Facilitation of parenting within the newborn intensive care unit

Abstract

The major challenge facing neonatal health care providers today is to combine the necessary technological intensive care for preterm infants with a sensitive and individualized approach to facilitate neurobehavioral development while acknowledging and supporting parents of these infants in their role as primary advocates and longterm caregivers. This exploratory pilot study specifically aimed to examine the therapeutic process of an individualized nursing intervention in terms of its integrity, strength, and effectiveness. The individualized therapeutic nursing intervention was based upon underlying assumptions of both infant and parent competence. It was designed to promote the parent's ability to critically appraise their infant's behavior and to integrate the appraisal in their response to the infant in a sensitive and supportive manner.The analysis focused on further describing and understanding the relationship of treatment integrity and strength on effectiveness. Three levels of effectiveness were explored: parent's ability to critically appraise their infant's behavior, parent's ability to integrate the critical appraisal in their approach toward providing care to their infant, and parent's integration of critical appraisal during caregiving enhancing the parenting experience and in turn the infant's outcome. Multiple sources of data were explored: log and field notes of the interventionist throughout the study; coding and analysis of audiotaped intervention sessions during which the interventionist maintained a therapeutic alliance and modeled the critical appraisal process while viewing and discussing the parent's own caregiving of their infant on videotape; coding and analysis of the videotaped parent infant interactions; formal feeding observations; an infant neurobehavioral assessment; parent visitation, infant length of stay; and finally weekly parent journal writing.Findings of this study explicate further understanding of the influences of integrity and strength on effectiveness as well as the complexity of individualization within a research study. The case by case descriptive findings and frequency counts of behaviors provide valuable information for the understanding of the therapeutic process of the intervention and how it may be studied further in a broader based research endeavor. All parents were able to do critical appraisal of their infant's behavior both verbally and in writing. Parents were able to integrate critical appraisal into their handling approach showing some decrease in this ability when the complexity of the caregiving task increased. Measurements of both parent and infant competence show very promising results.