Sari

Policies in the University Hospital in Turku, Finland

Before birth

• Prenatal consultation by the pediatrician
• Based on the family’s questions
• Remember the elements of the CLIP interview
• Tell the parents that their presence and participation is an essential part of good intensive care for the baby
• Tell the parents that they have a possibility to participate in care of their baby and in decision making concerning their baby
• Tell about the importance of the doctors’ rounds as information sharing moments where the parents are welcome any time they are able to come
• Tell about the importance of the mother’s milk for the child
• Parents visiting NICU before birth

After birth

• When the baby is being transferred from the delivery unit to NICU, the father is coming along.
• The pediatrician is to see the mother as soon as possible after the baby has been stabilized, bringing the mother a photo of her baby
• No later than two hours after the delivery

Daily rounds

• The parents are the first ones to report about their baby
• Listen to the parents’ close observations and concerns regarding their baby
• Problem solving individually based on the baby’s signals
• Encourage the parents to have their baby in the kangaroo care as soon as possible; at the same time listening to the parents’ own wishes about kangaroo care
• Individual agreements with the families regarding their participation in care procedures when the family shows desire to participate, e.g. parents’ desire to participate in adjusting the amount of oxygen given to the baby, acknowledging alarms, suctioning airways – according to the mutual written agreement by the doctor, primary nurse and parents
• Parents are allowed to be present during treatment procedures
• Parents can comfort their baby / ease pain e.g. by ‘facilitated tucking’ of their the baby with their hands

Weekly discussions

• Based on the questions the family has
• Remember the elements of the CLIP interview

Before transition from hospital-to-home

• If the baby has been hospitalized for a longer time or was born as a small preterm infant, give the baby’s medical summary to the parents approx. 5-7 days prior to the planned day when parents will take their baby home and have them read it through
• Go through the medical summary together with the parents at the wrap-up discussion during the last week they stay in hospital

Hospital-to-home transition based on the parents’ concerns

• The parents participate and consider what they would need for the transition from hospital to home; and in which order they would like to go through the following things:
  • Issues to be taught (medication at home, nutrition)
  • Follow-up visits to the child development clinic
  • Public health nurse from child health clinic visiting NICU before parents take their baby home. Parents may want to make the phone call to the public health nurse or they may ask the nurse to make it.
  • Rooming-in with the baby in NICU at least for one or two nights before parents take their baby home
  • Baby visiting (day visit or overnight according to the parents preference) at home before the final transition from hospital to home
  • Consultations, possibly a multi-professional care conference

Reflective supervision is a relationship–based supervisory approach (Heffron & Murch, 2011). Reflective supervision is especially beneficial in the fields of infant mental health, early childhood services and family support. In these fields the relationship formed with parents and coworkers is a crucial route to provide support or therapeutic intervention. There are certain crucial elements in building a relationship with parents, such as listening and acceptance which make the development of trust possible and which provide the necessary foundation for therapeutic change. As each trainee is listened to and respected in what they have to say, they are in turn more capable of developing the capacity of listening to parents and other colleagues. Also in this training model we believe that being heard and accepted by the supervisor is providing a model and a core experience, which trainees can use in their work with families.

Essential elements of reflective group supervision:

The reflective supervision group should be organized to meet frequently. Depending on the size of a unit the groups can be either open or closed groups. An open group means that the combination of participants differs each time a group meets. For example the combination of participants can be based on units’ work schedule. In that case, it is very important to keep track of each how frequently each individual staff member is able to participate in the supervision group. The other form of group supervision is a closed group which means that the participants of a group are always the same. The closed group assures the regularity of supervision for individuals. Also there is an increased likelihood that closed groups can be experienced as more secure than open groups. However, open groups can have other benefits like dissemination of novel ideas to a wider range of individuals.

Supervisors create an atmosphere of safety in supervision sessions by taking the role of container, and by a creating respectful atmosphere. Every issue brought up in supervision is handled with respect for that persons’ perspective and with honor to her/his work in the NICU. The secure atmosphere, in turn, helps people to genuinely express their thoughts, feelings, worries and concerns. Solutions or new perspectives are always explored in a collaborative way by developing a commitment to thinking together rather than quickly rejecting new ideas. In this training model supervision is not based on an attempt to direct work from a distance by telling the supervisee what to do. Rather, the supervision is offering an opportunity to think and wonder in collaboration with the supervisor and other colleagues. In this way all are partners contributing their experience, knowledge and intuition into the ongoing process. If followed consistently, reflective supervision and the atmosphere of safety inherent in it, might generate novel approaches, strategies and practices which can be applied to daily work in the NICU.

The reflective supervision supervisors’ responsibility is to help supervisees develop and exercise their capacities to explore how their work is filtered through their own perspectives, and those of parents, babies and other colleagues. One goal of reflective work is to become more conscious about one’s internal responses and not-yet-conscious experiences. Another goal is to learn that other people have a viewpoint of their own, and they can have their own internal responses that are not always immediately evident or quickly understandable. One important supervisor’s technique, to help trainees to experience how it feels when somebody is trying to understand what you “really” mean, is by repeating what was just said with their own words so that it reflects the supervisor’s understanding of the meaning for that person.

In the Close Collaboration with Parents training supervision should mostly focus on thoughts, feelings and questions that are generated from the actual events that occurred during training practice. From our experience the best way to explore these is to move beyond a generalized discussion and ask trainee to bring cases (concrete situation that occurred during practice) with them to supervision sessions. Trainees can, for example, tell about their individual practice with a certain baby and family. The supervisor can facilitate the trainee to tell the whole “story” about that particular situation with the family. The trainee can be encouraged to talk about what happened and how it occurred. This could be called a story telling technique that helps the trainees explore their own perspectives on an experiential level. In addition, supervisor can facilitate the trainee in exploring their experience in the situation from three different angles: how it was for herself, for the baby and for the parents. Learning to consider situations from the trainee-baby-parent triangle’s point of view, can be helpful in daily work with parents and babies.

Guidelines for the supervisor:

• The supervisor should know the training protocol, hopefully have participated in introductory lectures about the training program; reviewed training tapes and read the training manual.
• Supervision follows the training phases and provides reflective opportunities for trainees who are engaged in each training phase.
• Supervision focuses on both the individuals’s and the groups’ discovery processes related to understanding of the experiences during the practice sessions and during the training overall.
• The supervisor works in a collaborative way and with respect towards trainees’ work responsibilities and experiences in their work
• All that is said in supervision is handled with respect and confidentiality.
• Ensuring a reasonable size of the supervision groups makes it possible for all to participate to discussion (recommendation max. 10)
• The supervisor may guide the trainees to be prepared before every meeting to talk about their practice sessions or other “episodes” from their work with one or more babies and parents in the unit.
• The supervisor facilitates and guides the trainees to use reflection and the “story” telling technique by being genuinely interested, and modeling the use of respectful questions (i.e. Can you tell me more about that situation? How it started? What happened then? What about the situation was most difficult for you?, etc.).
• The supervisor facilitates and guides the supervisees to use the ‘triadic reflection technique’, which means that each event is always reflected upon from three different perspectives: the trainee’s, the parent’s and the baby’s.
• The supervisor recognizes and accepts individual differences between the trainees related to each person’s differing pace in adopting the new care culture.