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What Kinds of Support Help Parents Thrive in the NICU?

3 philosophies of care that benefit parents as well as babies and NICU staff.

Key points

  • Parents face many challenges when their newborn is admitted to intensive care, including intense emotions and feeling inadequate as a parent.
  • NICUs can be unwelcoming to parents, but the evidence is clear that everyone benefits when parents are involved in their baby's care.
  • Relationship-centered, developmentally supportive, family integrated care is the gold standard for supporting parents in the NICU.

When a premature or sick newborn is admitted to a neonatal intensive care unit (NICU), parents face many challenges. They experience a violation of expectations and grieve many layers of loss. They feel intense fear and worry while watching their baby struggle, plus sadness and longing due to separation distress. It’s also difficult to trust the nurses and doctors, all strangers at first. And while their bond is intact, it’s challenging to feel like a parent if they aren’t involved in their baby’s care. (For more on this, see my previous post: “Why Is Having a Baby in the NICU So Distressing?”)

Not surprisingly, if the NICU is technology-centered and the philosophy of care is focused on protocol, NICU professionals are likely to perceive parents as being “difficult to manage” and “in the way.” But the NICU doesn’t have to operate that way. Indeed, over the past several decades, there is mounting evidence that parents and their babies benefit when NICU staff welcome parents, form quality, compassionate, therapeutic relationships with them, attend to their developmental needs as parents, and engage them as their baby’s primary caregivers. When a NICU operates this way, the philosophy of care is focused on relationships, developmental support, and family involvement. Of course, following medical protocol is necessary, but as research shows, it is not sufficient for ensuring that babies will thrive in the NICU and beyond. What helps babies thrive is having parents who are involved in their care and who develop a sense of parental identity that includes feeling confident and competent as their baby’s parents.

As Dr. Shoo Lee, a researcher at Mount Sinai Hospital in Toronto, says, “In the past, we used to think that health care can only be delivered by professionals who are highly trained, and particularly in intensive care settings like the NICU. In FICare (Family Integrated Care), we are bringing families in to become part of the care team, where they are the primary caregivers. This is a shift, a big shift in thinking, a paradigm shift. Essentially, it says that we made a mistake. It cannot be that only professionals can provide care. In fact, families have a very important part to play in the care of their baby.”

Let’s look more closely at what it means for the NICU to prioritize relationships, developmental support, and family involvement.

Relationship-centered care recognizes that relationships are the cornerstone of quality medical care. Yes, clinical expertise is important, but caring relationships support healing like nothing else. Relationship-centered care also pays attention to:

  • Environmental settings
  • Behaviors
  • Attitudes
  • Philosophies
  • Interventions

These factors can cultivate good relationships between everyone—patients, family members, and medical professionals.

Developmentally supportive care recognizes that everyone has developmental needs—emotional, physical, cognitive, psychological, social, and spiritual—that, when met, promote healthy growth and development. Yes, ensuring babies’ survival is important, but ensuring that babies and their parents thrive is what promotes the best outcomes for NICU infants and their families. Developmentally supportive care in the NICU pays attention to:

  • The care each baby needs to ensure an optimal outcome
  • The support each parent needs to grow into parenting their baby with competence and confidence
  • What each medical professional needs to do their jobs effectively and to feel fulfilled in their work

Family Integrated Care (FICare) recognizes the value of parents being involved in their baby’s care. Yes, medical professionals are in charge of providing highly skilled medical care, but parents are in charge of parenting, which includes:

  • Devoted attention to getting to know their baby really well
  • Being able to tell how their baby is doing and sharing those insights with the medical professionals
  • Contributing to their baby’s well-being by reading and responding to their baby’s behavioral cues and providing gentle, nurturing care, including skin-to-skin (Kangaroo Care) that only parents can do

The gold-standard NICU can seamlessly implement all three of these overlapping philosophies of care by, for example:

  • Making room for parents to be involved in their baby’s care and considering the parents to be their baby’s primary caregivers
  • Ensuring the NICU environment is sensitive to the needs of babies and parents, such as dimming lights and sounds and providing comfortable places for parents to hold their babies for extended periods of time
  • Facilitating a non-hierarchical attitude and collaborative behaviors among NICU staff, who can value input from everyone on the health care team—including the parents

In the gold-standard NICU, everybody wins. Babies are better able to thrive. Parents can more easily adjust to this unexpected path of NICU parenting. And when NICU staff make room for parents to be meaningfully involved in their baby’s care, their jobs are far easier because they no longer perceive parents as “difficult to manage” or “in the way.”

References

Video of Dr. Shoo Lee, talking about Family Integrated Care.

Koloroutis M (ed). Relationship-Based Care: A Model for Transforming Practice. Creative Health Care Management, 2004.

Khosravan S, Khoshahang M, Heidarzadeh M, Basirimoghadam M. Effect of NIDCAP home care follow-up program of preterm newborns on maternal anxiety and stress. Ann Ig. 2020 Nov-Dec;32(6):627-634. doi: 10.7416/ai.2020.2384. PMID: 33175074.

Hasanpour M, Alavi M, Azizi F, Als H, Armanian AM. Iranian parent-staff communication and parental stress in the neonatal Intensive Care Unit. J Educ Health Promot. 2017 Jun 5;6:49. doi: 10.4103/jehp.jehp_117_15. PMID: 28616416; PMCID: PMC5470302.

Hall SL, Cross J, Selix NW, Patterson C, Segre L, Chuffo-Siewert R, Geller PA, Martin ML. Recommendations for enhancing psychosocial support of NICU parents through staff education and support. J Perinatol. 2015 Dec;35 Suppl 1(Suppl 1):S29-36. doi: 10.1038/jp.2015.147. PMID: 26597803; PMCID: PMC4660046.

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