Building relationships with families in the NICU: exploring the guarded alliance.

Extremely low-birthweight infants and their families experience prolonged hospitalization in the newborn intensive care unit (NICU). Prolonged hospitalization is particularly stressful for the family, leading to distress in most aspects of their lives, including separation of parents from each other and from other family members, a need for increased psychological support, and increased economic concerns. Based on these characteristics, these families appear to have needs more similar to that of families caring for chronically ill members. Indeed, this initial hospitalization may be the prelude to coping and surviving with a chronic illness for many of these children and families. This article proposes the adaption of "guarded alliance" as a framework for developing relationships and providing care to families in the NICU. This framework was derived from research with families of the chronically ill. Supportive research is used to justify the adoption of this framework for interactions with families in the NICU. In addition, linkages to family-centered care principles in critical care settings are also discussed.