Parents’ Perspectives: An Expanded View of Occupational and Co-Occupational Performance in the Neonatal Intensive Care Unit

Abstract

Importance: One limitation of occupation-based neonatal practice is the lack of clarity surrounding what parent and infant occupations exist in the neonatal intensive care unit (NICU). Without clear definitions and examples of these constructs, occupational therapists may not recognize or value them as part of practice. Objective: To explore concepts of occupational and co-occupational performance in the NICU and provide richly expanded descriptions of parent and infant occupations in this setting. Design: Phenomenological study with convenience sampling. Participants engaged in semistructured interviews. Inductive content analysis, in vivo and process coding methods, and cross-case analysis were used. Member checking and expert review of emergent themes were used to ensure authenticity. Setting: A metropolitan 48-bed Level 3 NICU with single-family rooms in the midwestern United States. Participants: Fourteen parents (mean age = 29.7 yr; range = 19–37 yr) volunteered for the study. Results: Five themes of active occupational engagement emerged: (1) perceiving “they” versus “I”; (2) maintaining proximity; (3) expressing emotions, values, and beliefs; (4) addressing health issues; and (5) analyzing. A matrix framework displayed emergent themes with definitions of parent occupations, infant occupations, and parent–infant co-occupations. Examples of both directly observable and hidden occupations were found at matrix intersections. Conclusions and Relevance: Occupational performance prevalently reflected attempts to balance power differentials and pursue meaningful engagement through observable and hidden participation in caregiving. Findings suggest that beyond typical occupations (e.g., feeding, socializing), neonatal therapists can address the doing, being, and becoming occupations expressed by parents in this study. What This Article Adds: Parents described five broad thematic categories of NICU-based occupation and co-occupation, which may be valuable to therapists seeking to strengthen the occupational focus of neonatal intervention. Neonatal therapists may need to advocate for service provision policy change to fully address the observable and nonobservable doing, being, and becoming occupational and co-occupational needs of parents and infants.

Reflections on COVID -19 and the potential impact on preterm infant feeding and speech, language and communication development

“…Parents working in partnership with neonatal colleagues play an essential role in developing competent skills to appraise an infant's function. For parents, learning to care and interact with their infant on a neonatal unit presents unexpected complications including learning to cope and be close to their baby in an unfamiliar setting (Cardin, 2020). The current COVID -19 pandemic has challenged all aspects of neonatal work causing anxiety and stress for all involved in infant care, both parents and neonatal staff.…”

Unprecedented opportunities for a transformational change

“…A Letter to the Editor regarding reflections on COVID -19 and the potential impact on preterm infant feeding, speech, language, and communication development completes the June issue of The Journal of Neonatal Nursing . For parents of a NICU baby, learning to care and interact with their infant presents unexpected complications, including learning to cope and be close to their baby in an unfamiliar setting ( Cardin, 2020 ). This is further complicated by the need for healthcare staff to use face-masks and personal protective equipment when caring for infants in the NICU, which has inevitably altered traditional developmental care approaches undertaken in the UK ( Altimier et al., 2015 ).…”

Infant and Parent Outcomes Related to NICU-Based Co-occupational Engagement

“…Co-occupation within the neonatal intensive care unit (NICU) is an emerging area of interest within occupational science (OS) and occupational therapy (OT). Although OTs have long focused on the importance of facilitating parent–infant co-occupation within this setting, the literature on this construct within the NICU context remains relatively sparse (Cardin, 2020). The provision of sensory interventions to the NICU infant by an adult requires engagement of both parties, with the intention to foster positive experiences to improve infant outcomes.…”

“…Parents report difficulty engaging in co-occupations with infants in the NICU due to the practical challenges of maintaining proximity to the infant and having to balance the additional cognitive demands of monitoring the infants’ medical and behavioral state during engagement while juggling their relationship with NICU staff (Cardin, 2020). These factors may all contribute to stress related to being a NICU parent and impact the capacity of the parent–infant dyad to engage in co-occupations.…”