Parents will interact with a multitude of teams from various disciplines during their child's admission to the neonatal intensive care unit. Recognition of the emotional stressors experienced by these parents is a first step in working to provide the crucial support and parenting skills needed for bonding and caring for their infant from admission through discharge and beyond. Family-centered care involves time-sensitive two-way communication between parents and the multidisciplinary team members who coordinate care transition by providing emotional, educational, medical and home visitor support for these families. To do this well, a thoughtful exchange of information between team members and parents is essential to identify psychosocial stress and ameliorate family concerns. Parents will need emotional and educational support and follow-up resources. Establishing individualized, flexible but realistic, pre- and post-discharge plans with parents is needed to start their healthy transition to home and community.

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The maltreated-maltreating cycle is the most striking example of the psychodynamic notion that early relationship experiences are carried forward and reenacted in subsequent relationships. Bowlby's attachment theory proposes that transmission of patterns of relating across generations, including maltreatment, is mediated by an individual's internal working models. Recent research that operationalizes working models in infants and in adults provides preliminary support for the congruence of working models across generations. Results from these investigations suggest that the maltreated-maltreating cycle should be redefined. Instead of specific types of maltreatment, an organizing theme of the parent-child relationship and an associated internal working model that provides a way of experiencing that theme are transmitted and later reenacted. In this paper, preliminary data implicating rejection, role-reversal and fear as themes organizing maltreating relationships are reviewed and directions for further research are discussed.

Nurses working in the Nurse Family Partnership (NFP) program provide intensive home-visitation services for first-time, low-income mothers. The goals are to improve maternal health outcomes, child health and development outcomes, and to enhance maternal life-course development; however, many of the families face significant psychosocial and mental health issues that can impede progress achieving their goals. Because of the importance of the nurse-client relationship in achieving positive outcomes, these non-mental-health nurses must shift their approaches and techniques from a medical to a psychosocial model. In this article, we examine the role of the nurse in the NFP and present results of focus groups with experienced NFP nurses regarding their perspectives, challenges, and rewards in conducting this work.

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