nurturing staff to nurture families: strategies to provide ... · pani pantelides “… hospitals...
TRANSCRIPT
Nurturing staff to nurture familiesStrategies to provide education systems building
and reflectionInga Warren MSc
University College London Hospital
Pani Pantelides
ldquohellip hospitals should consider the need to nurse the nurse to bolster well-being of the staff and ultimately facilitate the nurturing of familiesrdquo Roberta Cricco-Lizza 2014
What is expected of us the under-recognised demands of emotional labor(Cricco-Lizza 2014 Wigert 2014 Cleveland 2008))
A warm welcome at all times
Permanent ldquohappy facerdquo
Controlled emotions
Cultural sensitivity
Clear and personal communication
Attentive listeners
A human being
Partnership with parents
Support parenting roles
Promote parent-baby interaction
Constancy
Cope with challenging behaviour
Nurses expend labor to control emotions and to present to babies and parents a work persona of competence and composed professionalism (Cricco-Lizza 2014)
What happens to us Stress burnout and compassion fatigue(Profit 2014 Boyle 2011)
Tired Sad depressed Angry Apathetic Sleep disturbance Moral distress Health problems
Absenteeism Unable to keep up and
change Poor work life balance
impact on families High staff turnover Low job satisfaction
Burnout related to conflict within work settingCompassion fatigue related to interpersonal
intensity
Impact of burnout compassion fatigue on patient care
Poor safety culture
Higher rates of error
Suboptimal care eg increased risk of infection
Parent dissatisfaction
Complaints and law suits
Difficulty achieving quality improvements
Profit 2014 Prins et al 2009 Rochefort and Clarke 2010
1118 studies had outcomes for parents (218 fathers)
Positive effects on anxiety depressive symptoms and self efficacy
Interventions with psychosocial support had better outcomes
Parenting education - positive effect on anxiety
Parenting education alone did not reduce stress Parent support component did have an effect
Benzies K M et al Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC pregnancy and childbirth 13Suppl 1 (2013) S10
Parent support is an important component of interventions for pre-term infants
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesis International Journal of Nursing Sciences 1(3) 281ndash290
Four influencing factors in a NICU parents progression
1 contact with and proximity to their infant
2 relationship with the nurse
3 having information
4 social support
ldquoNurses must engage with NICU parents in such a way as to maximize the likelihood that these parents will reach at minimum the proficient and at maximum the expert parenting stage by dischargerdquo
CLOSENESS AND CONNECTION
ClosenessFlacking R et al for the SCENE group 2012 Closeness and separation in neonatal intensive care Acta Paed
Emotional connectionHane A et al Family Nurture Intervention improves the quality of maternal caregiving in the neonatal intensive care unit Evidence from a RCT J Dev Behav Pediatr 2015
STRATEGIES for nurturing staff and building resilience
Self maintenance
Systems organisation
Education
Reflection
( and mindfulness)
1 SELF MAINTENANCE ldquoresponsible selfishnessrdquo (Jones 2005)
Work-life balance
Exercise
Diet
Distractions
Diaryjournal
Meditation
Massage
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
ldquohellip hospitals should consider the need to nurse the nurse to bolster well-being of the staff and ultimately facilitate the nurturing of familiesrdquo Roberta Cricco-Lizza 2014
What is expected of us the under-recognised demands of emotional labor(Cricco-Lizza 2014 Wigert 2014 Cleveland 2008))
A warm welcome at all times
Permanent ldquohappy facerdquo
Controlled emotions
Cultural sensitivity
Clear and personal communication
Attentive listeners
A human being
Partnership with parents
Support parenting roles
Promote parent-baby interaction
Constancy
Cope with challenging behaviour
Nurses expend labor to control emotions and to present to babies and parents a work persona of competence and composed professionalism (Cricco-Lizza 2014)
What happens to us Stress burnout and compassion fatigue(Profit 2014 Boyle 2011)
Tired Sad depressed Angry Apathetic Sleep disturbance Moral distress Health problems
Absenteeism Unable to keep up and
change Poor work life balance
impact on families High staff turnover Low job satisfaction
Burnout related to conflict within work settingCompassion fatigue related to interpersonal
