Exploring neonatal nurses’ and parents’ understanding of the factors that both enhance and hinder communication and early interaction between preterm infants and their parents

Aim: To investigate nurses’ and parents’ understanding of factors that enhance or hinder communication and early interaction between preterm infants and their parents after experiencing care on a neonatal unit. Rationale: For parents, learning to interact with their infant on a neonatal unit presents an unexpected complication with time needed to enable confidence, learn to cope, care for and be close to their infant in a healthcare setting (Cardin, 2020). Becoming attached to an infant through involvement in care can support physical and emotional closeness for both the infant and carers providing important precursor skills for developing parent– infant interaction and communication (Evans et al, 2014; Flacking et al, 2012). Specifically, vocal stimuli from carers can improve preterm infants’ physiological stability and better feeding development (Saliba et al, 2018). Promoting early communication strategies to enhance maternal/carer sensitivity to an infant through eye contact, initiating talking with and responding using natural gestures and facial expressions can increase attachment and bonding, support improved parent well–being, and improve the interpretation of early infant communication signals during everyday care (Evans et al, 2014). The need to explore infant interaction in the early stages of development is an urgent necessity because increased mask wearing as part of protective personal equipment (PPE) use. This and reduced parent visiting during the pandemic has highlighted that communication and interaction is essential for infant development, but is largely poorly understood (Green et al, 2020). Healthcare practitioners, for example nurses and speech and language therapists, are in an important position to provide support for parents to enable the development of confident and competent communication skills during limited visiting times. Background: There are few studies which investigate in detail the type of early communication between preterm infants and their carers on a neonatal unit, and if interventions to support and encourage parent – infant communication are effective (Harding et al, 2019). Studies which investigate approaches such as early feeding (tube and oral) and skin to skin care, which are important for bonding and parent mental health, often allude to communication when discussing outcomes (Buil et al, 2020; Feldman et al, 2014). Such approaches are important antecedents for communication, but although some outcomes may relate to interaction, many of these studies fail to address the necessary skills to facilitate early communication and lack a clear rationale which highlights linguistic and communication development (Harding et al, 2019). Preterm birth is a risk factor for a range of difficulties, including language development (Aylward, 2014). Preterm infants are at increased risk of developing communication and language problems (Rautava et al, 2010; Stene-Larsen et al, 2014; Johnson et al, 2015). Use of both sustained practitioner and parent face masks during the COVID -19 pandemic, along with reduced parent contact has been considered as a matter of significant concern, specifically in relation to bonding, developing confident infant care skills, in particular learning to be a supportive and responsive communication partner. In addition, it has become apparent that specific antecedent skills which are necessary to enable positive communication environments for both developing preterm infants and their carers are poorly understood by neonatal practitioners, thus limiting the quality of interaction styles which can be encouraged by parents when developing skills for infant care. Very few studies have described core elements of early communication with preterm infants (Coppola & Cassiba, 2010), though it is now evident that there is a critical need to do so (Harding et al, 2020).