Organizational Strategy: BMC’s Strategic Plan Essay Example For College

Executive Summary

Organizations have a myriad of challenges in determining what is suitable for their operations. Whatever is suitable for the operation of an organization, in this case, will constitute what keep the stakeholders satisfied and the revenue generation high. Therefore, good strategic plans come in to enable organizations to realize what needs to be done for the business to achieve its goals. Making a better strategic plan always gives an organization a stepping stone towards achieving a competitive advantage over other organizations in the same industry. BMC is one of the organizations facing the challenge of putting things in order before advancing its expansion program. BMC must now use its available resources to realize profitability in the new adventure. A bigger market is waiting for BMC to conquer if it uses this strategic report in the right way. BMC needs to transform and make technology one of its strengths to attract the many youths in Manchester’s market. Satisfying the employees is also not left out in the strategic plan; BMC must have structures to ensure employees` morale is high to increase productivity.


The business environment has a way of changing to accommodate the changes within the organization. The changes propel the organization to operate to promote the stakeholder’s interests of profitability and efficiency within the organization. The organization’s management needs to have a skillful team to ensure there is an updated strategic decision to clear the path towards success. The dynamism of doing business requires organizations to have a solid strategic blueprint to direct their operations (Valeri 2021). The strategy should have plans to source the necessary resources and allocate them to drive the organization to its success. The allocation of resources provides a clear path that the organization will follow to ensure it is competitive and satisfies the stakeholders’ needs. The case of BMC requires the strategy to plan for the resources and ensure that the resources reach the deserving staff to ensure the company operates at its optimum level. The primary understanding of this work revolves around making the strategic organizational document a significant source of success within the BMC’s expansion program.

All the information on the strategic organizational document keeps everyone abreast of the organization’s steps. Employees must align their goals with that of the organization to perform in harmony with the overall organizational vision. Adopting the strategic plan by BMC will ensure the organization improves its profitability and competitiveness when the business is experiencing expansion, and the competition is growing too strong. The management is aware that becoming competitive requires the business strategy to focus on the business structure and its delivery of products and services. Aligning the employees’ aspirations with the organizational structure and the general objective of the organization becomes goal number one in this strategy. The contents of this strategic plan give the managers the most appropriate ways of solving the problem of profitability and competitiveness to keep the company to its past glory. The cornerstone of the strategic plan outlines treating the employees fairly and justly because the company will be using the employees` efforts to remain competitive.


Advantages and Disadvantages of Organizational Structures

Organizations need a seamless flow of information on command and work, which is only possible through having a working organizational structure. Responsive organizational structure supports an organization’s decision-making process and management, which depends on the constant flow of structured information (Joseph & Gaba 2020). Therefore, the organizational structure is the first determinant of a successful organization. Organizations like BMC must adopt a structure that resonates well with their expansion goals to accommodate every stakeholder.

Hierarchical Structure. BMC is known to be using this structure in its management. However, the time has come when the company must accept the changes and adopt another structure. The hierarchical structure has the executives who influence the company decisions sittings at the top; these executives are only answerable to the board of management. The top seats which the executives occupy tend to be for a small number of people, and the bottom is where everyone is found, making this structure look like a pyramid. The CEO possesses all the powers in this structure, and authority is centralized around the CEO.


  • The structure has a clear reporting structure from the CEO down to the junior staff
  • Employees have an idea of their career path because of its structured departments
  • The departments within this structure promote specialization among employees
  • The structure has a transparent chain of command since everyone knows their roles


  • The structure restricts information flow as more information go up the hierarchy and very little flow down the hierarchy
  • The several departments with departmental managers slow down decision making
  • The structure could stir departmental rivalry as heads of departments to compete for the CEO’s attention and approval
  • The various departments increase the management costs of this structure

Horizontal Structure. This structure receives recognition for its ability to integrate the executives and junior employees to work as one more robust unit. The horizontal organizational structure creates responsive management as staff members work together to achieve a common organizational goal (Moon et al 2020). Most organizations adopt the structure to solve the problems brought by other rigid structures like hierarchical structures.


