Sue Hall, MD, MSW, FAAP; Sara Mosher, RN, MHA; Keira Sorrells, BCFCS
The National Perinatal Association is proud to announce the publication of a paper detailing the results of a study recently conducted in two Neonatal Intensive Care Units (NICUs) that demonstrates the efficacy of its NICU staff education course, “Caring for Babies and Their Families: Providing Psychosocial Support in the NICU.” The paper, entitled “Improving Staff Knowledge and Attitudes towards Providing Psychosocial Support to NICU Parents
through an Online Education Course,” can be found online at this link (Hall, SL, ME Famuyide, SN Saxton, TA Moore, S Mosher, K Sorrells, CA Milford, and J Craig. 2019. “Improving Staff Knowledge and Attitudes towards Providing Psychosocial Support to NICU Parents through an Online Education Course.” Advances in Neonatal Care epub in advance of print.)
An interprofessional collaborative group made up of members of the National Perinatal Association, Patient + Family Care, and the Preemie Parent Alliance formed My NICU Network (www.mynicunetwork.com) to develop this 7-hour continuing education course for NICU providers, including nurses, physicians, social workers, and more. The study of 114 NICU staff (primarily nurses) and showed that before taking the course, staff were aware of the importance of providing emotional support to families in their care, but did not feel they had either the confidence or strategies to provide that care successfully. After taking the course, staff achieved significant improvement in both knowledge and
attitudes towards providing psychosocial support to parents, and improvements were sustained at a six-month follow-up evaluation. The course also eliminated differences between night and day shift staff, and between staff with less vs. more experience working in the NICU. In addition, the majority of staff agreed or strongly agreed that taking the course improved their knowledge (87.5%) and would change their practice (78%) and that they would recommend the course to their peers (90%).
Research has shown that parents whose babies are hospitalized in a NICU undergo considerable stress, and have much higher risks for both postpartum depression and posttraumatic stress disorder compared with parents of healthy term babies. NICU parents also view communication with providers as essential to their satisfaction with their experience. This comprehensive course aims to bring the emotional and communication needs of NICU parents to staff’s awareness and to give evidence-based, practical, and traumainformed approaches (Sanders, 2018) for meeting those needs. Involving NICU Parent Leaders in the creation of this course from development to instruction has been
an essential way to enable providers to understand the challenges that NICU parents face; numerous parent stories, audios, and videos illustrate the learning points in the course.
The staff education course is based on the “Interdisciplinary Recommendations for Psychosocial Support in NICU Parents,” published in the Journal of Perinatology in December, 2015. The core content areas covered in the course mirror the content areas of the “Recommendations,” and include: Providing Emotional Support, Communication, Peer-to-peer Support, FamilyCentered Developmental Care, Palliative and Bereavement Care, Discharge and Follow-up Care, and Supporting Staff as They Support Families.
The importance of supporting families, so that they can better bond with and support their sick or premature babies, has gained increasing recognition, as the model of NICU care has shifted to greater delivery of Family-Centered Care and now into Family-Integrated Care. When an entire NICU’s staff takes the course at the same time, the NICU’s culture can be transformed so that everyone sees the family – not just the baby – as the patient. It is hoped that by giving staff the tools they need to handle their expanded roles in involving parents in the care of their babies and supporting families, that infant developmental outcomes, parent mental health outcomes, and patient (parent) satisfaction will improve. Additionally, the course focuses on the critical importance of supporting staff, so that they can support families, with a goal of reducing provider burnout rates—which can be over 50% in some NICUs (Profit, 2014)—and ultimately minimizing staff turnover.
The course can be incorporated into unit-based quality improvement initiatives in a variety of ways. NICU staff can gather to jointly make an assessment of psychosocial support practices they currently have in place as well as to recognize areas that are lacking, using the NPA’s NICU Self-Assessment tool (Hall, 2016). As unit staff take the course together and share ideas on its Discussion Board, they can begin to identify and prioritize potentially better practices to implement either through the development of new policies and/or protocols or through traditional PDSA (Plan-DoStudy-Act) improvement cycles. A multitude of downloadable resources is shared in each content area to facilitate positive changes. A wrap-up staff discussion after taking the course can further illuminate the way forward. Some hospitals have elected to have staff take the course one content area at a time and then gather to discuss and process the information immediately thereafter.
What’s Coming Next?
The team at My NICU Network is collaborating with a team from Stanford University Medical Center, led by Dr. Melissa Scala, Director of the Neonatology Fellowship Program, to study the efficacy of the course in Neonatal Fellows nationwide. For this research project, the course has been condensed with the content focused
towards what physicians need to know about providing psychosocial support, and the research underpinning this knowledge base. This study, which is being funded by a grant from the Association of Pediatric Program Directors, will be launched soon.
