EDUCATIONAL METHODS TO IMPROVE THE ABILITY OF PARENTS TO PROVIDE DEVELOPMENTAL CARE FOR PREMATURE INFANTS: A LITERATUR REVIEW

Introduction Babies born prematurely are at risk of experiencing visual disturbances, hearing loss, disabilities, the risk of infection and even death. Care for premature babies requires serious attention for both health workers and parents. The role of parents is very important both during hospitalization and at home. Therefore, in order to improve the abilities of parents, it is necessary to make educational efforts with the right method. Objectives This literature review aims to provide an overview of educational methods that nurses can use to improve the ability of parents to care for or care for the development of premature babies. Methods The method used is to search for literature that fits the established theme using 5 data based, namely Scopus, ProQuest, Science Direct, Elsevier Clinicaly for Nursing and Web of Science. The strategy used in finding literature that fits the theme and is used in this literature review uses the PICOS framework. Then conducted a review with the PRISMA method. Results The literature selection results obtained 572 publications, after going through the selection obtained 11 literatures that match the theme, with 11 educational methods. These methods can be grouped into ideas, namely increasing parental involvement during treatment, using technology, stress management and continuous monitoring. Conclusion The ability of parents to care for premature babies is needed in order to minimize complications in infants, reduce morbidity, avoid disabilities, increase growth and development of premature babies optimally and reduce parental stress levels, increase parental confidence and good parents' self-efficacy. Choosing the right educational method can improve the ability of parents to properly care for and provide developmental care for premature babies.


INTRODUCTION Background
It is estimated that 15 bilion babies born prematurely, about 1 in 10 live birth (1).
Indonesia itself is ranked fifth after India, China, Nigeria and Pakistan. The data on the birth of preature babies in Indonesia is as many as 675.000. Approximately 1 million premature babies in the world die from complications that occur (1). Other impacts of birth are high morbidity and mortality rates, disabilities, learning difficulties, visual and hearing impairments and susceptibility to infection with infection with infectious diseases in the future (1) Various studies were developed to prevent and overcome various complications that can occur in premature babies. One methode develop to address this problem The Neonatal Integrative Developmental Care Model describes sevent Neuroprotective Core Measures for Family-Centered Developmental Care (2). Seven things namely The Healing Environment, Partnering with Families, Positioning & Handling, Safeguarding Sleep, Minimizing Stress & Pain, Protecting Skin, and Optimizing Nutrition (2). This model requires an active role parent in the care of premature babies. A study in Finland found that parents really want to be responsible for caring for their babies both while still in the hospital an at home. They need nurses to empower them in providing care for their babies (3). One of the efforts to increase the ability of parent to play an active role in caring for premature babies, it is necessary to provide the parents with accurate information. One approach is used by teaching the stress and stability cues of preterm infants and a combination of four parental care involvement activities [PCIAs] (4) Parent who have premature bebies not only need clear information regarding their baby's health development and care. But also need additional emotional support, clear and honest communication, way to deal with stress in dealing with situations as well as knowledge about managing babies in the transition from hospital to home (5). Premature babies and their families also often need ongoing cpmmunity-based care once the baby is at home (6). In this regard, nurses need to identify the specific needs of parents in order to provide optimal support including emotional support (7). The indetification od these needs becomes that basis for a nurse to make an appropriate discharge plan. Discharge planning related studies are develop and it is know tha with proper planning parenta will be a ready to care for their babies at home (8) The method of providing information greatly affects the ability of parents to absorb information and apply the information obtained. This literatur review discusses various methods that can be used to provide information to increase the knowledge and abilities of parents in providing developmental care or caring premature babies

Context
This literature review discusses various studies on educational methods or health education for parents to improve the ability of parents to care for or provide developmental care for premature babies.

Purpose
The general purpose of this literature review it to describe various educational methods that can improve the ability of parents to provide developmental care for premature babies.

