BackgroundExtremely premature infants (those born before 28 weeks’ gestational age) are highly immature, requiring months of care at a neonatal intensive care unit (NICU). For parents, their child’s grave medical condition and prolonged hospitalization are stressful and psychologically disruptive. This study aimed at exploring the needs of psychosocial support of parents of extremely premature infants, and how the NICU as an organization and its staff meets or fails to meet these needs.MethodSixteen open-ended interviews were conducted with 27 parents after their infant’s discharge from the NICU. Inductive content analysis was performed.ResultsFour themes were identified: Emotional support (with subthemes Empathic treatment by staff, Other parents as a unique source of support, Unclear roles of the various professions); Feeling able to trust the health care provider; Support in balancing time spent with the infant and other responsibilities; Privacy.Parents of extremely premature infants needed various forms of emotional support at the NICU, including support from staff, professional psychological help and/or companionship with other patients’ parents. Parents were highly variable in their desire to discuss their emotional state with staff. The respective roles of nursing staff, social workers and psychologists in supporting parents emotionally and identifying particularly vulnerable parents appeared unclear. Parents also needed to be able to maintain a solid sense of trust in the NICU and its staff. Poor communication with and among staff, partly due to staff discontinuity, damaged trust. Parents struggled with perceived pressure from staff to be at the hospital more than they could manage and with the limited privacy of the NICU.ConclusionsThe complex and individual psychosocial needs of parents of extremely preterm infants present many challenges for the NICU and its staff. Increasing staffing and improving nurses’ competence in addressing psychosocial aspects of neonatal care would help both nurses and families. Clarifying the roles of different professions in supporting parents and developing their teamwork would lessen the burden on nurses. Communicating with parents about their needs and informing them early in their NICU stay about available support would be essential in helping them cope with their infant’s hospitalization.

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Aim The aim of this work is to describe the organizational climate and interpersonal interactions experienced by registered nurses in a level III neonatal intensive care unit. Background Neonatal nurses have a demanding task in caring for a varied, highly vulnerable patient population and supporting patients' families. Nurses' psychosocial work environment affects quality of care as well as nurses' job satisfaction and organizational commitment. Method Semistructured interviews with 13 nurses, covering numerous aspects of their psychosocial work environment, were analyzed using thematic analysis. Results High staff turnover and a preponderance of inexperienced nurses were described as stressful and detrimental to group cohesion. Work at the unit was considered overly demanding for newly qualified nurses, while senior nurses expressed frustration at the work of training new nurses who might not stay. While some were very satisfied with the group climate, others complained of a negative climate and incivilities from some experienced nurses toward new recruits. Conclusions High turnover and variable competence among staff present challenges for maintaining a positive organizational climate. Implications for Nursing Management Management should communicate a clear sense of the nature of neonatal intensive care when recruiting, foster group cohesion (e.g., by creating stable work teams) and reward commitment to working at the unit.