  • The structure improves the relationship between the management and other employees
  • Due to its integration, it increases the speed of decision implementation
  • The structure encourages a good flow of information across the organization
  • The openness in the structure increases the employee satisfaction


  • It discourages specialization, which can lead to reduced expertise
  • It has unstructured supervision, which confuses the employees who require attachment under the supervisor
  • It is mainly operational in small and medium-sized organizations but may be slow and unresponsive in bigger organizations
  • Reduction in the management supervision in this structure can bring laxity among employees, thereby leading to deviation from the organizational goals

Functional Structure. The structure focuses on arranging workers to meet some standards set by the organization. It is famous for its usage in organizing the employees according to their skills and level of performance. The managers in this structure must have good knowledge of their juniors to allocate them tasks according to their abilities to perform. The organized employees work in units under the supervision and report directly to the top management, which oversees their performance. It serves the organizations that want to break the employee roles to reflect the overall organization goals.


  • Increase employee efficiency by grouping employees with similar skills and expertise
  • The structure enjoys some versatility as it can be applied in small, medium-sized, and large organizations
  • The structure has job security which increases the employees` morale and loyalty to the department and company vision
  • It gives guidelines to the employees, which promotes their awareness about their duties and reporting structure, thereby reducing confusion


  • It creates unhealthy competition between departments as the managers compete to outdo each other in terms of performance
  • Grouping of employees may create boredom as employees repeat tasks over and over again.
  • The structure can also create division among the employees if promotions are not handled with care
  • It has independent departments which might create communication problems within the organization

Connections between Organisational Strategy, Products & Services, Customers and Revenue Generation

The organizational strategy has some supporting pillars which strengthen its functionality within an organizational setup. These supporting pillars are the products and services an organization offers to the customers who promote its profitability. The final pillar is the resulting revenues from packaging the products and services to sell. The strategic plan of BMC intends to connect these pillars to salvage the company from its current moribund state. Maintaining the connection between the pillars requires the organization to make revenue generation and producing superior products and services part of their strategic goal. The organizational goals change into organizational behaviors, influencing the quality of services customers get and the amount of revenue the business generates (Gagné 2018). The strategic proposals for BMC will eventually increase its profitability if the managers adopt the new changes on reaching the customers and tapping from the broad market. BMC will have to adopt technology to reach many customers within and without Manchester. The expansion program should also focus more on fast food distribution to increase revenue generation.

The food business may be challenging, just like any other business with a high number of new entrants. The main challenge, in this case, is the stiff competition within the Manchester market; amidst the stiff competition hides a good reward for the companies with the impetus to upscale their investments. The market competition makes this strategy device a new way of generating income and satisfying the customer’s needs using the available resources. Therefore, the company will venture into providing goods and services to the customers from now on. The idea is a perfect way of capturing a broader market share that ensures the company generates enough revenues to facilitate its operations. The strategic shift now aims to base on the production of cooked foods. The idea of cooked food targets the growing youth in Manchester who find it easy to buy cooked foods from restaurants rather than take raw food to cook at home. The other product line is the provision of raw foods that a customer can buy and cook at home; this provision covers the customers with families. There is also a service line where the organization plans to deliver food to customers upon ordering.

The External Factors and Trends Impacting or are Likely to Impact BMC’s Future Strategic Direction

Big businesses like BMC are at high risk of closing down because of the challenges from external business factors. Businesses can close down because they lack control over these external factors affecting their growth and operations. The challenges grow more significant with the increase in the organization size like BMC will now experience more external challenges as it expands into Manchester’s market. However, there is a way out of the challenges this strategy addresses to rescue BMC and other struggling companies. The way out of these challenges only requires the organization to spot the challenges and work on better methods of improving or avoiding the challenges. One way to reduce these challenges is by introducing the use of PESTEL analysis to spot the challenges before deciding on the action to take (Jacobs 2019). The universality of the external factors affecting businesses makes them form a trend that managers should identify and weed out. These external challenges include political, economic, social, technological, and environmental factors.

Political and Legal Factors. BMC faces challenges from the council’s business regulations. The problem is more profound, mainly when BMC is a new entrant into the Manchester food business. BMC has no control over the rules made by the council; this reason makes the legal aspect of BMC’s business very challenging to navigate. The current political environment within Manchester is good for business growth. An excellent political environment can attract more customers, increasing BMC’S revenue generation goal.

