“All these people saved her life, but she needs me too”: Understanding and responding to parental mental health in the NICU

Klawetter, Susanne; Cetin, Nazan; McEvoy, Cindy T.; Dukhovny, Dmitry; Saxton, Sage N.; Rincón, Mónica; Rodriguez-JenKins, Jessica; Nicolaidis, Christina

doi:10.1038/s41372-022-01426-1

Cited by 8 publications

(11 citation statements)

References 38 publications

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“…Qualitative studies involving NICU families show that parents seek support from NICU staff to address their mental health needs. Parents need social connections not only with trained mental health providers but also with medical staff and other families [21 ▪ ]. Axelin et al [22 ▪ ] suggest that the parent's perception of supportive family-centred care is associated with lower depression screening scores.…”

Section: Introductionmentioning

confidence: 99%

Addressing caregiver mental health in the neonatal ICU

Sadler

Okito

Soghier

2023

Current Opinion in Pediatrics

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Purpose of reviewThe neonatal ICU (NICU) setting is a unique opportunity to not only detect major changes in caregiver mental health through universal perinatal mood and anxiety disorder (PMAD) screening but also intervene with specialized support. We review evidence for addressing caregiver mental health in the NICU, explore current guidelines and models for integrated behavioural health programmes, and describe challenges specific to NICUs, particularly in standalone paediatric hospitals.Recent findingsParents of infants admitted to the NICU are at an increased risk for developing PMADs at rates well above the general postpartum community. Select NICUs within the United States and internationally have recognized the importance of having an embedded psychologist to address caregiver PMADs. However, organizational structures within paediatric healthcare systems are not equipped to manage the logistical, ethical, legal and practical needs of comprehensive caregiver mental health programmes.SummaryTo properly address caregiver mental health in NICU settings, clinical and administrative teams must work together to ensure seamless service provision. Systems that facilitate the development of unique parent medical records at the onset of paediatric care are likely to significantly reduce potential liability risks and solve several challenges related to caregiver-focused mental health support in the NICU.Video abstracthttp://links.lww.com/MOP/A70

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Section: Introductionmentioning

confidence: 99%

Addressing caregiver mental health in the neonatal ICU

Sadler

Okito

Soghier

2023

Current Opinion in Pediatrics

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“…21,22,[24][25][26][29][30][31][32][33] Understanding the provisions and contributions of COC specific to the NICU is growing but remains limited. 18,19,33 We previously evaluated parental perspectives on neonatologist COC. 9 Parents described multiple components of COC, the most important being strong background knowledge of infants, as well as longitudinal clinicians and consistent clinical ABSTRACT Background: Families and staff in neonatal intensive care units (NICUs) value continuity of care (COC), though definitions, delivery, and impacts of COC are incompletely described.…”

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confidence: 99%

“…Studies evaluating family- and staff-related outcomes show an association of COC with less anxiety, stress, and distrust for families; less inefficiency and moral distress for clinicians; and improved communication, family–staff relationships, and shared decision-making that affect both groups 9–11,22–28. Attention to strategies for improving COC delivery in intensive care units (ICUs) in pediatric settings, including the neonatal intensive care unit (NICU), is increasing, especially given the complexity and chronicity of diseases encountered by this patient population 21,22,24–26,29–33…”

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confidence: 99%

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A Qualitative Study of Nurses' Perspectives on Neonatologist Continuity of Care

Machut¹,

Gilbart²,

Murthy³

et al. 2023

Advances in Neonatal Care

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Background: Families and staff in neonatal intensive care units (NICUs) value continuity of care (COC), though definitions, delivery, and impacts of COC are incompletely described. Previously, we used parental perspectives to define and build a conceptual model of COC provided by neonatologists. Nursing perspectives about COC remain unclear. Purpose: To describe nursing perspectives on neonatologist COC and revise our conceptual model with neonatal nurse input. Methods: This was a qualitative study interviewing NICU nurses. The investigators analyzed transcripts with directed content analysis guided by an existing framework of neonatologist COC. Codes were categorized according to previously described COC components, impact on infants and families, and improvements for neonatologist COC. New codes were identified, including impact on nurses, and codes were classified into themes. Results: From 15 nurses, 5 themes emerged: (1) nurses validated parental definitions and benefits of COC; (2) communication is nurses' most valued component of COC; (3) neonatologist COC impact on nurses; (4) factors that modulate the delivery of and need for COC; (5) conflict between the need for COC and the need for change. Suggested improvement strategies included optimizing staffing and transition processes, utilizing clinical guidelines, and enhancing communication at all levels. Our adapted conceptual model describes variables associated with COC. Implications for Practice and Research: Interdisciplinary NICU teams need to develop systematic strategies tailored to their unit's and patients' needs that promote COC, focused to improve parent–clinician communication and among clinicians. Our conceptual model can help future investigators develop targeted interventions to improve COC.

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“…Rates of postpartum depression among NICU parents are triple to quadruple that of the general postpartum population. 46 Parents experiencing acute anxiety and depression require intervention to be fully available to their infant. A parent cannot be the safe and stable presence the infant needs if the parent feels neither safe nor stable.…”

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confidence: 99%

Application of the Adverse Childhood Experiences Framework to the NICU

Malin,

Vittner,

Darilek

et al. 2023

Advances in Neonatal Care

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Background: Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families. Purpose: Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment. Methods: An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed. Results: NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU. Implications for Practice and Research: Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.

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“All these people saved her life, but she needs me too”: Understanding and responding to parental mental health in the NICU

Cited by 8 publications

References 38 publications

Addressing caregiver mental health in the neonatal ICU

Addressing caregiver mental health in the neonatal ICU

A Qualitative Study of Nurses' Perspectives on Neonatologist Continuity of Care

Application of the Adverse Childhood Experiences Framework to the NICU

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