EMPIRICAL STUDIES
doi: 10.1111/scs.12101
Nurses’ narratives on termination of primary nursing relationship with parents in neonatal intensive care Anne Korhonen PhD, RN (Specialist in Clinical Nursing Science, Postdoctoral Researcher)1 and Mari Kangasniemi PhD, RN (University Lecturer, Postdoctoral Researcher)2 1
Department of Pediatric and Adolescence, Oulu University Hospital, Oulu, Finland and 2Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
Scand J Caring Sci; 2014; 28; 716–723 Nurses’ narratives on termination of primary nursing relationship with parents in neonatal intensive care
Background: Primary nursing working model in the neonatal intensive care unit enables a long-lasting caring relationship with the infants and their parents. Terminating this kind of relationship is seldom discussed. Aim: The aim of the study was to describe nurses’ experiences of terminating the primary nursing relationship with the parents in neonatal intensive care. Methods: Qualitative design using narrative method was used because there is a little knowledge relating to the topic. The data were collected with active interviews and analysed with narrative analysis. Seven nurses with experience of neonatal intensive care and primary nursing were recruited by convenience sampling. The approval was granted according to the hospital guidelines. Results: The results gave rise to the three narratives that described the relationship between the primary nurse and the parents as the nursing relationship ends. All
Introduction Due to the new technological innovations, preterm infants who are smaller and more ill than before can be treated successfully (1, 2). When it comes to the outcome of the treatment, it is important to focus on comprehensive family-centred care in addition to medical treatment. In terms of neonatal intensive care, this means active involvement of parents and conscious strengthening of their participation in all the phases of the treatment process (3, 4). On the part of nurses, this demands for an ability to establish and maintain a caring relationship with the parents of preterm infants during the long Correspondence to: Anne Korhonen, Department of Pediatric and Adolescence, Oulu University Hospital, P.O. Box 23, 90029 OYS, Oulu, Finland. E-mail: [email protected]
716
narratives shared a common plot, ‘regulation of the closeness on nursing relationship’, but it was manifested in different ways in each narrative. The plot in the narratives changed on a closeness–distance axis according to how the primary nurse regulated the nursing relationship and its termination. In the first narrative, the regulation of the relationship promoted distance, in the second connection and in the third closeness and connection. Conclusions: The long-lasting nature of the primary nursing working model may allow different caring relationships which will be revealed in terminating phase of care. This phenomenon is poorly recognised. It is important to study the caring relationship between the primary nurse and the parents of a hospitalised child, because the caring relationship is the core of nursing and needs to be considered in research and supported in practice. Keywords: narrative research, parent, primary nurse, primary nursing, preterm infant, termination of caring relationship. Submitted 13 August 2013, Accepted 21 October 2013
treatment process, as well as the competence to terminate the relationship (5, 6). The establishment of a caring relationship has been described as the ethical ability and willingness of the nurse to promote parents’ participation in the care (5, 7). In nursing science, the understanding of primary nursing has varied from philosophy (8, 9) to different interpretation applications of working model depending on context (10–12). The common for different interpretations is that the primary nursing working model creates a favourable setting for establishing a caring relationship with the parents of a premature infant. The main idea of the model is that primary nurses can focus on the care of the infants and families assigned to them and familiarise themselves with their individual needs and situations, which promotes the establishment of a caring relationship with the family (8, 9). A long-term caring relationship calls for an ability to balance between closeness and distance on © 2013 Nordic College of Caring Science
Parents in neonatal intensive care the part of nurse (3). Maintenance of balance is important, as working in close collaboration with families enables the establishment of an emotional bond between primary nurses and their patients (3, 13). The caring relationship between the primary nurse and the parents of the preterm infant ends when the child is discharged from hospital. Very little is known about the termination of this longterm caring relationship. The aim of the study is to describe the nurses’ experiences of terminating the primary nursing relationship with the parents in neonatal intensive care.
