Parents In Neonatal Intensive Care Unit Research Articles

Parent Protector: Perceptions of NICU-to-Home Transition Readiness for NICU Parents of Black Preterm Infant.

Black infants have twice the incidence of infant mortality (IM), death before the first birthday, and preterm birth in comparison to other US racial/ethnic groups; these factors make Black infants a high-risk group. The literature on the factors impacting caregivers and home environments for these infants is sparse. The purpose of this descriptive qualitative study was to explore perceived parental readiness to care for their Black preterm infants at home after discharge from a neonatal intensive care unit (NICU). Ten NICU parents of Black preterm infants completed a structured interview and self-report questionnaires before hospital discharge; data were analyzed using descriptive and semantic content methods. Coded parent responses were categorized as Parent Protector of Infants' Health (n = 94, 29.2%); Hindrances to Parental Readiness for Transition to Home (n = 97, 30.1%), and Parent as Partner in NICU to Home Transition (n = 131, 40.6%). All parents rated themselves "confident" (n = 6) or "very confident" (n = 4) in their ability to care for their infant after NICU discharge. Partnership with the healthcare team was described as involving health information resources, effective communication, and, most importantly, support for the parental role as infant protector for transition to home for their high-risk infant after NICU discharge.

Parent Protector: Perceptions of NICU-to-Home Transition Readiness for NICU Parents of Black Preterm Infant.

Black infants have twice the incidence of infant mortality (IM), death before the first birthday, and preterm birth in comparison to other US racial/ethnic groups; these factors make Black infants a high-risk group. The literature on the factors impacting caregivers and home environments for these infants is sparse. The purpose of this descriptive qualitative study was to explore perceived parental readiness to care for their Black preterm infants at home after discharge from a neonatal intensive care unit (NICU). Ten NICU parents of Black preterm infants completed a structured interview and self-report questionnaires before hospital discharge; data were analyzed using descriptive and semantic content methods. Coded parent responses were categorized as Parent Protector of Infants' Health (n = 94, 29.2%); Hindrances to Parental Readiness for Transition to Home (n = 97, 30.1%), and Parent as Partner in NICU to Home Transition (n = 131, 40.6%). All parents rated themselves "confident" (n = 6) or "very confident" (n = 4) in their ability to care for their infant after NICU discharge. Partnership with the healthcare team was described as involving health information resources, effective communication, and, most importantly, support for the parental role as infant protector for transition to home for their high-risk infant after NICU discharge.

Improving safe sleep practices in an urban inpatient newborn nursery and neonatal intensive care unit.

To improve safe sleep compliance in a newborn nursery (NN) and neonatal intensive care unit (NICU) to >80% in 1 year. Prospective quality improvement study of infants admitted to a NN and NICU. Interventions were targeted at parent education, staff education, and system processes. Compliance with safe sleep improved to >80% in both units. Tracking of process measures revealed NICU parents received safe sleep education 98-100% of the time. No change was observed in the balancing measures. Transfers from the NN to the NICU for temperature instability did not increase. Parent satisfaction with discharge preparedness did not change (98.2% prior to and 99.6% after). We achieved improved compliance with safe sleep practices in our NN and NICU through education of staff and parents and improved system processes. We believe this will translate to improved safe sleep practices used by parents at home.

Caring for our caretakers: building resiliency in NICU parents and staff.

The neonatal intensive care unit (NICU) is a high-acuity, stressful unit for both parents and staff. Up to 50% of mothers and partners experience emotional distress (i.e., depression, anxiety, or posttraumatic stress) during NICU hospitalization and 30–60% continue to experience distress after discharge. Similarly, up to 50% of NICU staff report burnout and emotional distress. Although healthcare providers have developed interdisciplinary guidelines to enhance psychosocial resources for parents and staff, standardized psychosocial services are lacking. The purpose of this short communication is to describe: (1) the need for psychosocial interventions for NICU parents and staff; (2) existent psychosocial programs and their gaps and limitations; and (3) future directions for psychosocial care in NICU settings. We reviewed the current literature and propose a new conceptual model to inform psychosocial interventions for the NICU. We argue that brief, evidence-based, resiliency, and relationship-based programs are needed to enhance parent and staff outcomes and, ultimately, child development and the NICU unit culture.Conclusion: Given the lack of standardized psychosocial care, new interventions for NICU families and staff are needed more than ever. Resiliency, relationship-based interventions that leverage multidisciplinary support may be an innovative way to enhance NICU outcomes and care. What is Known:• 40-50% of parents in the NICU report elevated emotional distress and 30-50% of staff report burnout.• Psychosocial interventions for parents and staff are needed, yet lacking.What is New:• Interventions that focus on resiliency and relationships may improve the culture of the NICU.• New multidisciplinary collaborations and approaches are needed to improve implementation.

