Introduction/ Rationale: The Neonatal Intensive Care Unit (NICU) is a liminal space characterized by challenges in parent-infant co-occupational engagement, amplified by uncertain infant prognosis and outcomes. Certified neonatal therapists (CNTs) support parent-infant engagement, including co-occupations for families of terminally ill infants. Co-occupations during this stage may take on significant meaning given the time families and terminally ill infants have together.
Objectives: This study aims to document CNT perspectives on co-occupations between parents and infants receiving end-of-life care.
Methods/ Approach: Two rounds of semi-structured narrative interviews were conducted online with 12 CNTs practicing in Level III or IV NICUS in the United States. Interviews were recorded, transcribed, and coded in Dedoose using narrative and thematic analysis.
Results/ Practice Implications: Therapists reported differing approaches to the facilitation of co-occupation for families of infants receiving palliative care. For example, NICU rules and regulations were relaxed at times to allow for extended visitation, certain activities were encouraged to promote bonding and memory-making, and care tasks were tailored to meet family needs and cultural practices. Neonatal therapists described their skills in providing family-centered interventions to facilitate parent-infant bonding and attachment and reflexivity in evaluating practice strategies for families of infants at the end of life, noting complex emotions during this time.
Conclusion/ Contribution to the occupational therapy profession: Neonatal therapy for infants receiving palliative care remains an area of practice where limited training and resources for clinicians exist. Occupational therapists working in the NICU may benefit from the shared knowledge and perspectives of seasoned clinicians with experience in providing neonatal therapy during end-of-life care.