intensity
Impact of burnout compassion fatigue on patient care
Poor safety culture
Higher rates of error
Suboptimal care eg increased risk of infection
Parent dissatisfaction
Complaints and law suits
Difficulty achieving quality improvements
Profit 2014 Prins et al 2009 Rochefort and Clarke 2010
1118 studies had outcomes for parents (218 fathers)
Positive effects on anxiety depressive symptoms and self efficacy
Interventions with psychosocial support had better outcomes
Parenting education - positive effect on anxiety
Parenting education alone did not reduce stress Parent support component did have an effect
Benzies K M et al Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC pregnancy and childbirth 13Suppl 1 (2013) S10
Parent support is an important component of interventions for pre-term infants
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesis International Journal of Nursing Sciences 1(3) 281ndash290
Four influencing factors in a NICU parents progression
1 contact with and proximity to their infant
2 relationship with the nurse
3 having information
4 social support
ldquoNurses must engage with NICU parents in such a way as to maximize the likelihood that these parents will reach at minimum the proficient and at maximum the expert parenting stage by dischargerdquo
CLOSENESS AND CONNECTION
ClosenessFlacking R et al for the SCENE group 2012 Closeness and separation in neonatal intensive care Acta Paed
Emotional connectionHane A et al Family Nurture Intervention improves the quality of maternal caregiving in the neonatal intensive care unit Evidence from a RCT J Dev Behav Pediatr 2015
STRATEGIES for nurturing staff and building resilience
Self maintenance
Systems organisation
Education
Reflection
( and mindfulness)
1 SELF MAINTENANCE ldquoresponsible selfishnessrdquo (Jones 2005)
Work-life balance
Exercise
Diet
Distractions
Diaryjournal
Meditation
Massage
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
What is expected of us the under-recognised demands of emotional labor(Cricco-Lizza 2014 Wigert 2014 Cleveland 2008))
A warm welcome at all times
Permanent ldquohappy facerdquo
Controlled emotions
Cultural sensitivity
Clear and personal communication
Attentive listeners
A human being
Partnership with parents
Support parenting roles
Promote parent-baby interaction
Constancy
Cope with challenging behaviour
Nurses expend labor to control emotions and to present to babies and parents a work persona of competence and composed professionalism (Cricco-Lizza 2014)
What happens to us Stress burnout and compassion fatigue(Profit 2014 Boyle 2011)
Tired Sad depressed Angry Apathetic Sleep disturbance Moral distress Health problems
Absenteeism Unable to keep up and
change Poor work life balance
impact on families High staff turnover Low job satisfaction
Burnout related to conflict within work settingCompassion fatigue related to interpersonal
intensity
Impact of burnout compassion fatigue on patient care
Poor safety culture
Higher rates of error
Suboptimal care eg increased risk of infection
Parent dissatisfaction
Complaints and law suits
Difficulty achieving quality improvements
Profit 2014 Prins et al 2009 Rochefort and Clarke 2010
1118 studies had outcomes for parents (218 fathers)
Positive effects on anxiety depressive symptoms and self efficacy
Interventions with psychosocial support had better outcomes
Parenting education - positive effect on anxiety
Parenting education alone did not reduce stress Parent support component did have an effect
Benzies K M et al Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC pregnancy and childbirth 13Suppl 1 (2013) S10
Parent support is an important component of interventions for pre-term infants
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesis International Journal of Nursing Sciences 1(3) 281ndash290
Four influencing factors in a NICU parents progression
1 contact with and proximity to their infant
2 relationship with the nurse
3 having information
4 social support
ldquoNurses must engage with NICU parents in such a way as to maximize the likelihood that these parents will reach at minimum the proficient and at maximum the expert parenting stage by dischargerdquo
CLOSENESS AND CONNECTION
ClosenessFlacking R et al for the SCENE group 2012 Closeness and separation in neonatal intensive care Acta Paed
Emotional connectionHane A et al Family Nurture Intervention improves the quality of maternal caregiving in the neonatal intensive care unit Evidence from a RCT J Dev Behav Pediatr 2015