Technology and mental health among NICU parents during the COVID-19 pandemic

Parents of neonates in the Neonatal Intensive Care Unit (NICU) experience many mental health stressors. The COVID-19 pandemic exacerbated these stressors, as pandemic-related restrictions created barriers to resources and newborn bonding. Modern technology offers tools that can help NICU parents maintain their mental and social health remotely. We conducted a cross-sectional study to assess self-reported mental health and technology use among parents of infants hospitalized in the NICU at a single institution during the COVID-19 pandemic. We also studied the prevalence of specific COVID-19-related stressors among participants. Participants were asked to rank a series of statements on a Likert scale to describe their mental health, technology use, and COVID-19-related stress. Spearman rank coefficients were calculated to measure strength and direction of associations. A sample of 47 participants completed the voluntary assessment. Mental health was negatively associated with higher COVID-19-related stress (rs-0.40, p=.015). The most prevalent COVID-19-related stressor was hospital visitation restriction, which 31.9% of participants assigned the highest severity stress score. Higher COVID-19-related stress was associated with the use of text and video chat for social support [(rs 0.35, p .016)and ( rs 0.33 p=.025) respectively]. Further, we found that greater enjoyment of technology use and greater access to technology were both positively associated with higher mental health scores [(rs 0.42, p=.003) and (rs 0.38, p=.009), respectively]. Our findings support the value of technology for individuals impacted by the stress of having a newborn who is hospitalized during a global health crisis. Evidence showing clinical benefits of technology supports the expansion of patient access and incentivizing funding for hospital programs, especially as we continue to navigate the COVID-19 pandemic.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Community, Hope, and Resilience: Parental Perspectives on Peer Support in Neonatology

To describe the perspective of parents who participated in peer-to-peer support meetings with parents of children in a neonatal intensive care unit (NICU) and veteran resource parents with previous NICU experience. During a longitudinal evaluation in a tertiary care NICU, participating parents were asked to evaluate meetings; with open-ended questions, they were asked about their perspectives. Results were analyzed using mixed methods. Forty-five NICU parents participated over a 10-week study period. They were followed longitudinally after attending at least 1 of the 10 meetings offered; 95% of parents (43 of 45) reported that the meeting was useful to them and gave an overall evaluation of 8.7 out of 10 (average). For each meeting, all the subjects on the checklist of the moderators (veteran resource parents) were discussed with new parents. When describing why and how the meetings were useful to them in their answers to open-ended questions, NICU parents reported 3 major themes: (1) decreasing isolation and being a community (73%), (2) hope and resilience (63%), and (3) getting practical "parent" information (32%). Sharing stories with parents who also had experienced loss, sadness, and grief, NICU parents trusted that it was possible to adapt and thrive. The meetings normalized parents' emotions (92%), decreased negative emotions (eg, anger, sadness, guilt), empowered them in their parental role, and helped them communicate with loved ones and providers. Peer support meetings are a unique and useful means to support parents. Future investigations will investigate whether and how this type of intervention can improve clinical outcomes.

The Effect of Music Therapy on Perceived Parental Stress in Perinatal Care: An Exploratory Study

