The simple belief that “family-centered care” in the NICU means that the family will be present at the bedside while staff makes decisions and provides care doesn’t go nearly far enough in meeting families’ needs. In the model of the Neonatal Intensive Parenting Unit (Hall, 2017), parents are recognized as partners in their baby’s care and respected members of the care team. Their input is welcomed. Caregivers become coaches and mentors who encourage parents to assume active roles; care and decision-making become collaborative.
Providing this kind of comprehensive family support in the NICU means giving families the emotional support and education they need to fully understand their baby’s condition, development, and care. The goal of this comprehensive support is to help establish and cement parent/baby bonding, which is easily and all too often disrupted when a baby is admitted to the NICU. Facilitating and encouraging this bonding will give both baby and family the greatest chance to enjoy the best possible outcomes.
Providing emotional support to parents while caring for their baby is challenging for many NICU caregivers—and NICU parents are not always satisfied with their attempts. (Weiss, 2010) After all, doctors and nurses don’t receive much, if any, education on how to handle difficult conversations with families, how to recognize signs of serious parental distress, and how to help parents get beyond the anxiety created by the trauma of having a premature or sick newborn.
Moving beyond the “medical model” in which the focus is on the patient—the fragile and sick baby—and expanding care toward the family as a whole requires a shift in our thinking and our caregiving practices.
Parents view communication with staff as a key factor in their ability to manage their situation (Wigert, 2013; 2014). Communication is also a primary element when parents assess their satisfaction with the NICU experience, regardless of how they perceived their baby’s medical care and outcome.
One way of providing emotional support to parents is through clear, attentive, and empathetic communication that signals respect for their feelings and wishes. Not only does poor communication create parental dissatisfaction and stress, it also contributes to increased medico-legal risk for providers as well as burnout. (Orzalesi) Intensive caregiving is inherently stressful, putting those of us who work in the NICU at high risk for burnout and compassion fatigue. (Profit) Increasing communication with families in ways that resonate with them benefits not only the family, but also the caregiver. Communication training for NICU staff has been widely recommended for all these reasons. (Hall, 2015)
In addition to clear communication, family education is a critical component of providing support to parents and families. It is crucial that parents receive information to help them understand not only their baby’s condition, but also their own feelings and reactions to the NICU experience. Numerous studies demonstrated that helping parents understand their premature babies’ cues, helping them process their traumatic birth experience, and engaging them actively in their baby’s care not only increases their confidence and competence, but also lessens signs of depression and anxiety. (Craig, 2015)
Parents should have access to proven, well-researched, and relatable educational resources that introduce them to the NICU; explain all the terms, staff roles, and equipment; describe a variety of conditions seen in newborns; and impart information on important topics such as breastfeeding, kangaroo care, and preparing for discharge. Family resources that include peer-to-peer sharing and storytelling can be a vital tool to help quiet parental fears as they navigate this seemingly isolating experience.
To improve babies’ developmental outcomes as well as parents’ mental health outcomes, it is critical for NICU staff to know how to engage with and guide families as they grow into their parental roles. This means NICU staff need access to educational resources that can extend their ways of reaching and teaching parents. To find out more about two offerings that provide a complete solution to the challenge of providing comprehensive family support and education, click on this link.
- Weiss, S, E Goldlust, and YE Vaucher. 2010. “Improving Parent Satisfaction: An Intervention to Increase Neonatal Parent-Provider Communication.” Journal of Perinatology 30 (6):425–30. https://doi.org/10.1038/jp.2009.163.
- Hall, SL, MT Hynan, R Phillips, S Lassen, JW Craig, E Goyer, R Hatfield, and H Cohen. 2017. “The Neonatal Intensive Parenting Unit (NIPU): An Introduction.” Journal of Perinatology, epub ahead of print. https://doi.org/doi: 10.1038/jp.2017.108.
- Wigert, H, MD Blom, and K Bry. 2014. “Parents Experiences of Communication with Neonatal Intensive Care Unit Staff: An Interview Study.” BMC Pediatrics 14 (1):304. http://www.biomedcentral.com/1471-2431/14/304.
- Wigert, H, MB Dellenmark, and K Bry. 2013. “Strengths and Weaknesses of Parent-Staff Communication in the NICU: A Survey Assessment.” BMC Pediatrics 13:71. http://www.biomedcentral.com/1471-2431/13/71.
- Orzalesi, M., and L. Aite. 2011. “Communication with Parents in Neonatal Intensive Care.” The Journal of Maternal-Fetal and Neonatal Medicine 24 (1):135–37. https://doi.org/doi:10.3109/14767058.2011.607682.
- Profit, J, PJ Sharek, AB Amspoker, MA Kowalkowski, CC Nisbet, EJ Thomas, et al. 2014. “Burnout in the NICU Setting and Its Relation to Safety Culture.” British Medical Journal of Quality and Safety 10:806–13. https://doi.org/10.1136/bmjqs-2014-002831.
- Hall, SL, J Cross, NW Selix, C Patterson, L Segre, R Chuffo-Siewert, PA Geller, and ML Martin. 2015. “Recommendations for Enhancing Psychosocial Support of NICU Parents through Staff Education and Support.” Journal of Perinatology 35:S29–36. https://doi.org/10.1038/jp.2015.147.
- Craig, JW, C Glick, R Phillips, SL Hall, J Smith, and J Browne. 2015. “Recommendations for Involving the Family in Developmental Care of the NICU Baby.” Journal of Perinatology 35:S5–8. https://doi.org/10.1038/jp.2015.142.