Managing Parents in the NICU

8/14/2019 Managing Parents in the NICU

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Managing Parents inManaging Parents inthe NICUthe NICU

Mohamed KhashabaMohamed Khashaba

Professor of Pediatrics, NeonatologyProfessor of Pediatrics, Neonatology

Mansoura Faculty of MedicineMansoura Faculty of Medicine


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Admission of the Newborn to NICU isAdmission of the Newborn to NICU is

usually unexpected and stressful for theusually unexpected and stressful for the

parents.parents.

There is usually no time to prepare theThere is usually no time to prepare the

family.family.


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Emotional Responses by ParentsEmotional Responses by Parents

ShockShock

DenialDenial

GriefGrief FearFear

SadnessSadness

AngerAnger GuiltGuilt


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Those parents are more prone toThose parents are more prone to

clinical depression later on.clinical depression later on.

Cairo, 22nd March 2007


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Cultural and religious variations causeCultural and religious variations cause

differences in reactions.differences in reactions.

Different responses by parents are notDifferent responses by parents are not

necessarily abnormal.necessarily abnormal.



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Typical concernsTypical concerns

1.1. Infant appearance and health.Infant appearance and health.2.2. Course in the NICU.Course in the NICU.

3.3. Separation/ not feeling like a parent.Separation/ not feeling like a parent.

4.4. Disruption of family: family routines, time,Disruption of family: family routines, time,tasks and other siblings.tasks and other siblings.

5.5. Difficulty with breast feeding.Difficulty with breast feeding.

6.6. Communication with medical staff.Communication with medical staff.7.7. Post discharge expectations.Post discharge expectations.

8.8. NICU environment.NICU environment.

Cairo, 22nd

March 2007


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Additional stressesAdditional stresses

Maternal ill health.Maternal ill health.

Sudden changes.Sudden changes.

Financial hardship.Financial hardship.



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Mother and Father reactionMother and Father reaction

1.1. They experience stresses differently inThey experience stresses differently in

intensity and time schedule.intensity and time schedule.

2.2. They prioritize the concerns differently.They prioritize the concerns differently.



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Mother tends to look support from othersMother tends to look support from others

and to search for an explanation.and to search for an explanation.

Father tends to minimize the situationFather tends to minimize the situation

often by concentration on supporting hisoften by concentration on supporting his

partner.partner.



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Differences in stress and concernsDifferences in stress and concerns

may be a source of severe family distressmay be a source of severe family distress

and /or disruption.and /or disruption.



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Stresses after dischargeStresses after discharge

More dramatic for families of infantsMore dramatic for families of infants

with ongoing medical issues and homewith ongoing medical issues and home

care needs.care needs.



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Stresses after dischargeStresses after discharge

1.1. Insecurity with their abilities.Insecurity with their abilities.

2.2. Bonding and attachment issues.Bonding and attachment issues.

3.3. Financial stress.Financial stress.4.4. Isolation, reduced contact with familyIsolation, reduced contact with family

and friends.and friends.

5.5. Restment felt by siblings.Restment felt by siblings.



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Managing parents stressesManaging parents stresses

A family oriented approach to careA family oriented approach to care



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Neonatal team meet the parents beforeNeonatal team meet the parents before

birth when time permits to discuss anybirth when time permits to discuss any

likely admission.likely admission.

Parents may visit NICU before birth of theParents may visit NICU before birth of the

baby.baby.



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An official welcomeAn official welcome

Tour in the NICU.Tour in the NICU.

Knowledge tought about the routines.Knowledge tought about the routines.

Teach the mother how to touch and holdTeach the mother how to touch and hold

the baby.the baby.

Explain the technology.Explain the technology.

Short pamphlets and handouts.Short pamphlets and handouts.Cairo, 22nd March 2007


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Cairo, 22nd

March 2007


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Involvement of the parents in decisionInvolvement of the parents in decision

making and care from the early stages.making and care from the early stages.

Involvement may extend from simple toInvolvement may extend from simple to

more complicated issues.more complicated issues.



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Practical HintsPractical Hints

Special areas should be included in NICUs for:Special areas should be included in NICUs for:

2.2. Counseling of parents.Counseling of parents.

3.3. Breast feeding of infants.Breast feeding of infants.

4.4. Support of grieving parents.Support of grieving parents.



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Practical HintsPractical Hints

Rooms for parents in the hospital.Rooms for parents in the hospital.

Adjacent facilities outside the hospital.Adjacent facilities outside the hospital.

Reverse transportation.Reverse transportation.



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Discharge PlanningDischarge Planning

1.1. Learning how to manage medicinesLearning how to manage medicines

,tube feeding and other details.,tube feeding and other details.

2.2. Documentation of mothers knowledge,Documentation of mothers knowledge,

ability and confidence by a trained staff.ability and confidence by a trained staff.



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Examples of Training aspectsExamples of Training aspects

1.1. Preparation, dosing and storage of medicines.Preparation, dosing and storage of medicines.

2.2. Use of Oxygen and monitors.Use of Oxygen and monitors.

3.3. Ability to provide adequate nutrition.Ability to provide adequate nutrition.

4.4. Recognize signs of illness and acuteRecognize signs of illness and acute

deterioration.deterioration.

5.5. Basic NCPR training.Basic NCPR training.



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Discharge plan time tableDischarge plan time table

1.1. May start 1-2 weeks before discharge.May start 1-2 weeks before discharge.

2.2. Rooming in for 1-2 nights beforeRooming in for 1-2 nights beforedischarge will help.discharge will help.



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Summary PointsSummary Points

1.1. Having a NICU baby is stressful to parents.Having a NICU baby is stressful to parents.

2.2. Parents manage stress and anxiety in manyParents manage stress and anxiety in many

ways that are not consistent across differentways that are not consistent across different

families, religions and cultures.families, religions and cultures.

3.3. Fathers and mothers differ in how they copeFathers and mothers differ in how they cope

with stress.with stress.4.4. Appropriate support for parents should be anAppropriate support for parents should be an

integral part of neonatal care.integral part of neonatal care.

Cairo, 22

nd

March 2007


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Managing Parents in the NICU

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