Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Jean A. Bachman D.S.N.


Anne Folta Fish

Ruth Jenkins

Victor Battistich

Chao-Huei Chen


The purpose of this descriptive study was to examine relationships between stress physiological signals and stress behaviors in preterm infants during periods of environmental stress. The study used a repeated-measures design to examine the relationships between environmental stressors, sleep-wake states, and both stress physiological signals and stress behavioral responses in one group of preterm infants. Measurements of these variables for each preterm infant were recorded every two minutes during four 60-minute observation periods (two in the morning and two in the afternoon) conducted over two days (one morning and one afternoon observation each day). The sample was 37 preterm infants who were born at less than 37 weeks gestational age and were less than 28 days of age. Data collection took place in two Level III Neonatal Intensive Care Units at medical teaching hospitals in a city in central Taiwan. A generalized estimating equation approach was used to address the research hypotheses. It was found that there was a significantly significant (p<0) relationship between nine stress behavioral responses and a change in heart rate (seven increased, two decreased); between four environmental stressors (nursing interventions levels 2,3,4,5) and an increases in heart rate; between four environmental stressors (nursing interventions levels 1,2,3,4) and an increase in respiratory rate; between 11 stress behavioral responses and a change in oxygen saturation; and between two environmental stressors (nursing interventions levels 2,3) and decreases in oxygen saturation in the preterm infants. When environmental stressors of noise, light and nursing interventions were analyzed together there was a significantly relationship (seven positive, one negative) between environmental stressors and nine behavior responses. The benefits of recognizing preterm infant?s behavioral responses and stress physiological signals to environmental stressors allow for early intervention to reduce the possibility of a more serious physiological or pathological change in the status of the preterm infant.

OCLC Number


Included in

Nursing Commons