This issue of the Journal of Perinatal & Neonatal Nursing focuses on programs that support the transition to a family and some of the issues challenging this process. Perinatal nurses have an important role in the process of family development, one of assessing its progress and meeting the needs identified. This issue will explore several programs that focus on the family at all stages of its development and provide services in innovative ways. It will also examine situations that pose challenges to the beginning family, such as preterm labor and birth, perinatal loss, and congenital anomalies in the infant.
Roudebush et al present the concept of family-centered care. They discuss that true family-centered care is a complex practice that involves more than naming a unit. Family-centered care is a change in the organizational culture demonstrated by the decisions and practices promoted at the departmental, clinical, and individual provider and patient levels. A family-centered care approach provides a foundation for policy and program development, facility design, decision making, and daily interactions throughout the healthcare system. Finally, Roudebush et al compare the traditional concepts of family-centered maternity care and describe effective partnerships with childbearing women and their families.
Brown describes the Tender Beginnings Program, a coordinated educational program for the family that extends throughout pregnancy, the birth process, and into the postpartum period. It was created to address the shortened stay structure within the perinatal unit and the rapid learning process that it requires, as well as providing a strategy and framework for teaching. The Tender Beginnings Program is described as an integration of community educational outreach, nurse entrepreneurship, hospital-based education, and postpartum/neonatal follow-up.
Thorman and McClean discuss the While You Are Waiting program. This antepartum support program focuses on the needs of the hospitalized, high-risk pregnant women and by providing an atmosphere minimizing the side effects of long-term activity restrictions and prolonged hospitalization helps the developing family to meet specific goals. The program identifies 4 key opportunities that promote education, support, recreation, and outreach.
Callister presents the profoundly difficult situation of perinatal loss. She explains that perinatal loss engenders a unique kind of mourning, a mourning complicated by the fact that the child is a part of the parents' identity and that there are no societal expectations for mourning such a loss. Increasing research has guided the refinement of nursing interventions and culturally sensitive care so that they support health and healing in the face of perinatal loss. Callister describes interventions that will help to create meaning through sharing the loss, supporting sociocultural rituals, and validating the family's feelings associated with loss.
Howard explores the effects on the woman and the family when a prenatal diagnosis of fetal abnormality has been made. She describes the emotionally challenging choice options and the effects of that choice on the families. The diagnosis of fetal abnormality presents childbearing women and their family with the difficult choice of selecting one of the following: continuing the pregnancy with no intervention, terminating the pregnancy, or possibly experimental fetal therapy. Howard discusses the role of healthcare providers during this period of grief and loss.
Perinatal nurses have a unique role during the transition to a family. Nurses are involved during the pregnancy, intrapartal, and postpartal periods. Each period presents challenges to be met and their completion contributes to the foundation of the family. Further research and exploration will guide the development and refinement of evidence-based nursing care of the new family.
The neonatal topics for this issue include 3 family-focused areas of care that neonatal nurses encounter frequently: discharge planning, parent support in the neonatal intensive care unit (NICU), and end-of-life care. Each of the articles provides important information and evidence that can be used by neonatal nurses in practice to enhance care and meet the needs of newborns and their families.
Griffin and Abraham review the principles of family-centered care in the NICU and apply them to discharge planning. They provide information to help guide development of discharge planning processes that honor family-centered care principles and make a strong case for early and continued direct involvement of parents as partners throughout the neonatal hospitalization to facilitate discharge preparations, prioritize parent teaching, and build parent confidence and competence in caregiving.
Hurst presents an evaluation study on a NICU support program that utilized several methods including group support, one-to-one support, and telephone support. The evaluation showed the value of utilizing experienced parents who have credibility with parents receiving support and that a number of parents used more than one method of support, an important implication for nurses who are involved in program development and monitoring.
Moro et al provide a review of the research literature on neonatal palliative and end-of-life care. Findings from 10 studies are summarized in 1 of 4 categories: practices of withdrawing or withholding life-sustaining treatment, pain management during ventilator withdrawal, parents and the decision-making process, and the dying process. They point out gaps in knowledge and lack of generalizability of many research findings in this area due to the small number of participants and study design. Recommendations focus on the need for prospective research; application of evidence that does exist, for example, pain management; and the importance of communication between parents and healthcare providers, especially around difficult decisions pertaining to palliative and end-of-life care.
Susan Bakewell-Sachs, PhD, RN, APRN, BC, Neonatal Editor
Dotti C. James, PhD, RNC, Perinatal Issue Editor