Gina Rencken: This individual was responsible for overseeing this project by assisting the candidate in the process. Pragashnie Govender: This individual was responsible for co-supervising this project by assisting the candidate in the process.
INTRODUCTION
- Background of the study
- Problem statement
- Literature review
- Research aims and objectives
These clear neurological benefits of this intervention are reflected in the child's functioning and medical status. Achieving consensus on stroke topics and considerations for inclusion in the pediatric massage program.
Methodology
- Study design
- Data analysis
- Sampling techniques
- Data management
- Ethical considerations
After expert participants completed the online survey, the researcher analyzed the data using statistical summation into medians and upper and lower quartiles (Skulmoski, Hartman, & Krahn, 2007, p. 4). According to Hasson, Keeney, and McKenna (2000, p. 1012), reliability refers to "the extent to which a procedure produces similar results under constant conditions on all occasions."
ABSTRACT
INTRODUCTION
CONSENSUS ON AN INFANT MASSAGE PROGRAM FOR HIGH-RISK INFANTS FROM RESOURCE-LIMITED ENVIRONMENTS: THE DELPHI STUDY WITH PHYSIOTHERAPISTS. This high-risk infant is often unable to respond appropriately to caregiver cues, which can often lead to the primary caregiver feeling disconnected from their infant, as well as the infant feeling overwhelmed4. Due to the anticipated special needs of the infant in the future, as well as the possibility of losing a medically fragile infant, the caregiver may begin to develop a perception of failure3.
In addition to the underlying causes of the baby being born at high risk, there are also a variety of cultural and environmental factors that inhibit this bonding process such as the death of the baby's parent/s and resource-limited living conditions5 6. The aim of this study was to develop an infant massage program for high-risk infants that can be initiated by these primary caregivers in their context to assist this dyad in the bonding and attachment process.
LITERATURE REVIEW
This is due to several risk factors, such as the health status of the infant, the length of hospitalization, the distance of the infant from the mother's residence and the type of delivery8. These social factors, along with the infant's health problems, breastfeeding difficulties, and the emotional experiences of the primary caregiver, hinder the bonding and attachment process. Other goals include providing support and strategies to families of infants to become competent and confident in optimizing their child's development and empowering them to be active participants in their child's recovery program21.
Therefore, it is essential to increase caregiver competence and program sustainability to teach them stimulation techniques with their children21. Baby massage consists of gently and slowly hitting each part of the body through tangible stimulation by human hands22.
METHODOLOGY
The initial phase of the study focused on a comprehensive literature review by the researcher on the high-risk infant, the contextual considerations for this dyad from the resource-limited context as well as on infant massage in order to form a basis on which the initial online survey could be created31 . This phase consisted of the final composition and development of the infant massage program and was based on the consensus obtained in Round Three. The following selection criteria were used in this sampling approach to ensure representativeness of the sample to the study population which was based on the qualities of the expert panel rather than on the sample size30.
To maintain the rigor of the results from the Delphi technique, this study aimed for a response rate of 70% throughout the study31. The researcher was aware of the concepts of validity and reliability during the data collection and data analysis processes.
RESULTS
One participant commented when commenting on the lower limbs "push and slide - provides much more proprioceptive input" and which was confirmed by another participant who also noted "push and slide (push and twist)". When asked about the upper limbs, two participants said that "pressing and sliding" should be included, one participant recommended the inclusion of "Swedish milk" and two participants recommended "finger rolling"/"rolling each finger separately". It was also recommended by survey one participants that this routine be implemented "after bath time when cream needs to be applied" and "I would suggest after bath time", "when baby is happy and calm" and "as long as baby is calm - alert state" as well as "when the baby is in the silent alert state".
However, there was further non-consensus on the four sub-items discussed above in the second round on "hugging and sliding" and "Swedish milking" for the lower limbs as well. A further disagreement on the recommendation to use "coconut oil" was observed in the third survey, as in the second survey.