STRATEGIES for nurturing staff and building resilience
Self maintenance
Systems organisation
Education
Reflection
( and mindfulness)
1 SELF MAINTENANCE ldquoresponsible selfishnessrdquo (Jones 2005)
Work-life balance
Exercise
Diet
Distractions
Diaryjournal
Meditation
Massage
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
What happens to us Stress burnout and compassion fatigue(Profit 2014 Boyle 2011)
Tired Sad depressed Angry Apathetic Sleep disturbance Moral distress Health problems
Absenteeism Unable to keep up and
change Poor work life balance
impact on families High staff turnover Low job satisfaction
Burnout related to conflict within work settingCompassion fatigue related to interpersonal
intensity
Impact of burnout compassion fatigue on patient care
Poor safety culture
Higher rates of error
Suboptimal care eg increased risk of infection
Parent dissatisfaction
Complaints and law suits
Difficulty achieving quality improvements
Profit 2014 Prins et al 2009 Rochefort and Clarke 2010
1118 studies had outcomes for parents (218 fathers)
Positive effects on anxiety depressive symptoms and self efficacy
Interventions with psychosocial support had better outcomes
Parenting education - positive effect on anxiety
Parenting education alone did not reduce stress Parent support component did have an effect
Benzies K M et al Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC pregnancy and childbirth 13Suppl 1 (2013) S10
Parent support is an important component of interventions for pre-term infants
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesis International Journal of Nursing Sciences 1(3) 281ndash290
Four influencing factors in a NICU parents progression
1 contact with and proximity to their infant
2 relationship with the nurse
3 having information
4 social support
ldquoNurses must engage with NICU parents in such a way as to maximize the likelihood that these parents will reach at minimum the proficient and at maximum the expert parenting stage by dischargerdquo
CLOSENESS AND CONNECTION
ClosenessFlacking R et al for the SCENE group 2012 Closeness and separation in neonatal intensive care Acta Paed
Emotional connectionHane A et al Family Nurture Intervention improves the quality of maternal caregiving in the neonatal intensive care unit Evidence from a RCT J Dev Behav Pediatr 2015
STRATEGIES for nurturing staff and building resilience
Self maintenance
Systems organisation
Education
Reflection
( and mindfulness)
1 SELF MAINTENANCE ldquoresponsible selfishnessrdquo (Jones 2005)
Work-life balance
Exercise
Diet
Distractions
Diaryjournal
Meditation
Massage
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Impact of burnout compassion fatigue on patient care
Poor safety culture
Higher rates of error
Suboptimal care eg increased risk of infection
Parent dissatisfaction
Complaints and law suits
Difficulty achieving quality improvements
Profit 2014 Prins et al 2009 Rochefort and Clarke 2010
1118 studies had outcomes for parents (218 fathers)
Positive effects on anxiety depressive symptoms and self efficacy
Interventions with psychosocial support had better outcomes
Parenting education - positive effect on anxiety
Parenting education alone did not reduce stress Parent support component did have an effect
Benzies K M et al Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC pregnancy and childbirth 13Suppl 1 (2013) S10
Parent support is an important component of interventions for pre-term infants
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesis International Journal of Nursing Sciences 1(3) 281ndash290
Four influencing factors in a NICU parents progression
1 contact with and proximity to their infant
2 relationship with the nurse
3 having information
4 social support
ldquoNurses must engage with NICU parents in such a way as to maximize the likelihood that these parents will reach at minimum the proficient and at maximum the expert parenting stage by dischargerdquo
CLOSENESS AND CONNECTION
ClosenessFlacking R et al for the SCENE group 2012 Closeness and separation in neonatal intensive care Acta Paed
Emotional connectionHane A et al Family Nurture Intervention improves the quality of maternal caregiving in the neonatal intensive care unit Evidence from a RCT J Dev Behav Pediatr 2015
STRATEGIES for nurturing staff and building resilience
Self maintenance
Systems organisation
Education
Reflection
( and mindfulness)
