The Cues Program: A Review of a Nursing Journal Article
Rachel M
NURS

The Cues Program: A Review of a Nursing Journal Article
Infants born weighing less than 1,500 g are called very low birth weight (VLBW) infants. These infants are usually preterm and often require hospitalization in a neonatal intensive care unit (NICU.) VLBW infants are at higher risk of developmental problems so there has been an emphasis on developing programs to prevent these problems. The Cues program was designed to include six sessions that begin soon after birth. It focuses on helping lower the psychological stress on the mother which occurs when their infant is in the NICU and also to encourage sensitive mother – infant connections. This program includes written information, observational exercises, one on one discussions and video feedback. This gives important knowledge to mothers of VLBW infants on how to cope with anxiety, the skill of how to interpret their infants’ behavior cues all while encouraging a sensitive mother- infant bond (Feeley, Zelkowitz, Westreich, & Dunkley, 2011).

Purpose of the Study and Article
The purpose of the article, “The Evidence Based for the Cues Program of Very Low Birth Weight Infants: An Innovative Approach to Reduce Anxiety and Support Sensitive Interactions,” which was published in The Journal of Perinatal Education, “is to outline the empirical evidence that guided the development of the innovative Cues intervention program as well as to describe the program.” The goal of developing the Cues intervention program was to make a program that could be assessed “for feasibility, efficacy, and effectiveness” (Feeley et al., 2011, p. 143).

Summary of the Literature Review Feeley et al. (2011) references multiple well designed studies from Aarnoudse-Moens, Weisglas-Kuperus, van Goudoever, & Oosterlaan, 2009; Bhutta, Cleves, Casey, Cradock, & Anand, 2002; Hayes & Sharif, 2009; Nadeau, Tessier, Boivin, Lefebvre, & Robaey, 2003; Samuelsson et al., 2006; Taylor, Espy, & Anderson, 2009; all show evidence that VLBW children are at greater risk for reduced cognitive and language abilities, academic skills and achievement, and social and behavior competence when compared with normal birth weight peers. Intervention programs have been developed to prevent the widely recognized development problems for which VLBW children are at risk. Brooks- Gunn et al. (1994) states that some comprehensive intervention programs have been beneficial on the development of VLBW children as cited by Feeley et al., (2011). However, intervention programs like these have not been implemented into routine service because these programs are lengthy, costly, and time consuming for both families and professionals. Researchers are now trying to develop and evaluate cheaper, shorter and well- timed interventions (Feeley et al., 2011). According to Feeley et al., (2011), “Brief, focused interventions may be as effective but more readily adopted into clinical practice” (p. 143).

Study Design (Method, Participants, Data) The study by Feeley et al., (2011) is an observational research design that is also qualitative in nature. It first was essential to find out if the Cues program could feasibly be implemented during the highly stressful NICU hospitalization. This was evaluated in a single group pretest- protest study. Currently, the efficacy of the Cues program is being tested. This is being done in a randomized controlled clinical trial in which 122 mothers were picked at random to either receive the experimental Cues program or a program that gives basic infant care and health information. The effects of the programs on the mothers and children are then being examined at three set intervals post discharge from the NICU (Feeley et al., 2011).

Summary of Findings
The pilot study that was done to test the feasibility of the program showed that it was feasible to implement the program into the stressful environment of the NICU. The evidence of the study showed that 80% of the mothers completed all six sessions which proved it feasibility. The efficacy of the Cues program is still being determined. If the findings show the program reduces the mother’s anxiety and that educates the mothers on sensitive interactions, then it could be implemented into routine care given to all mothers of VLBW infants while hospitalized in the NICU (Feeley et al., 2011).

References
Feeley, N., Zelkowitz, P., Westreich. R., & Dunkley, D. (2011). The Evidence Base for the Cues Program for Mothers of Very Low Birth Weight Infants: An Innovative Approach to Reduce Anxiety and Support Sensitive Interaction. The Journal of Perinatal Education, 20(3), 142-153. doi: 10.1891/1058-1243.20.3.142