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Updated: Dec 25, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Parents' Perspectives: An Expanded View of Occupational and Co-Occupational Performance in the Neonatal Intensive
1Ashlea D. Cardin, OTD, OTR/L, BCP, CNT, is Assistant Professor, Occupational Therapy Department, Missouri State University, Springfield; ashleacardin@missouristate.edu.
Insights
Parents in the neonatal intensive care unit (NICU) engage in observable and hidden occupations, balancing caregiving roles and expressing their being and becoming. Occupational therapists can support these unique parent and infant occupations.
Area of Science:
- Occupational Therapy
- Neonatal Care
- Parent-Infant Interaction
Background:
- Occupation-based practice in neonatal settings lacks clear definitions of parent and infant occupations.
- This ambiguity may limit occupational therapists' recognition and valuation of these roles.
Purpose of the Study:
- To explore occupational and co-occupational performance concepts within the neonatal intensive care unit (NICU).
- To provide detailed descriptions of parent and infant occupations in the NICU setting.
Main Methods:
- A phenomenological study utilizing semistructured interviews with 14 parents.
- Inductive content analysis, in vivo coding, and cross-case analysis were employed.
- Authenticity was ensured through member checking and expert review.
Main Results:
- Five themes of active occupational engagement emerged: perceiving "they" versus "I," maintaining proximity, expressing emotions/values/beliefs, addressing health issues, and analyzing.
- A matrix framework detailed parent, infant, and co-occupations, including both observable and hidden activities.
- Occupational performance reflected efforts to balance power and engage meaningfully in caregiving.
Conclusions:
- Parental occupations in the NICU involve balancing power and pursuing meaningful engagement through visible and hidden caregiving.
- Neonatal therapists can address parents' "doing," "being," and "becoming" occupations beyond typical caregiving tasks.
- Findings support strengthening the occupational focus in neonatal interventions and may necessitate policy advocacy.
Importance:
One limitation of occupation-based neonatal practice is the lack of clarity surrounding what parent and infant occupations exist in the neonatal intensive care unit (NICU). Without clear definitions and examples of these constructs, occupational therapists may not recognize or value them as part of practice.
Objective:
To explore concepts of occupational and co-occupational performance in the NICU and provide richly expanded descriptions of parent and infant occupations in this setting.
Design:
Phenomenological study with convenience sampling. Participants engaged in semistructured interviews. Inductive content analysis, in vivo and process coding methods, and cross-case analysis were used. Member checking and expert review of emergent themes were used to ensure authenticity.
Setting:
A metropolitan 48-bed Level 3 NICU with single-family rooms in the midwestern United States.
Participants:
Fourteen parents (mean age = 29.7 yr; range = 19-37 yr) volunteered for the study.
Results:
Five themes of active occupational engagement emerged: (1) perceiving "they" versus "I"; (2) maintaining proximity; (3) expressing emotions, values, and beliefs; (4) addressing health issues; and (5) analyzing. A matrix framework displayed emergent themes with definitions of parent occupations, infant occupations, and parent-infant co-occupations. Examples of both directly observable and hidden occupations were found at matrix intersections.
Conclusions And Relevance:
Occupational performance prevalently reflected attempts to balance power differentials and pursue meaningful engagement through observable and hidden participation in caregiving. Findings suggest that beyond typical occupations (e.g., feeding, socializing), neonatal therapists can address the doing, being, and becoming occupations expressed by parents in this study.
What This Article Adds:
Parents described five broad thematic categories of NICU-based occupation and co-occupation, which may be valuable to therapists seeking to strengthen the occupational focus of neonatal intervention. Neonatal therapists may need to advocate for service provision policy change to fully address the observable and nonobservable doing, being, and becoming occupational and co-occupational needs of parents and infants.
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