“CARING FOR BABIES AND THEIR FAMILIES: PROVIDING PSYCHOSOCIAL SUPPORT IN THE NICU”: AN INNOVATIVE ONLINE EDUCATIONAL TOOL TO EMPOWER NEONATAL NURSES TO SUPPORT NICU FAMILIES
Parents whose newborns are hospitalized in the neonatal intensive care unit (NICU) nearly always experience stress. These parents have a higher prevalence of both postpartum depression (PPD) and posttraumatic stress disorder (PTSD) than new parents of infants born healthy, related in part to their perceptions of their experiences surrounding the birth of their infant or their NICU experiences that are traumatic. Prevalence of PPD among NICU mothers is 25% to 63%1,2 and for NICU fathers, approximately 36%,3 while rates of PTSD among NICU parents have been reported as 15% to 53% for mothers and 8% to 33% for fathers.4,5
A comprehensive evidence-based program is now available to empower neonatal nurses to support NICU families. The program is designed to psychosocially minimize the occurrence of both PPD and PTSD, and to optimize infant and family outcomes. This online continuing education (CE) program is entitled “Caring for Babies and Their Families: Providing Psychosocial Support in the NICU,” and it represents an exemplar for interprofessional collaboration in which family and other stakeholders improve education for neonatal health professionals, and ultimately the care in neonatal settings.6
My NICU Network was launched in January, 2018, with a mission of becoming the preeminent provider of compelling perinatal education on psychosocial support created with interprofessional collaboration. My NICU Network was recently expanded to become My NICU Network-My Perinatal Network (MNN-MPN), and is a collaborative endeavor between the National Perinatal Association7 and the NICU Parent Network.8 The goal is to provide online evidence-based education and “hands-on” bedside tools to empower healthcare staff working with mothers and infants. The focus of the education is to strengthen the critical parent–infant bonds and family functioning, and to improve developmental outcomes in the infant and mental health outcomes in their parents.
The 3 key guiding principles of course development are: (1) supporting NICU parents is equally as important to providing medical care to their baby; (2) healthcare staff must also be emotionally supported, so that they will have the emotional capacity to support the patients and parents in their care; and (3) interprofessional collaboration models are the foundation to fully realize family-centered care. These principles have been central to program development from inception to conclusion of this project. Stakeholders who are recipients of care (NICU parent leaders) collaborated every step of the way in designing and implementing these educational programs. The courses are rich with parent stories, audio clips, and videos that illustrate learning points. Parents helped to create the courses, conducted the surveys from which parent stories have been gleaned; contributed resources including web links and downloads to be available for the learners who take the course; have been instrumental in the development of the course's trauma-informed care scripts. There are examples of what providers should not say to parents, how the parent interprets what the provider has said, and what is a better way to communicate the idea based on principles of trauma-informed care.9 Other parents have reviewed and provided feedback, which was used to refine the course content. All of this parental input has been the key to success of the program, as parents' testimonials bring the evidence from the literature to life. As one nurse stated after taking the program: “It was very eye opening to see things through the eyes of the parents.” Few educational programs exist that include NICU parent leaders at every level from content development to content delivery, making this a truly unique and comprehensive educational experience.
All of the educational programs of MNN-MPN are based on principles of trauma-informed care, and NICU programs are based on the “Interdisciplinary Recommendations for Psychosocial Support of NICU Parents.”10 All are also available for CE credits. A study has demonstrated the efficacy of the initial learning program to improve nurses' knowledge and attitudes toward providing psychosocial care.11 The program consists of 7 courses including: communication skills, providing emotional support, peer-to-peer support, family-centered developmental care, palliative and bereavement care, discharge planning and follow-up, and caring for the caregiver (staff support).