1 SELF MAINTENANCE ldquoresponsible selfishnessrdquo (Jones 2005)
Work-life balance
Exercise
Diet
Distractions
Diaryjournal
Meditation
Massage
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
1118 studies had outcomes for parents (218 fathers)
Positive effects on anxiety depressive symptoms and self efficacy
Interventions with psychosocial support had better outcomes
Parenting education - positive effect on anxiety
Parenting education alone did not reduce stress Parent support component did have an effect
Benzies K M et al Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC pregnancy and childbirth 13Suppl 1 (2013) S10
Parent support is an important component of interventions for pre-term infants
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesis International Journal of Nursing Sciences 1(3) 281ndash290
Four influencing factors in a NICU parents progression
1 contact with and proximity to their infant
2 relationship with the nurse
3 having information
4 social support
ldquoNurses must engage with NICU parents in such a way as to maximize the likelihood that these parents will reach at minimum the proficient and at maximum the expert parenting stage by dischargerdquo
CLOSENESS AND CONNECTION
ClosenessFlacking R et al for the SCENE group 2012 Closeness and separation in neonatal intensive care Acta Paed
Emotional connectionHane A et al Family Nurture Intervention improves the quality of maternal caregiving in the neonatal intensive care unit Evidence from a RCT J Dev Behav Pediatr 2015
STRATEGIES for nurturing staff and building resilience
Self maintenance
Systems organisation
Education
Reflection
( and mindfulness)
1 SELF MAINTENANCE ldquoresponsible selfishnessrdquo (Jones 2005)
Work-life balance
Exercise
Diet
Distractions
Diaryjournal
Meditation
Massage
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesis International Journal of Nursing Sciences 1(3) 281ndash290
Four influencing factors in a NICU parents progression
1 contact with and proximity to their infant
2 relationship with the nurse
3 having information
4 social support
ldquoNurses must engage with NICU parents in such a way as to maximize the likelihood that these parents will reach at minimum the proficient and at maximum the expert parenting stage by dischargerdquo
CLOSENESS AND CONNECTION
ClosenessFlacking R et al for the SCENE group 2012 Closeness and separation in neonatal intensive care Acta Paed
Emotional connectionHane A et al Family Nurture Intervention improves the quality of maternal caregiving in the neonatal intensive care unit Evidence from a RCT J Dev Behav Pediatr 2015
STRATEGIES for nurturing staff and building resilience
Self maintenance
Systems organisation
Education
Reflection
( and mindfulness)
1 SELF MAINTENANCE ldquoresponsible selfishnessrdquo (Jones 2005)
Work-life balance
Exercise
Diet
Distractions
Diaryjournal
Meditation
Massage
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
CLOSENESS AND CONNECTION
ClosenessFlacking R et al for the SCENE group 2012 Closeness and separation in neonatal intensive care Acta Paed
Emotional connectionHane A et al Family Nurture Intervention improves the quality of maternal caregiving in the neonatal intensive care unit Evidence from a RCT J Dev Behav Pediatr 2015
STRATEGIES for nurturing staff and building resilience
Self maintenance
Systems organisation
Education
Reflection
( and mindfulness)
1 SELF MAINTENANCE ldquoresponsible selfishnessrdquo (Jones 2005)
Work-life balance
Exercise
Diet
Distractions
Diaryjournal
Meditation
Massage
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
STRATEGIES for nurturing staff and building resilience
Self maintenance
Systems organisation
Education
Reflection
( and mindfulness)
1 SELF MAINTENANCE ldquoresponsible selfishnessrdquo (Jones 2005)
Work-life balance
Exercise
Diet
Distractions
Diaryjournal
Meditation
Massage
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
1 SELF MAINTENANCE ldquoresponsible selfishnessrdquo (Jones 2005)
Work-life balance
Exercise
Diet
Distractions
Diaryjournal
Meditation
Massage
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Connect
Learn
(Be) Active
Notice
Give back
Eat well
Relax
Sleep(Phillip Hammond)
Does your institution support self maintenance good food health
services fitness support child care
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
1 Understand triggers
2 Review methods for coping
3 Caregiver plans for self treatment
4 Resources for addressing compassion fatigue
5 Teach effective self-soothing
