Parents Are Not Visiting. Parents Are Parenting

In their article “A Quality Improvement Project to Reduce Events of Visitor Escalation in the Intensive Care Nursery” (Vol 22, No. 1), the authors make repeated references to “visitors” to the neonatal intensive care nursery (NICU). As seasoned healthcare professionals and advocates for parents of premature and sick infants, our position is this: Parents are not visitors. Parents are parents—their child's first and most important caregiver.1 Globally, healthcare organizations have traditionally positioned parents as visitors. This language is used not just in articles like this one but also frequently present in hospital documents, signage, and in the ways parents are spoken to and about in the hospital. Preterm birth is traumatic. Often unexpected and unplanned, a preterm delivery to a medically fragile infant can leave a mother feeling like her body has failed. Parents are typically separated immediately from their infant, robbing them of that “moment” they have been waiting for—the moment they become parents. In the hours and days that follow, parents may not be allowed to hold or touch their infant. The clinical terms used to talk about their infant seem like a foreign language, everything is unfamiliar and sterile, and parents do not have any idea what to say, do, or ask. Parents of premature and sick infants are scared and anxious. They can feel powerless, alienated, alone—outsiders in their own infant's life.1,2 Therefore, language is so important. Calling parents visitors contributes to a culture of experts versus guests and us versus them.3 It evokes feelings for parents that this is the hospital's infant, not your infant.4 Healthcare professionals decide who can touch and care for your infant, when, and for how long. The word “visitor” and how we use it to describe parents—in writing as well as verbally—is simply inaccurate. Parents are an infant's primary caregiver. The words we use, as well as our tone, body language, and communication style, strongly affect how healthcare professionals see parents—and how parents see themselves. The culture of “allowing” parents' permission to care for their premature or sick infants must shift. Instead, healthcare providers' words, actions, and knowledge should be a tool for helping parents learn to care for their sick newborn, build trust and rapport, and enable open communication.5 The first days and weeks in the NICU are formative for the parent–infant relationship and can make or break parents' feelings of confidence, competence, and connection to their new infant. Parents must be at the center of a premature or sick infant's care team.6,7 Changing the language, we use, to talk about parents is a simple, cost-effective way to promote a culture of inclusion and involvement and improve outcomes. Looking at the wording in unit policies, notice boards, signage, parent education materials, staff presentations, in-services, training, and orientation is a good start. Calling parents “visitors” is exclusionary. Parents are not visiting. Parents are parenting. —Marianne Bracht, RN, RSCN Pediatrics Mount Sinai Hospital Toronto, Ontario, Canada —Linda S. Franck, PhD, RN, FRCPCH, FAAN School of Nursing University of California San Francisco —Karel O'Brien, MB, BCh, BAO, FRCPC, MSc Pediatrics Mount Sinai Hospital Toronto, Ontario, Canada —Fabiana Bacchini, MSc, BJ Canadian Premature Babies Foundation Toronto, Ontario, Canada