The birth of a child with special needs, regardless of whether the condition is temporary or permanent, creates unique concerns for the family, who mourns the loss of a normal, healthy child. Conditions range from prematurity, growth deviations, and infections to gross anomalies. Although each case is individual and varies in degree of involvement, many similarities are observed in the parents’ responses to their child.
NURSING PRIORITIES
1. Facilitate grieving and positive coping.
2. Provide appropriate information related to short- and long-term implications of child’s illness or anomaly.
3. Facilitate learning of parenting role and participation in infant care tasks.
DISCHARGE CRITERIA
1. Demonstrate progress in dealing with grief at own pace.
2. Display appropriate attachment/bonding behaviors.
3. Participate in infant care; develop mastery of therapeutic regimen.
4. Have plan in place to meet needs after discharge.
Nursing diagnosis: Grieving may be related to perceived loss of the perfect child/ pregnancy/delivery, alterations of future expectations possibly evidenced by expression of distress at loss, sorrow, guilt, anger; choked feelings; reliving of pregnancy events; interference with life activities; crying.
Nursing intervention with rationale:
1. Promote trusting relationship with parents and significant other(s). Encourage verbalization of feelings through listening and an unhurried attitude.
Rationale: Facilitates sharing of feelings, fears, and concerns. Helps parents to focus on reality of the situation and examine their emotional responses. Grieving for the loss of the perfect child must be completed before parents can establish a positive relationship with their offspring. Staff needs to remain available, even if client seems self-sufficient or withdrawn.
2. Facilitate the grief process, even if the newborn’s independent of the severity/permanency of the infant’s problem.
Rationale: The amount of grief the parents experience is problem is temporary or surgically correctable.
3. Determine parents’ religious orientation, and contact appropriate support, if they desire it.
Rationale: Many couples lean heavily on their faith as a source of strength during crisis resolution. Note: Perception of situation/condition and individual’s response will also be affected by religious beliefs.
4. Assess for usual grieving responses (e.g., initial shock, disbelief, and denial, then anger, guilt, sadness, and negative self-evaluation/questioning, followed by acceptance) based on cultural/religious practices. Let parents know that these responses are normal.
Rationale: Grief is the anticipated, healthy emotional response to the profound experience of giving birth to a special needs child, and it involves mourning the loss of the idealized perfect newborn.
5. Note the stage of grief being expressed. Discuss the individual nature of movement through the stages of grief; let parents know that delays in the grief process or relapses of grief are normal.
Rationale: The process of grieving is not usually a fluid progression through the stages to resolution; more often the individual fluctuates between the stages, possibly skipping one or more. Understanding that grieving is individual helps the couple let each other grieve at her or his own pace.
6. Accept use of defense mechanisms (e.g., denial, anger, or silence). Encourage expression of angry feelings, setting limits on unacceptable acting-out behavior.
Rationale: Use of defense mechanisms at this time may be the best way for parents to deal productively with the situation. However, continued use of defense mechanisms may impair resolution of grief. In addition, preventing destructive behavior is important to the maintenance of the client’s selfesteem.
7. Provide information about extreme mood swings, which may be hormonally induced in the postpartal period.
Rationale: Usual hormonal adjustments of postpartal period can trigger labile responses and may require further evaluation/treatment.
8. Ask parents what helps them most in dealing with the affected child. Observe nonverbal signals, such as anguished tone of voice, looking down, or crying.
Rationale: Parents may have a hard time handling the crisis and may have difficulty identifying means of facilitating coping.
9. Evaluate parents for abnormal grief responses, such as inappropriate humor; lack of interest in infant; continued denial of, or failure to recognize, infant’s problem; poor eye contact; continual crying, excessive or vague complaints; inability to carry out self-care activities; or use of distancing in interactions with child (e.g., holding child at arm’s length instead of cuddling).
Rationale: Inappropriate initial responses may result in long term emotional dysfunction and lack of resolution
of grief. Thus, the grief process may be left open ended, and the parents’ unresolved feelings continually resurface. Early identification of problems and prompt intervention facilitates individual growth and coping abilities. Note: Parents may be afraid of becoming emotionally attached if they believe that the child might die.
