VOL: 96, ISSUE: 44, PAGE NO: 39
Pat Foden, SRN, RM, Dip. Psychodynamic Counselling, Dip. Casework Supervision, co-ordinator/therapist, Child and Family Service, Birkenhead.
Evelyn Preston, RGN, RSCN, co-ordinator/therapist, Child and Family Service, Birkenhead.The neonatal unit, at Arrowe Park Hospital in Upton, the Wirral, is always busy, looking after on average 400 babies every year. The unit has a dedicated staff, but the unit's clinical manager became aware that parents were not fully expressing their feelings on the unit. She would often chat with parents as they left the unit and found that they were full of worries that they had been unable to express to the nurses who were actually caring for their babies. The neonatal staff recognised that despite their best attempts to provide holistic care to this patient group there was a gap in the care they were providing.
The neonatal unit, at Arrowe Park Hospital in Upton, the Wirral, is always busy, looking after on average 400 babies every year. The unit has a dedicated staff, but the unit's clinical manager became aware that parents were not fully expressing their feelings on the unit. She would often chat with parents as they left the unit and found that they were full of worries that they had been unable to express to the nurses who were actually caring for their babies. The neonatal staff recognised that despite their best attempts to provide holistic care to this patient group there was a gap in the care they were providing.
The Child and Family Service, a community-based child and adolescent mental health service, was keen to establish links with the paediatric/ neonatal staff and agreed to attend a meeting whereby possible solutions to this problem could be discussed. As a result of the meetings, it was identified that staff needed to become more at ease when directing questions and information to patients. The 'partnership model' appeared to be the ideal way forward.
The partnership model
The partnership model was first defined in 1993, by Hilton Davis, a clinical psychologist. It was designed for use with families in many different situations and was first used in a parent adviser scheme in south-east London. The 'partnership model' is a well-documented way of working with families (Davis, 1993).
The model works through 'active listening' and explores how the whole problem is perceived by the client, or in this case the parent/carer. It renounces the belief that professionals must always have the ability to resolve the problem.
The partnership model in practice
For professionals, the partnership model means they do not have the burden of feeling they must have all the answers and that when they do not know how to 'make it better' this is not failing. This frees up the discussion and allows far greater exploration of what the parents/clients are asking, by use of open-ended questions and, most importantly, by listening. No one then leaps to a prescriptive solution, which may block further description and investigation of the problem.
Instead, the partnership model proposes that parents/carers hold the solutions to their own problems. This is achieved by offering support, choices and, if requested, information.
Families are encouraged to find their own answers to issues through mutual respect, honesty and a full exploration of all the avenues and agencies that may be of use to them. It acknowledges parental expertise and offers support rather than advice and direction.
The helping relationship
There are seven elements involved in a helping relationship, as defined by Egan (1982) and modified and adapted for use by the staff on the neonatal unit:
1. Work closely together;
2. Establish and agree explicit common aims;
3. Acknowledge the complementary nature of expertise;
4. Communicate successfully;
5. Negotiate all decisions and actions;
6. Act honestly;
7. Be flexible.
Following the meetings with the Child and Family Service, it was decided to offer a series of workshops which were available to all staff irrespective of status. All unit staff attended the workshops voluntarily. Two workshops were held for all the staff on the unit (see Boxes 1 and 2).
The questionnaire (see Box 3) was created and introduced as a form of 'action research' and to provide self-evaluative data. This method has been shown to produce improvements in clinical practice, interaction and professional development (Sapsford and Abbott, 1992). The four questions used are known to be asked regularly by parents/carers. When analysed they are probably impossible to answer in most instances. For example, 'Why did I have a premature/small/sick baby?' may actually mean 'What have I done wrong?' Finding the real purpose of social interaction occurs only through careful and active listening.
Interpretation of responses
Answering 'a' or 'd'
Answering a question by passing it to someone else is a decision that may often appear the most tempting and simple way of dealing with what are sometimes 'uncomfortable' situations. Bender (1981) suggests that managing relationships in this way avoids the dilemmas of developing a deeper relationship with another person and also avoids the need to be empathic to the pain of others.
Responding to a question using technical and medical terminology may feel a 'safer' option for the health care professional. However, this can create a barrier between the clinician and the parent and a feeling of unequal 'power' (Davis, 1993).
Selecting this method encourages the patient to explore what they understand and how they feel about the situation.
Staff at Arrowe Park neonatal unit changed their approach to parents after just one workshop. Staff felt more able to interact positively with parents in a supportive way.