1. Neonatal ICU Parent Support Groups
Quality Improvement Project
Kate Thibault
University of South Florida, College of Nursing

2. Objectives Describe a Neonatal ICU Parent Support Group
Identify the benefits of implementing a parental support at Tampa General Hospital’s Neonatal ICU
Discuss a potential roll-out plan and how it may be implemented

3. Background
After discharge from Tampa General Hospital’s (TGH) Neonatal Intensive Care Unit (NICU), parents are sent a Press Ganey survey to evaluate their experience

4. Press Ganey
Benchmarked data from 9/30/2013 reported that the NICU at TGH scored lowest in the following categories:
Staff met emotional needs
Staff sensitivity re: stress

5. Current Problem Emotional needs of parents are not being met
Parental stress involved with parenting a NICU infant:
Infant’s appearance and behavior may be confusing
Unfamiliar environment of the NICU
Isolated from usual systems of support
Coping with their feelings of:
Anxiety
Fear
Guilt
Helplessness
Depression
- As described above, NICU parent support groups serve as a means to improve communication between staff and parents, as well as to assist in educational and coping techniques. The absence of a NICU parent support group at TGH may be directly related to the unfulfilled emotional needs of the parents, and in turn may have a direct effect on the lower scores received from the Press Ganey survey. - In addition, TGH’s NICU does not presently offer a parent support group. Gooding, Franck, and Berns (2011) discuss that NICU parent support groups can be a beneficial tool in improving the communication between parents and staff, as well as in serving as a valuable channel for parental education.

7. Meet Mrs. H
Mrs. H delivered her 1200g son, Joshua, prematurely at 27 weeks. Joshua was transferred to the NICU immediately after delivery. Since recovering from delivery, Mrs. H and her husband have been at Joshua’s bedside every day. As first time parents they have many questions, fears and anxieties that have been compounded by Joshua’s current condition and NICU hospitalization. They are feeling overwhelmed and do not like to bother the nursing staff with so many questions. Their friends who delivered at St. Joseph’s Hospital recommend that they get involved in a Parent Support group at TGH. Mrs. H and her husband think this is a great idea, and ask Joshua’s nurse– “Does TGH have a NICU parent support group?”

8. Opportunity for Improvement
“Does TGH have a NICU parent support group?”
No – TGH does not presently offer a NICU parent support group
How would a support group help?
Would provide a place of support for the parents of neonatal patients being cared for
Would improve the amount of emotional support & assistance provided
Would enhance family-centered care approach
A mother’s behavior with the infant is the most significant environmental modification that can be provided for high-risk infants
Findings suggest that interventions occurring during hospitalization impact cognitive development and parental perceptions of stress

9. What is a support group?
Ways to link current NICU parents with current and former NICU parents:
Scrapbooking nights/arts & crafts
Bedside/Telephone support to new NICU parents
Educational topic nights
Infant CPR certification classes
Transitioning home
Sibling support
Breastfeeding support
To ensure for a positive experience for all individuals former NICU parents must be screened, prepared, and trained

10. Purpose
Provide NICU parents with contact with other NICU parents and families – both past and present
Valuable source of:
Hope
Information
Advice
Support
Share their feelings
Connection
Similar conditions
Experiences

11. Benefits Place to share feelings Educational Receive advice
Help parents to cope with stress
More confident in their ability to provide care
Less depression & anxiety
Greater satisfaction with NICU stay
Increased self-esteem
Better maternal-infant relationships
More nurturing home environments
Improved communication with hospital staff

12. Parent-to-Parent Support
A study of 70 mothers of preterm infants in the NICU in a Midwestern regional perinatal center
Participants were divided into:
Nurse managed parent-to-parent support group (treatment group)
Comparison group
Results:
Mothers who participated in the treatment group had:
Less anxiety during first 4 months post discharge
Self-esteem increase during first 4 months post discharge
Better maternal-infant relationships
More nurturing home environments
Roman, L.A., Lindsay, J.K., Boger, R.P., DeWys, M., Beaumont, E.J., Jones, A.J., & Haas, B. (1995). Parent-to-parent support initiated in the neonatal intensive care unit. Research in Nursing & Health 18(5),

