Spiritual Well-Being, Parental Stress, and Coping strategies: A cross-sectional study of Iranian Mothers with Preterm neonates

Document Type : Original Article


1 Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran

2 Department of Pediatrics, Urmia University of Medical Sciences, Urmia, Iran

3 Iran University of Medical Sciences, Tehran, Iran

4 Critical Care and Management Nursing Department; School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

5 Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran


Background: The present study aimed to assess the correlation of spiritual well-being with parental stress and coping strategies in mothers with preterm neonates hospitalized in neonatal intensive care units (NICUs).
Methods: This prospective cross-sectional study assessed Spiritual Well-Being (SWB), parental stress, and coping strategies in mothers (n=200) of preterm infants admitted to NICUs. Mothers were further divided based on socio-demographic characteristics, such as mother’s age, gestational age, average scores at school, mothers’ literacy level, the birth rank, cesarean or vaginal delivery, number of children, job, and duration of hospital stay.
Results: The results pointed out that 46.6% and 53.4%of mothers had moderate and high levels of SWB, respectively. Moreover, the religion domain (53.30±7.33) had a higher score, in comparison with the existence domain (46.03±7.15). The planful problem-solving was the most frequently used (46.02±11.46) strategy. Religion domain had a significant positive and negative correlation with planful problem-solving strategy (r=0.439**; P≤0/000) and emotional-driven coping strategy (r=-0.420**; P≤0/000), respectively. There was a significant negative correlation (r=-0.322**; P≤.0/000) between the existence domain and the emotional-driven coping strategy.
Conclusion: Regarding the close interrelationship between mothers and NICU nursing staff, it is clear that nurses can help mothers to cope with stress more quickly and efficiently using accurate assessment and appropriate intervention in terms of their spiritual and religious beliefs.


