How Do You Welcome Families?

SteveNNP, MSN, NP · Mar 17, 2007

Siblings over age 4 are allowed to visit, but anyone under 12 must wear a mask during RSv season.

We let parents hold the infant as soon as possible, unless of course they have fresh umbilical lines, are intubated, etc. Personally, I try to involve the parents in the care of their baby as soon as I think they have the presence of mind, after the initial shock has worn off. I especially like to involve first time parents and dads.....

Gompers, BSN, RN · Mar 17, 2007

We don't let parents visit in the morning when the doctors and NNPs are doing their rounds. Reason? HIPAA!!! If parents want to meet with the doctors to discuss their baby's progress and plan of care, a meeting can be arranged that takes place privately in our conference room. The one thing I wish we would change is we really should have a half-hour period where parents aren't allowed to visit when nurses do nurse-to-nurse report, especially at 3pm and 7pm when there are a lot of visitors around. First of all, they can easily hear what is being said the next bedside over, so it is a HIPAA thing. Second of all, we can't always be as frank with each other when there are visitors listening.

Otherwise, we welcome the parents and try to make them feel a part of things. We allow them to visit ASAP after the baby is admitted and we're done doing any necessary procedures. Intubated babies on conventional vents can be held as long as they don't have umbilical or arterial lines, and they're relatively stable. We try to get the parents to help with diaper changes, bathing, linen changes, weights, etc.

We do a lot of little things, too, that might not seem like much to us but the parents always tell us later on that it meant a lot to them. On Mother's Day, Father's Day, a parent's birthday, or a wedding anniversary, we make little cards from the babies to their parents, complete with Polaroids and footprints. On Halloween we make sure every baby has a handmade costume if the parents celebrate the holiday. Even the really sick babies, we'll make something simple and leave it at the bedside so the parents have the choice to use it or not. Many times they are happy to because it's a "normal" thing to dress your child up at Halloween and probably any NICU parent will tell you that ANYTHING "normal" is a welcome change.

Another thing that helps with welcoming families is having primary nursing. We do primaries for every baby, and it's voluntary. There is no day primary and night primary - anyone, any shift may do it. Others can sign up to be an associate nurse for that baby and will be assigned to him or her on shifts the primary isn't working. When the kids are sick, it's great to have continuity of care and the parents seem to appreciate seeing the same faces and hearing the same voices over the phone. When they're getting better and heading towards home, it's helpful to have the same familiar faces there, cheering the baby on and doing the discharge teaching. It becomes kind of like a team mentality and the parents seem to really appreciate it.

As for siblings, any can visit as long as they're not sick and they do have to fill out a health questionnaire before entering the unit. It's suggested in our admission handouts to the parents that siblings only visit for a half an hour, once a week. However, it usually doesn't work out that way. Sometimes parents come to visit for hours in the evening, with very small children, staying past 11pm! Even with those questionnaires, we have had RSV outbreaks in our unit, and let's not forget chicken pox!

BittyBabyGrower, MSN, RN · Mar 19, 2007

We have a folder we give them upon admission that goes over a lot about our unit. We are in the process of changing our visitation right now.

We let parents hold stable intubated kids...no UA/UV's. As long as baby is tolerating it they can do it for as long as they want. Sometimes we bump up the O's. We also get them in there to change diapers, massage, etc as soon as they tolerate it, but sometimes we have kids that we can't even talk by the beds or the decompensate.

Hear you on the siblings that come in sick...we have had the same family come in and infect their kid with RSV and Roto....think they would learn. Of course we can't keep the sibs out because then that isn't "family friendly" and we have to "trust" the family not to lie. Yeah.

SteveNNP, MSN, NP · Mar 19, 2007

Yeah, we had a grandmother come in and hold her grandbaby for 2 hours, then broke out with shingles the next day.....big scare!