Supporting Preterm Infant Attachment and Socioemotional Development in the Neonatal Intensive Care Unit: Staff Perceptions

Abstract

The infant-parent relationship has been shown to be of particular significance to preterm infant socioemotional development. Supporting parents and infants in this process of developing their relationships is an integral part of neonatal intensive care; however, there is limited knowledge of NICU staff perceptions about this aspect of care. To explore NICU staff perceptions about attachment and socioemotional development of preterm infants, experience of training in this area and the emotional impact of their work. A cross-sectional questionnaire survey of staff perceptions of the emotional experiences of parents and the developing parent-infant relationship in an NICU was conducted in a Level III NICU, after pilot testing, revision, and ethical approval. Fifty-seven (68%) of NICU staff responded to the survey. Respondents identified parents' emotional experiences such as "anxiety," "shock," "loss of control," and "lack of feelings of competence as parents" as highly prevalent. Infant cues of "responding to parent's voice" and "quieting-alerting" were ranked most highly; "crying" and "physiological changes" were ranked lowest. Preterm infant medical risk, maternal emotional state, and mental health are perceived to impact most highly on the developing relationship, as compared with infant state or behavior and socioeconomic factors. Fifty-three (93%) respondents felt confident, and 50 (87.8%) felt competent discussing their emotional experiences with parents. Fifty-four (95%) responded that attending to these areas was an integral part of their role; however, staff had seldom received education in this area. Respondents also perceived that specific psychological support for parents was lacking both during and after the infant's discharge. While all staff surveyed perceived the nature of their work to be emotionally stressful, there were differences among NICU staff disciplines and with years of experience in the NICU in terms of their perceptions about education in this area, the place of supervision for staff, and in relation to opportunities to discuss the emotional impact of the work on staff. NICU staff perceive their role as integral to supporting the developing parent-infant relationship and preterm infant socioemotional development; however, education in this area and provision of specific psychological support are lacking. Opportunities for staff to discuss and reflect on this aspect of their work should be developed and evaluated given the essential, but emotionally challenging, nature of their work with preterm babies and their parents.

Experiences of Mothers of Extremely Preterm Infants after Hospital Discharge

“…Here, infants are frequently tube-fed, their weight is closely monitored and they may receive oxygen therapy (Dellenmark-Blom & Wigert, 2014;Aagaard et al, 2015). These processes interrupt the preparation and expectations of the mother (Twohig et al 2016;Aydon et al, 2017) as well as the mother-infant bond and relationship (Tooten et al, 2014;Sisson et al, 2015). Although the presence of parents in the NICU has increased (Al Maqhaireh et al, 2016), the environment, work routines and the complex needs of these infants become obstacles that stand in the way of a mother's role (Sisson et al, 2015;Raines & Brustad, 2013).…”

South Korean nurses’ lived experiences supporting maternal postpartum bonding in the neonatal intensive care unit

“…According to a cross-sectional survey in Ireland, NICU staff was aware of their essential role in support of the infant-parent relationship; however, they reported insufficient education regarding the social-emotional development and bonding of premature infants as well as psychological support for the parents (Twohig et al, 2016 ). Therefore, nursing college curricula should include therapeutic communication courses and mental health nursing courses guided by detailed educational protocols to mitigate the psychological and emotional pain of mothers of premature infants and promote infant-mother bonding.…”

Validation of the Korean Version of the Maternal Postpartum Attachment Development Scale for Mothers of Children who were in a Neonatal Intensive Care Unit

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