Economic Factor: BMC is going to Manchester, knowing very well the economic environment for new businesses. The interest rates are projected to increase in the coming years, making borrowing very difficult. The increase in the interest rates will, therefore, adversely affect the operations of BMC. The BMC’s growth may be just another ambitious move without success to show without affordable borrowing rates. There is also a wave of unemployment which is currently rife in Manchester. Unemployment reduces households’ disposable income in buying essential goods and services. BMC might remain with customers who do not have money to make a purchase.

Social Factor: Every market has different customers with different tastes and preferences. The Manchester expansion will also pass through the same; as BMC expands, it must face its customers’ differences in opinions and taste. The difference is part of the customers` social life, and the business must adjust to it or face extinction. The only way to reduce the effect will be employing the locals in some of the management positions because only the locals understand the diversity in the social life of the customers. Failure to factor in the social factors will make the business less popular, thereby preventing BMC from becoming profitable.

Technological Factor: Understanding technology is the current gold for most businesses. However, the technological landscape is fast-changing, and the business may not master all the best ways of using technology to create profitability (Haseeb et al 2019). Manchester is a technological hub that silently eliminates businesses that operate out of the current technology. BMC has no control of the technology which the market adopts to use. The challenges of maintaining the current technology to attract more customers come with high costs, which might reduce the profitability of BMC. However, adopting the current technology will enable BMC to make more profits.

Environmental Factors. BMC is under the environmental laws by the council to protect the environment. The conservation of the environment remains a challenge to the business since no one knows when the environmental conservation laws can twist to prohibit some of the usual business activities. The environmental factors make BMC look for how they dispose of their wastes without affecting the environment. With the increased activities of the environmental activist, any failure to operate according to the environmental regulations can lead to the automatic closure of business.

Advertising Market Trend: The era of intense advertisements is with us, and every business leader should take advantage of the available advertising options to capture the market niche. The business is shifting from the known giant billboards to a new trend of using market influencers to ensure the products reach the intended consumers (Iwashita 2019). The current advertising trend requires an organization to establish a good partnership with celebrities and other advertising companies. The celebrities can create traffic in the social media platforms, which gives the customers enough opportunity to scout the best products. Companies like Google are also in the advertising business, which BMC should consider working with to reach a more comprehensive customer.

Increased Multicultural Awareness. The current generation celebrates and embraces the differences in culture and lifestyle. Customers transfer the same feeling to the business and their preference of products. Businesses like BMC, which seek to expand into new markets, must understand the local culture of their customers if they want to make more profits. Most customers will prefer to take meals that resonate with their cultural backgrounds, like in Italy; most of the customers will prefer to eat pizza and not noodles like the customers in Asian nations. Restaurants must adjust their menus to cover the diversity of societal diversity.

Remote Working Trend: The coronavirus pandemic has come with some changes to the working class, limiting the possibility of working in crowded places. Remote working is now the current trend that most organizations adopt to make employees happy. The employees who can work remotely are happy and productive in their roles. BMC is aware of this trend, but they may do little about it because the nature of its business may restrict remote working. BMC business requires its employees to work from a centralized location, eliminating the remote working idea. However, the top management may work from home, but it will cause an uproar among the junior employees. As things change, the business will have to decide to fully adopt remote working despite its challenges to the BMC’s business.

Assessment of Organisational Priorities and the Associated Issues and Causes

Organizations’ priorities come in different forms; some organizations prioritize the production factors while others prioritize the people. Organizations like BMC, which operates in the current technological advancement, must prioritize the customers to acquire more customers. Technology will increase services’ automation, which increases efficiency (Kokina & Blanchette 2019). The finance and sales department are some of the departments that require the full implementation of automation. The organization needs to update its accounts to avoid unnecessary audit queries which may look suspicious. The sales department also needs to keep the customers informed about the new menu or products BMC is preparing. However, there are some issues that BMC faces, which may hinder the company from achieving its priorities. One of such issues is that technology keeps on changing. The business may not know the right technology to use at any given point because technology changes according to market trends.

Organizations like BMC prioritize their employees and always want employees to be productive. Therefore, the employees’ demand becomes part of the organization’s goals or aspirations. The current pandemic is making remote working essential for the employees, and the BMC is also making it its priority to keep the employees happy. The priority, however, comes at a price because the profitability may reduce because of inadequate coordination of the employees. The organization needs to find better ways of handling the employees` workspace away from their regular duty posts. The pandemic caused some businesses to make unfamiliar decisions to ensure their operations survived after coronavirus disruptions (Grima et al 2020). The pandemic situation allows only some of the critical organization’s functions to be managed from the office as other supporting duties are handled far from the office. The situation may derail the strategic growth BMC is having for its profitability because of some reduction in the productions.


