FAMILY DYNAMICS

From theRichmond,Address corFAAN, Sch980567, Ri© 2008 El1527-3369doi:10.1053

Supporting Information-Seeking Behaviors ofFamilies in the 21st Century

Whitney Hardy, BS undergraduate nursing student andJacqueline M. McGrath, PhD, RN, FNAP, FAAN

Keywords: Internet; World Wide Web; Infant; NICU

Parents are entering the neonatal intensive care unit (NICU)with more medical information about their baby than everbefore. They continue to actively broaden their knowledgethroughout their infant's hospital stay. On average, up to half ofparents spend 20 hours using the Internet to find informationabout their infant during the first week of hospitalization.1 Fourweeks later, one third of parents are still using the Internet atthis rate to continue to search for information related to theircritically ill newborn.2 Research has shown that these informa-tion-seeking behaviors continue throughout the hospitalizationand into the homecoming period. Health care providers mustacknowledge this growing trend and offer support and guidanceto parents as they navigate through the vast amount ofinformation available on the Internet.

Because parents are entering the health care system withinformation, it is important to ask what they already knowabout the care of infants in the NICU environment. It is alsoimportant to ask what resources were used to gather knowledgeabout their infant. The Internet is full of information that is notalways accurate, and users do not always take this into account.In a study performed in a gastroenterology clinic, only 14% ofpatients were concerned about the quality of their Internetsearch results.3 With these findings, it would be beneficial forhealth care providers to recommend Web sites that provideaccurate information to parents.

In many ways, NICU nurses must care for two sets ofpatients with very different needs—the critically ill infant andthe infant's family. While providing highly specialized nursingcare to the infant, the nurse must also evaluate the parent's

School of Nursing, Virginia Commonwealth University,VA.respondence to Jacqueline M. McGrath, PhD, RN, NNP, FNAP,ool of Nursing, Virginia Commonwealth University, PO Boxchmond, VA 23298. E-mail: jmmcgrath@vcu.edu.sevier Inc. All rights reserved./08/0803-0268$34.00/0/j.nainr.2008.06.013

knowledge about the infant's condition and provide health careinformation in an individualized manner. Researchers havefound that using a pragmatic sequential approach to providingpatient education may best support the synthesis of newinformation.4 By using this “representational approach” duringparent education, nurses can better determine the knowledgebase and any gaps or misconceptions that exist. Only then willnew information be integrated into the parent's currentunderstanding of the health condition of their infant.

The representational approach to patient education is based onthe theory of cognition of illness and the theory of how conceptualchange occurs and can be applied to parent education in theNICU.4 Before any new teaching takes place, the representationalapproach calls for the nurse or other health care provider to elicitthe parent's current knowledge and beliefs. Then together, thenurse and parent explore for any gaps or misconceptions in theknowledge. Once a parent recognizes that his or her knowledgebase is incomplete or flawed, he or she ismore open to conceptualchange. Only at this phase is the parent ready for the nurse toprovide additional information to fill the gaps and begin to rectifythe misconceptions. A summary of the newly introducedinformation provides the nurse the opportunity to discuss howit can be used to improve outcomes in the infant. Therepresentational approach is a fluid approach because the parentmust again return to the new knowledge base and assess for gapsand misconceptions before new information can be added.

Although the nurse strives to incorporate parent teachinginto every interaction, he or she must also realize that parentsseek information on their own. Helping parents to find the bestinformation and communicate regularly with families can be anenormous undertaking. Providing a safe and easy way tofacilitate communication between families and health profes-sionals is important. Internet-based programs created byneonatologists, nurse practitioners, nurses, respiratory thera-pists, social workers, child life specialists, and technologysupport personnel can be found on the World Wide Web. Theyserve a wide variety of functions, including providing parentswith a secure way to communicate with the health care team,allowing parents to receive updates on their infant's condition,

viewing daily photographs, searching topics that relate to theirinfant's medical conditions, learning about how to care for theircritically ill newborn, and learning how to prepare fordischarge. Studies of hospitals using these types of programhave found that parents report a higher level of overallsatisfaction with the care their infant received in the NICU.They also show that reports of problems with quality of caredecreased by 75%.2

Initially, it was thought that such Internet-based programswould not serve all populations (ie, lower vs higher economicstatus) with infants in the NICU. Some thought that if a varietyof social or economic factors existed, it was more important toaddress those through multiple strategies and provide hand-outs, booklets, individualized teaching off the unit, and/or taxivouchers instead of technology-based resources.2 However, thisway of thinking only results in more disparity and does notaddress the issue of the need for all to receive health careinformation in the most up-to-date fashion. Most householdstoday have access to a computer, and computer/Internet accesscan also be made available within the health care setting.

In today's world, most of us are being inundated with anabundance of information each day. Helping families to sift

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through and make sense of this information is important infacilitating their transition to parenthood of a child who hasrequired admission to the NICU. This different beginningmakes these families more vulnerable, and we need to increasetheir confidence and competence in being able to care best fortheir infant. The sooner we help parents to assume this role fortheir child, the better the long-term outcomes for the infantand family.

References1. Brazy JE, Anderson BMH, Becker PT, Becker M. How parents

of premature infants gather information and obtain support.Neonatal Netw. 2001;20:41-48.

2. Safran C. The collaborative edge: patient empowerment forvulnerable populations. Int J Med Inform. 2003;69:185-190.

3. O'Connor JB, Johanson JF. Use of Web for medicalinformation by gastroenterology clinic population. JAMA.2000;284:1962-1964.

4. Donovan HS, Ward SE, Song MK. An update on therepresentational approach to patient education. J NursScholarsh. 2007;39:259-265.

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