To date, over 700 NICU staff have completed the program, including the majority of nursing staff in 14 NICUs across the country. The goal for an entire NICU staff completing the program together is to transform the culture in the NICU to become more family-centered, and to mitigate long-term parental emotional complications such as PPD and PTSD. A condensed version of this program, called the Advanced NICU Provider Program, offers 2 CE credits for neonatologists and neonatal nurse practitioners. In mid-2020, 2 additional programs will be launched:
- “Caring for Pregnant Patients and Their Families: Providing Psychosocial Support During Pregnancy, Labor and Delivery” (for maternity care staff), and
- “Giving Birth During the Coronavirus Pandemic: Using Trauma-informed Care to Support Patients, Their Families, and Staff Through This Crisis” (for both NICU and maternity care staff).
NICU parents need, desire, and benefit from the emotional support from the nurses. Nursing interventions may mitigate the evolution of parents' typically expected distress upon entering the NICU, preventing it from developing into full-blown depression or PTSD. Neonatal nurses who are at the bedside daily form more intimate relationships with infants and their families than other health professionals and are in a position to make a positive impact when well-equipped with strategies to address their complex psychosocial needs. NICU families value nurses; one study reported how the quality of relationship parents have with the nurses supported parental ability to cope and bond with their infants in the NICU.12
One of the most critical goals for neonatal nurses is to improve the parent–infant bond in NICU to optimize families' mental health/resilience, so that they can emerge as the empowered, confident, and knowledgeable advocates for their fragile infants who can achieve optimal development. Utilizing an innovative educational model, created through involvement of family stakeholders, can give nurses the tools they need to achieve this very important goal for the families in their care. For more information, please visit www.mynicunetwork.com or www.myperinatalnetwork.org.
1. Segre LS, McCabe JE, Chuffo-Siewert R, O'Hara MD. Depression and anxiety symptoms in mothers of newborns on the neonatal intensive care unit. Nurs Res. 2014;63(5):320–332. doi:10.1097/NNR.0000000000000039.
2. Miles SM, Holditch-Davis D, Schwartz TA, Scher M. Depressive symptoms in mothers of prematurely born infants. J Dev Behav Pediatr. 2007;28(1):36–44.
3. Mackley AB, Locke RG, Speak ML, Joseph R. Forgotten parent: NICU paternal emotional response. Adv Neonatal Care. 2010;10(4):200–203.
4. Holditch-Davis D, Bartlett TR, Blickman AL, Miles MS. Posttraumatic stress symptoms in mothers of premature infants. J Obstet Gynecol Neonatal Nurs. 2003;32:161–171.
5. Shaw RJ, Bernard RS, Deblois T, Ikuta LM, Ginzburg K, Koopman C. The relationship between acute stress disorder and posttraumatic stress disorder in the neonatal intensive care unit. Psychosomatics. 2009;50:131–137.
6. Dahan S, Bourque CJ, Reichherzer M, et al. Beyond a seat at the table: the added value of family stakeholders to improve care, research, and education in neonatology. J Pediatr. 2019;207:123–129.e2. doi:10.1016/j.jpeds.2018.11.051.
7. National Perinatal Association home page. http://www.nationalperinatal.org/
Accessed May 4, 2020.
8. NICU Parent Network. Who Are We? https://nicuparentnetwork.org/
Accessed April 30, 2020.
9. Sanders MR, Hall SL. Trauma-informed care in the newborn intensive care unit: promoting safety, security and connectedness. J Perinatol. 2018;38(1):3–10. doi:10.1038/jp.2017.124.
10. Hall S, Hynan M. Interdisciplinary recommendations for the psychosocial support of NICU parents. J Perinatol. 2015;35(suppl 1):S1–S4.
11. Hall SL, Famuyide ME, Saxton SN, et al. Improving staff knowledge and attitudes toward providing psychosocial support to NICU parents through an online education course. Adv Neonatal Care. 2019;19:490–499.
12. Guillaume S, Michelin N, Amrani E, et al. Parents' expectations of staff in the early bonding process with their premature babies in the intensive care setting: a qualitative multicenter study with 60 parents. BMC Pediatr. 2013;13:18.