In conclusion, the BMC structure introduces what lies ahead in the Manchester market as the business expansion is in its final steps. BMC must prepare for very challenging times ahead in its expansion program to succeed in the coming years. The first step will be for BMC to keenly check its ability to remain competitive in a market that does not tolerate a lazy attitude. The organization must now invest in research to enable its employees to create special menus for the customers. Managers at BMC must now realize that there is no other way apart from decentralizing the company’s management. Decentralization will enable the Manchester branch to operate independently, making monthly or quarterly reports to the headquarters. The bid to decentralize operations must start by changing the rigid hierarchical structure for the management to accommodate different people with different ideologies. Moving into the new market will also require the company to update its technology to facilitate online food ordering, which is currently the backbone of a food business.


The recommendations for BMC expansion go to the management, who must change how they handle issues within the organization. The organization should learn how to embrace employees in different forms. As the business is now expanding to other towns, the management should change their attitude towards the employees and understand that employees are like the foundation of BMC. My recommendation is that the managers should be taken through refresher courses on management of employees. The course will wake the empathetic feeling of the managers who seem not to care about the plight of employees. Another recommendation is that the Manchester branch should be handled by the locals within Manchester and not those transferred from the headquarter; this is because the local employees understand the desires of the local customers. The Manchester branch should adopt a horizontal structure to keep everyone working and avoid the laziness that is crippling operations at the headquarter. The organization should initiate reward programs to motivate the employees during this challenging coronavirus situation.

References List

Gagné, M., 2018. From strategy to action: transforming organizational goals into organizational behavior. International Journal of Management Reviews20, pp.S83-S104.

Grima, S., Dalli Gonzi, R. and Thalassinos, E., 2020. The impact of COVID-19 on Malta and its economy and sustainable strategies.

Haseeb, M., Hussain, H.I., Ślusarczyk, B. and Jermsittiparsert, K., 2019. Industry 4.0: A solution towards technology challenges of sustainable business performance. Social Sciences8(5), p.154.

Iwashita, M., 2019, July. Trend of influencer marketing and future required functions. In 2019 20th IEEE/ACIS International Conference on Software Engineering, Artificial Intelligence, Networking, and Parallel/Distributed Computing (SNPD) (pp. 2-2). IEEE.

Jacobs, K., 2019. Looking upwards and outwards: why people professionals have a responsibility to understand the external world | CIPD.

Joseph, J. and Gaba, V., 2020. Organizational structure, information processing, and decision-making: A retrospective and road map for research. Academy of Management Annals14(1), pp.267-302.

Kokina, J. and Blanchette, S., 2019. Early evidence of digital labor in accounting: Innovation with Robotic Process Automation. International Journal of Accounting Information Systems35, p.100431.

Moon, C., Morais, C., de Moura, G.R. and Uskul, A.K., 2020. The role of organizational structure and deviant status in employees’ reactions to and acceptance of workplace deviance. International Journal of Conflict Management.

Valeri, M., 2021. Organizational Studies: Implications for the Strategic Management. Springer Nature.

Essay On Overpopulation Writing Sample


The rapid increase in the number of people in the current generation has raised significant concern among humans. Early marriages cause overpopulation, search for job opportunities, and underutilized contraceptives. Many problems arise as a result of overpopulation. These problems include; depletion of natural resources, unemployment, high cost of living and even degradation of the environment. Therefore, overpopulation can be defined as an increase in the number of people to the extent of exceeding the carrying capacity of the domain. This essay will discuss how overpopulation affects human beings and how to curb the problem.

Effects of Overpopulation

Overpopulation has led to the degradation of the environment. In developing countries, many people, especially the youth, move from rural areas to urban areas to seek job opportunities. Vegetation is cut down to create more buildings (Uniyal, Paliwal Kaphaliya & Sharma 2020). Cutting down trees and other vegetation leads the ground to bear, making it easy for soil to be carried away by agents of erosion. Population growth leads to an increase in the need to produce consumer products. In return, this causes overexploitation of environmental resources. Industrialization is also a result of rapid population growth. An increase in industries leads to both air and water pollution. Many enterprises do not follow the government policies on how to dispose of their waste products. When these waste products are released in drainage systems, they affect and even kill the aquatic life existing. It also makes the water insufficient for human consumption.

