Abstract
Prematurity is the leading cause of death in children under 5 years of age worldwide. Infants who survive this period have a greater risk of neurodevelopmental impairment than their full-term peers. Skin to skin is an intervention recommended during the neonatal period to improve physiological stability, decrease infant mortality and morbidity, improve neurobehavioral and psychosocial outcomes. Within New Zealand (NZ) the infant death rate is highest among Pacific infants born less than 28 weeks gestation, warranting further investigation into the delivery of all aspects of care for this population.
The purpose of this study was to explore Pacific parents’ lived experiences of skin to skin with their preterm infants while on NZ based neonatal units to inform culturally responsive care and service delivery. Interpretive Phenomenological analysis (IPA) informed by Talanoa research methodology was used to guide this qualitative study. Recruitment and data collection took place between November 2020 and July 2021 on the neonatal units at Auckland Hospital, Kidzfirst Hospital and Northshore Hospital. Interviews took place with Pacific parents of preterm infants born less than 33 weeks, while they were still on the neonatal unit before being discharged home or within one month of being discharged. Data were analysed consistent with IPA and presented as themes.
Seven families took part in semi-structured interviews which included four couples and three mothers. Following data analysis, five superordinate themes and 13 subordinate themes indicating Pacific parent’s experience of skin to skin were identified. These included the first superordinate theme of “overcoming fear and anxiety” with subordinate themes of “It’s a rollercoaster”, “longing met with fear” and “moving from fear to confidence”. The second superordinate theme was “connection” and included subordinate themes of “heart to heart”, “touch in lieu of skin to skin” and “becoming parents”. The third superordinate theme was “words matter” and included the subordinate themes of “reassurance and encouragement” and “do not do that”. The fourth superordinate theme was “actively managing racial bias” and included the subordinate themes of “differences in care”, “being an advocate for your infant” and “culturally supportive care”. The last superordinate theme was “spirituality and religious beliefs facilitates resilience” and included the subordinate themes of “pillar of strength” and “spiritual connection with your baby”. Skin to skin as an intervention, promoted connection and strengthened all four pou of the Fonofale model. The characteristics and communication styles of individual nurses impacted on the Vā (relational space) experienced by families, which subsequently affected their experience of skin to skin. Pacific parents in this study actively managed racial bias to gain the best care for their infants.
Findings indicate the need for Pacific cultural competence training in order to provide culturally safe care when supporting an intervention like skin to skin. Intentionally encouraging and facilitating Pacific parents’ spirituality and religious practices within the NICU is another key strategy to optimise skin to skin dosage. Within the stressful NICU environment supporting nurses in their communication and actions when facilitating skin to skin, has the potential to impact the initiation, uptake, and overall experience of skin to skin.