The Neonatal Intensive Care Unit: Environmental Stressors and Supports

Abstract

The relationship between maternal mental health and infant development has been established in the literature. The Neonatal Intensive Care Unit (NICU) is a particularly challenging environment for new mothers as several natural processes are disrupted. The objective of this study is to elucidate protective factors and environmental deficits associated with the NICU. The experiences of forty-six (n = 46) mothers of infants admitted to a Level III NICU in the Midwestern United States, who responded to a related open-ended question, were analyzed thematically. Five themes related to the NICU environment emerged as being either stressful or helpful: (1) amount and quality of communication with medical staff, (2) bedside manner of medical staff, (3) feeling alienated from infant’s care, (4) support from other NICU mothers and families, and (5) NICU Physical Environment and Regulations. There is a need for medical staff training on awareness, communication, empathy, and other behaviors that might improve maternal (and parental) experiences in the NICU. The physical environment, including rules and regulations of the NICU, should be reexamined with family comfort in mind in addition to the clinical care of the infant.

Understanding parents’ emotional experiences for neonatal education: A narrative, interpretive approach

“…In relation to staff, the perceived positive value of their role in the provision of parental support was purported by Turner et al () and in Trajkovski's , Schmied, Vickers, and Jackson () work on the necessity for collaborative family‐centred care. The parents views on the neonatal environment as having a significant impact on their experience were consistent with various authors (Cleveland, ; Hall & Brinchmann, ; Williams et al, ); certainly, providing an environment that encourages proximity and avoids physical barriers was seen to be a source of comfort, in line with the term “emotional closeness” stated by Flacking, Thomson, and Axelin (). For transitions within neonatal care, parents voiced mixed emotions commonplace through the trajectory of neonatal care (Ballantyne et al, ), and regarding going home, persistent accounts of emotional stress have been reported in relation to both the very premature (Petty, Whiting, Green, & Fowler, ) and the late premature baby (Premji et al, ).…”

“…The physical environment can be thought through carefully with comfort and family inclusion in mind, in line with the delivery of safe, clinical care of the baby. This can happen in conjunction with staff education on the importance of communication and empathic care (Williams et al, ) emphasising how all these areas link together to facilitate ongoing emotional care.…”

“…Without doubt, the need for intensive care in the early days of life is not only arduous for the baby themselves but also for the family. The behaviour and appearance of a neonate, limited opportunities to accomplish parenting roles and the nature of the neonatal environment are significant stressors related to being a parent in a neonatal unit (Aftyka, Rybojad, Rosa, Wróbel, & Karakuła‐Juchnowicz, ; Wigert, Dellenmark Blom, & Bry, ; Williams et al, ).…”

“…Present across global boundaries are significant emotional needs in relation to the support required to improve parent's neonatal care experience, extrapolated from research undertaken, for example in England, Europe, Northern Ireland and the United States, respectively (Picker Institute Europe, ; Franck, McNulty, & Alderdice, ; Howell & Graham, ; Williams et al, ). This was also found after discharge at home, as found in a large survey across the United Kingdom (The Smallest Things, ).…”

Experiences of mothers with preterm babies at a Mother and Baby Unit of a tertiary hospital: A descriptive phenomenological study

“…Nurses working in such units need to acknowledge the challenges experienced by mothers and plan effective care to meet the needs of both baby and mother. Provision of timely and comprehensive information to mothers on the condition, treatment and care of their babies (Gaucher & Payot, ; Steyn et al, ) could relieve mothers' anxiety and also promote confidence in the healthcare team (Arzani, Valizadeh, Zamanzadeh, & Mohammadi, ; Williams et al, ).…”