  1. Marlow N, Bennett C, Draper ES, Hennessy EM, Morgan AS, Costeloe KL. Perinatal outcomes for extremely preterm babies in relation to place of birth in England: the EPICure 2 study. Arch Dis Fetal Neonatal Ed. 2014; 99(3):181-8.
  2. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. Jama. 2015; 314(10):1039-51.
  3. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012; 379(9832):2162-72.
  4. Axelin A. Parents as pain killers in the pain management of preterm infants. Department of Nursing Science; University of Turku: 2010.
  5. Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019; 7(1):37-46.
  6. Hoffmeyer B. Mothers' self-perceived spirituality and coping (Doctoral dissertation, Lamar University-Beaumont).
  7. Kohan M, Borhani F, Abbaszadeh A, Sultan Ahmadi J, Khajehpoor M. Experience of mothers with premature infants in neonatal Intnensive Care Unit. Qual Health Res. 2012; 1(1):41-51.
  8. Malakouti J, Jabraeeli M , Valizadeh S, Babapour J. Mothers’ experience of having a preterm infant in the Neonatal Intensive Care Unit, a Phenomenological Study. Iran J Crit Care Nurs. 2013; 5(4):172–181.
  9. Bsiri-Moghaddam K, Basiri-Moghaddam M, Sadeghmoghaddam L, Ahmadi F. The concept of hospitalization of children from the view point of parents and children. Iran J Pediatr. 2011;
  10. Muscara F, McCarthy MC, Woolf C, Hearps SJ, Burke K, Anderson VA. Early psychological reactions in parents of children with a life threatening illness within a pediatric hospital setting. Eur Psychiatry. 2015; 30(5):555-61.
  11. Popp JM, Robinson JL, Britner PA, Blank TO. Parent adaptation and family functioning in relation to narratives of children with chronic illness. J Pediatr 2014; 29(1):58-64.
  12. Obeidat HM, Bond EA, Callister LC. The parental experience of having an infant in the newborn intensive care unit. J Perinat Educ. 2009; 18(3):23-9.
  13. Flacking R, Lehtonen L, Thomson G, Axelin A, Ahlqvist S, Moran VH, et al. Closeness and separation in neonatal intensive care. Acta Paediatr. 2012; 101(10):1032-7.
  14. Nyström K, Axelsson K. Mothers' experience of being separated from their newborns. J Obstet Gynecol Neonatal Nurs. 2002; 31(3):275-82.
  15. Shin H, White‐Traut R. The conceptual structure of transition to motherhood in the neonatal intensive care unit. J Adv Nurs. 2007; 58(1):90-8.
  16. Nolan A, Lawrence C. A pilot study of a nursing intervention protocol to minimize maternal-infant separation after cesarean birth. J Obstet Gynecol Neonatal Nurs. 2009; 38(4):430-42.
  17. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.
  18. Herdman HT, Kamitsuru S, editors. NANDA international nursing diagnoses: definitions & classification. New York: Thieme; 2017.
  19. Kaliampos A, Roussi P. Religious beliefs, coping, and psychological well-being among Greek cancer patients. J health psychol. 2017; 22(6):754-64.
  20. Arzani A, Valizadeh L, Zamanzadeh V, Mohammadi E. Mothers' strategies in handling the prematurely born infant: a qualitative study. J Caring Sci. 2015; 4(1):13-24.
  21. Galeano MD, Carvajal BV. Coping in mothers of premature newborns after hospital discharge. Newborn Infant Nurs Rev. 2016;16(3):105-9.
  22. Lam J, Spence K, Halliday R. Parents' perception of nursing support in the neonatal intensive care unit (NICU). Neonatal Paediatr Child Health Nurs. 2007; 10(3):19.
  23. Mok E, Leung SF. Nurses as providers of support for mothers of premature infants. J Clin Nurs. 2006; 15(6):726-34.
  24. Verklan MT, Walden M, Forest S. Core curriculum for neonatal intensive care nursing. New York: Elsevier; 2020.
  25. Kaliampos A, Roussi P. Religious beliefs, coping, and psychological well-being among Greek cancer patients. J Health psychol. 2017; 22(6):754-64.
  26. Krägeloh CU, Chai PP, Shepherd D, Billington R. How religious coping is used relative to other coping strategies depends on the individual’s level of religiosity and spirituality. J Relig Health. 2012; 51(4):1137-51.
  27. Koenig HG. Is religion good for your health? The effects of religion on physical and mental health. United Kingdom: Routledge; 2013.
  28. Seybold KS, Hill PC. The role of religion and spirituality in mental and physical health. Curr Dir Psychol Sci. 2001; 10(1):21-4.
  29. Doupnik SK, Hill D, Palakshappa D, Worsley D, Bae H, Shaik A, et al. Parent coping support interventions during acute pediatric hospitalizations: a meta-analysis. Pediatrics. 2017; 140(3):1-16.
  30. Paloutzian RF, Ellison CW. Loneliness, spiritual well-being and the quality of life. Loneliness: A sourcebook of current theory, research and therapy. New York: John Wiley & Sons;1982.
  31. Soleimani MA, Pahlevan Sharif S, Allen KA, Yaghoobzadeh A, Sharif Nia H, Gorgulu O. Psychometric properties of the Persian version of spiritual well-being scale in patients with acute myocardial infarction. J Relig Health. 2017; 56(6):1981-97.