Overpopulation, on the other hand, may also cause unemployment. Since jobs are limited and there are more applicants, many people are left unemployed. It results in poverty (Bahadur, 2019). The problem of poverty affects the unemployed people and affects those employed. It is experienced when the employer has many employees and is forced to pay few wages. Unemployment has led to an increase in theft cases as people want to provide their families with basic needs.

Overpopulation has also led to the depletion of natural resources. An increase in the number of people leads to higher energy consumption for transportation, food production and other activities (Garg 2020). The exploitation of fossil fuels for energy production leads to air pollution. The smoke produced from burning fossil fuels affects human beings causing respiratory diseases when inhaled.

Solutions That Can Help Manage Overpopulation

First, the government may equip married couples with contraceptives that will help reduce unwanted pregnancies. Forced birth control should be imposed to discourage families from having many children (Hendrixson, Ojeda, Sasser, Nadimpall, Foley, & Bhatia 2020). Couples that may need more children should pay tax to be granted permission to have more children.

They are creating awareness about overpopulation. Nowadays, many people are not familiar with the adverse effects of overpopulation (Yadav 2021). By spreading awareness, each family will know the number of children they are supposed to get.

The government should also enforce laws that protect young girls forced into early marriages. Those involved in such behaviors should be arrested to reduce early pregnancies (Moran & Baloy 2020). Girls at a younger age are more sexually active, and therefore sex education among teens to control early pregnancy.


Overpopulation has many effects, as expressed in the essay above. The next generation may experience many problems, including environmental hazards, if the problem of overpopulation is not controlled. Families mainly get many children since they still hold onto the old tradition. Thus, the main way to control the global problem is that people should be enlightened on how overpopulation affects each nation in many ways.


Bahadur, R. (2019). Impact of Over-population on Economic Growth and Development in India. International Journal of Research and Analytical Reviews, 6, 1-10. Retrieved from:

Garg, S. (2020). Impact of overpopulation on land use pattern. In Environmental and Agricultural Informatics: Concepts, Methodologies, Tools, and Applications (pp. 1517- 1534). IGI Global. Retrieved from: overpopulation-on-land-use-pattern/233025

Hendrixson, A., Ojeda, D., Sasser, J. S., Nadimpally, S., Foley, E. E., & Bhatia, R. (2020). Confronting populationism: Feminist challenges to population control in an era of climate change. Gender, Place & Culture, 27(3), 307-315. Retrieved from:

Moran, N. F., & Baloyi, K. (2020). Strategies to reduce deaths in early pregnancy. In Obstetrics and Gynaecology Forum (Vol. 30, No. 4, pp. 7-10). In House Publications. Retrieved from:

Uniyal, S., Paliwal, R., Kaphaliya, B., & Sharma, R. K. (2020). Human overpopulation: Impact on environment. In Megacities and Rapid Urbanization: Breakthroughs in Research and Practice (pp. 20-30). IGI Global. Retrieved from: https://www.igi-

Yadav, S. (2021). Overpopulation in India with Special Reference to Two Child Policy. Journal of Public Policy and Administration, 5(4), 139. Retrieved from:

Literature Review: Parent-Infant Attachment Post NICU Stay Essay Example

Problem Statement

Children born prematurely are highly vulnerable to the environments their development is subject to. For this reason, the mutual attachment that they share with their parents, especially after their stay in the neonatal intensive care unit, is key to their development and ultimate survival. This paper is therefore subjective in addressing the connection that a parent would share with their young ones the moments that follow after their discharge from the NICU. It will provide an in-depth evaluation of the various literature relevant to the subject. Parent child relationship is one that nurtures the psychological relationship between children and parents. Bonding occurs when parents touch, speak and relate well with their children. The unique relationship between children and parents lays a foundation for a child’s personality and characters for the children. Rocking a baby at the back and helping then to get a sound sleep creates a good bond between the parents and the children. On the contrary, getting neonatal babies to have a good bond with their children may be challenging. It takes the effort of the parents to establish a better relationship with the parents. Neonatal children who interact with parents have always had a good relationship and created a good bond with their parents. A good relationship with their children helps the parents to establish better goals for the neonatal babies. Incase the babies are not handled with care, it brings more problems to the children as they are growing. The number of neonatal babies having a good relationship with their parents are limited. Despite being in hospitals at infancy levels, parents still find a way of creating a good relationship with their children as they grow.

