Once the mother became more confident in handling her baby in the incubator, I broached the subject of taking her baby out for a first cuddle. I discussed with her the use of ‘Kangaroo care’ where a mother holds her baby between her breasts with a blanket draped over baby’s back. Research suggests its benefits include: improved parental bonding, enhanced weight gain, and an earlier discharge (Bohnhorst et al 2001, Furman &Kennell 2000). According to Crawford and Hickson (2002) it facilitates bonding, can enhance development and improve oxygenation. Merenstein& Gardner (2011) also suggest that successive sessions of kangaroo care has a helpful effect on the mother and is a way of recuperating self-confidence. I suggested to the mother that she wears a shirt for her next visit, which unfastens down the front so that she could just expose her chest, allowing the baby to lie so as to have a sheet placed over the baby. To ease her worries I explained that I would set up screens around the incubator to give her privacy and stay with them until she felt confident.
Holding the infant for first time has been described by mothers as a significant event (Reid 2000). When this mother held her baby for first time they both looked so content and happy. The mother began gently stroking her baby’s head and talking to her. I took some photographs for them to keep because this was a special time in both their lives to remember. For many of the mothers this event is delayed because of the condition of their infant (Crawford &Hickson 2002).
A study carried out by Bialoskurski (2000) looked at the relationship between maternal needs and priorities in the NICU environment. The authors cited other relevant studies in their initial literature search, with poor communication and conflicting advice from the nursing staff (Miles et al1992) being the common threads among the research. This study carried out a survey which aimed to investigate the nature and organisation of maternal needs and priorities in the neonatal unit using 209 mothers of premature infants. The search used a critical care inventory and a ranking scale and the data was analysed using multivariate analysis. It revealed clear priorities on maternal needs and the need for accurate infant related information, the priority of 93% of mothers. They also found that mothers appreciated the good communication practices with professionals. According to the authors the results show that infant related priorities may mask the mothers’ own need for support and further suggests healthcare professionals and the baby’s whole family should be involved in order to achieve successful mother-infant bonding. They found it was important to improve the communication skills between mothers and nurses, also expressing to mothers the necessity to look after themselves physically and mentally. The conclusion of this study recommends the importance of recognising the mother’s individual needs, essential for maternal well being. Parenting in NICU is linked to crisis with reactions and anxieties similar to those seen in acute and post traumatic stress disorders (Ringland 2008; Crathern2009). In practice, this is about giving explanations and information to mothers at their level of understanding.
Reis (2010) carried out a qualitative study of parents in which parents were interviewed in person or via telephone either following or close to discharge. They found that the most significant factor affecting parents’ satisfaction with their NICU experience is developing a collaborative and effective nurse-parent relationship. They recommended the need for consistent and continuing nursing care facilitates and the ability of both parties to develop their relationship.
A study by Wilson (2000) which aimed to develop and implement Family Focused developmental care (FFDC) found that parents become more confident in caring for their baby on the NICU, but that nurses often undervalued this aspect. FFDC is a model of nursing care which involves nurses encouraging parents to participate in their baby’s care. The parents and named nurse meet on a regular basis to discuss the baby and how the mother can try altered strategies for interacting with her baby. Darbyshire (1993) found that nurses appeared to be wary of tolerating parents’ presence, rather than actively encouraging it. Nurses often feel devalued when parents have increased involvement in the care of their child (Heermann and Wilson 2000). According to Merenstein and Garner (2011) nursing actions can hold parents back from physical closeness and intimacy with their premature infants. In practice family centred care is promoted and there are programmes and parent craft classes which cover issues such as coping strategies, the use of positive touch and Kangaroo care, infant feeding techniques and breast feeding, play and development, baby massage, car safety and resuscitation.
According to Coleman (2002) family centred care has evolved along with the many changes in society but it remains only significant concept for the 21st century. She recommends that nurses need to focus on partnership and collaboration with families, with the development of the appropriate skills to facilitate this. According to Dunst and Trivette (1996) to improve the practices with families, it is very important that nurses and other health care professionals fully understand the characteristics and consequences of using different approaches in their work.
On promoting parental involvement within the NICU, a number of issues have been raised and it remains vital that nurses consider the effects of separation. Parental involvement should be at a pace suggested by the parents themselves (Bialoskurski 2000). They need constant reassurance and caring for a family which takes time and effort. It will be more time consuming than working in a directive manner, as it involves allowing parents to be involved in their baby’s care by giving information from which they can make realistic choices. Sherr and Rosenblatt (1994) suggest that supporting parents in ways that allow them to assume this responsibility must be one of the neonatal nursing objectives.
On reflection I have discovered that informing the parents that premature birth doesn’t affect bonding, a friendlier nurse-parent relationship, and informational training sessions can all improve the parental participation in the NICU, as well as improve parent-baby relationship, making sure that they are well equipped to cope after discharge. These are very practical tasks that can be followed through and implemented in practice. The central aspect to this would be adequately informing the staff on how important parental participation is. The results of this should be that parents have a stronger involvement within the NICU, without being nurse led all the time. Any misconceptions by the lack of advice for the parents should be dealt with, by improving the theoretical knowledge and current advances in the clinical area such as the parent craft classes, giving as much theoretical and practical support as possible will make it a living reality. The parent-nurse relationship can be reinforced by a higher level of communication between the two parties, by updating the parents with sufficient information on their level of understanding. Further follow up classes and information can be used to further help the parents cope after discharge. In conclusion, Neonatal nurses are in the prime position to support the parents in the unexpected situation, to help them to take the first steps in initial attachment and to make them confident for the care of their baby. I suggest there is a need to confront the complex matter of parental involvement so that neonatal nurses can offer effective timely support and guidance for parents.
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