Balancing hope with reality: how neonatal nurses manage the uncertainty of caring for extremely premature babies.
OBJECTIVE
This article aims to explore the ways in which neonatal nurses manage the uncertainty associated with the treatment and outcomes of extremely premature babies.


BACKGROUND
Current literature suggests that survival rates of extremely premature babies have increased; however, the incidence of long-term problems has not decreased among survivors. The outcomes can often not be predicted; therefore, there is much uncertainty associated with survival and outcomes. Neonatal nurses care for babies and families during these times of uncertainty. This article will focus on how neonatal nurses manage and survive the challenges associated with uncertainty when caring for extremely premature babies.


METHODS
Qualitative.


METHODS
This article used a series of interviews in a qualitative study informed by phenomenological insights. The analysis of the interview data involved the discovery of thematic statements and the analysis of the emerging themes.


RESULTS
Three themes captured the experience of working with uncertainty from the perspective of the neonatal nurses: 'Everything is fine, then they crash': When the honeymoon is over; '"I don't know which one is going to be fine": it's like a lottery' and 'Balancing hope with reality'.


CONCLUSIONS
Uncertainty had both positive and negative aspects, because while ever there was uncertainty, there was room for hope. While initial uncertainty of the baby's prognosis and outcome gave the nurses hope, certainty of diagnosis and poor outcome could take that hope away.


CONCLUSIONS
Increasing survival of extremely premature babies will see neonatal nurses caring for more babies ≤24 weeks gestation. Prematurity has risks associated with life-sustaining treatments. Uncertainty is a reality of life for these babies, their families and the nursing and medical teams who care for them. It is important to recognise the challenges associated with uncertainty.
Faculty of Health, University of Technology, Sydney, Lindfield, NSW, Australia.
Janet
J
Green
Schools of Nursing & Midwifery, Monash University and Flinders University, Adelaide, SA, Australia.|Philip Darbyshire Consulting Ltd, Highbury, SA, Australia.
Philip
P
Darbyshire
Oxford Brookes University, Oxford, United Kingdom.|University of New England, Armidale, Australia.
Anne
A
Adams
Oxford Brookes University, Oxford, United Kingdom.|University of New England, Armidale, Australia.
Debra
D
Jackson
D000328:Adult; D001315:Australia; D005260:Female; D065026:Hope; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007407:Interviews as Topic; D008297:Male; D017283:Neonatal Nursing; D009723:Nurse-Patient Relations; D011795:Surveys and Questionnaires
extreme prematurity; infant care; neonatal nurses; qualitative approach; uncertainty