DISCUSSION AND IMPLICATIONS
Indian milking of the upper and lower limbs is included in the program, as it relaxes the limb and stimulates blood flow to the child's legs or arms23, thus encouraging normal movement patterns. However, it is still recommended that these two strokes be performed on the face, applying deep pressure around the perimeter of the baby's face, as well as using small circles around the baby's jaw. Incorporating skin-to-skin contact is beneficial because it helps the baby stay calm and relaxed, which is in addition to the soothing effect of the massage routine48.
The massage routine should be completed by integrating the baby's body by placing your hands on each part of the body you have massaged and naming the areas. This should be in addition to thanking the baby for accepting the massage and dressing him.
LIMITATIONS
It is recommended to start the massage routine with the use of oils/creams; such as unscented baby cream or aqueous cream. The substance must also be safe and suitable for the baby's sensitive skin and the ingredients of the formula must have been tested for their potential to cause contact sensitivity53. The use of coconut oil in this population has not generated consensus regarding its inclusion or exclusion.
However, research has shown the positive effects of premature weight gain with the use of coconut oil over mineral oils54 due to the transcutaneous absorption of the vegetable oil through the thinner and more vascular skin of the baby55. There is limited evidence of reliability when using the Delphi technique31 and the researcher could not test and retest the outcomes of the surveys with another sample due to time constraints.
CONCLUSION
A randomized, controlled trial to assess the effects of individualized newborn developmental care and assessment in a Swedish setting. Seeing in the Oracle: the Delphi method and its application to social policy and public health. Effects of massage and oil use on growth, blood flow and sleep pattern in infants.
A Delphi study of the trends or events that will impact the future of California charter schools. Appropriate and inappropriate use of humor in psychotherapy as perceived by certified reality therapists: a Delphi study.
Synthesis
This is done by warming the hands, placing them on the infant, and then allowing the hands to become heavy and warm (McClure, 2000, p. 49). This deep pressure will also be added to the infant's toes by touching each toe separately. The infant's fingers may also not have been mobilized very much in the device and therefore the individual will be asked to (n) open the hand, (o) roll the fingers.
Touching the infant's back activates a larger receptor field where receptor density is low and thus is less sensitive to touch (Bundy, Lane, & Murray, 2002, p. 44). Therefore, these strokes will be excluded from the program to avoid this aversive response. v) Swedish milking of the lower limbs was also a stroke that did not receive consensus in this study where the individual is asked to “place one of your hands on the baby's ankle.
Implications of the study
The primary caregiver is talking to the infant. iii.. v. Facial expressions of the primary caregiver .. j) The goal of the following closing techniques is to help the child integrate experiences and communicate with the primary caregiver. Integration, which involves using the hands on each part of the body that has been massaged and naming the areas.
Limitations of the study
Recommendations
Conclusion
Effectiveness of a Training and Support Program for Parents of Children with Disabilities: A Randomized Controlled Trial. Identifying serious drug-drug interactions: results of the partnership to prevent drug-drug interactions. Effects of early intervention on mental or neuromusculoskeletal and movement functions in children born with low birth weight or preterm: A meta-analysis.
The effect of deep cross friction massage on spasticity of children with cerebral palsy: a double-blind randomized controlled trial. Effects of tactile/kinesthetic stimulation on the clinical course and sleep/wake behavior of preterm neonates.
ANNEXURES
Question 5 Rate your opinion of the following infant massage strokes for use with high-risk infants from resource-limited settings. Question 7 Rate your opinion of the following infant massage strokes for use with high-risk infants from resource-limited settings. Question 9 Rate your opinion of the following infant massage strokes for use with high-risk infants from resource-limited settings.
Q11 Rate your opinion on the following infant massage strokes for use with high-risk infants from resource-limited contexts. Q13 Rate your opinion on the following infant massage strokes for use with high-risk infants from resource-limited contexts. Q8 Rate your opinion on the following infant massage strokes for use with high-risk infants from resource-limited contexts.
Q12 Rate your opinion on the following infant massage strokes for use with high-risk infants from resource-limited contexts.
