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Abstract
Despite evidence indicating high rates of distress among parents with infants in neonatal intensive care, few neonatal intensive care units (NICU) have psychologists on staff. Recently, the National Perinatal Association (NPA) has recommended that all NICUs staff psychologists dedicated to supporting families and medical providers. This article presents a three-part model of NICU psychological interventions that is relationship-based and context attentive, including: (1) the maternal/paternal experience, (2) transition to home, and (3) work with staff. The narrative descriptions are grounded in case vignettes, and supported by the literature as well as survey research obtained from a nation-wide sample of psychologists (n = 20) currently working in a NICU setting. Combined, a significant number of behavioral objectives are identified, and explored through the lens of ethical care and treatment in a NICU setting.
Acknowledgment
Many thanks to Susan Kraemer, PhD who accompanied me with insight and critical intelligence as we learned together about NICU families and staff. Also thanks to Laurel Wright, MA, for her keen editorial assistance. And to all the NICU families who taught us so much about the resilience of the human spirit, we are forever grateful for your trust and confidence.
Notes
1. See (Kraemer, Citation2006; Kraemer & Steinberg, Citation2006; Steinberg, Citation2006; Steinberg & Kraemer, Citation2010) for articles. Margaret Cohen (Citation2003) wrote a book beautifully describing her work in a London NICU.
2. For more than five years this group has conferenced called several times/year, sharing clinical dilemmas, supporting new psychologists, and planning multisite research projects. We thank Michael Hynan, PhD, for facilitating these calls. Transcripts are archived on NPA website.
3. At our NICUs—highly acute NICUs—on average, five babies die each month, a fact that weighs on the staff and the families.
4. A stillborn is a fetus who dies at or later than 20 weeks gestation. There are about 26,000 stillborn babies per year in the United States, equal to the number of deaths due to preterm birth. African-American women have a greater than two times increase in stillborn rate, even with prenatal care (Robert Silver; Caitlin, Citation2013).
5. Research emphasizes mothers, yet there is a burgeoning literature on fathers (Arockiasamy, Holsti, & Albersheim, Citation2008; Hollywood & Hollywood, Citation2011, Provenzi & Santoro, Citation2015).
6. The nursing research literature is replete with studies of the parent and nurse relationship in the NICU that support the idea of “nurse as emotional umbilical cord.” Some examples are (Aagaard & Hall, Citation2008; Fenwick et al., Citation2001, Citation2008; Flacking, Ewald, Nyqvist, & Starrin, Citation2006, Citation2012; Hurst, Citation2001a, Citation2001b).
Additional information
Notes on contributors
Zina Steinberg
Zina Steinberg is Assistant Clinical Professor of Medical Psychology (in Psychiatry and Pediatrics) at Columbia University College of Physicians and Surgeons, Psychologist, Neonatal Intensive Care Unit, New York-Presbyterian Morgan Stanley Children’s Hospital.
Chavis Patterson
Chavis Patterson is Assistant Professor of Clinical Psychology in Psychiatry at the Perelman School of Medicine at University of Pennsylvania, Director of Psychosocial Services, Division of Neonatology, The Children’s Hospital of Philadelphia.