NICU Clinicians and Parents: Building Supportive Relationships

Evi Dewhurst

Neonatal intensive care nurses, educators and other specialists hold demanding positions requiring versatility, knowledge and snap decision-making skills. The expectations for their capabilities are high. Added to these skills and talents is the necessary finesse of interacting and communicating with others intimately involved in patient care: the parents.

Preterm infants are a unique patient population, particularly when very preterm and born prior to 32 weeks. Facing their own set of challenges, these patients confront the monumental task of growing and healing. In tandem with these patients are their parents, attached by a fierce connection to their child, clinging to hope and praying for the best possible outcome. It can be a frustrating, depression-laden spiral to not feel as a contributor to your child’s well being.

Recent studies have looked into the clinician/parent dynamic when it comes to the neonatal intensive care unit environment. Clinicians have expectations from family members, and family members have expectations from clinicians. Where can these expectations meet to result in a cohesive working relationship for the best patient outcomes?

Seiderman, et al., 1997, found specific parental perceptions and coping experiences tied to neonatal care. They found that NICU parents were more responsive to problem-focused coping than appraisal- or emotion-focused coping. This information can help clinicians understand how to interact in the most positive way right from the beginning.

Three Key Things

Russell, et al., 2014, found three specific areas of parental concern in the NICU. Their study included parents of infants born less than thirty-two weeks gestation. This is what they found:

1. Parent’s Involvement: Interaction, Expression and Access

At first glance it may appear there is limited involvement for a parent of a preemie. Yet those parents polled stated that simple acts such as changing diapers, uncomplicated washing or cleaning, and holding or touching their baby allowed them to feel connected and part of the process. It is important for clinicians to feel comfortable encouraging parents to participate; some parents responded that they struggled with negative emotions when not encouraged to assist with personal care. This is turn only increased their feelings of helplessness.

Expressing breast milk was also a challenge. Every mother is different, and some may find expression easy while others experience difficulty. Their top concerns were:

-Lack of assistance from staff

-Lack of information regarding available facilities

-Pressure to express specific quantities immediately after birth

Clearly mothers are looking for supportive guidance. If they are not supported with adequate information and resources, they may feel the challenge is too much for them. As breast milk is the best nutrition for a premature infant, it is critical to encourage and enable mothers to produce. This may include helping her locate additional resources or support groups.

Additionally, access was important to parents. They expressed sincere appreciation for NICU clinicians who promoted as much access to their baby as could be offered, and especially their support in strengthening the parent-infant bond as much as possible.

2. Staff Competency and Efficiency: Communication, Experience and Confidence, and Information and Explanation

Communication is stated as a major factor determining a positive or negative NICU experience. Clinicians may be highly skilled and talented, yet a failure in communication with parents can ultimately lead to a decline in parents’ confidence with staff. Parents cited these examples as breakdowns in communication:

-When a baby is moved or transferred

-A sudden change in health

-Procedures mentioned without apparent communication between staff members

When parents are not notified with accurate details of changes in their infants’ care, it can be demoralizing and confusing. Conflicting advice can also cause anxiety, such as when one nurse promotes a specific kind of care while another discounts it. Open communication is an action clinicians can engage in for connecting with parents and fostering a sense of trust, while agreeing within their own ranks to form a united front when it comes to supporting certain methods of care.

Professional experience and nursing level of confidence was perceived by parents to be reassuring. When staff behaved in a confident manner, parents were more likely to believe a situation was under control, and even believed their child received the best care. Parents highlighted importance on clinicians being vigilant, performing frequent checks, taking notes, ensuring a clean environment and routinely monitoring patients as part of their overall experience in the NICU. If the nursing staff seemed understaffed and unable to meet these actions, parents felt concern about the amount of care that went to their own child.

Information shared and explanations given proved to be a large component of parents’ confidence in the NICU. Most parents prefer frequent updates and details on routine. When nurses take time to explain using simple terminology, parents feel a sense of participation and understanding; when confronted by unknown medical phrasing, they feel overwhelmed and frightened to be missing out on critical information. Some parents expressed interest in a dedicated premature baby advisor, who could help them navigate NICU terminology and protocol.

3. Interpersonal Relationships With Staff

Sensitive and emotional support cements a successful relationship between NICU staff and parents. Staff empathy came up as a high-ranking factor in parental experience in the NICU. This would include emotional support, reassurance and making a parent feel as an individual. When in the grip of anxiety for a loved one, a direct and compassionate communication from a clinical professional can ease fears and allow a parent to feel recognized.

Parents also value time nurses spend with their infants, taking opportunities to interact with the baby and provide comfort. When parents perceive that their child is receiving quality care, their stress level becomes more manageable, especially when they are unable to physically be in the NICU with their child. This in turn facilitates a productive interaction between clinician and parent.

These three major themes which influence neonatal care satisfaction can help clinicians understand what parents are looking for in the NICU. When it comes down to it, parents of babies in the NICU are frightened, worried and confused. Not all interactions will go smoothly; emotions run high and fear for the life of a loved one overtakes most rational thought in situations such as this. NICU nurses and educators are the lifeline of communication, education and support. Your position as a trusted advisor, professional, caretaker and friend can make an enormous difference not only to the babies you care for, but their families as well.

Seideman, et al. Parent stress and coping in NICU and PICU. Journal of Pediatric Nursing. June 1997, 169-177
Russell, et al. Parents’ views on care of their very premature babies in neonatal care units: a qualitative study. Published online September 13, 2014.