. 2024 Nov 4;11(11):e70071. doi: 10.1002/nop2.70071

TABLE 1.

PAGER framework.

Pattern	Advances	Gaps	Evidence for practice	Research recommendations
Investigating the relation between neonatal NICU admission and maternal stress. What challenges do LMIC mothers encounter while their babies are in the NICU?	There is evidence of an increased maternal stress with neonatal NICU admission, separation of baby, neonatal medical condition, lack of communication with healthcare members and maternal health literacy.	There is a need for ongoing research to investigate the specific stress and stressors and assess the comprehensive effects of interventions to improve maternal health literacy and reduce maternal stress during neonatal NICU admission in LMICs.	Primary studies have indicated that factors such as neonate separation, severity of the child's illness, limited communication with healthcare professionals and complexity of NICU environment can negatively impact maternal psychological health.	To conduct experimental research to deliver comprehensive healthcare support to parents, communicate with mothers and involve the mothers in neonatal care activities in NICU to minimise the maternal stress and stressors related to neonatal NICU admission in LMICs.
Maternal perception and participation in neonatal care activities in the NICU.	There is increasing evidence in LMICs concerning maternal perception of participation in neonatal care at NICU, and communication with healthcare members to alleviate maternal stress.	Limited evidence exists in LMICs regarding the impact of maternal participation in neonatal care activities in NICU to improve the psychological well‐being of mothers and neonates during NICU admission.	Nurses and physicians should recognise importance of maternal participation in neonatal care at NICU, including skin‐to‐skin contact, gentle touch and vocal stimulation, which can reduce maternal stress and enhance neonatal health outcomes.	To improve maternal health literacy and promote maternal participation in neonatal care activities within the NICU, such as KMC, feeding, holding and massaging the baby to decrease maternal stress and enhance maternal psychological well‐being and neonatal clinical outcomes.
What intervention can effectively lower maternal stress levels and enhance maternal coping skills in LMICs?	Evidence suggests that early intervention strategies can effectively lower maternal stress and enhance coping ability during complex neonatal NICU admissions.	No scoping reviews have been conducted in LMICs to identify what type of intervention strategies can effectively reduce maternal stress and enhance coping skills in the NICU.	Studies that include effective communication and involving the mothers in neonatal care activities at NICU should be prioritised to improve mother's psychological health including self‐efficacy and competencies in neonatal care activities at NICU.	Appropriate early strategies such as family‐centred care including constant emotional support should be integrated into routine neonatal care at NICU in LMICs to minimise maternal stress and enhance coping skills in neonatal care activities.

Pattern

Advances

Gaps

Evidence for practice

Research recommendations

Investigating the relation between neonatal NICU admission and maternal stress.

What challenges do LMIC mothers encounter while their babies are in the NICU?

There is evidence of an increased maternal stress with neonatal NICU admission, separation of baby, neonatal medical condition, lack of communication with healthcare members and maternal health literacy.

There is a need for ongoing research to investigate the specific stress and stressors and assess the comprehensive effects of interventions to improve maternal health literacy and reduce maternal stress during neonatal NICU admission in LMICs.

Primary studies have indicated that factors such as neonate separation, severity of the child's illness, limited communication with healthcare professionals and complexity of NICU environment can negatively impact maternal psychological health.

To conduct experimental research to deliver comprehensive healthcare support to parents, communicate with mothers and involve the mothers in neonatal care activities in NICU to minimise the maternal stress and stressors related to neonatal NICU admission in LMICs.

Maternal perception and participation in neonatal care activities in the NICU.

There is increasing evidence in LMICs concerning maternal perception of participation in neonatal care at NICU, and communication with healthcare members to alleviate maternal stress.

Limited evidence exists in LMICs regarding the impact of maternal participation in neonatal care activities in NICU to improve the psychological well‐being of mothers and neonates during NICU admission.

Nurses and physicians should recognise importance of maternal participation in neonatal care at NICU, including skin‐to‐skin contact, gentle touch and vocal stimulation, which can reduce maternal stress and enhance neonatal health outcomes.

To improve maternal health literacy and promote maternal participation in neonatal care activities within the NICU, such as KMC, feeding, holding and massaging the baby to decrease maternal stress and enhance maternal psychological well‐being and neonatal clinical outcomes.

What intervention can effectively lower maternal stress levels and enhance maternal coping skills in LMICs?

Evidence suggests that early intervention strategies can effectively lower maternal stress and enhance coping ability during complex neonatal NICU admissions.

No scoping reviews have been conducted in LMICs to identify what type of intervention strategies can effectively reduce maternal stress and enhance coping skills in the NICU.

Studies that include effective communication and involving the mothers in neonatal care activities at NICU should be prioritised to improve mother's psychological health including self‐efficacy and competencies in neonatal care activities at NICU.

Appropriate early strategies such as family‐centred care including constant emotional support should be integrated into routine neonatal care at NICU in LMICs to minimise maternal stress and enhance coping skills in neonatal care activities.