Neonatal Nurses NICU Quality Improvement: Embracing EBP Recommendations to Provide Parent Psychosocial Support.

BACKGROUND: The neonatal intensive care unit (NICU) can be a stressful environment for infants, their families, and the healthcare team. There is an immediate need for neonatal nurses to embrace and translate the new National Perinatal Association recommendations for psychosocial support of NICU parents into clinical practice to demonstrate best practices for infants, their families, and the whole team. PURPOSE: To summarize the current evidence-based practice recommendations and to provide suggestions for team members to develop strategies to adopt and implement them through quality improvement (QI) projects. METHODS: Literature reviews were conducted by the original 6 National Perinatal Association workgroup teams and covered all levels of available evidence (eg, qualitative, quantitative, and clinical research, guidelines, and clinical and parental expertise). Evidence was synthesized to formulate this set of recommendations published in December 2015. We describe their applicability to the vital role of neonatal nurses, while elucidating QI projects that track measurements of change to translate these recommendations into practice. RESULTS: Neonatal nurses are in an ideal position to transform systems of support for NICU parents through the adoption of these recommendations at the bedside, and further to identify areas for QI to enhance implementation. IMPLICATIONS FOR PRACTICE: Neonatal nurses are integral to problem solving and identifying QI strategies for translating these recommendations into NICU clinical practice to improve parent psychosocial support. IMPLICATIONS FOR RESEARCH: This article disseminates evidence and encourages scientific investigation into various methods of supporting emotional health of NICU parents to create better health outcomes.

Implementation of an innovative nurse-delivered depression intervention for mothers of NICU infants.

Depression affects approximately 19% of all postpartum women, and mounting evidence indicates increased risk for mothers of preterm infants, with prevalence estimates ranging from 28% to 67%. The current approach to management of maternal symptoms related to postpartum depression in the neonatal intensive care unit (NICU) ranges from no intervention to depression screening and referral. For depressed mothers of NICU infants, obtaining treatment is especially difficult and usually becomes a secondary priority; thus, we looked to a nurse-delivered counseling model. Listening visits (LV) are an empirically supported nurse-delivered intervention that focuses on relationship building and exploration of a mother's problems through active reflective listening and collaborative problem solving. An LV open trial in the NICU has been conducted to evaluate the effectiveness of this intervention for mothers of hospitalized infants. Results indicate that LV are associated with a reduction in both maternal depressive and anxiety symptoms. This case study following the description of the intervention demonstrates how the authors used the experiences from the NICU open trial to expand the application of LV to this new setting.

Depression and anxiety symptoms in mothers of newborns hospitalized on the neonatal intensive care unit.

BACKGROUND: Mothers of infants hospitalized in the neonatal intensive care unit (NICU) are at risk for clinically significant levels of depression and anxiety symptoms; however, the maternal/infant characteristics that predict risk have been difficult to determine. Previous studies have conceptualized depression and anxiety symptoms separately, ignoring their comorbidity. Moreover, risk factors for these symptoms have not been assessed together in one study sample. OBJECTIVES: The primary aim of this study was to determine whether a diagnostic classification approach or a common factor model better explained the pattern of symptoms reported by NICU mothers, including depression, generalized anxiety, panic, and trauma. A secondary aim was to assess risk factors of aversive emotional states in NICU mothers based on the supported conceptual model. METHOD: In this cross-sectional study, a nonprobability convenience sample of 200 NICU mothers completed questionnaires assessing maternal demographic and infant health characteristics, as well as maternal depression and anxiety symptoms. Structural equation modeling was used to test a diagnostic classification model and a common factor model of aversive emotional states and the risk factors of aversive emotional states in mothers in the NICU. RESULTS: Maximum likelihood estimates indicated that examining symptoms of depression and anxiety disorders as separate diagnostic classifications did not fit the data well, whereas examining the common factor of negative emotionality rendered an adequate fit to the data and identified a history of depression, infant illness, and infant prematurity as significant risk factors. DISCUSSION: This study supports a multidimensional view of depression and should guide both clinical practice and future research with NICU mothers.