Abstract The perinatal experience contains many stressors that can impact parental mental health. We examined the integration of music therapy (MT), an evidence-based health profession, and its stress reduction role in parents during their inpatient maternity and neonatal intensive care unit (NICU) experience. The Perceived Stress Scale (PSS) and Stress Numeric Rating Scale (SNRS-11) were used to measure stress reduction in 34 maternity and NICU parents (17 maternity patients and 17 NICU parents). Participants included parents on the antepartum unit (expecting parents on bedrest), laboring parents, pre-operation parents before cesarean delivery, parents of full-term healthy infants on the postpartum unit, and parents of premature infants on the NICU. Results were calculated based upon number of sessions rather than total number of participants and indicated that after one MT session, a 50% reduction in the SNRS-11 was measured in NICU and antepartum parents. The PSS score demonstrated a more modest stress reduction in the NICU parents but failed to achieve a statistically significant decrease in the maternity group. Findings were in line with existing literature in MT-associated stress reduction levels and may be integrated as part of an ongoing continuity of care during pregnancy, delivery, and NICU hospitalization. Earlier screening for stress may benefit parents during their perinatal hospital stay. Further research exploring the benefits of MT, as part of continuum of care and stress management for the inpatient perinatal parent population, may encourage the inclusion of MT services and improve quality of care.

Neonatal Nurses' Report of Family-Centered Care Resources and Practices.

A paucity of studies describes the prevalence of family-centered care (FCC) practices and resources in US neonatal units. To identify US prevalence of FCC practices and resources and to identify the largest gaps in resource provision. Neonatal nurses completed an online survey through national conferences (eg, NANN educational conference), neonatal organization Web sites (eg, NANN research survey), and social media (eg, NANN and NPA Facebook). Nurses provided demographics and the National Perinatal Association Self-Assessment on Comprehensive Family Support, a 61-item checklist of FCC practices and resources from 6 categories: family-centered developmental care, staff education/support, peer support, palliative care, discharge education, and mental health support. Nurses (n = 103) reported lowest resources for Peer Support and Mental Health Support. About a third had a neonatal intensive care unit parent advisory committee (n = 39; 37.9%). Only 43.7% (n = 45) had necessary amenities for families to stay with their infants. Less than a third felt that mental health professionals were adequately staffed to provide counseling to parents (n = 28; 27.5%). Very few nurses had adequate training on providing parents psychological support (n = 16; 15.8%). More than half (n = 58; 56.3%) stated that all staff receive training in family-centered developmental care. Finally, less than half (n = 42; 40.8%) stated that staff see parents as equal members of the care team. We demonstrate a consistent and widespread lack of training provided to neonatal staff in nearly every aspect of comprehensive FCC support. Researchers need to identify unit/organizational interventions that increase adoption and implementation of FCC practices and resources.

The Needs of NICU Fathers in Their Own Words: A Qualitative Descriptive Study.

Neonatal intensive care unit (NICU) nurses need a better understanding of fathers' needs and perceptions in order to provide more family holistic care. Previous research aimed at exploring fathers' experiences in the NICU resulted in identifying some needs; however, these studies mostly occurred outside the United States where practices may differ. Therefore, research is needed to explore NICU fathers' needs within the United States. The purpose of this study was to explore the needs of fathers who previously had a premature infant in the NICU. This qualitative descriptive study used semistructured interviews collected to obtain in-depth knowl-edge of fathers' needs in the NICU. Twenty-eight fathers were recruited through 3 parent support organizations: Hand to Hold, NICU Parent Support Network, and March of Dimes. Results revealed 3 themes: need for support, clarity and to be recognized. Fathers have specific needs in the NICU that need to be addressed and that may differ from mothers. Awareness of addressing fathers' needs promotes more holistic care to fathers, supports coping within the NICU environment and the multifaceted impact of the experience, and helps them engage in the care of their infant. Further research is needed to explore the needs of fathers from diverse backgrounds and those who perceive to be or are less involved in their infant's care as well as their experiences and needs related to the recent COVID-19 pandemic. Comparative research is also needed to identify differences between mothers' and fathers' needs in order to determine interventions that promoting more holistic, family-centered care.

Protecting the infant-parent relationship: special emphasis on perinatal mood and anxiety disorder screening and treatment in neonatal intensive care unit parents.

Perinatal mood and anxiety disorders (PMADs) are common, particularly among parents of infants requiring admission to the neonatal intensive care unit (NICU), yet remain underdiagnosed and undertreated. Undertreated parental mental health disorders can interfere with healthy infant development, compounding abnormal neurodevelopment and psychosocial development that preterm or ill newborns may already face. Interdisciplinary efforts to increase PMAD awareness, screening, and referral uptake may improve family-infant health and developmental outcomes in high-risk infants requiring NICU admission. Therefore, special emphasis on PMAD screening and treatment in NICU parents aligns with the American Academy of Pediatrics mission and should be a focus in neonatal care and included in education, quality improvement, and outcome-based research initiatives.

