Extraordinarily Ordinary Moments of Co-Occupation in a Neonatal Intensive Care Unit

Abstract

For occupational therapists working in neonatal intensive care units, the tenuousness of life is part of ordinary daily experience. However, for parents, having a premature infant must feel like a break from their expectations of having a healthy infant and an ordinary family life. Occupational therapists provide opportunities for co-occupation that promote the development of the family and support parents by providing the knowledge that family life is still possible even if the infant has severe disabilities. This article will illustrate how one occupational therapist facilitated extraordinarily ordinary moments of becoming a family for a mother and premature infant through negotiating the meaning of parenting and parenting co-occupations and providing opportunities for parenting co-occupations, which are both important aspects of occupation-based practice implemented in the neonatal intensive care unit.

Mother becoming: Learning to read Mikala's signs

“…The findings presented in this study stem from a continuation study (13,14,16) that examines how occupation and occupation-based practices emerge in the practices of peer-nominated, experienced occupational therapists. This study combines interviews with Erin and Carmen and observations of their therapy process with Mikala in order to reveal both of their reflections on and interpretations of the therapy actions and interactions that occurred between them.…”

“…Erin did not ask Carmen a lot of questions about their culture or their family life and routines, yet Erin seemed to glean this information from observing and interacting with Carmen and Mikala. As the interpretation will illustrate, Erin tacitly tacked between procedural reasoning (31) and narrative reasoning (14,16,18,22). She employed procedural reasoning when she fostered Carmen's acquisition of competence by systematically teaching her how to feed Mikala given Mikala's functional problems.…”

“…Erin felt that Carmen needed to develop an appreciation for who Mikala was becoming and needed to become an expert in knowing Mikala in order to make medical decisions for her in the future. As a result, Erin employed two main strategies with Carmen: (1) systematically teaching her to feed Mikala, and (2) helping them to attach through meaningful experiences and narrative storytelling (14,16,18,20,21) about who they were becoming as a family. Prior to examining the observational sessions in depth, the following sections describe these strategies in detail.…”

“…As Carmen and Mikala learned to read and respond to each other's signs, they developed a foundation for the Mikala to enter family life. Generic feeding became occupation as it became imbued with personal meaning (13,14,16,18). Carmen engaged in a learning process with Erin that enabled her to acquire competence in managing and advocating for Mikala's biomedical and disability issues as well as develop mutual affection with Mikala and confidence in parenting her.…”

“…This article will describe the therapy process between Erin, a NICU therapist, and Carmen and her infant, Mikala (all pseudonyms), to help them become a family. The interpretations in this article are derived from an ongoing study (13,14,16) of occupational therapists who are nominated as and self-espoused to practice from an occupation-based perspective. Erin worked in a tertiary NICU of a large, metropolitan hospital with children who were teetering between living and dying, requiring her to use hands-on approaches to teach parents to competently perform parenting co-occupations (11,12).…”