Elsa Afonso
Country: Portugal
Background:Nursing
Research Project: The needs and experiences of Immigrant Parents whose sick or preterm newborn was in the NICU, in Dublin, and has recently been discharged home.
BACKGROUND: Addressing issues related to Neonatal Care should be sensitive to each socio-cultural context. The process of parenthood in high income countries involves anxiety, specifically in the NICU context. There is a dearth of research on this topic specific to ethnic minorities. Recent demographic trends reveal an increase in the number of immigrant mothers and newborns in Dublin and eventually this population will experience difficulties in the particularities of a new health system. The challenge in Neonatal Care Services in Dublin is now to make them adequate and equally accessible to the heterogeneous population it serves.
METHODS: This exploratory qualitative study took place over a month in the Rotunda Hospital, Dublin. The study population was immigrant parents whose sick or preterm newborn was in the NICU and had recently been discharged home. Seven semistructured interviews took place with sets of parents selected by a Gatekeeper. Data was then analysed through a framework analysis.
RESULTS: Environment and infrastructure were mentioned as stressors. Prenatal visits to the NICU are offered to parents, but are not a widespread practice. Photographs of other newborns’ successful health outcomes were helpful to these parents. Photograph of their own baby taken on admission is a preliminary procedure that generated adverse reactions from parents of extremely small babies. Overcrowded hospital rooms and out-patient services, and privacy for mothers of sick babies were identified problems. Access to information and communication between immigrant parents and staff was seen as inadequate. Participants refer to overloading and complexity of information, insufficient amount of important details and lack of sensitivity in providing information. As sources of social bearing and support, parents mention their peers and extended family, which sometimes are not in Ireland. Some hospital protocols were inconsistent and unhelpful regarding this need. Staff shortage was mentioned, but cultural incompetence was more noticeable with institutional protocols rather than staff attitudes. There was confusion about where to go after the newborn had been discharged home. The PHN and the POPD were mentioned as a useful help in the first days after discharge; before serious concerns, parents would call the NICU. Follow up information provided to parents was perceived as inconsistent and confusing and the waiting times in outreach services in hospitals was a negative aspect mentioned.
CONCLUSION: Neonatal care infrastructures should be reviewed in terms of capacity to serve a diverse and increasing population. Prenatal visits to the NICU should be adequately and widely performed with parents. Information failure and communication gaps with health care providers could be tackled by the use of professional interpreters and training of health professionals. Health providers should become aware of the parent’s psychosocial networks and integrate them in the NICU experience and in the transition to home. The existence of cultural mediators could be beneficial to these parents. The alliance between hospital and community services seems weak and confusing for immigrant parents and should be revised for more equitable service provision. The overcrowding of out-reach hospital services, the lack of alignment between hospital and community services and the limited availability of emergency services should be addressed.
Keywords: Immigrant, NICU, newborn, Dublin, discharge home