10. Refer for appropriate individual or family counseling.
Rationale: Counseling may be necessary for resolution of grief and maintenance of family unity.
NURSING PRIORITIES
1. Facilitate grieving and positive coping.
2. Provide appropriate information related to short- and long-term implications of child’s illness or anomaly.
3. Facilitate learning of parenting role and participation in infant care tasks.
DISCHARGE CRITERIA
1. Demonstrate progress in dealing with grief at own pace.
2. Display appropriate attachment/bonding behaviors.
3. Participate in infant care; develop mastery of therapeutic regimen.
4. Have plan in place to meet needs after discharge.
Nursing diagnosis: Grieving may be related to perceived loss of the perfect child/ pregnancy/delivery, alterations of future expectations possibly evidenced by expression of distress at loss, sorrow, guilt, anger; choked feelings; reliving of pregnancy events; interference with life activities; crying.
Nursing intervention with rationale:
1. Promote trusting relationship with parents and significant other(s). Encourage verbalization of feelings through listening and an unhurried attitude.
Rationale: Facilitates sharing of feelings, fears, and concerns. Helps parents to focus on reality of the situation and examine their emotional responses. Grieving for the loss of the perfect child must be completed before parents can establish a positive relationship with their offspring. Staff needs to remain available, even if client seems self-sufficient or withdrawn.
2. Facilitate the grief process, even if the newborn’s independent of the severity/permanency of the infant’s problem.
Rationale: The amount of grief the parents experience is problem is temporary or surgically correctable.
3. Determine parents’ religious orientation, and contact appropriate support, if they desire it.
Rationale: Many couples lean heavily on their faith as a source of strength during crisis resolution. Note: Perception of situation/condition and individual’s response will also be affected by religious beliefs.
4. Assess for usual grieving responses (e.g., initial shock, disbelief, and denial, then anger, guilt, sadness, and negative self-evaluation/questioning, followed by acceptance) based on cultural/religious practices. Let parents know that these responses are normal.
Rationale: Grief is the anticipated, healthy emotional response to the profound experience of giving birth to a special needs child, and it involves mourning the loss of the idealized perfect newborn.
5. Note the stage of grief being expressed. Discuss the individual nature of movement through the stages of grief; let parents know that delays in the grief process or relapses of grief are normal.
Rationale: The process of grieving is not usually a fluid progression through the stages to resolution; more often the individual fluctuates between the stages, possibly skipping one or more. Understanding that grieving is individual helps the couple let each other grieve at her or his own pace.
6. Accept use of defense mechanisms (e.g., denial, anger, or silence). Encourage expression of angry feelings, setting limits on unacceptable acting-out behavior.
Rationale: Use of defense mechanisms at this time may be the best way for parents to deal productively with the situation. However, continued use of defense mechanisms may impair resolution of grief. In addition, preventing destructive behavior is important to the maintenance of the client’s selfesteem.
7. Provide information about extreme mood swings, which may be hormonally induced in the postpartal period.
Rationale: Usual hormonal adjustments of postpartal period can trigger labile responses and may require further evaluation/treatment.
8. Ask parents what helps them most in dealing with the affected child. Observe nonverbal signals, such as anguished tone of voice, looking down, or crying.
Rationale: Parents may have a hard time handling the crisis and may have difficulty identifying means of facilitating coping.
9. Evaluate parents for abnormal grief responses, such as inappropriate humor; lack of interest in infant; continued denial of, or failure to recognize, infant’s problem; poor eye contact; continual crying, excessive or vague complaints; inability to carry out self-care activities; or use of distancing in interactions with child (e.g., holding child at arm’s length instead of cuddling).
Rationale: Inappropriate initial responses may result in long term emotional dysfunction and lack of resolution
of grief. Thus, the grief process may be left open ended, and the parents’ unresolved feelings continually resurface. Early identification of problems and prompt intervention facilitates individual growth and coping abilities. Note: Parents may be afraid of becoming emotionally attached if they believe that the child might die.
10. Refer for appropriate individual or family counseling.
Rationale: Counseling may be necessary for resolution of grief and maintenance of family unity.