Stressful Life in NICU: Time to Nurse the Neonatal Nurses.

Abstract

Nurses working in the neonatal intensive care units (NICU) have to provide highly technical care to the sick and often terminally ill neonates. More critical the neonate, more stressful their work becomes. But most NICU nurses understand the roles they play in comforting the babies and their parents, and as such their work often satisfies them personally [1]. Transporting a sick newborn from labour room to the NICU, and providing intensive care is an extremely stressful situation, which can occur multiple times during the duty hours. That is why theymust control their emotional responses, at the same time maintaining a high degree of professionalism [2]. Parents of sick babies are often demanding and desperate, and the nurses must learn to interact with them. Emotional labour adds to the physical labour for nurses working in NICU [3, 4]. Most of the time, they are on their feet, and normally work 12h shifts including rotation through day, night and overnight shifts. In addition, they regularly move machines/equipments within the neonatal unit. Some nurses also take classes in addition, which makes the working hours more hectic. In this issue of the Journal, Amin et al. reported the result of a multicenter, cross-sectional study describing about the perceived stress and professional quality of life in NICUs of nine hospitals of major cities of Gujarat [5]. The authors identified 70.5 % nurses as perceiving moderate to high degree of stress, and the perceived stress correlated with professional quality of life domains. Though the findings of the present study are not entirely new, the study is unique of its kind for the following reasons. First, it was conducted in India where the nurse-patient ratio in the NICUs ranges from 1:3 to 1:25, unlike that of a developed country where the ratio is 1:1, except in special situations. Extrapolating the data from developed countries does not truly project the picture in a developing country setting. Second, the authors included a demographic questionnaire, Perceived Stress Scale 14 (PSS14), and Professional Quality of Life Scale Version 5 (ProQOL5), which are the standard methods to study stress and quality of life. Third, the study involved both the government and private hospitals where the nurse-patient ratio in the NICUs varies to a greater extent (the authors found a ratio of 1:4 to 1:8 in the private setups and 1:25 to 1:35 in government sector). The present study falls into the category of ethnographic research, in which the investigator tries to get embedded in the everyday lives of the study group and interact with the participants in their natural settings. In a NICU setting, this would involve observations of the nurses’ behavior while interactions with babies, families, other nurses, and staff members as well as conduction of interviews with nurses and parents. By doing this, the investigator gets a true picture of the burden of the problem, thereby minimizing the bias in the study. A previous ethnographic study by Cricco-Lizza has shown NICU nurses to experience 3 main sources of stress or emotional labour: (a) caring for the babies – a need for constant vigilance, narrow margin for error with preterm babies, dealing with parental anxiety, emotional attachment to the babies, and multitasking; (b) demand from the employer – fear of making mistakes, shortage of manpower and equipment, dealing with new technology, and hectic duty shifts; (c) personal life – experience of nurses who are mothers being closely tied to how they respond to situations in the NICU, anxiety of pregnant nurses about their unborn children, and emotional * M. Jeeva Sankar jeevasankar@aiims.ac.in