Encouraging parental participation in the NICU. According to Wigert et al (2006) the most difficult aspect of having a baby in NICU for mothers is being unable to take the important first steps to attachment: Haut et al (1994) states that family bonding
HIGH DEPENDENCY CARE OF THE NEWBORN
PROMOTING AND ENCOURAGING
PARENTAL PARTICIPATION IN NICU
Registration NO: 100252125
Module NO : SNM3115
Unit Leader : Angela Thurlby
Word Count : 1649
The focus of this discussion will be to encourage parental involvement in the NICU. My motivation for choosing this subject is an experience that occurred when I nursed a baby, who was a surviving twin from a premature delivery. The mother refused to handle her daughter saying that she was frightened of hurting her. Unfortunately the other twin had died shortly after delivery. The aim is to analyse the factors that can affect the initial parental attachment, the complex psychological needs of families during this stressful time, and also to make recommendations for interventions which can be used for future practice.
According to Wigert et al (2006) the most difficult aspect of having a baby in NICU for mothers is being unable to take the important first steps to attachment: Haut et al (1994) states that family bonding within the neonatal environment is very difficult due to separation. Affonso et al (1992) supports this, suggesting that separating a mother from her baby when in need of intensive care prevents initial bonding. According to Boxwell (2010) the early delivery of a baby may make parents feel guilty and think that they have caused the unwanted situation for the infant. Once the baby is admitted to NICU the parents lose the images of having a normal delivery and taking the baby home, holding, feeding, and changing nappies (Dyer 2005). Further stress was added in this case, because the baby is a surviving twin.
According to Hazinski (2009) and Shaw et al (2006) parents may display initial coping strategies which they describe as serenity on entering NICU; performing a visual inspection of the machinery and layout, pulling out from the environment, over protectiveness, over focusing on small things like tapes or blood stains on sheets or clothing.
They then eventually move on to try and recognise how the machines work, interpretation of blood results and showing curiosity in the cause of the baby’s problems.
Reid (2000) describe that when a mother holds her baby it remains the most momentous event, along with feeding them for the first time. Turril (1999) and Cathern (2009) identified that neonatal nurses are in the prime position to provide support through the time of crisis. In my case, to encourage the mother to hold her baby, I asked her to help me with changing the baby’s sheets, showing her the best way to hold her baby, whilst taking care to support the CPAP tubing. I felt that the care of the baby should be nurse-led until she felt more confident overall, though I was happy to encourage her. Though very frightened initially when lifting her baby up, with support and assurance, the mother managed very well. Nethercott (1993) suggests that parental involvement in care is a precursor to family centred care as parents are enabled to be with their baby all the time, and be involved with basic care and some decisions. However the nurse remains in control of the family’s participation.
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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.
AffonsoD.D,Hurst.I,Mayberry.L.J,Haller.L,Yost.K and Lynch.M.E(1992)@Stressors reported by mothers of hospitalised premature infants’,Neonatal network11(6):63-70.
Bioloskurski.MM , C.L.Cox,WiggingsRD(2002),The relationship between maternal needs and priorities in the neonatal intensive care environment. Journal of advanced nursing. Volume37 ,Issue 1, pg 62-69.
Busakorn Punthmatharith,Utaiwan.B,Thidarath.K-Comparisons of needs, need responses and need response satisfaction of mothers of infants in NICU., Volume 22,Issue 6, pg 498-506.
Crawford.D,Hickson.W, (2002) An introduction to neonatal nursing care.2nd edition
G.Boxwell, Neonatal intensive care nursing 2nd edition(2010)
Damato , Elizabeth.G-Parental attachment and other correlates of post natal maternal attachment to twins , Advances in neonatal care ,Oct 2004, Volume 4, Issue 5, p 274-291.
Hazinski M.F(2009)Nursing care of the critically ill child .3rd edition ,Mosby.
Haut.C, Peddicord.K,O’brien.E.(1994)Supporting parental bonding in the NICU: a care plan for nurses’.Neonatal network.13(8):19-25.
Heerman .J.A and WilsonM.E (2000)Nurses experiences working with families in NICU during the implementation of family focused developmental care. Neonatal network. 19(40pg 23-29.
Jeanine Young, Developmental care of the premature baby(1996)
Lynda Smith ,Valerie Coleman, Maureen Bradshaw, Family centred care –concept, theory and practice(2002)
Merenstein & Gardner’s hand book of neonatal intensive care(2011) ,7th edition, Mosby Elsevier.
Miles .M, Frunk.S and Kasper.M,(1991) ‘The neonatal intensive Care unit:source of stress for parents’, Clinical nursing 2(20;346-54.
Misty D Reis,Gwen R R,Shanon DS , Barbara A, John Van A ,Developing nurse /parent relationships in the NICU through negotiate partnership.JOGNN,Volume 39,Issue6,pg 675-683 ,Nov/Dec 2010.
Oxford .T,(1996)Psychological support for parents whose children require neonatal intensive care nursing..Journal of neonatal nursing.2(1) pg 11-13.
Reid.T,(2000) Maternal identity in preterm birth, journal of child health.4(1) pg 23-9.
The multiple birth explosion and nursing implications.Journal of obstetric ,gynaecologic and neonatal nursing27 930 pg 302-310.