1. The Psychosocial Wellbeing of Parents with Infants in the Special Care Nursery
Presenter: Kathryn Elliott
Honours Thesis – Bachelor of Social Work (Honours)
Victoria University
Supervisors:
Prof Marty Grace (Victoria University)
Dr Anita Morris (Western Health)
Karina Rosa (Western Health)
Leila Rahimi (Victoria University)
Good Afternoon. My name is Kathryn Elliott and I will be speaking to you about my Honours research I have conducted for my Bachelor of Social Work (Honours) through Victoria University and Western Health. My Supervisors Professor Marty Grace at Victoria University and Leila Rahimi and my supervisors Dr. Anita Morris who is the Allied Health Manager of Social Work and Pastoral Care at Western Health and Karina Rosa who is a Social Worker at Sunshine Hospital in the Special Care Nursery.

2. Introduction
Background
Research Aims
Research Questions
Literature Review
Theoretical Framework
Research Design
Preliminary Findings
Parent’s experiences

3. Background of Research
Admission rates across Victoria
15.4% of live births in Australia were admitted to a SCN or NICU. In Victoria 15.8% of the total admitted across Australia.
Attachment and Bonding/ Kangaroo Care
The Role of Social Work in the SCN
It was identified by staff in the Women’s and Children’s team at Sunshine Hospital that there may be unmet needs for parents that have infant’s admitted into the Special Care Nursery and no clearly defined role in which social work can optimise the experiences of parents especially in terms of facilitating bonding and attachment processes that may be disrupted with an infant’s admission.
Admission into a neonatal nursery is not just defined by prematurity or low-birth weight but is associated with other health complications as well as in certain circumstances where babies may have had to be resuscitated at birth
). For a Level 2 – SCN this would mean infants are born from 34 weeks plus and more than 2500grams but negotiable. For Sunshine 21 cots and 32 plus gestation.
SW saw instances where they felt they needed to be more informed about parents experiences and in what ways they can facilitate better bonding and attachment.

4. Research Aims
Explore the experiences of parents whose infants are in the SCN.
To contribute the psychosocial wellbeing of parents and infants.
Optimise hospital service design to facilitate an improved attachment and bonding that can be disrupted with an infant’s admission into a SCN
This proposed research aims to explore the experiences of parents whose infants are admitted into a SCN. Through this exploration, the research will contribute to understandings of the psychosocial wellbeing of parents and infants, and in what ways hospital service design can facilitate an improved attachment and bonding process between infant and parent that can be disrupted with an infant’s admission into the SCN.
The study aims to understand the experiences of parents with infants admitted into a SCN and to explore the psychosocial needs of parents and the role of Social Work (SW) within a SCN. This information will then guide possible future service design approaches.

5. Research Questions
What hospital practices promote the development of relationships between parents and their babies who have been admitted to Special Care Nurseries?  
What hospital practices limit the development of relationships between parents and their babies who have been admitted to Special Care Nurseries?
What changes to hospital practices and social work services could promote the development of healthy parent and child relationships in circumstances where there is disruption to the usual processes of early bonding and attachment, in particular when a baby has been admitted to a Special Care Nursery?

6. Literature Review
Parent-Infant Relationship Building, attachment and the Importance of Kangaroo Care.
The Nurses Role and the Neonatal Nursery.
Psychosocial Well-being and Psychosocial Support in Neonatal Nurseries.
Social Work, the Neonatal Intensive Care and the Special Care Nursery.

7. Theoretical Framework
Critical Social Work Theory
Social Context
Family Centred Care
Hospital Setting
Attachment Theory
Good Attachment, Supporting Wellbeing
Critical Social Work Theory
Historically, a hospital setting is hierarchal and sees the patient-doctor relationship to be very clinical. Critical social work theory allows us to examine within that system and take an anti-oppressive approach to allow individuals to voice their stories, to be heard and to identify factors in the personal, political and structural levels of their stories to hopefully bring about change. To question the dominant clinical discourses that surround patients stories in hospitals.
Family Centred Theory
Family centred theory you will see a lot in the hospital system. It is used as a guide to involve family members in the care for their family. It identifies the individuals that usually do most of the caring and helps to use that to enhance an individuals health outcomes.
Attachment Theory
Using this theory helped us identify different attachment styles that can form for a child and how that can influence their future psychological and socio cognitive development. Good attachment important to impact on good short term and long term outcomes for a child. Good attachment can promote wellbeing for parents as well as their infant. In the case of this research that opportunity for good attachment and bonding can be disrupted.

