The admission of a premature or critically ill infant to a neonatal intensive care unit (NICU) is a stressful event for parents.
Parents in the NICU experience stress-induced emotional problems related to infant hospitalization, loss of control, and loss of contact with their infant.
The NICU staff can help develop strategies and interventions to help parents feel more comfortable and involved.
There is a need for mindful, cost-effective interventions to reduce parental distress.
The neonatal intensive care unit (NICU) is an emotionally charged environment both for parents and for healthcare providers. Having a newborn who needs to be in the NICU may come as an unexpected and traumatic event for parents. Furthermore, their infant’s medical issues requiring the NICU may lead to higher levels of distress, symptoms of depression, anxiety, and trauma, along with increased sleep disturbance and fatigue, compared with parents with full-term, healthy newborns. Nurses in the NICU provide critical round-the-clock care and services for vulnerable newborns and their families. Because their constant presence in the NICU is a requirement of the job, NICU nurses not only frequently witness parents’ suffering and loss but also have their own and their fellow nurses’ emotional turmoil (“contagious grief”). , There is a great need to address the mental health and well-being of both parents and nursing staff in the NICU. In this section, we review literature on the impact of the NICU environment on parents and nursing staff and recommendations for meeting the unique needs of NICU parents and nursing staff.
Many parents are unprepared to face the challenges of the NICU experience because most parents imagine having a healthy baby, who will be in the well-baby nursery for a day or two and be discharged home. Stemming from fears of their infant’s medical problems and the possibility of losing their baby, parents with infants in the NICU experience greater feelings of sadness and anxiety. Because of the medical needs of infants in the NICU, parents also experience interrupted contact and reduced time being physically close to their newborn in the NICU, which also contributes to delayed parent–infant bonding.
A systematic review of qualitative studies on parental experiences in the NICU showed stress-induced emotional problems, stress of infant hospitalization, and loss of control or contact with babies as the top concerns of NICU parents. These parents report experiencing extreme stress owing to feelings of restlessness, worry, fear, shame, guilt, and nervousness from their infant’s admission to the NICU. As a likely contributor to these feelings, the physical NICU environment includes issues with complex staff communication and hospital equipment and technology that may overwhelm NICU parents. , Experiencing good communication with staff and longer interaction times with their infants in a welcoming and quiet atmosphere can compensate for some of these stressors and may, at least for short, intermittent periods, improve the NICU experience ( Fig. 2.1 ).
Very few studies have explored fathers’ or both parents’ experiences in the NICU, possibly because fathers typically spend fewer hours in the NICU. Fathers with infants in the NICU often experience similar or lower levels of stress than mothers do, but they show the tendency to cope with their stressful NICU experiences by withdrawing and becoming disconnected. , Younger fathers and fathers of infants with extremely low birth weight or infants who are very preterm reported increased stress in the NICU. Fathers with newborns in the NICU face difficulties carrying out double duties as caretaker and breadwinner, including job loss owing to changes in family dynamics and interruption in their routine life.
Opportunities in the NICU for Reducing Distress
The staff and environment in the NICU can have a positive impact on parents. Negative feelings and stress that mothers experience in the NICU are the main factors of delayed transition to parenthood. The NICU staff could play a crucial role in developing and carrying out strategies and interventions that aim to help parents feel more comfortable and involved. The NICU staff can help parents by providing emotional support and, perhaps most importantly, actively engaging parents to participate in their infant’s care in any way appropriate for their medical condition.
Because the experience of separation from their infant evokes stress among NICU parents, the NICU management could develop parent-oriented approaches to infant care, including involving parents in caring for their newborn infants in the NICU in any way possible. Involving parents directly in their infant’s care, even in small ways, has the potential to increase parent-infant bonding and empower parents to gain confidence in their capability to take care of their infant, especially as their infant approaches discharge from the hospital. The availability of novel electronic devices to improve communication between parents and care providers can also be helpful ( Figs. 2.2 and 2.3 ). Such a strategy will likely have the added benefit of strengthening the relationship between NICU parents and healthcare team members and lead to achieving optimal health of the whole family.
Acknowledging fathers’ emotional states and stressors in the NICU is a step to help them feel included and valued. The NICU staff’s early assessment of fathers’ perceptions of potential environmental stressors in the NICU and their coping strategies can be valuable in engaging fathers in their infant’s care. Being alert and quick to link fathers with available resources, particularly for younger fathers and fathers with low birth weight or preterm infants, is also crucial.
A growing number of NICU-based interventions for parents have been found to reduce long-term distress, particularly depressive symptoms. , Mindfulness-based interventions are gaining popularity owing to their cost-effective implementation and growing evidence for their effectiveness for stress reduction, which is a critical concern for NICU parents ( Figs. 2.4 and 2.5 ). A pilot study of a mindfulness intervention delivered via video and audio recordings for mothers whose babies are in the NICU showed promising preliminary results in reducing maternal psychological distress and stress symptoms and improving sleep. The individual and flexible nature of an audio-video program that can be used flexibly by parents offers significant potential for future implementation and dissemination in the NICU setting.