire equaled to 0.904.Based on the factor analysis, the items with a correlation coefficient of less than 0.4 were excluded (one item was omitted).
Conclusion: Most survey questionnaires found in the existing literature have investigated the types of stressors experienced by parents with an infant in NICU. In this study, researchers offer a novel 11-item questionnaire designed to assess the level of stress among parents with a hospitalized infant in NICU.


  1. Nouri R, Kelishadi R, Ziaoddini AH. Study of common stresses among students in tehran. J Isfahan Med Sch (IUMS). 2010; 28(105).
  2. Higman W, Shaw K. Nurses' understanding about the delivery of family centred care in the neonatal unit. J Neonatal Nurs. 2008; 14(6):193-8.
  3. Zelkowitz P, Papageorgiou A, Bardin C, Wang T. Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months. Early Human Development. 2009; 85(1):51-8
  4. Merenstein GB. Handbook of Neonatal Intensive Care. 6th ed. St. Louis: Mosby Elsevier; 2006.
  5. Gale G, Brooks A. Implementing a palliative care program in a newborn intensive care unit. Advance in Neonatal Care. 2006; 6(1):37-53.
  6. Hockenberry MJ, Wilson D. Wong's Nursing Care of Infants and Children Multimedia Enhanced Version. 9th ed. St. Louis: Mosby Elsevier; 2013.
  7. Kliegman R, Nelson WB. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders Elsevier; 2007.
  8. Caldeira S, Hall J. Spiritual leadership and spiritual care in neonatology. J Nurs Manag. 2012; 20(8):1069-75.
  9. Claas MJ, de Vries LS, Koopman C, Uniken Venema MM, Eijsermans MJ, Bruinse HW, et al. Postnatal growth of preterm born children≤ 750g at birth. Early Hum Dev. 2011; 87(7):495-507.
10. Pyhälä R, Räikkönen K, Pesonen AK, Heinonen K, Hovi P, Eriksson JG, et al. Behavioral inhibition and behavioral approach in young adults with very low birth weight–The Helsinki study of very low birth weight adults. Pers Individ Dif. 2009; 46(2):106-10.

  1. 11.  Saunders RP, Abraham MR, Crosby MJ, Thomas K, Edwards WH. Evaluation and development of potentially better practices for improving family-centered care in neonatal intensive care units. Pediatrics. 2003; 111(4 Pt 2):e437-49.
12. Punthmatharith B, Buddharat U, Kamlangdee T. Comparisons of needs, need responses, and need response satisfaction of mothers of infants in neonatal intensive care units. J Pediatr Nurs. 2007; 22(6):498-506.

13. Heidari H, Hasanpour M, Fooladi M. The Iranian parents of premature infants in NICU experience stigma of shame. Med Arh. 2012; 66(1):35-40

14. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008; 62(1):107-15.

15. Polit DF, Beck CT. Essentials of Nursing Research: Appraising Evidence for Nursing Practice. Philadelphia: Lippincott Williams & Wilkins; 2013.

16. Vakili MM, Hidarnia AR, Niknami Sh. Development and psychometrics of an interpersonal communication skills scale (A.S.M.A) among Zanjan health Volunteers. Hayat J. 2012; 18(1):5-19.

17. Scherbaum CA, Cohen-Charash Y, Kern MJ. Measuring general self-efficacy: A comparison of three measures using item response theory. Educ Psychol Meas. 2006; 66(6):1047-63.

18. Brown TA. Confirmatory Factor Analysis for Applied Research. Philadelphia: Guilford Press; 2012.

19. Munro BH. Statistical Methods for Health Care Research. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

20. Franck LS, Cox S, Allen A, Winter I. Measuring neonatal intensive care unit‐related parental stress. J Adv Nurs. 2005; 49(6):608-15.

21. Valizadeh L. akbarbegloo M, Asadollahy M. The effective stressors on mothers of preterm babies in the neonatal intensive care unit. J Tabriz univ Med Sci. 2009; 31(1):85-90