Background Information

Several factors can potentially interrupt the mutual connection that a parent shares with their infant. These factors may be inclusive of the sickness of the newborn, psycho-emotional distress of the parent, and admission to the NICU that takes place almost immediately after the delivery. According to research, there are higher chances of disorganized attachment prevailing among children admitted in the NICU compared to their counterparts with no such records. This adverse development is often evident among the affected infants at the age of 3 (Ettenberger et al., 2021). Despite efforts by specialists to reverse this course, there are still high chances of manifestation of the various adversities related to the impaired relationship. In this case, the various parental roles are significantly altered, the victim’s family is also likely to suffer a post-traumatic shock, and higher possibilities of neurodevelopmental complications in the preterm baby.

The attachment process is better explained from the developmental view of human survival. For the efficient development of a child, the initial bond that they create with their primary caregiver is crucial. In this case, the caregiver is referred to as the ‘secure bag’ from where the young one can explore and adapt to the environments around them (He et al, 2021). Neurobiological findings on human attachment assert that the brain of the infant matures according to the kind of attachment they share with their mother. This development often takes place within the first two years of the child’s existence. The attachment referred to in this context refers to the connection that a mother shares with the infant. This type of bonding is more focused on the mother’s perception of their relationship with the child. The parent’s view can be defined by both psychological and behavioral domains in the same measure. However, the terms bonding and attachment may be viewed differently, they seem to be used interchangeably by the various authors of literature review on the subject.

There are two distinct perspectives of the parent-infant attachment during the post NICU stay. Older pieces of literature tend to view the process as one with unique features from a parent and infant bond to the next. This view is not shared by some of the recent researchers who argue that the process is autonomic. According to the literature, the parent-infant bond can potentially manifest through various protective features of the mother. They include: caregiving, maintaining proximity with the infant, nurturing touch, staying sensitive to the infant’s cues, and having sensitive responsiveness to the needs of the infant (Grunberg et al., 2019). However, the attachment process remains vulnerable to the early separation of the preterm baby from their respective parents. The traumatic technological environments that the infant is subjected to during their stay in the NICU is also a potential interruption of the connection after they are discharged from the facility’s critical care unit. Despite the different views on attachment by the different studies, they remain in unanimous agreement on the characteristic of the same. Both the older and recent pieces of literature meet at a consensus that the neonatal features of the parent-infant relationship are defined by factors of infant NICU environmental and family-related features (Harding et al., 2019). For this reason, the various efforts towards restricting or improving these features during the infant’s stay in the critical care unit should consequently be strategic in enhancing the parent-infant bond.

Multiple systematic reviews on applicable interventions on the aforementioned factors remain considerate of the health and family outcomes of the preterm baby. Health outcome areas addressed by the studies in this context include microbiome, neurodevelopment, the infant’s speech, and communication skills, and their health severity. On family outcomes on the same, the studies identify parental sensitivity, general family stress, and parental stress in particular (Lavallée et al., 2021). There is a detailed review of the various parental-based interventions on the parent-infant bond. However, no literature is exclusively subjective in evaluating the level of effectiveness that NICU-based interventions have on the promotion of the bond during the duo’s stay in the hospital, especially in their post NICU stay. There is an improvement potential in identifying the various interventions aimed at promoting the connection among NICU families following preterm birth. Such strategic interventions are aimed at fostering both short- and long-term developmental health results. They are also targeting to improve both maternal and parental wellbeing in the same measure. With the discussed background, literature in the subject area remains subject to a further comprehensive review. Information realized out of the review would act as a strategic guide towards the ultimate development and implementation of the various connection and relationship-oriented interventions within the context of neonatal clinical practice.

Purpose Statement

This literature review is subjective in conducting a comprehensive assessment on the impacts of the attachment and relationship-based interventions that are strategically designed to promote a parental closeness to their preterm infant. The review is also aimed at evaluating implications that the mother-infant relationship during their stay in the NICU has on the aftermath parenting and parenting roles. This review is therefore based on four broad areas related to the subject: the infant’s growth and development process; health outcomes of both the family and maternal aspects of the same; the outcome of clinical measures towards the affected infant, and the broader parental experience. There are also specific parameter questions that guide the review. One, if there are relation-based interventions effective in helping infants in the NICU; what is the level of effectiveness of the aforementioned intervention on the victim infants and their respective mother in terms of developmental health results of the infants, maternal and parental experiences.

