Use of the Newborn Behavioral Observation System to Promote Healthy Relationships Between Parents and Neonates

Abstract

To facilitate understanding of a newborn’s unique “voice,” thus nurturing awareness of newborns’ abilities and stimulating the development of positive relationships with parents and caregivers, starting at birth. Some parents are attuned to their newborn’s cues whereas others seem overwhelmed and unsure of what their newborn’s behavior means. To implement a formal system to help parents identify and respond to their newborn’s needs. A local pediatrician approached staff about the Newborn Behavioral Observation (NBO) system and encouraged us to implement the NBO at our hospital. On the basis of work by the physician T. Berry Brazelton, the NBO was developed as a tool to help parents learn about their infants’ specific behaviors and methods of communicating to promote healthy parent–infant relationships. Staff, including pediatricians, attended a 2-day workshop to learn the theoretical framework, current research on the parent–infant relationship, neurobehavioral development, and strategies to implement the NBO in practice. After implementation began, the nurses videotaped interactions to identify teachable moments and reflect on practice and opportunities for improvement. One of our early barriers was feeling that the NBO was another task, but we quickly became adept at incorporating it into routine care. Follow up included gathering feedback from the parents before discharge and again during a postpartum phone call. Since implementation, we have seen a transformation in parent–newborn relationships. Our qualitative data, elicited through postpartum interviews, reveal that parents were more comfortable and confident when leaving the hospital. Parents verbalized a positive experience and amazement at what their newborn could “say.” Staff members are writing case studies and have become certified in NBO or are in progress of becoming certified. Early and healthy bonding has long-term effects on a newborn’s social and emotional well being. Nurses have the opportunity to facilitate these positive relationships. The NBO system is a valuable addition to care and supports our commitment to relationship-based care. It is a vehicle that empowers parents and allows us to shift the focus from nurse to parent as the expert of their newborn. The NBO should be a standard of care so all families can reap the benefits of improved bonding.