Question
What educational methods can enhance the role of parent ini providing developmental care for premature babies? which are used to expand or specify the search, making it easier to find journals that match the theme and will be used in writing this literature. The keywords used in finding jaournals that are in accordance with the review literature are adjusted to the Medical Subject Heading MeSH), the keywords used in the review literature are as follows: Based on the literature selection results, 572 publications were obtained from searching data bases. The results of this selection are described in Figure 1.  Title identified and screened (n=177)

RESULTS
The results of a literature study related to educational methods to improve the ability of parents to provide developmental care for premature babies are describe in Table 3

DISCUSSION
The results of literature study regarding the methods used to improve the ability of parents to provide developmental care for premature babies can be grouped into several ideas: 1. Increase parental involvement during care The methods used to parental involvement during care include Alberta Family Integrated Care (Alberta FiCare) (11), The Parent Participation Improvement Program (18), Involved in nursing action or nursing implementation (13), Alberte FiCare is a development of the FiCare method. The FiCare method has been developed to support family involvement in wind care at NICU level III. Alberte FiCare develops the FiCare model for level II NICUs. FiCare is one of the recommended methods for implementing family centered care (FCC) in the NICU. As a result, parent feel respected and dignified. Communication with health workers is good, the information provided by the family is good and complete, the family is also involved in decision making during treatment. The parent are more involved, the length of stay is shorter and the morbidity rateis also low (19). This is one of the bases for developing Alberte FiCare. The Results obtained from the Alberte FiCare application, lower length of stay (LOS), lower re-visits related to emergencies in infants, better types of eating when going home, maternal psychosocial pressure and better parenting self-sefficacy when discharge from the hospital (11).
The Parent Participation Improvement Program aims to develop a program to increase parental participation in caring for infants who are cared for in the Intensive Unit (NICU) and to evaluate their effects on nurse-parent cooperation, closeness to infants and infant weight (18). This research was conducted in two stages, the first to develop a parental participation program, the second phase to conduct a trial program to determine the effectiveness of the program being made. In this second phase, it was carried out in several stages in intervention group, namely the interaction stage, the pre-participation stage and the active participation stage, while the control group was allowed to make regular visits (18). The results showed tha this program was able to increase the cooperation between nurses and parents as well as their closeness to their babies.
2. Using technology to increase the knowledge and abilities or parents in caring for or providing care including E Health(10), Telenursing (20) and WeChat (17) E-Health is a type of health service that has complex information data. The complexity of e-health can be seen from services which include content, commerce, connectivity, and care. E-health which was developed in the study through 2 stages, namely participants were given access to the parenting website developed, so that they could access them during the perinatal periode (10). The information that can be accessed includes reasons for breastfeeding, how to breastfeed the first days of life, general problems, support from mothers/ fathers/ spouses/ partners, where to get help, daily life and useful links (10). Second stage couples who are willing to be informed about the resources of breast milk avalaible resources of breast milk available in the community. This aims to increase cooperation with partners in meeting the goals of breastfeeding (10). The results of this study indicate that e-health an help especially in finding sources of information (10). Another study explains that health education through technology (e-health) can improve optimal health outcomes for infants and their families (21).
The development of e-health is also developed with smartphones. Smartphones have become one of the most reable communication tools in the world, through smartphones people can share information. One of the applications on smartphones is WeChat. In this study, the steps for developing educational techniques using WeChat are as follews: 1) developing information-based data, 2) meeting research groups to identify messages to be published, 3) developing multimedia according to the content to be used, 4) socializing to respondents. (17). The implementation of education using the WeChat application is carried out for the first 1 month after childbirth, then followed by 4 post delivery. Furthermore, a competition was conducted to find out the mother's knowledge about breastfeeding, as well as to monitor the child's growth. Next, online meetings are held and there is a reward for respondent who has a good score. This study proves that the use of WeChat can increase exclusive breastfeeding in China (17) Other research related to the effectiveness of using smartphones as a medium for health education, also proves that users are satisfied with applications made and increase the tendency of mothers to find out what is needed in caring for their babies (22). The content developed in this study included physical conditions and emotional needs, nutrition, sleep and hygiene, medical and nursing needs as well as vaccinations and growth curves (22).

