Journal of Obstetric, Gynecologic & Neonatal Nursing
RESEARCHHow Nurses Assist Parents Regarding Life Support Decisions for Extremely Premature Infants
Section snippets
Types of Treatment Decisions
Life-support treatment decisions involve prenatal decisions regarding pregnancy management, delivery, and immediate care of the infant, and postnatal decisions for life support for the infant, including decisions for end-of-life care. Mothers at risk for delivering between 22 and 25 weeks may have several options for medical treatment, which will differ based on the individual case, such as the exact gestational age of the infant and the condition of the mother and of the infant (Batton, 2009).
Method
The current study was descriptive, prospective, and longitudinal and used a qualitative case study approach. Collective case study is a way to examine a number of cases within a study (Stake, 1995). The goal of qualitative case study research is to seek an understanding of the case, particularly the complexity of its interactions within its contexts, as well as the interrelationships that exist among all cases. In this article, we present study findings related to the nurse behaviors that
Description of the Sample
A total of 40 cases were recruited. For these 40 cases, participants included: a total of 54 parents (40 mothers, 14 fathers), 29 nurses (17 obstetric, 6 neonatal, 6 NNP), and 42 physicians (3 obstetricians, 19 maternal-fetal medicine physicians or fellows, 20 neonatalogists or fellows). Of the 40 cases, only 21 fathers met eligibility criteria for the study. Of these 21, 14 were interviewed and 7 were not able to be interviewed. Demographic characteristics of the parents, nurses, and
Nurse Description of Their Behaviors
Providing Emotional Support. Most nurses reported that they assisted parents by providing emotional support. Nurses provided emotional support by (a) taking the time to listen, (b) forming a bond with the mother, (c) being nonjudgmental of the parent lifestyle or decision choices, (d) offering hope, and (e) giving spiritual support. These behaviors helped mothers get through the emotionally charged nature of their experience and were done to decrease their stress and to help them comprehend all
Physician Description of Nurse Behaviors
The physician descriptions of the ways that nurses assisted parents surrounding decision making were limited. A number of physicians described how the nurses were there to provide emotional support and assist them to understand information. According to several physicians, nurses provided emotional support by talking to parents and just “supporting them.” One physician even described how nurses offered to travel to a family's home to bring a mother to the NICU because she had no way to get to
Discussion
Parents reported that nurses played a very important role as they were struggling to understand information and make critical decisions. This finding is similar to other research (Kowalski et al., 2006, McHaffie 2001, Wocial 2000). In addition, parents and nurses reported similar nurse behaviors, which suggests that both have similar expectations for the role of nurses. Although the same degree of comparison cannot be made with the physicians' reports because of limited data, these seem to be
Conclusion
Nurses play an important role in assisting parents surrounding decision making for life support for their extremely premature infant. By providing parents with quality care, support, and information, nurses create the context that is needed to facilitate and support parental decision making.
Acknowledgments
Funded by the National Institutes of Health, National Institute of Nursing Research, Grants R0107904 and P30 NR010680.
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