Nursing Roles in Parental Support: A cross-cultural comparisons between Neonatal Intensive Care Units in New Zealand and Japan

Introduction: Past studies have indicated that nursing support reduces parental stress and anxiety during a child’s NICU hospitalisation and therefore fosters the parents’ abilities to cope with the difficulties they are facing. The importance of parental support has been emphasised in numerous studies in Western countries, however the nursing support which is responsive to the parents may vary between different cultures. The cultural norms of medical and nursing care environments can affect parental stress-related experiences as well as nursing roles in the NICUs across different countries. The aims of this study are, first, to compare the medical and nursing care environments of the two NICUs. Second, the study establishes any similarities and differences in sources of parental stress in the two NICUs. Third, the study illustrates the underlying philosophy of Doane and Varcoe’s (2005) relational approach to family nursing and highlights the importance of relational inquiry in the process of determining the parental support which best responds to individual families’ needs in the NICU. Methods: This study analyses the nursing roles that support parents of children hospitalised in a Neonatal Intensive Care Unit (NICU). It is a cross-cultural comparison between two NICUs, one in Christchurch, New Zealand and the other in Tokyo, Japan, with both quantitative and qualitative components. Thirty-one families participated voluntarily in the study from each NICU (n=121). The three main sources of data were a NICU staff interview, parental interview, and parental questionnaire using the Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU) (Miles, 2002). A thematic analysis was used in order to examine parental comments. Results: The differences between the two NICUs in terms of the NICU care environment, including NICU regulations and routine nursing care, were identified by the staff interviews, highlighting the contrasting dominant ideologies of individualism and collectivism reflected in each culture. The three sources of parental stress, measured by PSS: NICU: Sights and Sounds; Baby’s Appearance and Behaviour; the Parental Role Alteration, were examined. The sources most responsible for parental stress differed between the four groups of parents. Overall, The Tokyo parents seemed to be most concerned about the infant’s condition. The Christchurch parents, however, perceived the change in parental role to be most stressful. Additionally, only the Tokyo fathers experienced stress in association with Sights and Sounds more often than other areas of stress. The infant’s medical/nursing care requirements, oxygen therapy and/or tube feeding, were associated with a high degree of stress for each of the parents’ groups except that of the Christchurch fathers. There was a positive relationship between parental NICU visiting and stress level among the Tokyo parents while this was not the case for the Christchurch parents. The infants’ and parental characteristics were found to be associated with stress level for the Tokyo mothers and Christchurch fathers only. The thematic analysis of interview data revealed three key themes of NICU parental experiences: Uncertainty, NICU contexts and Communication with staff. These themes were identical between the two NICUs. Discussion: This study highlighted the influence of the norms of each NICU, particularly the NICU regulations and nursing care on parental stress-related experiences, and the importance of reflecting upon these norms to critique those professional beliefs which may hamper parental coping abilities. The areas of parental support needing attention were different between the two NICUs. These areas were: the establishment of oral feeding, and infants’ nursing care-related decision-making for the Christchurch NICU whilst parental information/involvement in the early stage of hospitalisation, the influence of visiting regulations, and importing Western-based NICU intervention for the Tokyo NICU. In providing these areas of parental support, the importance of effective, meaningful communication between parents and staff was equally evident in the two NICU settings. In the light of the relational approach to family nursing, this study demonstrated that how nurses communicate with families is not universal: one way to reach across the differences is to listen to parents, and this, it is clear, is crucial to the role of nurses in NICU settings