How Nurses Can Help Parent in the NICU
Practical advice for NICU nurses from a nurse and preemie mother.
By Dianne I. Maroney
Firsthand experience is the most effective teacher! I was a nurse myself before I had my own baby prematurely. I learned from both positive and negative experiences during my daughter's' journey. Here are some suggestions that might help other nurses deal with the emotional issues of parents in the NICU.
(1) Keep babies comfortable and as "normal" looking as possible. Give parents a few moments of feeling they have their own little baby, not a sick "preemie". This will help them through the grieving process of losing their "normal" infant. Swaddling, noise reduction, soft music, dressing them, or even a small bow in their hair can mean the world to parents. If sedation is available, use it. It will help keep babies comfortable and able to cope with their noxious surroundings.
(2) Show parents that you're trying to understand their struggle by recognizing their feelings. Nurses can only do so much, but often just asking how they feel and validating their feelings is enough. Remember that, although you may perceive the baby as doing well on a particular day (and it may help parents to hear that), it may not be how the parents are feeling. Explore how they are feeling first. Avoid using the words "at least". "At least you have the girl you wanted"; "At least you have two other kids at home". "At least statements are not empathetic statements; they do not validate and may trigger anger.
(3) Let parents have as much control as possible. You are working with a family, not just an infant. There are a number of family dynamics that you probably won't know. Educate families, give them choices, and involve them in the baby's care. The more you educate, the more you can enable parents to feel control. This can range from taking temperatures, to feeding schedules, to whether to do surgery on a patent ductus arteriosus. Make parents feel they are part of the team taking care of their baby. My daughter's nurses sometimes provided this feeling for me by calling me at home to update me on the baby's condition. This made me feel that what I said and felt really mattered.
(4) Be accountable for your actions, right or wrong. If there is a problem, whether big or small, your fault or not, let the parents know what is being done. When my daughter aspirated I was angry. The anger was present regardless of the fact that I knew, better than the average parent, that these incidents happen. The nurse may or may not have been at fault. A simple, empathetic "I'm sorry" would have helped heal my anger. Because of my daughter's long-term problems resulting from the aspiration, I frequently go over this incident and feel anger.
Keeping parents naive does not prevent lawsuits; it creates fear, suspicion, and anger. Prompt explanations and apologies are the best healers.
(5) Do extensive teaching and encourage home care. I cannot imagine surviving my daughter's homecoming without my nursing knowledge. Because of daughter's problems with significant reflux, we received approximately 12 hours of respite care per week. Home care was a lifesaver for us and should be offered to all parents whenever possible.
(6) Most important, recognize that the baby you are taking care of is a child of a parent or parents in a family with a distinct set of dynamics. Remember that the NICU is a very intimidating place. (There were moments my husband was so intimidated he had to push himself to walk through the door.) Help parents to overcome intimidation so they can be a part of their child's life. Don't forget to speak to the father as well as the mother. Often fathers feel left out because medical people tend to address only the mothers.
Many parents feel similar emotions, but each family expresses them differently. Recognize those differences and be their advocate. If there are no parents, then you are the baby's advocate.