Other Important Considerations
Families with Distinct Cultural + Philosophical Expectations
HONORING FAMILIES' BELIEFS
The standardized comprehensive discharge planning process must be individualized to the family. In order to meet the needs of the family, it is important to understand the cultural and philosophical expectations of the family.
Never assume to know a family’s beliefs or values. Even within identified cultural groups there will be important, discernable differences. Therefore, it is imperative to have a culturally-respectful approach that is individualized and informed by the family.
If there are questions about what is and is not culturally-appropriate, ask the family.
This section discusses a few items to take into account when doing discharge planning.
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Ensure discharge education strategies are culturally-appropriate and tailored to meet the specific needs of the family. Supporting the family’s unique cultural philosophy and expectations is always important throughout the family’s stay in the NICU and when planning for discharge.
Confirm that all written materials given to families is written in a manner that is simple, clear, concise, and devoid of medical jargon to aid understanding and decrease confusion.
Be flexible with which caregivers are given the instruction (e.g., in some cultures it is the grandmother, not the mother, who primarily cares for the infant). Have the tenets of diversity inclusion and heath equity inform practice
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Families should define their own support network. There can be cultural differences in parenting and caregiving roles. As part of the family assessment, it is important to ask about roles and expectations because otherwise this information may not be disclosed.
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Some families will be reluctant to have an outsider enter their space. This should be taken into account when making arrangements for services such as visiting nurses or early intervention. Some services can be provided in a community setting (e.g., daycare, school, church, etc.) if the family prefers.​​​​
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Family Belief Systems
Belief systems (e.g., religion, faith, creed, doctrine ,philosophy, spirituality, etc.) shape a family’s medical experience. Ask how the NICU staff can be supportive and respectful of their belief systems.
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Ask the family to share information about their belief systems, including:
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specific cultural circumstances
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religious and/or spiritual grounding
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role of extended family
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role of community, cultural, and spiritual leaders
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any information the family feels is important to understand their unique needs
Document this information in the record.
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Establish an environment that encourages questions and communication. Remember, every family’s NICU experience is unique, and each family may react to trauma differently.
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Designate a specific location in the medical record where relevant information the family shares can be found. This avoids the need for the family to repeatedly communicate information to multiple providers (excluding confidential information shared by a family member). Ask the NICU team members to review this section at the beginning of their shift and/or prior to interacting with the family.
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Family Support People
Confirm with the family who they would like to have as their designated support network.
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Invite and encourage families to include a cultural or community leader to be present for teaching and at important meetings when it is the family’s preference.
IMPORTANT: Do not wait for this request. Ask if this is something the family would like to do up front to support inclusiveness and enhance social support for the family.
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Cultural Practices
Work with the family to incorporate special cultural practices, and adapt them if medically necessary.
Utilize appropriate tools and technology to make these practices accessible and inclusive.
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Community Resources
When making a referral to community resources (e.g., early intervention, visiting nurse program, etc.) confirm with the family where they would like to receive their services. Services may be delivered in many settings, not just at home.
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Identify which community services and resources are available and appropriate for the family within the context of their cultural and philosophical belief systems.
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When indicated, discuss the need for visiting nurse or early intervention indicated services in advance and plan creative options when a family’s beliefs or circumstances do not allow outsiders in their home.
Alternative meeting locations per the family’s request could include, for example, a local clinic, library, day care, mosque, church, temple, cultural center, etc.
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