Terminating the caring process in neonatal intensive care unit Special features of neonatal intensive care A main feature of neonatal intensive care is the complete dependence of the child on the ability of the people around it to answer to its needs. The reasons for admittance to neonatal intensive care unit (NICU) are associated with both prematurity (born
doi: 10.1111/scs.12101
Nurses’ narratives on termination of primary nursing relationship with parents in neonatal intensive care Anne Korhonen PhD, RN (Specialist in Clinical Nursing Science, Postdoctoral Researcher)1 and Mari Kangasniemi PhD, RN (University Lecturer, Postdoctoral Researcher)2 1
Department of Pediatric and Adolescence, Oulu University Hospital, Oulu, Finland and 2Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
Scand J Caring Sci; 2014; 28; 716–723 Nurses’ narratives on termination of primary nursing relationship with parents in neonatal intensive care
Background: Primary nursing working model in the neonatal intensive care unit enables a long-lasting caring relationship with the infants and their parents. Terminating this kind of relationship is seldom discussed. Aim: The aim of the study was to describe nurses’ experiences of terminating the primary nursing relationship with the parents in neonatal intensive care. Methods: Qualitative design using narrative method was used because there is a little knowledge relating to the topic. The data were collected with active interviews and analysed with narrative analysis. Seven nurses with experience of neonatal intensive care and primary nursing were recruited by convenience sampling. The approval was granted according to the hospital guidelines. Results: The results gave rise to the three narratives that described the relationship between the primary nurse and the parents as the nursing relationship ends. All
Introduction Due to the new technological innovations, preterm infants who are smaller and more ill than before can be treated successfully (1, 2). When it comes to the outcome of the treatment, it is important to focus on comprehensive family-centred care in addition to medical treatment. In terms of neonatal intensive care, this means active involvement of parents and conscious strengthening of their participation in all the phases of the treatment process (3, 4). On the part of nurses, this demands for an ability to establish and maintain a caring relationship with the parents of preterm infants during the long Correspondence to: Anne Korhonen, Department of Pediatric and Adolescence, Oulu University Hospital, P.O. Box 23, 90029 OYS, Oulu, Finland. E-mail: [email protected]
716
narratives shared a common plot, ‘regulation of the closeness on nursing relationship’, but it was manifested in different ways in each narrative. The plot in the narratives changed on a closeness–distance axis according to how the primary nurse regulated the nursing relationship and its termination. In the first narrative, the regulation of the relationship promoted distance, in the second connection and in the third closeness and connection. Conclusions: The long-lasting nature of the primary nursing working model may allow different caring relationships which will be revealed in terminating phase of care. This phenomenon is poorly recognised. It is important to study the caring relationship between the primary nurse and the parents of a hospitalised child, because the caring relationship is the core of nursing and needs to be considered in research and supported in practice. Keywords: narrative research, parent, primary nurse, primary nursing, preterm infant, termination of caring relationship. Submitted 13 August 2013, Accepted 21 October 2013
treatment process, as well as the competence to terminate the relationship (5, 6). The establishment of a caring relationship has been described as the ethical ability and willingness of the nurse to promote parents’ participation in the care (5, 7). In nursing science, the understanding of primary nursing has varied from philosophy (8, 9) to different interpretation applications of working model depending on context (10–12). The common for different interpretations is that the primary nursing working model creates a favourable setting for establishing a caring relationship with the parents of a premature infant. The main idea of the model is that primary nurses can focus on the care of the infants and families assigned to them and familiarise themselves with their individual needs and situations, which promotes the establishment of a caring relationship with the family (8, 9). A long-term caring relationship calls for an ability to balance between closeness and distance on © 2013 Nordic College of Caring Science
Parents in neonatal intensive care the part of nurse (3). Maintenance of balance is important, as working in close collaboration with families enables the establishment of an emotional bond between primary nurses and their patients (3, 13). The caring relationship between the primary nurse and the parents of the preterm infant ends when the child is discharged from hospital. Very little is known about the termination of this longterm caring relationship. The aim of the study is to describe the nurses’ experiences of terminating the primary nursing relationship with the parents in neonatal intensive care.
Terminating the caring process in neonatal intensive care unit Special features of neonatal intensive care A main feature of neonatal intensive care is the complete dependence of the child on the ability of the people around it to answer to its needs. The reasons for admittance to neonatal intensive care unit (NICU) are associated with both prematurity (born