The Effect of Supportive Nursing Interventions on Reducing Stress Levels of Mothers of Infants in the Neonatal Intensive Care Unit: A Randomized Controlled Trial.

The purpose of this study was to determine the effects of supportive interventions on the stress levels of mothers with infants hospitalized in the Neonatal Intensive Care Unit (NICU). This study was a prospective, pre-and post-test randomized controlled trial. The research was completed with 85 mothers in two groups of 45 subjects and 40 controls selected at random. Data collection used the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), NICU Parent Belief Scale (NICU:PBS), State-Trait Anxiety Inventory (STAI TX-2) and saliva cortisol analysis. There were statistically significant differences in favor of the experiment group for the PSS:NICU images and sounds subscale and PBS total points after supportive interventions (p < .05). Supportive nursing interventions were effective in reducing stress related to the intensive care environment, anxiety levels and saliva cortisol levels and increasing parental belief among mothers.

Psychological Wellbeing of Parents with Infants Admitted to the Neonatal Intensive Care Unit during SARS-CoV-2 Pandemic.

The current SARS-CoV-2 disease (COVID-19) pandemic is a sudden major stressor superimposed on pre-existing high distress in parents of infants admitted to the neonatal intensive care unit (NICU). This study aimed to investigate the psychological wellbeing of NICU parents during the COVID-19 pandemic. Forty-four parents of 25 inpatients of the Padua University Hospital NICU were included from June 2020 to February 2021. At 7–14 days postpartum parents completed the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Parental Stressor Scale: NICU (PSS:NICU) and an ad-hoc questionnaire measuring parental COVID-19 related stress. About one third of parents reported extreme/high stress and a relevant negative impact on parenthood experience. Less time (82%) and less physical contact (73%) with infants due to COVID-19 preventive measures were the most frequent negative factors. Higher COVID-19 related parental stress was positively associated with anxiety, depression, NICU parental stress, stress related to NICU environment, and parental role alterations. Depression symptoms, stress related to infant condition and parental role alterations were higher in mothers. The pandemic affected parental emotional and relational wellbeing directly through additional stress due to COVID-19 concerns and indirectly through the impact of restrictions on the experience of becoming parents.

Parent Preferences for Neonatal Intensive Care Unit Physician Attire: A Cross-Sectional Study.

Physician attire may influence the parent-provider relationship. Previous studies in adult and outpatient pediatrics showed that formal attire with a white coat was preferred. We aimed to describe parent preferences for physician attire in the neonatal intensive care unit (NICU). We surveyed 101 parents in a level IV NICU. The survey included photographs of a physician in seven different attires. Attire was scored in five domains and parents selected the most preferred attire in different contexts. All attires were compared with formal attire with white coat. Descriptive statistics, Fisher's exact tests, and one-way analysis of variance were used to compare parent responses. Scrubs without white coat (40.8 [7.0]) and formal attire without white coat (39.7 [8.0]) had the highest mean (standard deviation) composite preference scores. However, no significant differences between formal attire with white coat (37.1 [9.0]) versus any other attire were observed. When asked to choose a single most preferred attire, scrubs with a coat (32%) and formal with a coat (32%) were chosen most often, but preferences varied by clinical context and parent age. For example, parents preferred surgical scrubs for physicians performing procedures. Parents indicated that physician attire is important to them but does not influence their satisfaction with care. Although parents generally favored formal attire and scrubs, the variations based on the context of care and lack of significant preference of one attire suggests that a single dress code policy for physicians in a NICU is unlikely to improve the patient-provider relationship. · Adult patients prefer doctors to wear formal attire.. · Physician attire preferences influenced by age, setting, and context of care.. · Little is known about physician attire preferences of the parents of neonates.. · Unlike adult patients, NICU parents did not prefer formal attire with a white coat..

A clinical-academic partnership to develop a family management intervention for parents of preterm infants.

