NICU Families in Crisis

Topics: Emotion, Intensive care medicine, Neonatal intensive care unit Pages: 9 (951 words) Published: November 16, 2013
Families in Crisis
We as NICU nurses are given a very
difficult task of caring for the most
fragile population…as well as
ministering to the most vulnerable
families in the hospital.

Families in Crisis
Neither of these tasks is easy, yet we
have to perform them simultaneously.
It is difficult and stressful…and also
rewarding.
Here we will focus on the family.

Objectives
 Recognition of the unique psychological tasks

and stressors of NICU families
 Description of assessment strategies for
families in crisis
 Discussion of the impact on and interventions
for successful family-infant bonding in NICU

Definition of Crisis
 Temporary disequilibrium

 A problem or transitional phase so stressful

that normal coping strategies may not work
Key Point: The premature birth or the birth of
a sick infant catapults a family into crisis

Major Psychological Tasks
for NICU Families
Acknowledgement of failure to deliver a

term infant
Maternal guilt
Perceived (or real) blaming by others

Psychological Tasks
 Preparation for possible loss of infant

Possibility of death
Hoping for survival

Fear of what survival may bring

Psychological Tasks
Adaptation to NICU environment
Special entry/access procedure
Intimidating setting
Environmental/equipment barriers
Absence of the social support that

accompanies term birth & homecoming

Psychological Tasks
 Establishment of a healthy relationship

with infant
Bonding vs. on-going threat of loss
Parental competence vs.incompetence
Absence of reciprocal relationship
from infant

Psychological Tasks
Preparation for discharge
 Parent concern about ability to care

for infant
Risk for maladaptive parenting
Failure to bondNeglect
Over-protectiveVulnerable Child
Syndrome

Assessment of Coping Strategies:
Factors that Influence Coping
Socioeconomic status
 Limited resources (transportation issues)
 Lack of role models

Adolescent pregnancy
Presence/absence of support

Mother’s medical condition

More Factors Affecting Coping
Cultural
 Perfect vs. imperfect child
 Role of the male vs. female in

communication & decision making
 Visitation

Assessment of Parents’
Emotional States
Grief
 Response of sadness/sorrow to the loss of a

valued object
 Loss of dream of normal healthy infant
 Loss of control
 Potential loss of infant

Key Point: Grief is the core of emotional state of
NICU parents

Emotional States
Shock/Terror
 Cannot process information (especially on
admission)
 Rash Decisions/Disorganized
 Signs
Glazed or “deer in the headlights” look
Repeats questions already answered
Agrees to everything without questions

Emotional States
Fear
 Overwhelming vulnerability
 Unable to form attachment to infant
 Signs
Detachment, distancing, frozen

Darting eyes, rapid speech, frequent topic
changes
Avoid infant, leave visit early, failure to visit
Feel vulnerable, fragile, weak

Emotional States
Guilt
 Parent as cause of prematurity/illness
 Seen as punishment: “Good things happen to
good people, bad things to bad people”
 Should/could have done something different
 Signs
 Dejection, self-blame, remorse, low self-esteem

 Seeking explanations “Why did this happen”

Emotional States
Depression
 Situational depression—circumstances of NICU stay
 Post-partum depression—serious seek counsel

 Signs
 Weak affect, lethargic

 Loss of appetite, neglect of self
 Sleep disturbance
 Feel despair, hopeless, powerless

 Chronic sorrow—handicapped or delayed infant

Emotional States
Anger
 Powerful emotion waiting to surface/explode
 Free-floating: directed at staff, spouse or
significant other, God
 Signs
 Aggression, clenched hands
 Closed posture or open accusing

 Feel abandoned, victimized, out of control

Emotional States
Jealousy
 Jealous of nursing role in...

References: Verklan, M. T., Core, M. W., Ed. Curriculum for
Neonatal Intensive Care Nursing.
Wyly, M. V., Allen, J. Stress and Coping in the
Neonatal Intensive Care Unit.
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