The impetus for this study comes from the recently implemented directives put forth by both the American Board of Pediatrics (ABP) and the Accreditation Council for Graduate Medical Education (ACGME). In 2014, the ABP’s Strategic Planning Committee identified the areas of behavioral and mental health as the highest priorities for the education of pediatric trainees, including Neonatal Fellows. This led to the development of their Roadmap Project, which advocates supporting “the resilience, emotional, and mental health of pediatric patients with chronic conditions and their families.” The Roadmap’s Key Drivers are to increase clinician awareness, knowledge, confidence, and clinical skill in providing support to patients and their families. And, effective July, 2019, the ACGME added the following requirements for Fellows in neonatal-perinatal medicine: “Fellows must demonstrate an understanding of the emotional impact on the family of having a child born prematurely or born with a life-threatening and/or chronic condition, and must demonstrate the communication skills necessary for encouraging dialogue.” Our course for Neonatal Fellows will meet all of these requirements, as well as serve as an exemplar for similar courses in other pediatric subspecialties.
An Annual Refresher Course, which is a 2 CEU/CME review of key points in the original long-form course, will be ready to launch in 2020; it is to be used to maintain nursing competencies. And finally, My NICU Network will be adding My Perinatal Network in 2020, with a course for obstetric providers on how to provide psychosocial support to women during and after pregnancy (“Caring for Women and Their Families”). All of the courses, including both
the NICU and obstetric courses, have a specific focus on the prevention, recognition, and mitigation of Perinatal Mood and Anxiety Disorders (PMADs), and all outline a trauma-informed approach to providing care.
Details about the Course
Usually, a NICU Nurse Manager, Clinical Nurse Educator, or NICU Medical Director will take the lead in identifying the value that this course can bring to their staff, and will put the process in play to bring the course to their unit. The course, which is available online and can also be accessed on smartphones, can be made available to a NICU for a period of several months, to give everyone a chance to complete it.
Cost for continuing education credits:
For nurses and neonatal nurse practitioners (NNPs): $10/CEU or $70 for the whole course For physicians, licensed clinical social workers (LCSWs), licensed professional clinical counselors (LPCCs), licensed marriage and family therapists (LMFTs): $35/CME or $245 for the whole course. Continuing education credits are provided by PAC/LAC, the Perinatal Advisory Council: Leadership, Advocacy, Consultation. While CEUs are not yet available for licensed neonatal therapists (OT, PT, SLP or for RCPs), they are invited to take the course as part of an entire NICU staff, with the only charge being a $10/person administrative fee for the 7-hour course.
While course modules can be taken individually, it is highly recommended that a NICU’s staff goes through the entire course at the same time. For more information or to obtain quotes to bring the course to your NICU, please visit www.mynicunetwork.com, or email sara@mynicunetwork.com.
The email heading should read “I’m interested in your online course!” The body should read: “Please contact me with more information about your online NICU staff education course, “Caring for Babies and Their Families.” I can be reached at __.”
References:
- Article URL: journals.lww.com/advancesinneonatalcare/Abstract/publishahead/Improving_Staff_Knowledge_and_Attitudes_Toward.99734.aspx#pdf-link
- Hall, SL, and MT Hynan, eds. 2015. “Interdisciplinary Recommendations for the Psychosocial Support of NICU Parents.” Journal of Perinatology 35: Supplement.
- Sanders, MR, and SL Hall. 2018. “Trauma-Informed Care in the Newborn Intensive Care Unit: Promoting Safety, Security, and Connectedness.” Journal of Perinatology 38 (1): 3-10. https://doi.org/10.1038/jp.2017.124.
- Profit, J, PJ Sharek, AB Amspoker, MA Kowalkowski, CC Nisbet, EJ Thomas, et al. 2014. “Burnout in the NICU Setting and Its Relation to Safety Culture.” British Medical Journal of Quality and Safety 10: 806–13. https://doi.org/10.1136/bmjqs-2014-002831.
- Hall, SL, MT Hynan, and R Phillips. 2016. “Transforming NICU Care to Provide Comprehensive Family Support.”
Newborn and Infant Nursing Reviews16: 69-73. https://doi.org/doi:10.1053/j.nainr.2016.03.008.
Disclosure: The National Perinatal Association www.nationalperinatal.org is a 501c3 organization that provides education and advocacy around issues affecting the health of mothers, babies, and
families. www.nationalperinatal.org.