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

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.

UNPACKING THE BURDEN OF CARE FOR INFANTS IN THE NICU.

Infants who begin early life in the medicalized environment of the neonatal intensive care unit (NICU) experience disruption to numerous fundamental expectancies. In the NICU, infants are exposed to chronic, extreme stressors that include painful medical procedures and parental separation. Due to their preverbal stage of development, infants are unable to fully express these experiences, and linking these experiences to long-term outcomes has been difficult. This clinical article proposes the terminology Infant Medical Trauma in the NICU (IMTN) to describe the infant experience. Following a discussion of the NICU as an adverse childhood event, the article has three sections: (a) the unique and critical factors that define the newborn period, (b) a review of the IMTN conceptual model, and (c) recommendations for supportive neuroprotective strategies to moderate the intensity of adverse NICU infant experiences.

End-of-life care in the neonatal intensive care unit: experiences of staff and parents.

OBJECTIVE: The aim of the study is to determine the perceptions of end-of-life care practices and experience with infants who have died in the NICU among neonatologists, advanced practitioners, nurses, and parents, and also to determine perceived areas for improvement and the perceived value of a palliative care team. STUDY DESIGN: This descriptive, exploratory cross-sectional study using surveys consisting of 7-point Likert scales and free response comments was sent to all neonatologists (n = 14), advanced practitioners (n = 40), and nurses (n = 184) at Connecticut Children's Medical Center's neonatal intensive care units (NICUs) in April 2013 and to all parents whose infants died in these NICUs from July 1, 2011, to December 31, 2012 (n = 28). RESULTS: The response rates were 64.3% for physicians; 50.0% for practitioners; 40.8% for nurses; and 30.4% for parents. Most providers reported they feel comfortable delivering end-of-life care. Bereavement support, debriefing/closure conferences, and education did not occur routinely. Families stressed the importance of memory making and bereavement/follow-up. Consistent themes of free responses include modalities for improving end-of-life care, inconsistency of care delivery among providers, and the importance of memory making and follow-up. CONCLUSION: End-of-life experiences in the NICU were perceived as variable and end-of-life practices were, at times, perceived as inconsistent among providers. There are areas for improvement, and participants reported that a formalized palliative care team could help. Families desire memory making, follow-up, and bereavement support.