Literature Review

Implications of Parent-Infant Relationship

According to studies in the US, more than 11% of children are delivered preterm. However, a substantial number of such infants survive their stays in the NICU. For this reason, families of the affected children have an investable responsibility to interact with the medical babies within the setting of the NICU. As they interact with the affected babies, they also become highly prone to various adversities of maternal distress and depression which are often elevated (Givrad et al., 2021). There has been, therefore, the need to counter the stressful environment created by NICU. Consequently, the various models of family-centered care have become prevalent to deal with the situation. The models are based on the principles of building on family potentials, integrating the affected families in decision-making, and offering support to the families through their transitioning to their homes. The models advocate for a skin-to-skin connection and parental awareness creation exclusively designed in aid of both development and good interaction features while at home (Mäkelä et al., 2018). However, according to other disputing studies, family-based models are often focused on the universal frameworks at the expense of the various preventions subjective to improving the quality of interaction for the affected families or those at the verge of suffering the same.

As already mentioned, the quality of interaction between a child and the mother plays a central role in the ultimate development of the former. This interaction forms the basis upon which the infants secure environmental attachment, the creation of joint attention and emotional control, and ultimately their socio-emotional and cognitive growth (Shoemark, 2018). For this reason, it becomes paramount to maintain the quality of the mutual interaction at its best. A secure attachment is highly beneficial to the infant. A child with secure attachment develops the ability to draw a level of conformity from the interaction in an event that a stressful or distressing condition checks in. In such a situation the child can use the attachment as a strategic basis to further explore the threatening environment with advanced confidence over time. As much as the quality of the parent-child interaction is supposed to remain paramount, it is often jeopardized when the infant is born prematurely. Preterm infants exhibit unique features while interacting with their normal counterparts, especially during play. In most cases, the affected children as seen to show less emotional positivity, cooperation, and responsiveness to the environment compared to term infants. Mothers to the affected infants also remain subject to certain behavioral defections. For instance, they are likely to engage in behaviors that are more intrusive and less sensitive (Shoemark, 2018). Other studies on the behavioral pattern of the mothers to preterm infants also indicate increased levels of intrusiveness, reduced levels of sensitivity, and less sensitive behaviors compared to their term counterpart mothers.

According to research, two main reasons make the interaction between a parent and infant born preterm vulnerable. To begin with, such infants are more likely to have lower vagal functions, increased difficulty with state control, and deterred visual attention compared to their term counterparts (Lean et al., 2018). For this reason, the parent-infant interaction in his context needs to remain responsive and sensitive to the needs of the affected infant. These features would ensure the emergence of both self-regulation and other skills crucial to the child’s ultimate development. The study by Lean et al. (2018) asserted that maternal responsiveness is an important component of the brain development of infants born preterm. Other supportive studies also indicate that sensitivity and responsiveness of the mother-infant interaction can potentially lead to improved self-regulation, better joint attention, and reduced behavioral problems among children born preterm.

Apart from the level of risks posed to the parent-child interaction by the neonatal status of the affected child, the interaction between the two is also vulnerable to interference by other various contextual factors that manifest as the infant remains under care in the NICU. Additionally, there are other studies that associate poor social support, maternal depression, and low socio-economic status of the affected families with a difficulty in coping with the child’s NICU stay and ultimate transition to home. It is also determined that the same factors are partially responsible for the quality of the parent-infant relationship throughout the early development stages of a preterm infant (Linnér et al., 2020). This reason makes it important to screen for the various challenging interactions between the mother and the preterm infant during their stay in the NICU. This function would aid identification of the most vulnerable infants for future undesirable interactions and potentially deterred development.

