Nurse Ana Freitas

Master’s Student in Nursing in Child 
and Paediatric Health

Hospital discharde of the premature baby
Nurses’ function and responsibility

HPA Magazine 15

Prematurity is the main cause of hospitalization in a Neonatal Intensive Care Unit. 15 Million premature babies (NBs) are born worldwide, which means that in 10 births 1 baby is born prematurely. In Portugal, between 2013 and 2018 there was an increase in the percentage of premature babies from 7.8% to 8%.

Premature birth is unexpected and a delicate situation for the parents, resulting in concerns, anxiety, insecurity and a feeling of frustration due to the fact that the parents need to be separated from their child. The family experiences mixed feelings of hope, when witnessing their premature baby’s struggle for life, but also anxiety due to the constant clinical instability.
The need for a prolonged hospital stay, with the consequent and indefinite separation from the parents, the constant stressful contact with a hospital environment, the appearance and health condition of the premature baby, the presence of various technical equipment and the interaction of different health professionals, can hamper the bond between the premature infant and its parents. 
The birth of a baby is a unique phenomenon involving a multitude of emotions. However, the birth of a premature child is a shock, compromising parenthood and destroying the expectations that parents create throughout pregnancy when idealizing their future baby. Being the parent of a premature baby is totally different when compared to a full-term baby that does not need intensive care; parents live “trapped” in a hospital environment, often highly stressful and surrounded by a lot of technical equipment, monitors and alarms.
The date that they can take their baby home is a moment long awaited by parents, but it is also at the same time frightening, full of challenges and fears, with expectations and uncertainties, as it is a turning point, where parents are faced with the moment when they have to take care of the baby on their own. For this reason, it is important for parents to be involved as early as possible, in every step of caring for their baby. When parents are involved in the care of their child, confidence and bonding will increase, preparing them for when the baby is discharged from hospital. 
For the success of this stage, it is important to have a nursing team that encourages the continuous participation of parents, so that they are part of the whole process, enabling them, guiding and supporting them, so that when the time comes to take their baby home they feel confident and capable.

The term empower is a very common concept used in association with health and arises mainly as a way to operationalize the concept of empowerment, that is, to give the person power so that he has resources to make decisions and to have the power of choice and autonomy over what happens in his life. It is up to health professionals to stimulate this capacity.
Therefore, the Neonatal Intensive Care Unit needs a team of nurses specialized and trained in the area of Child and Paediatric Health Nursing, who are fundamental in this whole process of parent training, guidance and support.
The role of the nurse is to facilitate, teach skills and competences related to health, necessary for successful parenting. Evaluating the development, implementation and managing a health plan in partnership with the parents with the object of promoting parenthood is essential, while at the same time seeking opportunities to work with the family and the child, to guide in the choice of solutions that will enhance the child’s health.
Nurses develop strategies that promote bonding between parents and children, helping parents to acquire self-confidence and independence when caring for their premature child once discharged from hospital. A nurses’ intervention is not only based on day-to-day care, such as hygiene, feeding/breastfeeding and comfort, but also holistic care, considering multiple perspectives, such as the psychosocial and cultural aspects of the family unit.
In this way, they have a set of diverse competences with the power to contribute to a better society with more informed, more qualified citizens and better decision-makers as far as health issues are concerned.
Follow-up of the premature baby and his family after discharge from hospital are part of our health policies and are essential for the promotion of health and the prevention of disease. Thus, it is important to attend medical and nursing consultations regularly, available in the Paediatric Out-Patients Unit, where a holistic assessment of the child is carried out, a follow-up continuation and early detection of risk situations, as well as promoting successfully the full potential of the baby and his family.