Coping and Caring in Different Ways: Understanding and Meaningful Involvement

Pediatric Nursing, March, 2000 by Nancy Sydnor-Greenberg, Deborah Dokken

It is not easy to communicate with and support someone whose background, experience, and perspective are different from one's own; the crisis environment of the NICU can make this task even more difficult. However, nurses are encouraged to develop a "dual perspective" approach (Jarrett et al., 1994) -- to see issues and problems from the perspectives of the families with whom they interact as well as from their own.

It is important to remember that the backgrounds of families and of nurses encompass many different experiences and values. Zaner and Bliton (1991, p. 20) argue that when "participating in discussions of moral concern in the NICU" one should always consider the source of one's own values and that "every clinical situation is inherently complex ... with its own tangled communicative network." This observation applies in the less urgent, more "everyday" routines and interactions involved in the care of medically fragile babies and their families as well.

Skills of Nurses and Other Professionals to Support Families

Although family-centered care is now common terminology in pediatric health care, it is possible to find discrepancies between philosophy and practice (Ahmann, 1998). It is possible for nurses to espouse respect for family differences and still misread families' behavior in the NICU ... to talk about the central role of families and, yet, suggest involvement that is uncomfortable or inappropriate.

To move from theory to practice, nurses "need to further develop their assessment skills and direct their attention at strategies for supporting the family with its unique needs" (Jerrett, 1994, p. 1055). They need to be skilled in two important and related processes: (a) assessing and understanding the families with whom they work and (b) jointly planning with families for meaningful involvement in their babies' care.

Similar to other planning endeavors, defining meaningful involvement for families in the NICU first requires thoughtful assessment. The five frameworks previously discussed provide a wealth of "prompts" for nurses to use in the assessment process. This information can be gathered through observation of families in the NICU, through open-ended questions asked directly of family members, and through self-reflection. Table 1 incorporates the five frameworks into opening questions for nurses to ask themselves as they begin the assessment process.

Table 1. Assessing Family Background and Strengths

1. What do I know about this family's home life?

2. What do I know about this family's cultural background?

3. What do I know about this family's previous experience with pregnancy and infants?

4. What do I know about other losses and crises this family has experienced and how they coped?

5. What have I observed about personality styles, skills, and preferences of key family members?

6. What do I know about this family's support system, including extended family, worship, community, etc?

7. What key information or understanding am I lacking about this family and what resources might I use to find it?