1. Gregory, Katherine E. PhD, RN
  2. Senior Nurse Scientist

Article Content

For the majority of families, the birth of a new baby is a joyful experience. However, for approximately 1 in 10 families, this experience can be unexpectedly stressful as a result of having an infant who requires special care in the newborn intensive care unit (NICU). As NICU nurses know well, the NICU is a place of unparalleled medical technology, which has resulted in an ability to care for the smallest infants and infants with complications and their families. While advances in technology and sophisticated medical and nursing care make life a possibility for infants born premature or with medical complications at birth, the parental experience associated with the NICU can be a time of uncertainty and stress. The sources of stress for parents in the NICU include the sights and sounds that characterize the environment of care, the behavior and appearance of their infant, and their loss of parental role.1,2


Overcoming the parental stress and trauma that are associated with having an infant in the NICU has been the focus of multiple research studies.2-6 These studies have shown that the stress experienced by parents in the NICU is characterized by a constellation of both physical and emotional outcomes, including anxiety, depression, fatigue, and sleep disruption,7 and in the most severe cases, posttraumatic stress disorder.3 Some of the interventions that have been shown to help mitigate the emotional distress that is associated with having an infant in the NICU include prenatal education tailored to the needs of a mother who anticipates having an infant who will require NICU care,6 brief educational and cognitive restructuring interventions targeted specifically toward overcoming maternal traumatic stress,3,4 and, most recently, a psychological intervention that was individualized to the unique needs of NICU parents and delivered over the course of at least 4 weeks.8 These interventions have been shown to alleviate the stress, anxiety, and depression parents' experience but have been less successful in overcoming the role alteration they experience as a result of having an infant in the NICU.


To overcome the negative experience of parenting in the NICU, future interventions must be targeted at coping with both the trauma of a premature or complicated birth and techniques focused on enhancing parenting confidence and altering negative parental perceptions of their infant. Nurses are well positioned to develop, implement, and study these interventions. In addition, future interventions will ideally be guided by the insights and experiences of NICU families themselves. Ensuring that this work is patient-centered and family-focused will position it for the highest likelihood of success in meeting the emotional health needs of parents during and after the NICU hospitalization.


Even for experienced NICU nurses, helping parents survive and thrive throughout their infant's NICU hospitalization can be challenging. While there are some evidence-based practices that have been shown to be effective in supporting the needs of parents in the NICU, not all hospitals have the resources to implement these interventions. For this reason, a simple list of suggestions can be a helpful resource for families that are coping with the NICU experience. Box 1 provides the list that was developed as a resource that NICU nurses might use with the families of infants who are in their care. It is primarily written for birth mothers but may be helpful for all parents who have an infant in the NICU. While this list of strategies is not all encompassing and may need to be tailored to the unique needs of the patient population in a specific NICU, it is meant to be a helpful list of suggestions that can be offered to NICU parents. Use this list in your practice with NICU families as needed and build upon it based on your experience of successful strategies for surviving and thriving as parents in the NICU.


-Katherine E. Gregory, PhD, RN

Box 1 - Click to enlarge in new windowBox 1. Ten suggestions for families during an NICU hospitalization
Box 1 - Click to enlarge in new windowBox 1. Ten suggestions for families during an NICU hospitalization
Box 1 - Click to enlarge in new windowBox 1. Ten suggestions for families during an NICU hospitalization

Senior Nurse Scientist


Department of Pediatric Newborn Medicine


Department of Nursing


Brigham and Women's Hospital


Boston, Massachusetts




1. Miles MS, Funk SG, Carlson J. Parental Stressor Scale: neonatal intensive care unit. Nurs Res. 1993;42(3):148-152. [Context Link]


2. Bouet KM, Claudio N, Ramirez V, Garcia-Fragoso L. Loss of parental role as a cause of stress in the neonatal intensive care unit. Bol Asoc Med Puerto Rico. 2012;104(1):8-11. [Context Link]


3. Shaw RJ, John N St, Lilo EA, et al. Prevention of traumatic stress in mothers with preterm infants: a randomized controlled trial. Pediatrics. 2013;132(4):e886-e894. [Context Link]


4. Shaw RJ, John N St, Lilo E, et al. Prevention of traumatic stress in mothers of preterms: 6-month outcomes. Pediatrics. 2014;134(2):e481-e488. [Context Link]


5. Horwitz SM, Leibovitz A, Lilo E, et al. Does an intervention to reduce maternal anxiety, depression and trauma also improve mothers' perceptions of their preterm infants' vulnerability? Infant Ment Health J. 2015;36(1):42-52. [Context Link]


6. Morey JA, Gregory K. Nurse-led education mitigates maternal stress and enhances knowledge in the NICU. MCN Am J Matern Child Nurs. 2012;37(3):182-191. [Context Link]


7. Busse M, Stromgren K, Thorngate L, Thomas KA. Parents' responses to stress in the neonatal intensive care unit. Crit Care Nurse. 2013;33(4):52-59; quiz 60. [Context Link]


8. Cano Gimenez E, Sanchez-Luna M. Providing parents with individualised support in a neonatal intensive care unit reduced stress, anxiety and depression. Acta Paediatr. 2015;104(7):e300-e305. [Context Link]