6 Teach grounding and containment skills
7 Enhance proficiency in self care and boundary setting
8 Video- dialogue techniques for self supervision
9 Self administered self care planning
Accelerated Recovery Program (ARP)(Gentry et al 2000)
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
2 SYSTEMS ORGANISATION
Policies ndash compatibility with family centred philosophy
Attitudes to FCDC Being allowed to deliver good quality care
Ratio of senior staff (Turner 2014)
Rostering
Group size - magic number 150 (Dunbar 1992)
Equal opportunities (Williamson 1992)
Constant organisational change (influenced by competition technology legalregulatory constraints) is EXHAUSTING (Cricco-Lizza 2014)
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
EQUAL OPPORTUNITIES
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Policies donrsquot implement themselvesWallin et al 2004 Staff experiences in implementing guidelines for
kangaroo mother care Int J Nurse Studies
Evidence based guidelines
4 units Change team
2 units FACILITATOR
Change activities
Focus groups
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
ARRC project Sheffield (Skene)
Action Research on Relationship Centred Care
Exploration bull Parent and staff surveysbull Parent and staff focus groupsbull Baseline data
Interventioncycles x 3
bull Planningbull Actingbull Observationbull Re-planning
Evaluation bull Parent and staff focus groupsbull Parent and staff interviewsbull Compare with baseline data
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
3 ENVIRONMENT
Space to help parents interact with their baby
Space to talk to parents privately
(Wigert 2014 Turner et al2014)
Impact of single room design on staffbull Increased workload and isolationbull Increased satisfaction from benefits to infants and families(Hagen et al 2015)
Feilden Clegg 2011
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
AESTHETICS ndash impact on well-being and confidence in the institution
Colour
Art work
Lighting
Daylight
Views of nature
References to nature
Lankston et al 2010 Ulrich and Gilpin 2003 Behrman 1997
Fluorescent Gallery
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
ENVIRONMENTAL STRESSORS(White et al 2013 Ulrich 2004)
bull Light bright areas for breaks and work surfaces light showers for night staff morning light
bull Sound levels and characteristics - fatigue errors communication
bull Temperature (Williamson 1993) and ventilation
An environment that is appropriate safe and healthy for infants parents and STAFF
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
SOCIAL ENVIRONMENT
Community ndash ldquothe village effectrdquo
(Pinker 2014) shared food book swop
birthdays events
Space to take breaks to meet eat
talk chat and laugh together
bull Culture of mutual assistance and respect (Williamson 1992)
bull Psychological support relationships moral dilemmas
bull Protection eg from aggressive behaviour bullying
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
RELATIONSHIPS WITHIN THE SYSTEM
Parents are sensitive to power struggles difficult relationships and inconsistencies in the system
Adopt deferential behaviour with staff and anxious surveillance to protect baby
Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
LEADERSHIP
Transformational leadership (Nielsen et al 2009) Leaders and their followers raise one another to higher levels of morality and motivation vision identity role modelling strengths and weaknesses
Management style ndash visibility fairness walk rounds feedback (Sexton et al 2014)
Good manners ndash rudeness undermines performance (Riskin et al 2016)
Developmental care team (Hendricks-Munoz et al 2007)
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
3 EDUCATION ndash Recommendations for enhancing psychosocial support of NICU parents through staff education
and support Hall et al 2015 J Perinatol)
ldquoNormalrdquo responses to infant hospitalisation
Mood and anxiety disorders
Family Centred Developmental Care
Cultural sensitivity with self awareness and flexibility
Self care
Competent communications
Focusing on staff training alone is insufficient as it neglects employment practices and issues of management style that
contribute to burnout Hall et al 2015
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
COMPETENCIES Relationship based (Warren and Brown 2014)
Relationship with the Infant
Relationship with the Family
Relationships within the system
