الفهرس 
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Abstract
Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks’ gestational age, as opposed to the usual about 40 weeks. Symptoms of preterm labor include uterine contractions which occur more often than every ten minutes or the leaking of fluid from the vagina. Premature infants are at greater risk for cerebral palsy, delays in development, hearing problems and sight problems. These risks are greater the earlier a baby is born (Henderson, Carson, & Redshaw, 2016).
Premature infants experience many problems during their stay in the neonatal intensive care unit (NICU). Premature birth creates a sense of loss in family members, especially mothers, and causes tension and stress. Moreover, inefficient coping strategies increase stress, incompatibility, and mental problems (Ncube, Barlow, & Mayers, 2016).
The aim of this study was to
1- Assessing types of stressors facing parents with premature infant
2- Assessing the level of stress facing parents with premature infant
3- Assessing the coping strategies for parents with premature infant
4- Technical Design:
Research design:
A descriptive research design was utilized in this study to conduct the study aim.
Setting:
This study was conducted at al Raml children hospital (neonatal intensive care unit) Alexandria city.
Sampling:
Convenient sample of all available parents (50 parents of premature infant)
Tools of data collection: three tools were used in this study for data collection
Tool І: Interviewing Questionnaire: form was designed by the investigator and written in simple Arabic language based on scientific literature review to assess data about the following (Appendix):
Part one: Socio demographic interviewing sheet was used to assess socio-demographic characteristics age, gender, educational level, occupation, income, salary and residence.
Part two: Medical assessment of preterm infant including: diagnosis, preterm infant condition, gestational age, APGAR score, and vital signs.
Tool ІI: The Parent stressor scale (PSS NICU) developed by Miles, (1991) to measure the types of stressors facing parents the PSS: NICU and transferred into in Arabic language. It included 46 items in four subscales. The four subscales were sights and sounds (5 items); infant appearance (19 items); parent-infant relationship (10 items); and health care staff (11items).
Tool ІII: Ways of Coping check list (WCCL) developed by Lazarus and folkman, (1984) to measure the coping strategies for parents with premature infant to deal with stressors, modified by the investigator transferred into in Arabic language. It included 57 items denial (4 items); minimize situation (3 items); social support for emotional reason (3 items); wishful thinking (3 items); social withdrawal (4 items); escape -/ avoidance of problem (4 items); positive reinterpretation (4 items); acceptance (3 items); turning to religion (3 items); express of emotion (2 items); self-controlling (3 items); self-criticism (2 items); behavioral restructuring (4 items); cognitive restructuring (6 items), active coping (4 items); and seeking social support for instrumental reason (5 items).
II. Operational Design:
The operational design for this study consisted of three phases, namely preparatory phase, pilot study, and fieldwork.
Preparatory phase:
This phase included reviewing of literature related to types of stressors facing parents, and coping strategies for parents with premature infant by using books, articles, journals, and internet. This served to develop the study tools for data collection. During this phase, the investigator also visited the selected places to get acquainted with the personnel and the study settings. Development of the tools was under supervisors’ guidance and expert’s opinions were considered.
Pilot Study:
A pilot study was conducted on 10% of total sample of parents to test availability of study sample and clarity of the study tools. The pilot has also served to estimate the time needed for each subject to fill in the questions. According to the results of the pilot, no corrections and omissions of items were performed as needed. They were included in the main study subjects during the actual collection of data. The process of pilot study took one week (from 1-7/9) in sept. 2019.
The study results can be summarized as follows:
1- The majority (86.0%) of them was female, near about two third (62.0%) of them had read and write, and all (100.0%) of them married. Mostly of third or higher was free work and governmental work (44.0% & 36.0% respectively), more than half of them had daily income (54.0%), three quarters of them had insufficient salary and near to three quarters living in rural areas (76.0% & 70.0% respectively
2- Half of the parents in the study sample mentioned presence of monitors and equipment very stressful (50.0%), near to two thirds of them alarm noises increase their stress level (64.0%).
3- The majority of the parents in the studied sample mentioned unusual breathing of their premature infants was extremely stressful events to them (84.0) followed by more than half of them mentioned suddenly changes color, unusual color, and bruises, cuts or incisions (58.0%, 58.0%, & 52.0% respectively.
4- Near to one third of parents had mild stress, more than one quarters of them had moderate stress and near to half of them had sever stress level.
5- More than one thirds of the parents in the study sample used a great deal with they feel that their experienced nightmare and themselves was wakeup from it (34.0%), more than three quarters of them used a quite a bit when they went on as if nothing had happen (76.0%), and more than two thirds of them feel that they were experiencing a nightmare and themself were waking up from it (62.0%)
6- The majority of the parents in the study sample don’t trying to avoid the problem out of their mind and not trying to forget what happened (82.0% & 82.0% respectively) and more than one quarters of them used sometimes busy with other mattered so that what happened does not control their thinking (28.0%)
7- The majority of the parents in the study sample don’t tried to keep their feeling to themselves, or depend on themselves in facing new circumstances without dependent on anyone (84.0% & 84.0% respectively) but more than one third of them used somewhat some strength and resilience (38.0%).
8- Parents seeking social support for instrumental reason had high mean percent (79.2 % ± 13.8) followed by turning to religion (74.7% ± 22.2), then denial of illness (67.2% ± 11.2). Also, parents had more than half of mean percent in express of feeling (58.7% ± 19.9), wishful thinking (56.0% ± 11.7), behavioral restructuring (52.8% ± 17.6), self-criticism (52.7% ± 25.3) and social support for emotional reason (51.6% ± 13.4).
9- Increasing parents age lead to increase mean scores of parents’ engagement, male parents had high mean scores in engagement than female parent, and free work parents had high mean scores in engagement than other occupation with statistically significance differences p - value.05, .0001, &.001 respectively.
10- Increasing parents age lead to increase mean scores of stress due to changes in infant appearance and decrease parent infant relationship stressor with statistically significance differences p - value.0001&.0001 respectively.
11- Faire negative correlation between parents engagement and different types of stressors as infant appearance (r=-.460, p value.0001), health care staff behaviors (r=-.323, p - value.016), parent infant relationship (r=-.287, p - value.044) and health care staff behaviors (r=-.301, p - value.034). Also, there was a fair negative association between parent disengagement and infant appearance (r=-.339, P - value.016)