How Nurses Assist Parents Regarding Life Support Decisions for Extremely Premature Infants

Objective To describe nurse behaviors that assisted parents to make life-support decisions for an extremely premature infant before and after the infant's birth. Design Qualitative, longitudinal, collective case study where interviews were done pre- and postnatally and medical chart data were collected. Setting Interviews were conducted face-to-face in a private room in the hospital, in the mother's home, or over the telephone. Participants A sample of 40 cases (40 mothers, 14 fathers, 42 physicians, 17 obstetric nurses, 6 neonatal nurses, and 6 neonatal nurse practitioners) was recruited from three hospitals that provided high-risk perinatal care. Parents were at least 18 years of age, English speaking, and had participated in a prenatal discussion with a physician regarding treatment decisions for their infant due to threatened preterm delivery. Physicians and nurses were those identified by parents who had spoken to them about life-support treatment decisions for the infant. Methods Using a semistructured interview guide, a total of 203 interviews were conducted (137 prenatal, 51 postnatal, and 15 end-of-life). For this analysis, all coded data related to the nurse's role were analyzed and summarized. Results Parents and nurses described several nurse behaviors: providing emotional support, giving information, and meeting the physical care needs of mothers, infants, and fathers. Physicians' description of the nurse behaviors focused on the way nurses provided emotional support and gave information. Conclusions Nurses play a critical role in assisting parents surrounding life-support decisions.