The birth of Lauren and Jason’s first child had been fairly routine – no major problems and they went home from the hospital as many new parents do, learning each day as they went. With their second child on the way, they felt much more prepared. They had learned the ropes as parents and were ready to go. Then the completely unexpected happened. Lauren and Jason found themselves and their new baby girl in the neonatal intensive care unit (NICU), fighting for her life.
“Everything was out of our hands and she was so small. It was touch and go at first, so It was a really scary time,” says Lauren. “When I first came in to see Audrey in the NICU it was a shock. Like I fell in love and was afraid at the same time.”
Lauren and her family received Family Nurture Care throughout their baby girl’s stay in the NICU. Nurture nurse specialists met with the whole family and supported them through their difficult NICU journey. The nurture nurses showed Lauren and Jason how they could connect with their daughter, touching her and comforting her, even before they could pick her up and hold her.
Lauren remembers the first time she felt she really connected with her daughter. “They showed me how to put my hands on her, even when I couldn’t hold her.”
Lauren and Jason’s daughter spent almost two months in the NICU at The Valley Hospital in Ridgewood, NJ. They met regularly with a nurture specialist to help them build a connection with their daughter, and with one another.
The NICU team at The Valley Hospital works hard to support families. They treat the family as a unit, educating parents and including them in discussions and decisions while simultaneously caring for their newborn infants. The hospital has received many awards for its family-centered care, but NICU leaders wanted to do more. Partnering with the Columbia Nurture Science Program provided the opportunity to take family support to the next level. Studies have shown that NICU parents suffer from higher levels of stress, anxiety and depression compared with parents in the general population. This can in turn have a negative impact on infant and child development.
“I am very excited to have the Nurture Science Program here,” says Dr. Christiana Farkouh-Karoleski, Associate Director of the NICU at The Valley Hospital. “Family Nurture Intervention provides an opportunity for families to become better connected with their babies in a way that I don’t think is as usually feasible when you’re in the NICU. There are so many barriers to connecting with their baby when in the NICU that parents and mothers really have a hard time overcoming.” Overcoming those barriers and creating opportunities to connect is the goal of FNI.
The Valley Hospital and the Nurture Science Program are conducting a research study – an effectiveness trial – to understand what it takes to provide Family Nurture Intervention (FNI) to every family in the NICU, and what the short-term and long-term effects of this NICU-wide effort are on the families, the babies, and, importantly, on the staff.
The first phase was to study what happened in the NICU without FNI – how the staff provides care and what the outcomes are for babies and their mothers. Next, NICU staff were trained in FNI. Now, in the second phase, NICU staff and nurture specialists offer FNI support to all NICU families. Ultimately, the outcomes for NICU babies and mothers will be compared to the outcomes before FNI was introduced. The hope is that FNI will lead to benefits for babies and mothers, as was seen in the first randomized control trial conducted at Columbia. That study found that babies who received FNI showed more mature brain activity while they were still in the NICU, and at 18 months they had improved cognition and language, fewer attention problems and reduced risk for autism, compared to babies who did not receive FNI while they were in the NICU. Mothers who received FNI while their babies were in the NICU showed improved caregiving behaviors while their babies were in the NICU, and lower levels of depression and anxiety when their babies were four months old, compared to mothers who did not receive FNI.
Suzanne Bryjak, MA, BSN, HN-BC, is a NICU nurse who leads the Nurture Science Program’s training initiatives, and is part of the leadership team for the study at The Valley Hospital. She says there are two key benefits for conducting this study at The Valley Hospital. First, the Valley NICU team is already committed to working closely with families, so this new approach supports their goals. However, she says it is also important that The Valley Hospital is a community-based hospital. “These types of studies are usually done at big university hospitals,” she explains. “But the interesting thing is that over 70 percent of the hospitals in the United States are community-based, smaller NICUs, very similar to The Valley Hospital.” So, if FNI can be successfully implemented here, and show significant benefits, it could be successfully introduced in many hospitals across the country.
“Our staff is so attuned to our families,” says Dr. Farkouh-Karoleski, “and when families are stressed and upset, it really weighs very heavily upon our staff.”
Burnout is a significant problem in healthcare. The study at The Valley Hospital is examining staff satisfaction, in addition to outcomes for babies and mothers, to see if FNI in the NICU can help prevent burnout.
Dr. Farkouh explains that initially, there was skepticism. “I think the NICU Nursing team was afraid that we were now going to put additional expectations on top of already a lot of responsibilities. There is a lot that they’re trying to get done when caring for infants and their families. So, the last thing you want to do is feel like we’re just going to add one more thing.”
FNI is delivered by a Nurture Specialist who is a NICU nurse with special training to help families establish and maintain emotional connection despite a very stressful environment.
“The idea behind the Family Nurture Intervention is that we’re adding a layer to family NICU care that further supports everything that you really want to see happen,” says Dr. Farkouh-Karoleski. “I believe that FNI offers a lot of positive. But to have successful implementation of FNI in the NICU there also needs to be staff introduction and education because I think everyone walks into it a little dubious, a little concerned – like ‘oh, they’re going to make me do more.’ And that’s really not it at all. “
Suzanne Bryjak says FNI fills a gap in NICU care. “We are missing so much by not allowing our moms to connect with their babies when they are critically ill,” she says. “And by doing this, we have an opportunity to improve outcomes.”
Bryjak believes FNI in the NICU can provide important benefits at many levels — for the family, the hospital, and eventually, for the entire community.
“Hospitals are looking for cost-effective ways to address the healthcare needs of these NICU babies, while also improving outcomes for these babies and their families,” she says. “We know that what happens in NICU in just a few months has long term effects on the overall health and economy of the family, as well as on the educational system. This ultimately impacts the fabric of our communities. FNI offers an opportunity to address this problem with a low-cost intervention, and that is something that I believe everyone can get on board with.