Megan Brooks

October 15, 2013

For parents of premature infants, stress levels often soar as the day of discharge from the neonatal intensive care unit (NICU) approaches.

To help ease the burden, the NICU at Brigham and Women's Hospital in Boston offers an educational class to help homeward-bound parents of premature infants become more comfortable caring for their infant at home.

Jessica Marchetti, RNC, and Jennifer Fluckiger, RN, who developed the class, describe it in a poster presented at the National Association of Neonatal Nurses 29th Annual Educational Conference in Nashville, Tennessee.

It became increasingly apparent that there was a disconnect between nurses' perceptions of discharge readiness and parent readiness to care for their infant at home, Marchetti explained in an interview with Medscape Medical News.

Some parents told us "that they felt the discharge information they received at the bedside was good, but very piecemeal," she said. "Many had a lot of questions when they got home because much of the information brought to their attention at the bedside was new to them."

Many parents feel uneasy about bathing their baby. Many had never even held a baby before, let alone a premature baby.

Armed with this feedback, Marchetti and Fluckiger designed an interactive education class that provides newborn essentials for parents of premature infants leaving the NICU. They currently offer the class twice a week. "It's been very successful. We are trying to offer it more often because we have so many parents — both mothers and fathers — who want to attend," Marchetti said.

"Many parents feel uneasy about bathing their baby. Many had never even held a baby before, let alone a premature baby," she added. In the class, parents can get the information they need, get some hands-on practice using dolls, and have the opportunity to ask questions long before discharge," Marchetti said.

Topics include everyday tasks the parents will face at home: bathing, swaddling, bulb-syringe use, diapering, mixing higher-calorie formula, rectal temperature techniques, medication dosing, when to call the doctor, and how to use a car seat. "It's basic newborn information, but tailored to the extra needs of the premature baby who is going home. We get a lot of questions about car seats," Marchetti said.

Parents have suggested that future classes cover sibling issues, twin-specific multitasking, and pet safety.

This type of class is important, said Deborah Raines, PhD, RN, from the University at Buffalo School of Nursing in New York, who has studied stress in mothers as the day of discharge from the NICU approaches.

Special Needs

In the NICU, experienced professionals care for the baby, who often has special needs because of a medical condition. Parents can feel a separation. "A class that helps parents see themselves as the baby's primary caregiver is helpful as they are preparing for discharge," she told Medscape Medical News.

Dr. Raines said she found the suggestions from parents for future topics to be "insightful. I think this acknowledges the need to address situations encountered in the home, and not just to reinforce the care procedures used in the nursery," she said.

When they began developing the class, "we tried to find one that was already established to shadow it, but we couldn't," Marchetti said.

Dr. Raines said her "gut feeling is that most of this type of teaching is done by individual nurses at the bedside as part of unit-based discharge standards. Bedside teaching is often limited to verbal explanations, with limited opportunity for hand-on experiences."

Ms. Marchetti and Dr. Raines have disclosed no relevant financial relationships.

National Association of Neonatal Nurses (NANN) 29th Annual Educational Conference: Poster 1036. Presented October 5, 2013.


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