logic model for the (COPE )

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Section A: Program Description

The name of this program is the COPE (creating opportunities for parent empowerment)

NICU (neonatal intensive care unit) Program. This particular program has multiple target

populations. It is geared towards parents, infants and nurses involved in the program. One goal

of this program is to help teach parents how to effectively interact with their preterm infant in a

way that will enhance cognitive and physical development. Another goal of the program is to

give parents an understanding of the NICU program in order to make them more comfortable

while their infant is staying there. These goals will lead to the overall objective of lowering the

stress of the parents and teach them how to properly care for their babies. After completion of

the program, parents will know what to expect from their premature babies, how to interact and

build a relationship with their infant while they’re in the NICU, and how to deal with the stresses

that will come along with being parents of infants in the NICU.

Activities include an educational program given to parents in four phases throughout

their stay. Phase one is given 2-4 days after admission into the NICU and includes helping the

baby grow and develop. Phase two is given 4-8 after admission and involves helping the

parents cope. Phase three occurs 1-7 days before discharge and involves getting both parent

and infant ready for life at home. Phase four takes place 1-2 weeks after discharge and involves

adjusting to life at home with a preterm baby. All these educational activities provided by the

program are aimed towards helping with the program’s main goals.

The stakeholders are the infants being treated, parents of the infants, nurses involved in

the program, the hospital that has the program, the taxpayers that pay taxes that benefit the

hospital, insurance companies, and the family and friends of those with infants in the NICU.

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Section B: Literature Review

Introduction

The primary topic of interest for our literature review is Creating Opportunities for Parent

Empowerment (COPE) Programs and the effects of these programs. We looked at various

different aspects, such as infantile development and the anxiety of the parents in the program

compared to parents who did not participate.

Parental Coping

A main goal of COPE Programs is to help parents with the stress of having a preterm

infant. An article by Melnyk (2001) states that, “researchers have found that the appearance

and behaviors of LBW [low birth weight] premature infants are anxiety producing for parents.”

COPE Programs aim to reduce stress by educating parents about what their infant will look like

as well as how the infant will act. There were several articles that gave statistical analysis that

showed that mothers had an overall decrease in anxiety after completing a COPE Program

(Mianaei, 2014; Melnyk, 2001). The article by Melnyk used the State-trait Anxiety Inventory Test

to determine several different emotional coping outcomes including: tension, anxiety,

depression, dejection, anger-hostility, fatigue, and confusion. Results found that when an

educational COPE Program was implemented, mothers experienced an overall decrease in

these areas.

One of the main focuses of the COPE program, as well as other programs like it, is to

ensure the parents are comfortable, and that the they will actually use the it while their child

resides in the NICU. According to Irene Hurst (2006), the best parent support programs are

those that utilize more than one type of format. Programs that provide emotional support, as

well as group support, information support about the NICU and involvement with baby’s care are

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better because the variety of support allows parents to find something that works best for them

instead of being stuck with one option. “Parent support programs offer an important mechanism

to assess provider approaches to facilitate family-centered care,” (Hurst, 2006).

Infant Development

Another goal of the COPE Program is to help develop a preterm infant’s cognitive

development. At baseline, there was no significant statistical difference between infants that

their parents participated in COPE Program and those whose parents did not participate in

COPE Programs. The pilot study conducted by Melnyk showed that infants that were involved in

a COPE Program showed significantly higher scores on the BSID-II MDI (a cognitive test) than

infants that were not involved in a COPE Program (2001). The scores were even farther apart

when the infants were remeasured at six months of age (Melnyk,2001).

Section C: Critique Preparation

The name of this study is The effect of Creating Opportunities for Parent Empowerment

program on maternal stress, anxiety, and participation in NICU wards in Iran. The study was

performed by ​Soheila Jafari Mianaei, Fatemeh Alaee Karahroudy, Maryam Rassouli, and

Mansoureh Zagheri Tafreshi. The study was released in Volume 19, issue 1 of the journal

Iranian Nursing and Midwifery Research ​ on pages 94-100. ​The purpose of this was study was

to implement the COPE Program for Iranian mothers and evaluate the effectiveness of the

program. It evaluated the effectiveness of reducing stress and anxiety among mothers with

preterm infants. The study was a randomized clinical trial completed in Iran. The control group

did not participate in the COPE Program and the study group participated in the COPE

Program. All of the participants took the State-Trait Anxiety Inventory (STAI) as a baseline, and

then again after every phase of the program. The STAI measures anxiety, and the higher the

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score, the more anxious the person is. The mothers that participated in the program consistently

had lower scores on the STAI.

The study clearly states its purpose of evaluating the effectiveness of the COPE

Program in the introduction. The objective of this study was to evaluate the effectiveness of the

COPE Program on the mother’s anxiety levels. This objective is appropriate because one of the

goals of the COPE Program is to reduce stress and anxiety for the parental units. The authors

explained all of the methods and tools used in their study, but they did not explain how to

interpret the results from the STAI. They just put the results in a table in the study. When the

authors explained that they used the STAI, they described it as well-known and left that as

enough for a description of it. They did not explain how to interpret the results. It would be

incredibly simple for the authors to simply add a very short explanation to what the numbers that

the STAI mean. The authors could have also explained the difference between trait and state

anxiety. Another major factor of the study was that the authors did not implement phase III or IV

of COPE Programs. While it can be assumed that the results would most likely be consistent

with the previous parts of the study, it cannot be validated without actually implementing the

program and observing the results. Phases III and IV both require significantly more time than

phases I and II, and phase IV takes place at home where the mother is no longer in the hospital

to immediately ask any questions that they might have. The environment at home may be

significantly different enough to have a negative impact on the mothers that participated in the

program. One of the key objectives of the program is to help reduce parental stress at home by

teaching the parents enough about caring for their infants to be confident in their abilities to care

for their infant. Without having the last two phases of the program implemented, there isn’t

enough information to determine if the program worked the same way as it does in other

countries, which was part of the study. The study wanted to compare how COPE Programs

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worked in Iran compared to other studies that had been done on the program, but they didn’t

have the full program implemented to do so. The authors could compare the results after the

first two phases, but that’s not a comprehensive comparison of the program. One reason for

why the authors did not implement Phases III and IV was that home visits are not common in

Iran, and it is very important to understand cultural differences whenever you do studies in

foreign areas, but this program requires home visits for full implementation. Ideally, future

studies will be able to implement the last two phases after enough time and evidence to prove

the effectiveness will build enough trust to allow the researchers to do the home visits that are

necessary for implementation of Phase IV.

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Work Cited

B. Melnyk, L. Alpert-Gillis, N. Feinstein, et al. (2001) Improving Cognitive Development of

Low-Birth-Weight Premature Infants With The COPE Program: A Pilot Study of The Benefit

of Early NICU Interventions with Mothers. Research in Nursing and Health, 24, 373-389.

Hurst, I. (2006). One Size Does Not Fit All: Parents’ Evaluations of a Support Program in a

Newborn Intensive Care Nursery. ​Journal of Perinatal and Neonatal Nursing​ ,​ 20​ (3),

252-261.

Karahroudy, F. A., Mianaei, S. J., Rassouli, M., Tafreshi, M. Z. (2014). The effect of Creating

Opportunities for Parent Empowerment program on maternal stress, anxiety, and

participation in NICU wards in Iran. Iranian Journal of Nursing Midwifery Research. 14.

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