Neonatal & Infancy
and depression. Additionally, Doering et al (1999) determined mothers reporting higher stress levels than fathers in such circumstances. Busse et al (2013), when using the Parental Stress Survey NICU scale, found that parental stress increased, leading to sleep deprivation, increased anxiety and depression. The survey was self-reported, which could influence some factors within its reliability and validity, although two studies (Reid & Bramwell 2003, Franck et al 2005) concur with these findings. Reid & Bramwell (2003) and Franck et al (2005) elaborate further, highlighting areas of possible stresses within the neonatal environment, eg unfamiliar sights and sounds, the appearance of their infant possibly supported by equipment alien to the new parents, such as ventilators, monitors and medication pumps, and communication concerns with staff over such issues as receiving conflicting information.
Parental coping There are several factors which may determine an individual’s ability to cope with the birth of a preterm or sick infant. Lancaster et al (2010) noted that mothers who have suffered from stress during their pregnancy often go on to develop depression after delivery and beyond. In addition, this was often found to be associated with the absence of partner support, so it is vital that single mothers are provided with support and encouragement within the NICU to help them cope with their new infant (Lancaster et al 2010). Often parents feel too upset to visit, or they visit infrequently. They may not wish to hold or even touch their infant, and may feel unable to bond with their infant, apprehensive in case they potentially have to deal with a consequential loss (Aargaard & Hall 2008). Whilst some parents may have an excellent family and friendship support system and therefore feel more able to deal with such a situation, others could find themselves alone with no support other than nursing and medical staff who are unknown to the parent. It is therefore essential that nursing care incorporates the parents’ involvement to ensure that they are part of the decision-making process, provided with up to date information, feel welcome within the unit and that their wishes are respected. Reid et al (2007) maintain that introducing or supporting these factors may therefore ensure anxiety and distress is kept to a minimum.
Providing family-centred care Providing family-centred care for parents within the neonatal setting is challenging for the nursing and medical team. However, for parents who are trying to come to terms with their new parental role and the difficulties this may entail in having a child who is sick or preterm, family-centred care is essential (Nethercott 1993, Bliss 2010, Picker Institute Europe MIDIRS Midwifery Digest 27:4 2017
2011). Furthermore, Ramezani et al (2014) agree that holistic care of the child and family is an essential aspect of care. Nonetheless, Pinch & Spielman (1989) noted that care within neonatal units in practice does often defer to patriarchal methods of care whereby the medical and nursing staff control much of what parents can, or are allowed, to do. However, Bliss (2016) signifies that engaging parents in the care of their infant can help to reduce stress and anxiety and may in turn reduce pressure on neonatal staff. Daley & Willis (1989) consider that parents may want to defer their infant’s care to staff who they feel are more able to deal with the complexities of care required, until they feel able to provide care themselves. Today’s hospital environment should openly welcome the participation of families in the care of their infant, and provide a welcoming and non-judgmental attitude within the neonatal setting. This can be accomplished if they are provided with open access to visit their infant whenever they wish, instead of feeling that they are merely visitors. This can be facilitated by the nurse who should always introduce her or himself to parents and visitors. Moreover, Bliss (2016) recommends care should also be negotiated between the nurse and the parents to ensure that parents have plenty of opportunities to provide care for their infant.
Promoting family support Mader et al (2010) are of the belief that promoting family support and involvement is one area of neonatal care which is currently not encouraged as often as it should. The ‘Parents of Premature babies Project’ steering group (POPPY) (2009) highlighted that family-centred care within the UK is sadly lacking in neonatal units. They recommend that many improvements in family involvement can and should be made. POPPY (2009) also identified several interventions that nursing and medical teams could carry out that would help in the promotion of parenting, and also assist in reducing parental stress. These include: • ensuring that the parents are involved in and recognised as the most important aspect of the child’s psychosocial and developmental care • providing parents with the necessary education to help them care for their infant and any specific health needs • ensuring that any given communication and information provides an understanding of the infants’ developmental care needs and assistance with breastfeeding. It has also been suggested that care of the family is promoted during and following discharge. Once home, parents may often feel bewildered; both POPPY (2009) and the Picker Institute Europe (2011) have emphasised the importance of the neonatal outreach service which can help families to adjust. 515