13. Parent “Buddy” Program
This study evaluated the effectiveness of parent-to-parent peer support for mothers of very preterm infants in a NICU
32 mothers in the intervention group/28 mothers in control
Intervention Group:
Paired with trained mothers who had previously had a very preterm infant in the NICU
Telephone support was provided
Results - Mothers in the intervention group reported:
Less stress
Less anxiety
Less depression
Greater perceived social support
Overall – support from trained peers was found to be effective in helping mothers deal with the stress of a very preterm birth
Preyde, M. & Ardal, F. (2003). Effectiveness of a parent “buddy” program for mothers of very preterm infants in a neonatal intensive care unit. Canadian Medical Association Journal 168(8),

14. Potential Roll-Out Plan at TGH
Utilize an interdisciplinary approach – involving all members of healthcare team
Locate a meeting space for the parental support group
Identify and screen graduate NICU parent volunteers
Develop educational topics & ideas for meetings
Place informational posters about the group and meeting times around the unit
Educate the Staff about:
Implementation of the group
Encourage them to share the information with parents & families
Upon NICU admission, parents will be provided with information about the NICU support group and how to be involved
Upon discharge, NICU parents will be encouraged to stay involved
Interdisciplinary approach - NICU Supervisor, NICU Manager, QI Specialist, NICU Charge Nurses, NICU Floor Nurses, NICU Transport Nurses, NICU Patient Care Technicians, NICU Advanced Registered Nurse Practitioners, Physicians, Social Work, Lactation Consultants, Pastoral Care, and all other staff of the Neonatal Intensive Care Unit and at the follow-up clinics.

15. Remember Mrs. H?
After the implementation of TGH’s NICU Parent Support Group – Mrs. H became one of its first members!
Mrs. H utilized the group for:
Support
As a place to share her feelings
To aid her in coping with stress & anxiety
Education
As a result – Mrs. H felt that the following improved:
Communication with the staff
Satisfaction with NICU stay
Involvement in her son’s care
Relationship with her son

16. Conclusion
Implementing a NICU support group at TGH would benefit the parents, the patients, and the unit
A support group would:
Meet the emotional needs of the parents/families
Promote parental involvement
Enhance family-centered care approach
Improve communication between parents and staff
Provide a forum for parental education
By meeting the emotional needs of the parents/families – Press Ganey discharge survey scores in the following categories should increase: staff met emotional needs and staff sensitivity

17. Help me AND my Mom & Dad

18. References
Browne, J.V. & Talmi, A. (2005). Family-based intervention to enhance infant-parent relationships in the neonatal intensive care unit. Journal of Pediatric Psychology, 30(8), Doi: /jpepsy/jsi053
Coughlin, M., Gibbins, S., & Hoath, S. (2009). Core measures for developmentally supportive care in neonatal intensive care units: Theory, precedence and practice. Journal Of Advanced Nursing, 65 (10), doi: /j x
Gooding, J., Cooper, L., Blaine, A., Franck, L., Howse, J., & Berns, S. (2011). Family support and family-centered care in the neonatal intensive care unit: Origins, advances, impact. Seminars In Perinatology, 35(1), doi: /j.semperi
Preyde, M. & Ardal, F. (2003). Effectiveness of a parent “buddy” program for mothers of very preterm infants in a neonatal intensive care unit. Canadian Medical Association Journal 168(8),
Roman, L.A., Lindsay, J.K., Boger, R.P., DeWys, M., Beaumont, E.J., Jones, A.J., & Haas, B. (1995). Parent-to-parent support initiated in the neonatal intensive care unit. Research in Nursing & Health 18(5),