Nurses' psychosocial work environment, parental needs and communication at the neonatal intensive care unit

Abstract

Background. Parents with an infant in the neonatal intensive care unit (NICU) often experience great emotional distress. They are dependent on staff for help in caring for and relating to their infant. Nursing staff who care for vulnerable infants and their families are subject to stress and burnout. Insufficient research exists on psychosocial aspects of the NICU environment. The present studies aimed at (1) describing needs of psychosocial support of parents of extremely premature infants at the NICU (2) describing registered nurses’ perceptions of their psychosocial work environment in a level II NICU, a special care nursery for moderately ill infants and (3) in a level III NICU with severely ill infants requiring advanced intensive care and (4) designing and evaluating a training program in communication for NICU nurses and studying relationships between difficult communication and burnout among the nurses. Methods. Study I: Sixteen interviews with parents of extremely premature infants were analyzed with inductive content analysis. Studies II and III: In each study, thirteen semi-structured interviews with registered nurses were analyzed using qualitative content analysis and thematic analysis, respectively. Study IV: Twenty-nine nurses participated in a new case-based communication course. Participants’ experiences of communication with parents and their degree of burnout were assessed. Communication skills were assessed before and after the course and at four-month follow-up. Results. Study I: Parents needed various forms of emotional support, where nursing staff had a key role. Further, parents needed to be able to maintain trust in the NICU and its staff. Parents struggled with perceived pressure to spend more time at the hospital and with the limited privacy of the NICU. Study II: Sources of stress included high workload, the emotional intensity of work and inexperienced nurses’ unfamiliarity with neonatal care. Nurses valued support from colleagues and educational opportunities. Study III: High staff turnover, with many inexperienced nurses, was described as stressful and negatively affecting group cohesion. While some were very satisfied with the workplace atmosphere, others described a negative climate and incivilities directed at new nurses. Study IV: High burnout scores were associated with communication-related difficulties. The course significantly improved participants’ confidence in their communication skills in challenging situations. Participants evaluated the course as highly interesting and important for their work. Conclusions. Parents of extremely premature infants in the NICU have complex, varied needs of psychosocial support. To meet parents’ needs, nurses need sufficient time, support and training. Organizations should give attention to the needs of support of both inexperienced and experienced nurses, and to the emotional strain of nurses’ work. Collegial social support and group cohesion should be fostered. NICU nurses experience communication with parents as important and rewarding but also stressful. They benefit from communication training addressing the specific communication challenges of their work.