Clinician Perceptions of the NICU Infant Experience: Is the NICU Hospitalization Traumatic?

Abstract

Objective Infants cared for in a newborn intensive care unit (NICU) experience pain, parental separation, and stress that may approach toxic levels, thus are potentially traumatic. Lack of accepted clinical terminology to describe the infant experience may result in under appreciation of NICU hospitalization on infant and family outcomes. This study explored NICU clinician perceptions of the infant experience and how the terms trauma/traumatic would impact their clinical roles and practices.

Study Design Semistructured focus group interviews and thematic analysis were used to describe professionals' perceptions of the infant's experience and terminology. Focus groups were organized by professional role, including NICU leadership, physicians, nurses, and ancillary providers.

Result Six themes emerged from the qualitative analysis: at our mercy, trauma defined and redefined, and now you have broken them too, perceptions of NICU experience change over time, trauma in the NICU: whose trauma is it, and not knowing the infant and family experience.

Conclusion While recognizing potentially toxic infant stress levels, clinicians are reluctant to describe the NICU infant experience as traumatic. Hesitations relate to clinicians' personal concerns that they may be seen as agents of trauma and the impact for families if the NICU experience was described as traumatic by clinicians.

Keywords

preterm infants - NICU - trauma - traumatic - focus group

Note

Mary Coughlin is the president and founder of Caring Essentials Collaborative, LLC. Human subject approval was obtained for this work.

• References

• 1 Perry BD, Pollard R. Homeostasis, stress, trauma, and adaptation. A neurodevelopmental view of childhood trauma. Child Adolesc Psychiatr Clin N Am 1998; 7 (01) 33-51
• 2 Felitti VJ, Anda RF, Nordenberg D. , et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998; 14 (04) 245-258
• 3 National Scientific Council on the Developing Child. Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper 3. 2014
• 4 National Scientific Council on the Developing Child. Young Children Develop in an Environment of Relationships: Working Paper 1. 2004
• 5 Pynoos RS, Steinberg AM, Layne CM. , et al. Modeling constellations of trauma exposure in the National Child Traumatic Stress Network Core Data Set. Psychol Trauma 2014; 6 (Suppl. 01) S9-S17
• 6 Coughlin ME. Transformative Nursing in the NICU: Trauma-Informed Age-Appropriate Care. New York, NY: Springer Publishing Company; 2014
• 7 D'Agata AL, Sanders MR, Grasso DJ, Young EE, Cong X, McGrath JM. Unpacking the burden of care for infants in the NICU. Infant Ment Health J 2017; 38 (02) 306-317
• 8 DʼAgata AL, Young EE, Cong X, Grasso DJ, McGrath JM. Infant medical trauma in the neonatal intensive care unit (IMTN): a proposed concept for science and practice. Adv Neonatal Care 2016; 16 (04) 289-297
• 9 Coughlin M. Trauma-Informed Care in the NICU: Evidence-Based Practice Guidelines for Neonatal Clinicians. New York, NY: Springer Publishing Company; 2016
• 10 Krueger RA, Casey MA. Focus Groups: A Practical Guide for Applied Research, 4th ed. Thousand Oaks: CA: Sage Publications, Inc.; 2009
• 11 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 (02) 77-101
• 12 Sanders MR, Hall SL. Trauma-informed care in the newborn intensive care unit: promoting safety, security and connectedness. J Perinat 2018; 38 (01) 3-10
• 13 Als H, Tronick E, Lester BM, Brazelton TB. The Brazelton Neonatal Behavioral Assessment Scale (BNBAS). J Abnorm Child Psychol 1977; 5 (03) 215-231
• 14 Brazelton TB. Neonatal Behavioral Assessment Scale. Philadelphia: J. B. Lippincott; 1973
• 15 Als H, Gilkerson L. Developmentally supportive care in the neonatal intensive care unit. Zero Three 1995; 15 (06) 2-11
• 16 Ohlsson A, Jacobs SE. NIDCAP: a systematic review and meta-analyses of randomized controlled trials. Pediatrics 2013; 131 (03) e881-e893
• 17 Shaw RJ, Bernard RS, Deblois T, Ikuta LM, Ginzburg K, Koopman C. The relationship between acute stress disorder and posttraumatic stress disorder in the neonatal intensive care unit. Psychosomatics 2009; 50 (02) 131-137
• 18 Kersting A, Dorsch M, Wesselmann U. , et al. Maternal posttraumatic stress response after the birth of a very low-birth-weight infant. J Psychosom Res 2004; 57 (05) 473-476
• 19 Cheng ER, Kotelchuck M, Gerstein ED, Taveras EM, Poehlmann-Tynan J. Postnatal depressive symptoms among mothers and fathers of infants born preterm: prevalence and impacts on children's early cognitive function. J Dev Behav Pediatr 2016; 37 (01) 33-42
• 20 Lasiuk GC, Comeau T, Newburn-Cook C. Unexpected: an interpretive description of parental traumas' associated with preterm birth. BMC Pregnancy Childbirth 2013; 13 (Suppl. 01) S13
• 21 Hane AA, Myers MM, Hofer MA. , et al. Family nurture intervention improves the quality of maternal caregiving in the neonatal intensive care unit: evidence from a randomized controlled trial. J Dev Behav Pediatr 2015; 36 (03) 188-196
• 22 Welch MG, Halperin MS, Austin J. , et al. Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with family nurture intervention in the NICU. Arch Women Ment Health 2016; 19 (01) 51-61
• 23 Welch MG, Firestein MR, Austin J. , et al. Family nurture intervention in the neonatal intensive care unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial. J Child Psychol Psychiatry 2015; 56 (11) 1202-1211
• 24 Dalia C, Abbas K, Colville G, Brierley J. Resilience, post-traumatic stress, burnout and coping in medical staff on the paediatric and neonatal intensive care unit (P/NICU) – a survey. Arch Dis Child 2013; 98 (Suppl. 01) A26-A27
• 25 Keene EA, Hutton N, Hall B, Rushton C. Bereavement debriefing sessions: an intervention to support health care professionals in managing their grief after the death of a patient. Pediatr Nurs 2010; 36 (04) 185-189
• 26 Sharp CG. Use of the chaplaincy in the neonatal intensive care unit. South Med J 1991; 84 (12) 1482-1486
• 27 Minnesota Department of Health. Psychological first aid (PFA). Available at: http://www.health.state.mn.us/oep/responsesystems/pfa.html . Accessed February 1, 2018