  32. Miles MS, Funk SG, Carlson J. Parental Stressor Scale: neonatal intensive care unit. Nurs Res. 1993; 42(3):148-52.
  33. Mianaei SJ, Karahroudy FA, Rassouli M, Tafreshi MZ. The effect of Creating Opportunities for Parent Empowerment program on maternal stress, anxiety, and participation in NICU wards in Iran. Iran J Nurs Midwifery Res. 2014; 19(1):94-100.
  34. Folkman S, Lazarus RS. Coping as a mediator of emotion. J Pers Soc Psychol. 1988; 54(3):466-75.
  35. Agha Yusefi A, Dadsetan P, Ejeie J, Mansur M. The role of personal factors on coping strategies and effectiveness of coping therapy intervention on personal factors and depression. J Pers Soc Psychol. 2000; 4(16):347-70.
  36. Cheraghi MA, Payne S, Salsali M. Spiritual aspects of end-of-life care for Muslim patients: experiences from Iran. Int J Palliat Nurs. 2005; 11(9):468-74.
  37. Vafaei Fooladi A, Rassouli M, Yaghmaie F, Shakeri N. Assessing correlation between spiritual wellbeing and stress of mothers of hospitalized newborns in neonatal intensive care units. Iran J Nurs Res. 2015; 28(95):54-62.
  38. Seyedfatemi N, Rezaie M, Givari A, Hosseini F. Prayer and spiritual well-being in cancer patients. Payesh. 2006; 5(4):1-10.
  39. Sajadi M, Niazi N, Khosravi S, Yaghobi A, Rezaei M, Koenig HG. Effect of spiritual counseling on spiritual well-being in Iranian women with cancer: A randomized clinical trial. Complement Ther Clin Pract. 2018; 30:79-84.
  40. Jaberi A, Momennasab M, Yektatalab S, Ebadi A, Cheraghi MA. Spiritual health: A concept analysis. J Relig Health. 2019; 58(5):1537-60.
  41. Iranmanesh S, Tirgari B, Cheraghi MA. Developing and testing a spiritual care questionnaire in the Iranian context. J Relig Health. 2012; 51(4):1104-16.
  42. Tirgari B, Iranmanesh S, Cheraghi MA, Arefi A. Meaning of spiritual care: Iranian nurses' experiences. Holist Nurs Pract. 2013; 27(4):199-206.
  43. Brelsford GM, Doheny KK. Religious and spiritual journeys: brief reflections from mothers and fathers in a neonatal intensive care unit (NICU). Pastor psychol. 2016; 65(1):79-87.
  44. Asadi M, Asad Zandi M, Ebadi A. The effect of spiritual care based on «GHALBE SALIM» model on spiritual experiences of patients undergoing coronary artery bypass surgery. J Cardiovasc Nurs. 2013; 2(2):30-9.
  45. Jabraeili M, Hassankhani H, Negarandeh R, Abbaszadeh M, Cleveland LM. Mothers' emotional experiences providing care for their infants within the culture of an Iranian neonatal unit. Adv Neonatal Care. 2018; 18(4):3-12.
  46. Woodward LJ, Bora S, Clark CA, Montgomery-Hönger A, Pritchard VE, Spencer C, et al. Very preterm birth: maternal experiences of the neonatal intensive care environment. J Perinatol. 2014; 34(7):555-61.
  47. Burlaka V, Wu Q, Wu S, Churakova I. Internalizing and externalizing behaviors among Ukrainian children: The role of family communication and maternal coping. J Child Fam Stud. 2019; 28(5):1283-93.
  48. Irani M, Khadivzadeh T, Asghari-Nekah SM, Ebrahimipour H. Coping strategies of pregnant women with detected fetal anomalies in Iran: a qualitative study. Iran J Nurs Midwifery Res. 2019; 24(3):227-33.
  49. Mahfouz EM, Kamal NN, Mohammed ES, Refaei SA. Effects of mothers’ knowledge and coping strategies on the glycemic control of their diabetic children in Egypt. Int J Prev Med. 2018; 9:1-6.
  50. Sorato DB, Osório FL. Coping, psychopathology, and quality of life in cancer patients under palliative care. Palliat Support Care. 2015; 13(3):517-25.
  51. Harbitz MB, Brandstorp H, Gaski M. Rural general practice patients’ coping with hazards and harm: an interview study. BMJ Open. 2019; 9(10):1-7.
  52. Safavi M, Yahyavi ST, Narab HF, Yahyavi SH. Association between spiritual intelligence and stress, anxiety, and depression coping styles in patients with cancer receiving chemotherapy in university hospitals of Tehran University of medical science. J Cancer Res Ther. 2019; 15(5):1124-30.
  53. Wood JD, Ware CM, Correll T, Heaton JE, McBride T, Haynes JT. Relationship between spiritual well-being and post-traumatic stress disorder symptoms in United States air force remotely piloted aircraft and intelligence personnel. Mil Med. 2018; 183(9-10):489-93.
  54. Mihaljević S, Vuksan-Ćusa B, Marčinko D, Koić E, Kušević Z, Jakovljević M. Spiritual well-being, cortisol, and suicidality in Croatian war veterans suffering from PTSD. J Relig Health. 2011; 50(2):464-73.
  55. Le Roux S, Lotter GA, Steyn HS, Malan L. Cultural coping as a risk for depression and hypertension: the SABPA prospective study. Cardiovasc J Afr. 2018; 29(6):366-73.
  56. Das S, Punnoose VP, Doval N, Nair VY. Spirituality, religiousness and coping in patients with schizophrenia: A cross sectional study in a tertiary care hospital. Psychiatry Res. 2018; 265:238-43.
  57. Shah R, Kulhara P, Grover S, Kumar S, Malhotra R, Tyagi S. Relationship between spirituality/
    religiousness and coping in patients with residual schizophrenia. Qual Life Res. 2011; 20(7):1053-60.