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Bush RN 1984 Effective staff development
1013 14
19
95
0
10
20
30
40
50
60
70
80
90
100
1
Rate of transfer into classroom practice following peer coaching
Workshop
Workshop and modeling
Workshop modeling and practice
Workshop modeling practice and feedback
Workshop modeling practice feedback and peercoaching
The most effective way to learn
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
COACHING what makes it work
Job embedded directly applicable to practice
Focused on a few highly important strategies
Intensive (one-to-one)and on-going
Partnership equal partner collaborator with coach
Dialogue reflective conversations
Non-judgemental and confidential
Respectful open and honest communication
Management interest and support
Voluntary
Coach needs deep understanding of area of work
Adapted from Knight J 2009
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
bull NIDCAP (Als 1985 2003)
bull Mother Infant Transaction Programme (Rauh
1990 Kaareson 2006 Newnham 2009)
bull Family Nurture Intervention (Welch 2012 Hane
2015))
Training with COACHING component and improved parent outcomes
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Author Year Country Impact on parents
Als et al 2003 USA bull Lower family stress and enhanced appreciation of the infant
Wielngaet al
2006 Nether-lands
bull Parents more satisfied with care given according to NIDCAP than with traditional care
Kleberg et al
2007 Sweden bull Perceived more closeness to their infants than control mothers (p=0022)
bull Rated staffrsquos ability to support them in their role as a mother higher
Van der Pal et al
2007 Nether-lands
bull No significant differences were found in confidence perceived nursing support or parental stress
Newborn Individualised Developmental Care and Assessment Programme
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Author Year Country Impact on parents
Rauh et al 1998 USA Greater satisfaction and confidence with mothering More favourable perceptions of infant temperament
Kaaresen et al
2006 Norway Mothers and fathers in the intervention group reported significant lower scores in child domain parent domain and total stress
Newnham 2009 Australia Mothers less stressed by their infant at 3 months
Mother Infant Transaction Programme staff trained with Brazelton Neonatal Behavioural Assessment Scale
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Close Collaboration with Parents Training Programme Ahlqvist-Bjorkroth S et al (2013)
bull Increased parental involvement in infant care
bull Increased interaction with parents
bullThe role of the nurse changed from an active caretaker to a facilitator
Axelin et al 2014 Nurses perspectives on the close collaboration with parents training program in the NICU
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Communication skills
ldquoLimited conversationrdquo (McCarthy et al 2013)
Education in use of translators
Using simple non-technical language
Availability of printed materials ndash words and pictures
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Programme to Enhance Relational and Communication Skills (PERCS-NICU) (Meyer et al
2011 Boston)
Interdisciplinary workshops (6h) 10-15 participants and 3 facilitators
Collaborative exercise educational film didactic presentation
Case scenario with actors
Conversation feedback reflection action plans
RESULTS questionnaire at 12 m100 improved preparation communication skills and confidence83 reduced anxiety
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Neonatal Critical Care Communication (NC3)(Boss et al 2013)
13 Medical and NNPs
3 day retreat
Didactic overviews (10 key communication skills)
Facilitated groups with role play (actors)
Written curriculum (referenced) with 6 modules which included specific skills such as ask-tell-ask jargon free language open ended questions
RESULTS ( Surveys before during and 1 month after)bull Improvement in perceived competence in 10 key skillsbull More confident to talk to families
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
4 REFLECTIONThinking about who we are what we do and who
we want to be Learning from experience
Rosalie Fiennes 2014
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
REFLECTIONMenu of work setting options (Boyle 2011)
On-site counselling
Staff support groups
De-briefing sessions
Art therapy
Massage
Encourage integration of self care plans into performance appraisals
Talking with the sisterhoodrdquo (Cricco-Lizza 2014)
