Contributor: Laura Sophia da Silva

I’ve been working as a nurse in a Neonatal Intensive Care Unit (NICU) for about five years. In this unit, parents are only allowed to stay in the NICU during the night in situations where the newborn is facing imminent death. The restriction of parents’ presence can be justified for various reasons, such as an infection control measure, the need imposed by health professionals on parental rest, or the lack of adequate accommodation.

The child’s need for hospitalization and separation from their parents has adverse effects for both (Murray & Swanson, 2020). In the 1950s, it was scientifically demonstrated that prolonged hospitalization of children, with the consequent separation from their families, was detrimental to the children’s emotional and psychological well-being. Several associations emerged in Europe with the aim of helping to advise and assist families and health professionals to improve the well-being of these children (European Association for Children in Hospital, 2016). In 1988, 12 associations met in Leiden and stipulated in 10 points the rights of sick children and their families in hospitals and other healthcare services. Initially, this charter was called the Leiden Charter and was later renamed to the European Association for Children in Hospital Charter (European Association for Children in Hospital, 2022).

The European Association for Children in Hospital Charter was gradually ratified by all European countries but gained more strength after the United Nations Convention on the Rights of the Child (European Association for Children in Hospital, 2016). Children’s rights, particularly in relation to the protection of their health, have been on the agenda of European institutions. The European Association for Children in Hospital Charter serves as a reference document for providing excellent care (European Association for Children in Hospital, 2016). According to the 2nd article of this charter: “Children in hospital shall have the right to have their parents or parent substitute with them at all times.”, regardless of the child’s age. It also includes children in neonatal or paediatric intensive care units, and parents should be encouraged to stay with their children (European Association for Children in Hospital, 2022, p. 4). On the other hand, article 9 of the Convention on the Rights of the Child states that children shall not be separated from their parents except in situations where the permanence of the parentus is considered incompatible with the best interests of the child. This convention also recognizes the right of the child to enjoy the best possible state of health and to benefit from health care (UNICEF, 2019).

The hospitalization of a newborn can have a profound emotional and psychological impact on parents (due to the stress, anxiety, and post-traumatic stress they may experience during hospitalization), can compromise attachment, and consequently affect the newborn’s development (Mahoney et al., 2020). In addition, it can make it challenging to identify the parents’ needs, as well as decrease the psychological support given to them (Murray & Swanson, 2020). According to Alsop-Shields (2002), it is essential to identify how parents feel about the hospitalization and if they have any problems that need to be addressed.

There are nursing theories that can inform nursing care in the NICU, including

• Barnard’s Child health assessment model – addresses the intersections among the Caregiver, Environment, and Child
• Watson’s theory of Human caring – addresses the nature of the nurse caring relationship with those being cared for.

However, these theories do not address specifially a theoretical perspective on the parent-staff relationship. The Parent-Staff Interaction Model, published in the Journal of Pediatric Nursing, is a theoretical conception of pediatric care, which targets nursing care towards the parent-child unit, the person in the metaparadigmatic concepts (Alsop-Shields, 2002). This interaction model was first published in 1999 and can be applied to other health disciplines. It aims to identify problems arising from interpersonal interactions and define strategies to promote positive socialization based on the assumption: “In every culture, children need the care of their parents” (Alsop-Shields, 2002, p. 447).

The central concepts of this model are the presence of the parents and the communication established between the nurses and the parent-child in the hospital context (Alsop-Shields, 2002). Nurses aim to provide culturally sensitive care in order to promote the functioning of the parent-child unit during the child’s recovery or adaptation to their new condition (Alsop-Shields, 2002). Alsop-Shields recognizes that the existence of cultural differences between professionals and parents increases the risk of negative interactions between them, and nurses need to remember these differences in order to be able to adapt their care. Communication, along with awareness of cultural beliefs and values, are crucial aspects of nursing care (Alsop-Shields, 2002).

Through negotiation, the nurse determines the parents’ level of involvement in the care and identifies their needs, thereby increasing parental trust and satisfaction (Alsop-Shields, 2002). Therefore, no teaching, care, or treatment should be given without first identifying both parties’ perceptions (Alsop-Shields, 2002). Each party has a role to play: nurses provide care, and the parent-child unit receives it, with the possibility of adopting other roles to respect their cultural beliefs and values (Alsop-Shields, 2002).

In the NICU, the target of nursing care is the newborn and their parents. Restricting the presence of parents in the NICU affects the establishment of the therapeutic relationship between the nurse and the parents, which in turn will influence the delivery of care. It is through the interaction established between the parents and the nurse that the nurse identifies the parents’ needs and understands their perceptions regarding care. This information is crucial for providing holistic and culturally sensitive nursing care.

According to Alsop-Shields (2002), nurses are in constant contact with children and their parents and care about them as a whole, so they have a significant influence on the way care is provided. Therefore, it is the nursing team’s responsibility to alert service managers to the negative impact that restricting the presence of parents has on the parents themselves, on the newborn, and on the way care is delivered.

References

Alsop-Shields, L. (2002). The Parent-Staff Interaction Model of Pediatric Care. Journal of Pediatric Nursing, 17(6), 442–449. https://www.sciencedirect.com/science/article/pii/S0882596302000659

European Association for Children in Hospital. (2016). Anotações à Carta da Criança Hospitalizada. Instituto de Apoio à Criança. https://each-for-sick-children.org/wp-content/uploads/2021/04/EACH-Charter-Portuguese.pdf

European Association for Children in Hospital. (2022). EACH Promoting Children´s Rights and Needs in Healthcare: The EACH Charter with Annotations. https://each-for-sick-children.org/wp-content/uploads/2023/06/EACH-Charter-brochure-with-annotations.pdf

Mahoney, A., White, R., Velasquez, A., Barrett, T., Clark, R., & Ahmad, K. (2020). Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019. Journal of Perinatology, 40, 36–46. https://doi.org/10.1038/s41372-020-0753-7

Murray, P. D., & Swanson, J. R. (2020). Visitation restrictions: Is it right and how do we support families in the NICU during COVID-19? Journal of Perinatology, 40, 1576–7581. https://doi.org/10.1038/s41372-020-00781-1

UNICEF. (2019). Convenção sobre os Direitos da Criança e Protocolos Facultativos. https://www.unicef.pt/media/2766/unicef_convenc-a-o_dos_direitos_da_crianca.pdf

About Laura Sophia da Silva

I am a nurse since 2019, and my experience has always been in the NICU.
Since September 2023, I have been attending the Master Nursing Course in Child and Paediatric Health at the Faculty of Health Sciences and Nursing / School of Nursing (Lisbon). This post was created in the nursing theories curricular unit, with the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).