7 Bronchopulmonary Dysplasia (BPD) Nursing Care Plans

Compromised Family Coping

Parents of very preterm infants experience substantially more psychological distress in the first months of life than mothers of full-term infants. This stress may continue for the first few years beyond discharge from the NICU, particularly for parents of the highest-risk infants. In one parental survey, parental perceived health-related quality of life (QOL) of children with severe BPD at 18 to 26 months of corrected age was substantially lower than that of preterm children without BPD (Thebaud et al., 2019).

Nursing Diagnosis

• Compromised Family Coping

May be related to

• Long-term illness that wears out the supportive capacity of significant people
• Lack of coping skills
• Temporary family disorganization and role changes

Possibly evidenced by

• Frequent and prolonged hospitalizations
• The preoccupation of significant persons with anxiety, guilt, and fear regardless of infant/child illness
• Display of protective behaviors by significant persons that are disproportionate to infant/child needs (too much or too little)

Desired Outcomes

• The family will identify resources within themselves to deal with the situation.
• The family will express major stressors accompanying the infant’s ailment.
• The family will verbalize knowledge and understanding of the situation.
• The family will identify coping mechanisms/support systems they can utilize.

Nursing Assessment and Rationales

1. Determine current knowledge and perception of the situation.
A lack of information and unrealistic perceptions can interfere with the family members’ and clients’ responses to the situation. Parents face the sudden and often unfamiliar responsibility of making healthcare decisions that may affect an infant’s life or health. Healthcare professionals can and should provide guidance and recommendations, but parents often feel the weight of responsibility heavily (Chiafery & D’Angio, 2020).

2. Assess anxiety, fear, erratic behavior, and perception of a crisis situation by family members.
This provides information affecting the family’s ability to adjust to infant/child long-term disease. Parents suffer high levels of anxiety, fatigue, depression, and sleep disturbances. Poor sleep and the resultant chronic fatigue place mothers at increased risk for postpartum depression. One-third of fathers also demonstrated symptoms of depression, which may last for months (Chiafery & D’Angio, 2020).

3. Evaluate the family members’ level of stress and coping abilities, especially before planning for discharge.
Caring for clients with chronic conditions places a heavy strain on the family members. Recognizing their own strengths and areas for improvement provides opportunities for personal growth, enhancing the potential for success when the client returns home.

Nursing Interventions and Rationales

1. Encourage the verbalization of feelings and questions openly in an accepting, nonjudgmental manner.
This lessens anxiety and improves the family’s understanding of the condition of the infant. Excellent communication skills and the ability to listen well are crucial to these tasks. Parents may not be aware of available resources, therefore the healthcare team needs to provide guidance within the context of nonjudgemental regard as they help families cope with the crisis of NICU admission (Chiafery & D’Angio, 2020).

2. Establish rapport with the family and actively listen to their concerns.
Nurses often have the most contact and opportunity to help relieve parental burden and stress and help parents gain confidence in their parenting skills. Listening with the intent to understand the parents’ perceptions is the fundamental basis to develop effective strategies to teach, guide, and relieve the stressors or burdens of parents and is cited as among the most common positive experiences by NICU parents (Chiafery & D’Angio, 2020).

3. Encourage the family to discuss and develop previous coping methods used.
This recognizes coping methods that were effective and the need to come up with new coping mechanisms. Parents who receive support to address stressors, develop coping strategies, and learn how to parent a sick child are more readily able to develop important parent-child bonds (Chiafery & D’Angio, 2020).

4. Encourage family involvement in care during and after hospitalization.
Parental involvement has been shown to decrease the length of hospital stay. Infants who spent more time during the NICU stay in skin-to-skin contact with their parents scored higher on the Bayley psychomotor developmental indexes at six months of age. Family-integrated care of NICU infants at risk for developing BPD has been shown to improve a number of NICU outcomes, including lowering the amount of time on respiratory support (Chiafery & D’Angio, 2020).

5. Provide a resting place for family members and encourage them to take care of themselves too.
Parents should be encouraged to find a balance between caring for the self and caring for their infant. Parents may be hesitant to leave their child and may need permission to take breaks from the bedside or even the NICU to recharge, refresh, or even check on other family members. Parents need to be reminded that it is necessary that they address their own basic needs for sleep, a healthy diet, exercise, and social support (Chiafery & D’Angio, 2020).

