Running head: FROM OUTSIDER TO PARTNER

From Outsider to Partner

Grand Canyon University NRS-433V
September 11, 2011
Linnette Nolte, RN

Introduction and Purpose Nearly 400,000 infants are admitted to the Neonatal Intensive Care Unit (NICU) each year. This can be an intensely overwhelming, stressful, and emotionally draining experience for the families and, especially the parents, of the infants requiring care in the NICU. With the help of an emerging care delivery model known as family centered care, health care providers can ease some of the stress during a NICU stay by involving the parents in the cares of their infant. Basic ideas of family centered care include: parental involvement in the cares of their infant, unrestricted parental presence in the NICU, and open communication between parents and all care provider team members (Griffin, T., 2006). Griffin states that family centered care is “a philosophy of care that embraces a partnership between staff and families.” As this type of delivery care model is becoming more the norm in NICUs across the world, many researchers have posed the question of the parents and their feelings of the overall environment and care of their infant. Making the parents feel like they have control over certain areas of the entire NICU experience can make the difference between a smooth hospital stay and one that is not ridden with problems. 1.) In the qualitative research article Mothers in the NICU: Outsider to Partner by Judith A. Heermann, Margaret E. Wilson, and Patricia A. Wilhelm the main focus was to examine the process of involving the mother in the care of her infant; as to make her feel as if she were an important component in the care of her infant, as well as a mother that has control and a voice when it comes to issues related to her infant’s NICU stay. Thus, encouraging family centered care, which has numerous benefits, such as a decrease in the length of the infant’s hospital stay, enhanced bonding between parent and infant, an improvement in the overall well being of the premature infant, improved mental health outcomes for the infant, a decrease in the likelihood of lawsuits related to the care received, and greater satisfaction of care from families and parents (Cooper, L., et al., 2007). 2.) “The purpose of this study was to explore and describe mother’s experience of becoming a mother while their infants were receiving care in the NICU” (Griffin). Clearly stated, the purpose of this research study provides caretakers with an alternative perspective on the importance of family centered care in the NICU. Review of the Literature 1.) While the literature that was reviewed was, for the most part, relative, one of the articles that was reviewed for this study stated that interventions that actually incorporate mothers into the care of their infant in the NICU are anecdotal and have not yet been tested. The other articles reviewed stressed the importance of involving parents in the care of their infants in order to increase the chances of better outcomes. Common themes of the reviewed articles include: the value of good communication between parents and health care providers, and how a power differential can occur between nurse and mother, thus creating inhibition of the developing maternal role. 2.) The area of practice that was primarily discussed and studied in all the review articles is the NICU and the premature infants was the primary population.

Study Design 1a.) While the study is qualitative in nature, it may also be described as a phenomenological design, in which information is gathered thru inductive methods such as interviews and discussions. The individual being studied provides information on his or her experiences and perceptions, which in turn can be used as a basis for practical theory and implementation of change in policies and actions (Lester, S. 1999). 1b.) With the information provided, this author is unable to identify the expressed interest of the researcher. 1c.) The depth of understanding of the topic on the author’s part is evident throughout the research study. 1d.) The researcher is seeking information regarding the process of maternal development in four domains in this research study. They include: focus, ownership, caregiving, and voice. The results in the focus domain showed that initially a mother with an infant in the NICU is focused on the technology that abounds in the NICU, not her infant. The expertise of the nurses and the language and culture of the surrounding staff also gained most of her attention while the care of her infant was forced into the background. Progression along the focus continuum allowed the fading of technology over time, which allowed the mother to focus fully on her infant. The ownership domain results were in regard to the mother’s view of her relationship with her infant. Overall, the results showed that most mothers considered the infant as belonging to the nurse. The actuality of being the infant’s mother was difficult to realize because of the assumed responsibility of the infant’s care by the nurses. “The development of the infant played a role in the mother’s ability to claim ownership” (Heermann, et al). Caregiving was another area that was focused on. In this domain focus was on the advancement of caregiving from passive to active. Mothers that took a more passive role in the care of their infant felt like the nurses were the only ones able to provide the level of care needed by the infant and were in awe of the role the nurses took caring for their infant. Some of the mothers were intimidated by the ability of the nurse to care for their infant. “The movement from passive to active caregiving could be influenced by the nurses’ actions” (Heermann, et al). Some of the mothers felt as if they had to be invited by the nurse to be involved in the care of the infant. In the voice (from silence to advocacy) domain involved the mother and her claiming of responsibility in the infant’s care. Although some mothers never felt comfortable enough to leave the silent observer role, many others moved progressively along the continuum and intended to take on the role of advocate for her infant. Methods 1). The methods used in this study were interviews with broad, open-ended questions. Probes were used as needed to gather more detailed information. The interviews were audio taped and transcribed verbatim. Sampling 1a). Purposeful selection included mother of infants in the NICU that were premature between 24 and 34 weeks gestation, Caucasian, without anomalies, and in the NICU for at least one week. 1b). Sampling was not done until redundancy was reached. 1c). Informed consent was obtained from the 15 participants prior to the hour-long interviews. Data Collection 1). The phenomena being studied was clearly and completely described by the researcher. 2). The researcher’s assumptions and biases were not presented in the study. Data Analysis 1). Inductive methods were not used in the data analysis of this research study. 2). The findings of this study were consistent with reflective data. 3). The process of transforming themes into data was described well by the author. Each of the categories of collected data were presented in a clear and concise manner. 4). Truth value was established by using strategies appropriate in a qualitative survey, including maintaining an audit trail and searching for negative evidence. Conclusions 1). The conclusions of the study are appropriate given the findings of the study. The partnering of nurse and mother were only evident in a few cases. Most mothers described the lack of continuity of care a major issue in the progression from outsider to partner. 2). Although the sampling was of mostly middle class, Caucasian women, the results can be considered for implementation for NICUs wanting to move towards a more family centered model of care. The findings can aid in enhancing a nurse’s knowledge of the importance of including the mother in the care of her infant for the benefit of the mother and her infant, as well as the nurse. The findings give insight into the feelings of a mother with a hospitalized infant, which is something most nurses cannot empathize with.

References
Cooper, L., Gooding, J., Gallagher, J., Sternesky, L., Ledsky, L., Berns, S. (2007). Impact of Family Centered Care Initiative on NICU Care, Staff and Families. Journal of Perinatology. Vol 27.
Griffin, T. (2006). Family Centered Care in the NICU. Journal of Perinatal & Neonatal Nursing. Vol. 20. Issue1.
Heermann, Judith A., Wilson, Margaret E., Wilhelm, Patirica A. (2005). Mothers in the NICU: Outsider to Partner. Pediatric Nursing. Vol. 31. Issue 3.
Lester, Stan (1999). An Introduction to Phenomenological Research. Retrieved on September 11, 2011 from: http://www.sld.demon.co.uk/resmethy.pdf