NICU discharge planning and beyond: recommendations for parent psychosocial support

Abstract

Parents will interact with a multitude of teams from various disciplines during their child's admission to the neonatal intensive care unit. Recognition of the emotional stressors experienced by these parents is a first step in working to provide the crucial support and parenting skills needed for bonding and caring for their infant from admission through discharge and beyond. Family-centered care involves time-sensitive two-way communication between parents and the multidisciplinary team members who coordinate care transition by providing emotional, educational, medical and home visitor support for these families. To do this well, a thoughtful exchange of information between team members and parents is essential to identify psychosocial stress and ameliorate family concerns. Parents will need emotional and educational support and follow-up resources. Establishing individualized, flexible but realistic, pre- and post-discharge plans with parents is needed to start their healthy transition to home and community.

Trends in Family-Centered Care in Neonatal Intensive Care

“…19 Family-centered care practice includes open visitation for parents to be present, and nurses facilitating interaction and communication between infants and their parents at birth or as soon as possible after. 7,8 …”

“…2 Johnson et al 6 described FCC as a philosophy of care where the family's role is recognized and respected as being essential. Stress and negative outcomes are reduced through parent/family involvement in care activities, communication and education, 7,8 group and individual therapy and support systems, 9 and consideration of age-specific needs (eg, needs of a teenage mother). 3 In the NICU context, family often refers to the neonate, the mother, and the father, but it can include grandparents, extended family members, significant other(s) identified by the mother/father, and the sibling(s).…”

Infant/Early Childhood Mental Health and Collaborative Partnerships: Beyond the NICU

“…Several key categories of support for parents with babies in the NICU have been identified that are well aligned with I/ECMH practice. These include parent emotional support, parent education, and child development support (Benzies, Magill-Evans, Hayden & Ballantyne, 2013;Purdy, Craig, & Zeanah, 2015). I/ECMH interventions have been shown to result in changes in parent-child interactions, parental mental health status, and child behavior and physiological status in the population of newborn intensive care unit graduates.…”

“…Parents of these babies are likely to experience greater emotional stress, depression, and uncertainty about their baby's future, as well as financial stress than do parents of term infants (Blackburn, 2010;Boyova, Kenner, 2012;Fraley, 1989;Gennaro, Grisemer, Musci, 1992;Purdy, Craig, & Zeanah, 2015). Examples of parental stress related to hospital experiences include "the sudden nature of the situation, the separation from the child, and the lack of information concerning the prognosis" (Habersaat, Pierrehumbert, Forcada-Guex, Nessi, & Ansermet, 2014, p. 458;Singer, Salvator, Guo, Collin, Lilien, Baley, 1999).…”

“…Across populations, modern medical technology has allowed smaller and smaller babies to survive; many of these infants do very well, despite their early neonatal course. However, many more of these babies are at immediate risk for mortality and morbidity (CDC, 2012), and attention to these urgent issues is the primary focus in the NICU (Purdy, Craig, & Zeanah, 2015).…”