Most observational studies on the kind of interaction a parent has with their infants are often conducted out of both NICUs. They are done either in-home or laboratory settings with multiple exceptions. The results from such observations are then used as an assessment tool for evaluating the nature of the preterm infant’s stay in the NICU. They suggest the potential that the parent has in learning the various ways of identifying cues in the infant and subsequently providing stimulating interactions and ultimately a positive effect on the relationship (Ettenberger et al., 2021). Other studies have also used the parent-infant interactions to assess the child’s feeding outcomes, especially in the post NICU stages. However, the studies present potential limitations in the assessment of the areas aforementioned. For instance, they hardly provide for the long-term tracking or investigate the stability of the variables over the periods of assessment. Additionally, most of the studies on the parent-infant interaction hardly commence before the corrected age of 4 months. There is inadequate evidence on the relationship that studies of the parent-infant interaction have with later parenting functions that occur in environments where the child becomes more active. Later parenting at this stage is met with more experience in caring for their infants making it a crucial component of the parent-infant bond.

Impacts of Parent-Infant Interventions

The Parent-Child Early Relational Assessment (PCERA) is one measurement tool that is often used in the examination of the parent-infant interaction in the early stages of development for the latter. There are several developmental theories from which the tool draws its assumptions and conclusions. Among them are the attachment model, emotional presence, combined attention, self-psychology, and the various cognitive linguistic models (Grunberg et al., 2019). The PCERA provides a description of the pattern of the level of relationship that a parent has with the infant. For this reason, the tool can as well be used to record the value of affection and behavior in the parent-infant interaction, especially during the child’s play, feeding, or any other definite activities during infancy to early childhood stages.

PCERA was developed subjectively to provide profiles to specific areas of the parent-infant relationship. Targeted details were both strengths and concerns for which the therapeutic interventions are necessary. By so doing, the tool aims to record notable changes among particular parent-infant pacts that are more vulnerable to early relational impairments. According to various studies on the use of PCERA with preterm infants, there is more positivity than negativity in the parenting interactions that are associated with improved sleeping patterns, weight gain, advanced cognitive skills, and less attentional and behavioral complications (Grunberg et al., 2019). Just like any other applicable intervention in healthcare, the application of the PCERA indicates a practical gap. Only a few studies have used the model in a subsequent examination of the parent-infant interactions of the preterm children in the post NICU stay. Furthermore, studies that have used the model lack a long-term follow-up which is also crucial for the tool’s effectiveness. The studies are also said to delay until the infant turns 4 months old, an age that is deemed late for the observations. However, the effectiveness of the measure tool remains. Professionals can potentially utilize the PCERA strategically in the identification of parent-infant pacts at risk for various interaction constraints. In this case, the tool allows for the subsequent development of more sophisticated intervention tools for the affected families.

Search Strategy

This review deployed a step-by-step search model in aid of a comprehensive search on literature used. To begin with, the systematic review formulated the research questions to guide the process. Proposed questions for the review aligned to the subject area of parent-infant interaction during the post NICU stay. The next step was the identification of the key concepts to narrow the search to the subject area. Major concepts in parent-infant attachment were used in the evaluation of relevant literature for the review. To effectively execute the search on the already identified concepts, the review developed search terms on two different levels. The first level involved the development of free text terms while the other was on controlled vocabulary terms. The review then identified relevant search fields to execute literature findings. Lastly, there was practical phrase searching, use of wildcards, and proximity operators in the actual search.

Themes in Literature Review

Several themes are addressed in the systematic literature review. The most dominant theme in the literature review section of the paper was the theme of assessment. Assessment in this context implied follow-up on the nature of attachment that the parent has with their infant babies after transitioning from the NICU to their respective homes. Another theme that remains dominant in the review is the theme of parenting. The whole concept of parent-infant interaction is based on the various parenting obligations that the mother has to the child. It is therefore relevant to have the theme run through the entire review. The other themes that also remain relevant to the review are themes of prematurity and social support, both on the infant who is the main interest in all literature reviewed.

Supporting Content

The review utilized several studies relevant to the subject area. Most of the literature used was observational research on preterm infants during and after their stay in the NICU. There were specific inclusion criteria used in the identification of specific studies to be reviewed. The only studies reviewed lied within the past four years with the restriction of examining parent-infant attachment in preterm babies.


This systematic review had specific objectives towards the parent-infant bond past their NICU stay. The first aim was to examine feasibility levels for the observation of parent-child interaction in the post-NICU moments. This function was regardless of whether the interactions in the said periods relate to interactions during their stay in the NICU. Another strategic objective for the review was to determine the relationship that exists between the infant and the various maternal features. The paper also reviewed the impact that applicable interventions have on improving the attachment between a mother and their preterm baby.


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