Hospitalization of a High Risk Infant High-Risk Infant and Hospitalization
The birth of a high-risk infant—whether preterm or term with significant health issues—presents profound challenges for families. The neonatal intensive care unit (NICU) becomes a pivotal setting for these families, where the stakes are incredibly high. Nurses and healthcare providers recognize the critical role parents play in the lives of their high-risk infants and have increasingly focused on addressing the needs of these parents.
Family-centered care has emerged as a crucial concept in NICU settings, driven by an understanding of the emotional and practical challenges faced by parents. Over the past two decades, research has significantly contributed to our understanding of the parental experience, primarily focusing on two broad areas: the stressors parents face and their emotional responses.
Hospitalization as a Stressor
Hospitalization of a high-risk infant in the NICU is a major stressor for parents. The development of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS
) by Miles, Funk, and Carlson (1993) has been instrumental in identifying these stressors. Research using this scale highlights several key areas of parental distress:
- Inability to Protect the Baby: Parents often feel helpless as they cannot shield their infant from the pain and discomfort associated with hospitalization. The sight of their baby undergoing medical procedures or suffering from illness can be profoundly distressing.
- Separation from the Infant: The physical separation from their baby, especially for extended periods, adds to the emotional burden. Parents may struggle with the fear of missing crucial moments and the emotional distance from their child.
- Appearance and Behavior of the Infant: Observing their baby in a state of illness—connected to tubes, machines, and experiencing discomfort—can be traumatic. The unfamiliar appearance and behavior of the sick infant contribute significantly to parental stress.
Research by Shields-Poe and Pinelli (1997) and others underscores that the sight of needles, tubes, and respirators can exacerbate parental distress. These stressors impact parents’ psychological well-being and highlight the need for supportive interventions in the NICU environment.
Parents’ Role in a Seriously Ill Preterm Baby
Parents of seriously ill preterm infants face unique challenges. Research suggests that these parents experience substantial stress and intense emotional responses, particularly anxiety and depressive symptoms. Several studies indicate that mothers generally report higher levels of stress compared to fathers (Doering et al., 1999; Meyer et al., 1995; Miles et al., 1992). However, much of this research has focused on small, homogeneous samples, often excluding diverse populations and different family structures.
The role of fathers, particularly those from diverse ethnic backgrounds or single fathers, is an area requiring further exploration. Understanding the father’s contribution to maternal mental health, parenting, and infant outcomes is crucial for a comprehensive approach to care. Research should expand to include diverse family dynamics and provide insights into how different family members contribute to and cope with the stress associated with having a high-risk infant.
Factors Affecting Parental Distress
Parental distress in the NICU is influenced by various factors, including parent and family characteristics, as well as the infant’s illness. Research by Doering et al. (2000) and others has explored these factors, although many studies rely on quantitative methods with limited use of conceptual frameworks. This leaves a gap in understanding the long-term implications of parental distress and how it evolves over time.
Preterm infants often face prolonged hospitalizations, making it essential to study parental responses over the course of the NICU stay. Longitudinal studies are needed to better understand how parental distress impacts parenting behaviors and the parent-child relationship. Additionally, there is a need to link parental emotional responses to the care and outcomes of the infant, incorporating both qualitative and quantitative methods to gain a fuller understanding of the parental experience.
Despite existing literature on parent-infant interactions in the NICU, there is a lack of research linking these interactions to parental emotional responses (Holditch-Davis & Miles, 1997). Qualitative research methods could provide deeper insights into the complexities of parental experiences and the impact of these experiences on family dynamics.
Parental Stress in the NICU
Research on parental stress in the NICU has primarily focused on descriptive studies, with fewer interventions aimed at alleviating parental distress. Melnyk and colleagues (2001) tested a parent empowerment intervention, which showed positive outcomes for low birth weight infants and their mothers. This intervention led to reduced stress related to the NICU environment and improved understanding of preterm infants’ behavior.
However, more research is needed to develop and evaluate interventions that can effectively reduce parental stress and support parents in their role. Interventions should address both emotional and practical aspects of caregiving, providing parents with tools and resources to manage their stress and engage effectively with their infant’s care.
Future View and Neonatal Care
Looking forward, research in neonatal care should be grounded in developmentally sensitive and ecological conceptual models. These models should explore personal and illness-related factors affecting parental responses and link these responses to parenting and child outcomes.
Combining qualitative and quantitative research methods will provide a more comprehensive understanding of parental experiences. Longitudinal studies and repeated measures designs are essential for capturing the evolving nature of parental distress and its impact over time. Research should also focus on both problematic responses and positive growth outcomes, offering a balanced view of the parental experience.
It is crucial to examine how parents from different ethnic and cultural backgrounds respond to the birth and hospitalization of a high-risk infant. Understanding these diverse experiences will help tailor interventions and support strategies to meet the needs of all families.
Neonatal Hospitalization and Nursing Role
Nurse researchers have made significant contributions to understanding parental responses to the birth and hospitalization of high-risk infants. Their research has influenced nursing interventions and practices in the NICU, emphasizing the importance of family-centered care.
NICUs have adopted practices such as open visiting hours and recognizing the critical role of parents in the care of their infants. Nurses work diligently to facilitate the development of the parental role, even when the infant is critically ill. This approach ensures that parents remain actively involved in their infant’s care and are supported throughout the NICU stay.
Nurses play a multifaceted role in supporting parents of high-risk infants. They provide emotional support, education, and practical guidance to help parents navigate the challenges of the NICU environment. By fostering a supportive and inclusive atmosphere, nurses help alleviate parental stress and enhance the overall experience for families.
In summary, the experience of parents with high-risk infants in the NICU is complex and multifaceted. Research has highlighted the significant stressors faced by parents and the need for targeted interventions to support them. Future research should continue to explore the diverse experiences of parents, incorporating both qualitative and quantitative methods to gain a comprehensive understanding of their needs. By addressing these needs, healthcare providers can improve the care and support offered to families during this challenging time, ultimately enhancing outcomes for both infants and their parents.