Healthcare professionals in a Neonatal Intensive Care Unit: Source of social support to fathers
Introduction
Healthcare professionals have a demanding role to fill in a Neonatal Intensive Care Unit (NICU). Not only do they develop a caregiving relationship with the hospitalized infant, they also develop a relationship with the parents. Moreover, they encourage the parent-premature infant relationship, by helping parents to adapt to the specificities of the parental role in a particular context such as that of premature birth.
Parents and professionals are connected in a caregiving process which may last for weeks or even months. Thereby, a close relationship is established on both a physical and an emotional level (Dowling, 2006, Espezel and Canam, 2003, McAllister and Dionne, 2006). The establishment of a satisfactory and mutual relationship is needed in order to facilitate the caregiving process (Fegran et al., 2008, Fegran and Helseth, 2009). When this closeness is achieved, parents have the sense of being entirely involved. Fegran's et al. (2008) qualitative study conducted on parents and healthcare professionals identified three stages in this relationship. The critical phase, during which parents are mostly in an observatory position of the caregiving process; however, if the communication with the physicians is satisfactory and if parents are invited and encouraged to participate as caregivers they will not feel excluded. In the beginning of the hospitalization, the premature infant is very fragile and needs highly specialized medical care, so its survival depends on the healthcare team, which is perceived as highly competent by parents (Borghini and Müller-Nix, 2008). During the stabilization phase, parents handle the caregiving of their child on their own with the help and supervision of the healthcare professionals. The parent-nurse relationship evolves from parental involvement to parental participation (Hutchfield, 1999). The healthcare team encourages parents in becoming independent and autonomous regarding the caregiving. From the moment the premature infant's condition improves, parents take over and play an even more central and active role. They feel directly responsible for their child's well-being and health (Borghini and Müller-Nix, 2008). During the final phase, before discharge, parents are the principal caregivers of their child and the healthcare professionals are present to support and reinforce the therapeutic alliance (Hutchfield, 1999). Even if parents are usually stressed and frightened by their infant being discharged and taking care of their infant on their own, they remain optimistic and work with the team in order to organize the discharge (Fegran et al., 2008).
A positive relationship with the healthcare team may help to increase the parents' adaptability (Borghini and Müller Nix, 2008, Tombeur et al., 2007) as it creates a positive social environment for infants and parental engagement (Borghini and Müller Nix, 2008, Fraser et al., 2007). Consequently, the healthcare team represents an important source of social support during the hospitalization of the infant (Blanch D'Souza et al., 2009), due to their protective role towards parents (Lasiuk et al., 2013). On the other hand, negative relations can increase the parents' stress levels (Blanch D'Souza et al., 2009). Thus, physicians and nurses contribute to helping the parents in their role attainment and reducing their stress levels by participating in the caregiving process of the premature infant and transmitting information about baby's health (Lee et al., 2013). However, many parents may be hyper cautious/attentive to the words that the medical staff use, trying to sometimes over interpret the information received. Fathers in particular, evaluate the transmitted information as very important; this information has an impact on their well-being and their sense of control of the situation (Ignell-Modé, Mard, Nyqvist & Blomqvist, 2014). Receiving clear, comprehensible and transparent information about the unit, staff and technical equipment surrounding their baby is appreciated by fathers and improves paternal involvement. On the contrary, research shows that an overload of information may be as harmful as the lack of it, causing parents to feel stress, panic and confusion (Svensson et al., 2006, Wilkins, 2006).
Parents experience the vulnerability of the first bond and they feel the need to establish a relationship with their infant which is not always easy hence the importance of the social support in the NICU. O'Brien and Warren (2014) conducted a study on paternal perceptions towards the healthcare team and fathers evaluate it as an important source of support. In particular, 86% of fathers say they received an important informational support, 69% emotional support and 77% of fathers think that physicians and nurses were giving them sufficient feedback on their participation in the caregiving process. Nearly every father (98%) valued the very high level of caregiver support, meaning that the team was available to give the right information about the infant's condition and facilitate the caregiving process (O'Brien and Warren, 2014, Santiago-Delefosse, 2002, Blanch D'Souza et al., 2009).
Recently, Mahon et al. (2015) created a tool for identifying the techniques employed by the healthcare team to assess the fathers’ stressors and to decide their reactions in order to provide support; nonetheless further investigation is yet to be carried out. A recent review of literature held by Walmsley and Jones (2016) suggests that specific father-centred care plans could be beneficial for fathers. In particular, fathers appreciate the nurses’ positive feedback on their caregiving attitudes which helps them increase their confidence.
The aim of this study is to explore the relationship that is created between fathers and the healthcare team (nurses, physicians) in the NICU in France, during the hospitalization of the premature infant.
Section snippets
Sampling and participants
Purposeful theoretical-based sampling is used in this study. This type of sampling is based on the study purpose and investigator judgments about which people and settings will provide the best and most comprehensive information for the research questions (Palinkas et al., 2015, Patton, 2015, Tuckett, 2004, Wu et al., 2016). The inclusion criteria were: 1) French speaking fathers, 2) infant gestational age (26–35 weeks), 3) the time spent in the NICU being more than one week. Fathers whose
Results
Firstly, the categories of the interview are presented, followed by the descriptive statistics of the questionnaire.
Discussion
The relationship with the healthcare team is evaluated as “satisfactory” or even “very satisfactory” by nearly all fathers. This satisfactory relationship corresponds to accessibility, empathy, quality of shared information and competent caregiving (Galanis et al., 2016, Koliouli et al., 2016).
In this sample, communication with the team reassures fathers. Similar results are found in the study of Arockiasamy et al. (2008) which shows that fathers search for a good level of communication with
Conclusion
In summary, the outcome of the interviews show that fathers perceive that healthcare professionals as a veritable source of social support. For them, attention, accessibility, empathy and precious shared information compose the dimensions of a satisfactory relationship. Communication will reassure them and it will motivate them to be more involved in the unit as they have a specific role to fill as fathers.
In general, our findings emphasize the vulnerability of the paternal role in the context
Conflicts of interest
None.
Acknowledgments
A special thanks to all fathers who accepted to participate to our research, to the health care team of the NICU-Purpan of the Toulouse University Hospital, and in particular Charlotte Casper, pediatrician-neonatologist, and Françoise Hopker, psychologist of the unit. The manuscript was reviewed with the help of Julia Kallergi-Sideri.
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