8. Research Design Study Design Qualitative Research Design
Recruitment / Data Collection
Parents with infants currently admitted to Special Care Nursery
Individual interviews
Parent or current caregiver
Over 18years
Face to face
Onsite at Sunshine Hospital
Voice recorded
Data Analysis
Thematic Analysis
Transcribed Verbatim
Ethical Considerations
Ethics Approved through WH LREP
Confidentiality
Recruitment
So this is where we came to design the research and found there was a gap of evidence for what the role of SW could be optimised in the SCN. As it was found that Kangaroo care and attachment was important for wellbeing of parents and their infants, we thought that doing interviews with parents would help understanding what might facilitate this, especially with it being disrupted with the admission to SCN.
Taking a Qualitative approach seemed most appropriate to understand parent’s experiences. This allows the researcher to explore the complexities of the social world. Baum (2015) comments that qualitative research allows for an individuals complex story to be heard, understood and interpreted. Previous approaches have lacked understanding of a patients experiences. Baum (2015) sees this to be advantageous to public health research.
Interviews put the power in the individuals hands, it also gives them an opportunity to tell their story that otherwise not be told. So this has the potential to be therapeutic for the participant as well. Being onsite is more convenient.
Ethical considerations, we had to consider the relationships between nurses and parents. Some parents may want to participate but feel that they may be judged or not supported by nursing staff. Also data and confidentiality – ensure interviews were confidential and if the participant had issues with the hospital that they had the best avenue to go down. Also support of social workers and a psych if needed.

9. Preliminary Findings Participants (n=10) Age 24-38 Participants
8 Mothers and 2 Fathers
Other dependants
All first time parents
Location
All lived within 30 minutes
Family / Social support
All had family and Social Support/ All participants were partnered with the other parent
Emotional Support
Parents identified a need for emotional support
Peer Support
Parents identified the need for peer to peer support in the SCN
Social Work
2 parents identified the need for Social Work specifically but all identified an need for a individual to provide support, emotional, practical and peer support.

10. Emotional Support
Of course, I would have loved to have talked to someone at that time and because I was really struggling. What kept me going was the baby. Every time seeing him looking at me and seeing him smile.
I think every woman that has just delivered a baby, they need social worker or someone to talk to about what they are going through that day and at that time.

11. Engagement with the SCN
“Very…. quite, scared, nervous and you know, not the preference. But at the same time I think, fortunate that it was picked up so quickly. It wasn’t, there, there weren’t signs and symptoms we would have recognised. But yeah very, very upset especially when we came into this ward and particularly with seeing the Humidi Cribs. That was, was a bit of breakdown.”
Separation

12. Relationship Building
Kangaroo Care/Bonding
I knew that he was in safe hands and then they would tell me to have skin to skin which is Kangaroo Care and I would do that over time. That’s when I developed the bond.

13. References
Aargaard, H. & Hall, OC 2008, ‘Mothers’ experiences of having a preterm infant in the neonatal care unit: a meta- synthesis’, Journal of Pediatric Nursing, 23, 3, pp
Adams, R, Dominelli, L. & Payne, M 2009, Critical practice in Social Work, 2nd Edition, Palgrave Macmillan, New York
Arney, F & Scott, D 2013, Working with vulnerable families; A partnership approach, 2nd Edition, Cambridge University Press, Port Melbourne
Department of Health, Victoria, Statewide – Babies admitted to neonatal intensive care units and special care nurseries – Quarterly Data, Victorian Health Services Performance, viewed 26 March 2015,
Department of Human Services Victoria 2005, Neonatal guidelines: Defining levels of care in Victorian hospitals,
Fenwick, J, Barclay, L. & Schmied, V 2008, ‘Craving closeness: A grounded theory analysis of women’s experiences of mothering in the Special Care Nursery’, Women and Birth, 21, pp
Fook, J 2012, Social Work; A critical approach to practice, 2nd Edition, Sage, London
Grzyb, M.J, Coo, H, Rühland, L. & Dow, K 2014, ‘Views of parents and health-care providers regarding parental presence at bedside rounds in a neonatal intensive care unit’, Journal of Perinatology, 34, 2, pp
Hall, S, Hynan, M, Phillips, R, Press, J., Kenner, C. & Ryan, DJ 2015, ‘Development of program standards for psychsocial support of parents of infants admitted to a Neonatal Intensive Care Unit: A national interdisciplinary consensus model’, Newborn and Infant Nursing Reviews, 1, 7, pp
Henn, M, Weinstein, M & Foard, N 2009, A critical introduction to social research, 2nd Edition, Sage, London.

14. Heinemann, A, Hellström-Westas, L & Hedberg Nyqvist
Heinemann, A, Hellström-Westas, L & Hedberg Nyqvist. K 2013, ‘Factors affecting parents’ presence with their extremely preterm infants in a neonatal intensive care room’, Acta Pædiatrica, 102, p
Hugill, K., Letherby, G., Reid, T., & Lavender, T 2013, ‘Experiences of fathers shortly after the birth of their preterm infants’, JOGNN, 42, pp
Huhtala, M, Korja, R, Lehtonen, L, Haataja, L, Lapinleimu, H. & Rautava, P 2014, ‘Associations between parental psychological well-being and socio-emotional development in 5-year-old preterm children’, Early Human Development, 90, 3, pp
Kearvell, H & Grant, J 2010, ‘Getting connected: How nurses can Support mother/infant attachment in the Neonatal Intensive Care Unit’, The Australian Journal of Advanced Nursing, 27, 3, pp
Klaus, MH & Kennell, JH 1976, Maternal Infant Bonding. St Louis, MO: C.V.
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Liamputtong, P 2013, Qualitative research methods, 4th Edition, Oxford University Press, South Melbourne.
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Obeidat, HM, Bond, EA, & Callister, LC ‘The parental experience of having an infant in the Newborn Intensive Care Unit’, The Journal of Perinatal Education, 18, 3, p. 23–29.
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