To examine the critical role that an academic clinical partnership played in the development and refinement of a family management intervention in the Neonatal Intensive Care Unit (NICU). Clinical-academic partnerships enable earlier infusion of implementation science principles into development of evidence-based interventions, yet partners often report difficulty leveraging resources, personnel and expertise to create beneficial outcomes for all. Longitudinal qualitative descriptive design. To develop and refine the intervention, designated time was taken during meetings of the NICU's Parent Partnership Council (PPC), a committee comprised of nursing, physician and allied health leadership and former NICU parents. Partnership was also achieved by having bedside clinical nurses, in addition to medical and nursing students, participate as research team members. Qualitative data were collected via email, research team and Council meetings, and informal individual chats with key stakeholders (N=25) and NICU mothers (N=22). Qualitative data were analysed deductively using thematic analysis based on MacPhee's partnership logic model and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) model. The consolidated criteria for reporting qualitative research checklist guided our work. During Council meetings, the clinical-academic nurse, Director of Family-Integrated Care and Council members identified the need for a family management intervention, and worked together to develop and refine PREEMIE PROGRESS. Mothers found the intervention had numerous strengths and perceived a benefit knowing they helped future parents. This work was only possible by leveraging both the university's technology/research resources and the clinical expertise of the NICU staff and PPC. Co-authored presentations, publications and grant funding continued this NICU's legacy in family-centred care and helped shape the clinical-academic nurse's career. Clinical-academic partnerships can promote excellence in nursing practice, research and education through swifter knowledge translation and earlier infusion of implementation science principles into the development of evidence-based nursing interventions.

Barriers to Kangaroo Care in the NICU: A Qualitative Study Analyzing Parent Survey Responses.

Despite its benefits, parents in the neonatal intensive care unit (NICU) face significant barriers to kangaroo care (KC). Clinician-reported barriers to KC include staff education, environment, and equipment among others; however, parent-perceived barriers are underexplored. To examine parental understanding of KC, parental perception of experiences with KC, and parental views on the key factors that help or hinder KC. This is an observational, mixed-methods study that used an author-developed survey to assess parental feelings, perceived importance, and barriers to KC. Likert scale responses were analyzed using descriptive statistics. Free-text responses were analyzed using thematic analysis. A comparison of results was made between parents receiving and not receiving infant mental health services. Fifty (N = 50) parents completed surveys. Eighty percent of parents stated they wanted more information on KC. Common barriers to KC were reported by parents, such as issues with space/environment. The most frequently reported barrier when asked openly was fear of hurting their infant. Ninety-six percent of parents believed that KC helped their emotional well-being. Parents receiving mental health services reported more fear but results did not reach significance. The frequency with which factors are reported as important to parents may allow a prioritization of barriers to KC, which may help focus quality improvement initiatives. The results of this study underscore the vital role nurses play in supporting KC. Additional attention needs to be given to the mental health of NICU parents and its impact on care practices.

Experiences of Neonatal Intensive Care Unit Nurses as Mothers of Newborns in Neonatal Intensive Care Units: A Jordanian Qualitative Study

PurposeLittle research has explored the experiences and perspectives of neonatal intensive care unit (NICU) nurses who have also experienced being NICU parents. The purpose of this study was to explore the experiences of these nurses who have or have ever had an infant hospitalized in a NICU. Design and methodsA qualitative descriptive design using semi-structured interviews with a purposive sample of 9 registered Jordanian NICU nurses who have or have had a child admitted to a NICU. ResultsFindings suggest an oscillation between the role of being a nurse and the role of being a mother. The nurses' background clinical experience has an impact on how they provided and received care and on the decisions they made regarding their infants' care plans. Nurses reported fears of the “recommended patient syndrome” and tried to avoid being labeled as “nagging” by other healthcare providers. ConclusionsStudy findings shed light on the needs of NICU nurses with NICU admitted infants and the struggle faced by nurses-mothers as a result of their dual role, and highlights the importance of the family centered developmental care approach that recognizes the family as the cornerstone of the NICU health care team. Practice implicationsFindings highlight issues related to the shared needs between mothers and nurse-mothers in relation to proximity and involvement in newborn care plan.

Uptake and impact of journaling program on wellbeing of NICU parents.