VERP Video Enhanced Reflective Practice video clips of self at work to discuss in supervision
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
SHARING STORIESAn example from palliative care (Campion Smith 2011)
Six 2 hour sessions
Topics weekly themes Symptom control
Communication
Benefits
Family issues
Ethics
Emergencies
Organisation of care
Multidisciplinary groups to share stories on the theme of the day - feedback ideas
Fast feedback forms one-to-one telephone interviews 5 months later
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Modified KIRKPATRICKrsquoS LEVELS OF EVALUATION (Barr et al 2000)
1 Learnersrsquo reactions
2a Modification of attitudes and perceptions
2b Acquisition of knowledge and skills
3 Change in behaviour
4a Change in organisational practice
4b Benefits to patients and relativescarers
bull Technique of listening to othersrsquo experiences and sharing stories was an effective way to cross inter-professional boundaries
bull Evaluation was positive for all domains
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Holding staff who hold parents in the NICUPsychoanalytic perspectives (Kraemer 2006 Cohen 2003)
Ambivalence about psychological support (Profit 2014)
ldquoClinging to fragmentation of carerdquo - detachment denial and
depersonalisation as coping strategies
Seek relief from the draining Intensive contact with families
Resistant to putting themselves in the parentsrsquo shoes
Psychotherapists have a powerful role as translators and meaning makers They can help to structure free-floating chaos and to provide shape and context to wordless anxieties Kraemer 2006
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
SUPPORTING PARENTS TO REFLECT (Underdown 2013)
Capacity to ldquomentaliserdquo ndash interpret behaviour in terms of underlying feelings ndash important for developing sensitive interactions
Parents with low reflective function more likely to misinterpret babyrsquos behaviour
Opportunities for parents to develop perceptions of their baby as a person ndash likes dislikes strengths and sensitivities
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Other opportunities and ways to enhance job satisfaction
Seeing the benefits of quality care ndash audit and feedback
Visits from children
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Ahlqvist-Bjorkroth S et al (2013) Close Collaboration with Parents Training ProgrammeTurku University Finland
Als H (1986 rev 2015) Program Guide - Newborn Individualized Developmental Care and Assessment Program (NIDCAP) An Education and Training Program for Health Care Professionals Boston Copyright NIDCAP Federation International wwwnidcaporg
Als H et al (2003) A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants medical neurodevelopmental parenting and caregiving effects Journal of Developmental amp Behavioral Pediatrics 24(6)399-408
Axelin Anna et al Nurses perspectives on the close collaboration with parents training program in the NICU MCN The American Journal of MaternalChild Nursing 394 (2014) 260-268
Barr H Freeth D Hammick M Koppel I amp Reeves S (2000) Evaluations of interprofessional education London United Kingdom Re view of Health and Social Care
Bellieni CV et al (2012) Assessing burnout among neonatologists J Mat-Fetal amp Neonat Med 2510 (2012) 2130-2134
Benzies KM et al (2013) Key components of early intervention programs for preterm infants and their parents a systematic review and meta-analysis BMC Pregnancy and Childbirth 13Suppl 1 (2013) S10
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Behrman P 1997 Art in hospitals Why is it there and what is it for Lancet350584-5Boss and Harris on single rooms)
Boss R D et al Neonatal Critical Care Communication (NC3) training NICU physicians and nurse practitioners Journal of Perinatology 338 (2013) 642-646
Boyle Deborah (2011) Countering compassion fatigue A requisite nursing agenda The Online Journal of Issues in Nursing 161
Campion Smith C Austin H et al (2011) Can sharing stories change practice A qualitative study of an interprofessional narrative based palliative care course Journal of Interprofessional Care 25105-111
bull Cleveland L M (2008) Parenting in the neonatal intensive care unit Journal of Obstetric Gynecologic and Neonatal Nursing JOGNN NAACOG 37(6) 666ndash91
bull Cohen M 2003 Sent Before My Time A Child Pyschotherapistrsquos View of Life on a Neonatal Intensive Care Unit KarnacLondon
