Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Disrupted Bonds - Parental Perceptions of Regionalised Transfer of Very Preterm Infants: A Small-Scale Study

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Disrupted Bonds - Parental Perceptions of Regionalised Transfer of Very Preterm Infants: A Small-Scale Study

Article excerpt

Background

Since the 1970s, the majority of Westernised countries have regionalised neonatal care. Hospital units are categorised based on the intensity of care they provide. Infants are often transferred from a high acuity Neonatal Intensive Care Unit (NICU) to a lower acuity Special Care Baby Unit (SCBU) when they are ready for convalescence prior to discharge.

Primary reasons for regionalised transfer centre around fiscal prudency and clinical efficiency (Attar, Lang, Gates, Iatrow & Bratton, 2005; Jung & Bose, 1983; Phibbs & Mortensen, 1992). Secondary considerations include utilising local resources; placing the family closer to home; providing the SCBU physicians' opportunities to familiarise themselves with the infants and their families prior to discharge; and enhancing the relationship between the NICU and the SCBU (Hanrahan et al., 2007). Though regionalised transfer signals an infant's improving health, many parents find the transition fraught. This study was undertaken on the initiative of the first author, an experienced NICU nurse, who had repeated clinical experiences of parental distress at the time of back transfer. Listening to parents voice their reasons for not wanting their child to be transferred, she reflected on how these anecdotal accounts were linked. When an opportunity to conduct a piece of research arose, the first author used the opportunity to formally explore this topic, convinced of its relevance to her workplace. The study's aims were as follows: to investigate parents' perceptions of the regionalised transfer of preterm infants within the New Zealand context; to provide neonatal healthcare professionals with insight regarding parental perceptions of the regionalised transfer of preterm infants with the view to optimising service provision.

The context that underpins families' perceptions of regionalised transfer of these infants is that parents with very preterm babies experience increased anxiety, depression and trauma symptoms compared to parents of healthy infants (Carter, Mulder, Bartram, & Darlow, 2004). This study focuses on experiences of parents with very preterm infants, born at 29 weeks gestation or less, as research highlights that these parents experience greater distress than those NICU parents with babies born at a later gestation age. A premature infant translates into parental loss of control. This relative helplessness can lead to extreme sensitivity to surroundings and changes (Hawthorne & Killen, 2006). Parents experience increased anxiety when told their infant will be transferred to another hospital. This distress is particularly significant with an extended hospitalisation period as parents, over time, often come to associate NICU with safety and community (Helder, Verweij, & van Staa, 2012).

By the time, very preterm infants are medically ready for transfer, many parents have come to find the initially distressing environment of the NICU a place of reassurance. Donohue, Hussey- Gardner, Sulpar, Fox, and Aucott (2009) report that, out of 236 parents, less than half wanted their babies to be transferred; psychological comfort with the NICU was the most frequently reported reason for diffidence. Themes of comfort and familiarity are common throughout the small body of literature pertaining to back transfer of very preterm infants. Coyle (2001) highlights how parents perceive intensive care as a secure and safe environment for their babies. Their time in NICU is spent watching and learning from the environment around them, and they attain a wealth of knowledge about neonatal care rules and rituals, causing them to question care variations once transferred to the SCBU (Hall & Brinchmann, 2009).

Parents of NICU extended-stay infants acclimatise to the NICU environment, and perhaps most significantly, bond with the staff. The benefits and challenges of strong, trusting relationships with familiar staff are highlighted throughout the literature. …

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