This pilot study evaluated a brief parent journaling program in the neonatal intensive care unit (NICU). Hundred NICU parents were randomized to a control group (no journal) or an intervention group (journal provided). Parents reported pre- and post-intervention anxiety and depression symptoms using the hospital anxiety and depression scale (HADS) and qualitative journal use data. The analysis included Student's paired two-tailed t-test and two-way ANOVA. This study was registered with clinicaltrials.gov on April 1, 2020, NCT04331925. At baseline, clinically significant anxiety was more prevalent than depression (66% vs. 23%). Post-intervention scores were best predicted by baseline scores. Relative to controls, intervention group parents experienced a decrease in anxiety from baseline (t = -1.983, p = 0.056). The same effect was not seen for depression. Most intervention group parents used the journal and provided positive feedback. Journal use rates and positive feedback support the acceptability of a NICU journaling program.

Increasing Parent Satisfaction With Discharge Planning: An Improvement Project Using Technology in a Level 3 NICU.

Background:Neonatal intensive care unit (NICU) families are often overwhelmed by the discharge process. Their anxiety can inhibit learning and contribute to poor infant outcomes and increased healthcare utilization after discharge. Quality of the discharge teaching is the strongest predictor of discharge readiness, so NICUs must develop excellent discharge preparation programs.Purpose:This improvement project enhances NICU discharge preparedness by providing consistent, early discharge teaching using technology as a supplemental resource and raises parental satisfaction with the process.Methods:Neonatal intensive care unit staff and former NICU parents developed a task force to create technology-based discharge education content. The content was originally uploaded to an e-book and later transferred to the electronic health record inpatient portal. Families were able to view discharge teaching content at their own convenience and pace and review topics as needed with the NICU staff. Postdischarge follow-up phone calls provided insight into parental reaction to the new education format.Results:Parent satisfaction top-box scores, reflecting the highest rating in the “Prepared for Discharge” category of the patient satisfaction survey, improved from a baseline of 47% in 2017 to 70% in 2019. Overwhelmingly, 92% of families highly rated the tablet-based discharge teaching during postdischarge phone calls.Implications for Practice:A comprehensive, consistent, and early discharge program using technology can lead to more effective and efficient NICU discharge education and improved parent satisfaction.Implications for Research:Further studies are needed to generalize hospital-based inpatient portal teaching as an additional resource for parental education in the NICU.

Use of an internet camera system in the neonatal intensive care unit: parental and nursing perspectives and its effects on stress.

ObjectiveThe objective of this study is to evaluate associations between webcam use in the neonatal intensive care unit (NICU) with parental stress and nursing work-related stress and burnout.DesignProspective validated and de novo questionnaires administered to NICU parents and nurses during two observation periods: (1) no webcam access (off webcam) and (2) webcam access (on webcam).ResultsSeventy-nine “off webcam” parents, 80 “on webcam” parents, and 35 nurses were included. Parental stress levels were significantly lower “on webcam” and perceptions of the technology were overwhelmingly positive. There were no significant differences in nursing stress levels and burnout between periods. Only 14% of nurses believed that webcam use improves infant’s quality of care. Majority nurses felt that webcams increase parental and nursing stress.ConclusionsWebcam use in the NICU is associated with lower parental stress levels and has no effect on nursing stress levels or work-related burnout. These findings contradict nurses’ beliefs that webcams increase parent and nurse stress.

Improving Neonatal Follow-up: A Quality Improvement Study Analyzing In-hospital Interventions and Long-term Show Rates

Participants included neonatal intensive care unit (NICU) physicians, physician extenders, registered nurses, and parents of preterm patients admitted to the NICU who qualified for NFU. Our 75-bed NICU is the regional perinatal center within an urban free-standing children's hospital. Our bundle included NICU provider education, discharge planning, and parent education. A tracking system was developed to identify qualifying patients to streamline workflow. The monthly first visit show rate improved from 60% to 76% during the intervention period. Seventy-five percent of families who received parent education presented for their initial visit, compared to 51% of families who did not receive parent education. In anonymous surveys of families who presented for their initial visits, 95% indicated that bedside education played the most important role in appointment attendance. Interdisciplinary rounds are crucial for reaching all families before discharge. Implementing a multidimensional in-hospital education bundle and tracking system is feasible and can improve NFU clinic show rates, but may require dedicated personnel for sustainability.