Stress Manajement
The mental health of the mother at the time of giving birth to a premature baby is one of the important factors that can affect the mental health of the child and the stability of their family (23). This is because women are more suspectible than men to psychological problems such as depression, anxiety and other disorders (23). The birth of a premature baby can have a psychological impact on the mother, such as changes in mood, stress and depression (13). Treatment of premature babies requires parent to stay in the hospital, where the length of stay can be from days to months. This can negate the psychological impact of the parents, because the NICU is a stressful and environmental stressful place for parents (14).
Good stress management can help parents reduce stress, increase self-confidence and the ability to care for premature babies. Some of the methods obtained in this literature study include involved in nursing action or nursing implementation (13), Help, Understanding, and Guidance (HUG) your baby (14), Journal therapy counseling(12) dan Supportive counseling (16).
Increasing the participation of mothers in the care of premature babies can improve the mental health of mothers. Various methods were carried out by scientists, one of the studies conducted by Lotfalipour, et al, aimed to determine the effect of maternal involvement in one of the selected interventions, namely infant massage on the mother's mood (13). The intervention was carried out for five days, while the results of the study showed a greater improvement in mood compared to the control group (13).
The HUG Your Baby program was developed to reduce parental stress and increase parental confidence in caring for their babies when they are discharged (14). Interventions are carried out by providing videos and handouts related to standar knowledge usually this interventions id carried out between 4-6 days after the patient is admitted. The next step id for participant to make the program coordinator to face-to-face education, discussion and clarification os the point taught in the HUG program (14). Visits can be made while still being treated and before the baby comes home. Evaluation is carried out by means of a questionnaire and demonstration of the knowledge taught. Some of the things that were evaluated included eating the baby, skin-to-skin contact, holding and talking to the baby, recognizing excessive stimulation or sign and signs of active sleep and restful sleep. The results showed a descrease in stress and an increase in mother confidence in caring for her child (14).
Journal therapy counseling was conducted with three face-to-face journal therapy sessions and three telephone counseling sessions. The results of this study explained that the maternal anxiety score was lower in the intervention group than in the control group. The importance of stress management in mothers because mothers who are anxious and experiencing psychological stress can affect the quality of sleep of the baby and the duration of the baby's sleep is also lower (12). Another study explained that depressed mothers tended to be less close to their babies, they were also less concerned with their babies, had less exercise and also had an effect on the quality of breastfeeding than mothers who were not depressed (24).
The supportive counseling method aims to improve the mental health of mothers who have premature babies, besides this method also aims to improve the bond between mother and baby, and its effect on the growth of premature babies (16). This method was developed in 6 stages starting from introduction, counseling, infant massage training, educational films, to follow-up activities. The results of this study explain that supportive counseling can improve mental health and postpartum bonding in mothers of premature babies (16) 4. Conducting continuous education and monitoring during treatment until at home The results of the literature study obtained several sustainable education and monitoring methods, including Stockholm preterm interaction-based intervention (SPIBI) (15) and Creating Opportunities for Parent Empowerment (COPE). Stockholm preterm interaction-based intervention (SPIBI) (15), is one of the methods used to improve people's ability to provide developmental care. Stockholm preterm interactionbased intervention (SPIBI) is a planning model or preparation for the discharge of premature babies (discharge planning) in the Intensive Unit (NICU) developed in Stockholm Sweden for extremely preterm (EPT) babies. Interventions from SPIBI are brief, namely providing strength-based support from parent-child interactions, making parents sensitive to baby cues, providing support for further developmental care when they are at home and improving self-regulation and joint regulation (15). The results of this study show positive results on parent-child interaction, child development, mental health development of parents and children's participation in preschool (15) Creating Opportunities for Parent Empowerment (COPE) is a behavior education designed to provide support for parents. A study suggests that COPE can reduce stress through increasing parental knowledge and changing beliefs in caring for premature babies (9). The steps for implementing COPE are by providing behavioral education in the form of compact disks (CDs) along with instructions and strengthening activities in the form of workbooks. The COPE program is implemented in four stages. The first is carried out after the baby has been treated for 2-4 days. The second phase is 2-4 days after the first phase is carried out, the third phase is 1-4 days before discharge, while the fourth phase is carried out 1 week after discharge. This activity is also monitored by a supervisor, apart from serving as a therapist as well as providing daily comments in the workbook. Assessment was followed up for 1 month after discharge. This method can increase parents' confidence, knowledge and also the desire to improve their ability to care for premature babies (9).
This assistance is needed because the process after being discharged from the hospital is the most difficult period for both the baby and the parents. This can affect the quality of life for both mother and family (25). The importance of discharge planning and the development of educational strategies used in training babies and parents since they are still in the hospital is needed, so that the next nursing process when at home can run well and have no impact on babies, mothers and their families.

CONCLUSION
The ability of parents to care for premature babies is needed is orded to minimeze complicationsnin infants, reduce morbidity, avoid disabilities, increase growth and optimal development of premature babies. In addiction, increasing parental abilities can also reduce parental stress levels, increase parental confidence and selft efficacy of good parents. Selection of the right educational method can improve the care for and provide developmental care for premature babies.