bull Cricco-Lizza R (2014) The Need to Nurse the Nurse Emotional Labor in Neonatal Intensive Care Qualitative Health Res 245 615-628
bull Dickson KE Kinney MV et al (2015)Sscaling up quality care for mothers and newborns around the time of birth an overview of methods and analyses of intervention-specific bottlenecks and solutions BMC Pregnancy and Childbirth15(Suppl 2) S1
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
bull Finlayson K Dixon A et al (2014) Mothers perceptions of family centred care in neonatal intensive care units Sexual and Reproductive Healthcare 5 119-124
bull Gentry et al (2002) The Accelerated Recovery Program( ARP) In Figley CR Ed Treating Compassion Fatigue New York Brunner-Routledge pp 123-138
bull Hall S L et al (2015) Recommendations for enhancing psychosocial support of NICU parents through staff education and support Journal of Perinatology35 (2015) S29-S36
bull Hendricks-Munoz Karen D and Carol C Prendergast Barriers to provision of developmental care in the neonatal intensive care unit neonatal nursing perceptions American journal of perinatology 242 (2007) 71-77
bull Karina Nielsen K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire surveyInternational Journal of Nursing Studies 46(9) 1236ndash1244
Knight J (2009) Coaching The key to translating research into practice lies in continuous job-embedded learning with ongoing support Journal of Staff Development 30 (1) 18-22
Kraemer SB (2006) So the cradle wont fall Holding the staff who hold the parents in the NICU Psychoanalytic Dialogues 162 149-164
Lankston L Cusack P et al (2010) Visual art in hospitals case studies and review of the evidence Journal of the Royal Society of Medicine 2010103(12)490-499
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Lester BM et al (2011) Infant Neurobehavioral Development Semin Perinatol 35(1) 8ndash19
Neilson K Yarker J et al (2009) The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals A cross-sectional questionnaire survey International Journal of Nursing Studies 46(9) 1236ndash1244
Meyer EC et al (2011) An interdisciplinary family-focused approach to relational learning in neonatal intensive care J Perinatol 31(3) 212-219
Pineda RG et al (2012) The single patient room in the NICU Maternal and family effects J Perinatol 32(7) 545ndash551
Pinker S The Village Effect
Profit J et al (2014) Burnout in the NICU setting and its relation to safety culture BMJ Quality amp Safety 2310 806-813
Rauh VA et al (1990) The mother-infant transaction program Clin in Perinatol 17(1) 31-45
Sexton J Bryan et al Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout BMJ quality amp safety (2014)
Shahheidari M Homer C (2012) Impact of the design of neonatal intensive care units on neonates staff and families a systematic literature review J Perinat Neonatal Nurs 26(3)260-6
Shepley MM Smith JA et al (2014) The businesss case for building better neonatal intensive care units J Perinatol 34811-815
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95
Stevens DC Helseth Cc et al (2010) Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design Journal of Perinatology (2010) 30 352ndash358 TurnerM et al (2014) The neonatal nurses view of their role in emotional support of parents and its complexities Journal of clinical nursing 23 (21-22) 3156-3165
Ulrich R Zimring C (2004) The role of the physical environment in the hospital of the 21st century A once in a lifetime opportunity Report to The Centre for Health Design for the Designing the 21st Century Hospital Project
Ulrich R S amp Gilpin L (2003) Healing arts Nutrition for the soul In S B FramptonL Gilpin amp P A Charmel (Eds) Putting patients first Designing and practicing patient-centered care (pp 117ndash146) San Francisco CA John Wiley amp Sons
Underdown A (2013) Parent-infant relationships Supporting parents to adopt a reflective stance J Health Visiting 1(2)76-79
VazQuez V Cong X (2014) Parenting the NICU infant A meta-ethnographic synthesisInternational Journal of Nursing Sciences 1(3) 281ndash290
Vittner D (2009) Reflective strategies in the neonatal clinical areaAdvances in
Neonatal Care 9(1) 43-45
bull White RD et al (2013) Recommended standards for newborn ICU design eighth edition Journal of Perinatology 33s2-s16
bull Wigert H et al (2014) Parentsrsquo experiences of communication with neonatal intensive-care unit staff an interview study BMC Pediatrics 14(1)304
bull Williamson S (1993) Job satisfaction and dissatisfaction amongst neonatal nurses Midwifery 985-95