Critical Care Plus
Ease Fears For Parents Caring For Preemies
Parents Must Join Staff for Hands-On Education
By Susan Cort Johnson
Parents often do a lot to prepare for a new baby, enrolling in parenting classes and reading books on baby care. When the baby is placed in the intensive care unit, however, parents must learn new ways of interacting with their newborn, which they didn’t read about in a book or learn in a class.
"Parents read a lot about bonding and interacting and they want to do all those things, but the baby isn’t up to it. Some of the first things we have to show them is how they can be there for the baby but not stress the baby," says Connie Remmer, BSN, RNC, clinician care coordinator in the Neonatal Intensive Care Unit (NICU) at Baptist Children’s Hospital in Miami.
It’s important to show the parents new ways to bond with their baby, agrees Nancy Gillilan, BSN, RNCNP, neonatal nurse practitioner and clinical education specialist at Grant/Riverside Methodist Hospitals in Columbus, Oh. She encourages them to bring a toy for the baby, tape-record their voice, or bring a music tape nurses can play for the baby. This helps parents feel there is some contact. When the babies are stable, nurses encourage "kangaroo care" where the premature baby is placed skin-to-skin with the mom or dad. "We increase parents’ involvement as the babies can tolerate it, and as the parents are ready for it," explains Gillilan.
Parents often grieve over the loss of their perfect baby, especially if they expected a normal birth. Many experience feelings of anger, shame, and guilt thinking that they may have done something to cause the problem. "Caregivers in the hospital are doing all of the primary care for [the parents’] baby. It is like their baby doesn’t belong to them, and sometimes, depending on how the baby responds while they are there, they are feeling the baby doesn’t want them," says Gillilan.
In the midst of this emotional turmoil, education must begin. The most stressful time for parents is immediately following the birth—just prior to discharge—and during the early post-discharge period. Therefore, education must target those critical times, says Gillilan.
At Grant/Riverside, nurses take parents to the baby’s bedside as quickly as possible to learn all about the equipment, such as the monitors, so they won’t be alarmed when they are visiting their baby. They also explain the primary health problem the baby is struggling with, such as premature lungs.
Letting parents know that the next few weeks is likely to be a roller-coaster ride, with their baby making a lot of progress one day and the very next day having nothing go right, is another important part of the preparation. "We try to prepare them ahead of time for those emotional ups and downs that are associated with the premature babies and the conditions they experience," says Gillilan.
Communication with families early on is vital, says Remmer. At Baptist Children’s Hospital the entire health team, including the social worker, meets with the family to help them understand the baby’s condition and what the care plan should be.
Prepare Parents Well for Discharge
Discharge teaching begins upon admission in the special care nursery at Grant/Riverside. Parents are assessed to determine how they learn best, what their support system is like, their age, socioeconomic status, and previous experience with this medical issue. A lot of hands-on teaching takes place with parents bathing and feeding the baby and drawing up medications. "The physical care needs of the baby must be returned-demonstrated several times," says Gillilan.
While the baby is in the special-care nursery, the parents all learn infant cardiopulmonary resuscitation, as well as the basics of safe infant care, which includes feeding, bathing, and diapering. In addition, they need to learn about any special equipment their baby will go home with, such as a feeding tube.
"They need to feel comfortable that they can assess how their baby is doing. It takes a lot of hands-on to get to that point," says Remmer. To help parents learn, the hospital provides lots of written materials, videos, and one-on-one training with nurses and other disciplines explaining procedures over and over again.
Once the baby is discharged, nurses make a follow-up call to the parents one to two days later. If the baby is very fragile, the call is made the next day, says Gillilan. However, parents are encouraged to call the nursery if they have questions at any time, day or night. A visit from a home health nurse is mandatory when the baby is discharged unless the parents refuse the visit. "A lot of issues resurface once the family gets home. Parents wonder if the baby is really OK, and if they are doing all right," says Gillilan.
For more information on caring for premature babies or babies born with a health problem, contact:
• Nancy Gillilan, BSN, RNCNP, Neonatal Nurse Practitioner and Clinical Education Specialist, Grant Riverside Methodist Hospitals, 111 S. Grant Ave., Columbus, OH 43215. Telephone: (614) 566-8546. E-mail: [email protected].
• Connie Remmer, BSN, RNC, Clinician Care Coordinator, NICU, Baptist Children’s Hospital, 8900 N. Kendall Drive, Miami, FL 33176. Telephone: (305) 596-1960, ext. 6353.
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