Skin-to-skin care for dying preterm newborns and their parents - A phenomenological study from the perspective of NICU nurses

摘要

Background: Consequences of separation between preterm newborns and their parents have been discussed in many aspects, thus skin-to-skin care (SSC) has become common practice in Scandinavian Neonatal Intensive Care Units (NICUs) since the 1980s. The International workshop on Kangaroo Mother Care (KMC), 2009, recommends implementation of continuous KMC as the gold standard pervading all medical and nursing care, based on empirical studies and clinical guidelines and they suggest that KMC may be used during terminal care in agreement with parents. Parents have a strong desire to be near their child and give support and emotional comfort when the condition of the child requires it, and it has been suggested that medical staff expect parents to be with the neonates, and therefore, encourages them to hold the neonate while it is dying. The practice of SSC at the end of life has been under-researched, however. Aim: The aim of this study, which is part of a larger study on neonatal nursing care, was to describe the phenomenon of how nurses enact SSC for dying preterm newborns and their parents. Design: A phenomenological reflective life world design. Setting and participants: A purposive sample of 18 nurses from three Scandinavian NICUs. Findings: The essential meaning of the phenomenon was expressed as strong belief in the urgency of SSC in providing mutual proximity and comfort for dying preterm newborns and their parents. The nurses act upon this belief and upon an engagement in securing the best possible present and future experiences of being close, in which the SSC is understood as a necessary premise in achieving the intended optimal conditions. The findings are elaborated in relation to previous caring and nursing research and phenomenology. Conclusions: Skin-to-skin care for dying preterm newborns and their parents is the preferred caring practice among Scandinavian NICU nurses who consider it of major importance to facilitate proximity and comfort through SSC when the newborn is still alive. The authors suggest this practical knowledge from NICU nurses perspective to be acknowledged in discussions concerning end-of-life care for preterm newborns and their parents and we recommend more formal establishment of this practice. Further research is needed on parents' experiences of skin-to skin caring in this vulnerable end of life situation of 'being with' their dying newborn.