6. Encourage open visitation and allow telephone calls to the hospital by family members.
This facilitates bonding and helps the infant/child adjust to hospitalization if the family is unable to stay. Fathers can easily feel like an outsider in the NICU, so measures to invite and include are critical. Visitations should be encouraged, no matter the time of the day, as fathers will likely have to plan visits around their work schedules (Chiafery & D’Angio, 2020).

7. Provide positive feedback and recognize family efforts in creating coping and problem-solving techniques and caring for the infant.
Positive feedback encourages parents and family to join in care and gain some control over the situation. Sensitive listening for cues that feelings of guilt are a concern can alert the staff to provide reassurance that this situation is not their fault. Parents often need to be reminded of the ways they are being good parents (Chiafery & D’Angio, 2020).

8. Educate the parents regarding a “buddy system” inside the NICU.
A buddy system of pairing mothers of NICU infants with mothers who have previously undergone the experience may be helpful. Through shared experiences, the mother may feel less alone in the experience, find other resources, and realize that the current situation will not last forever (Chiafery & D’Angio, 2020).

9. Provide support to fathers by introducing them to support groups and counseling.
Father support groups may be helpful. Offering fathers supportive counseling should be routine, yet in one study, only 27% of the nurses had made an attempt to discover if fathers were under stress and less than 20% offered assistance in seeking helpful resources. Fathers also carry different stressors that are no less important and tend to tie into traditional gender role expectations, such as financial burden and the stress of maintaining a job. Many fathers also provide emotional support for the infant’s mother and assure the care of other children at home. Such changes in parental duties may contribute to stress for all family members (Chiafery & D’Angio, 2020).

10. Encourage the family members to take care of their spiritual health.
Spiritual care can also facilitate coping, diminish parental stress, and help strengthen bonds with staff. Regular visits by the families’ spiritual leaders or hospital chaplaincy may be helpful. Other staff can provide spiritual support by exploring family beliefs in an open and compassionate way, sitting quietly, listening and praying with them, or simply honoring and making space for spiritual rituals (Chiafery & D’Angio, 2020).

11. Suggest a referral to a social worker as needed.
Social workers may assist families to obtain support and resources for financial or infant/childcare relief. Parents come to the NICU with varying resources and support systems, thus conversations about these topics are crucial. Social workers and other staff can help direct families to resources in the hospital or the community to meet their particular needs and assist with applications for secondary insurance, or other financial resources (Chiafery & D’Angio, 2020).

12. Suggest and reinforce appropriate coping behaviors.
This promotes behavior change and adaptation to care for the infant with oxygen dependence. Allowing parents to experience the infant’s “firsts” of milestones as frequently as possible helps to foster a feeling of parenthood. The healthcare team must be aware of the long-term impact of their interventions and actions on the family in order to help parents develop the strength needed for the current and future well-being of the individual parent, infant, and family unit (Chiafery & D’Angio, 2020).

13. Suggest that assistance may be secured by telephoning the hospital or via virtual correspondence after discharge.
This provides a family with a resource in a crisis situation. Successful transition to home for a medically complex infant requires a multifaceted approach involving close coordination between hospital and community resources. Most programs include some form of enhanced education while the infant remained hospitalized and in-home support, through physical or virtual visits. The component most closely associated with program success was the provision of in-home nursing support (Chiafery & D’Angio, 2020).

14. Provide knowledge about the infant’s condition and progress, oxygen dependence needs, and reason for care and medications.
This lessens parents’ and family’s anxiety and foresees the need for information about disease and care. An important parental role is one of protection for their vulnerable infant. This can be facilitated by keeping them informed of their infant’s condition and providing ways to be actively involved in the infant’s care. Taking time to provide factual information and clarify misunderstandings helps promote a trusting relationship (Chiafery & D’Angio, 2020).

15. Provide teachings about cardiopulmonary resuscitation (CPR), oxygen administration, and safety measures to eliminate fire hazards.
This empowers the family to deal with an emergency situation and maintain safe oxygen administration. The Ohio Perinatal Quality Collaborative recently released a guide to improving mechanisms for the transition home that cites early identification of needs, strengthened community resources, improved hospital-community communication and collaboration, standardized procedures, and an adequate, trained home-nursing workforce (Chiafery & D’Angio, 2020).