Main Article Content
Abstract
The Neonatal Intensive Care Unit (NICU) presents a highly emotional and stressful environment for both mothers and midwives. Understanding their lived experiences is critical to improving family-centered care and staff well-being. This study aimed to explore the experiences, emotional responses, and coping strategies of mothers and midwives involved in NICU care at the Federal Medical Centre (FMC), Asaba, Delta State, Nigeria. A qualitative design was employed. Data was collected through face-to-face interview with 20 mothers of NICU-admitted neonates and 10 midwives providing direct neonatal care. Interviews were transcribed verbatim and analyzed using thematic analysis, facilitated by NVivo software. Results revealed eleven themes reflecting emotional, psychological, and operational dimensions of NICU care. These include, overwhelming fear and anxiety, guilt and self-blame, and separation anxiety for mothers. Midwives expressed emotional burnout, grief over infant death, and challenges in high-stress environments. Coping strategies included peer support, faith-based, collegial debriefing and mindfulness practices. In conclusion, this study highlighted the relevance of structured and functional emotional support systems, family-centred approach to care and a boost in NICU staff. The incorporation of these strategies in NICU care could greatly improve the quality of neonatal care, and the well-being of mothers and midwives.
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References
- Adama, E. A., Sundin, D., & Bayes, S. (2016). Parents’ experiences of caring for preterm infants after discharge from neonatal intensive care unit: A meta-synthesis of the literature. Journal of Neonatal Nursing, 22(1), 27–51. https://doi.org/10.1016/j.jnn.2015.07.006
- Aftyka, A., Rozalska-Walaszek, I., Rosa, W., Wrobel, A., & Samardakiewicz, M. (2021). Perceived stress, marital satisfaction, and parental sense of competence in parents of preterm-born children. BMC Psychology, 9(1), 44. https://doi.org/10.1186/s40359-021-00547-6
- Benzies, K. M., Mychasiuk, R., Tough, S., Edwards, N., & Donnelly, C. (2020). Maternal self-efficacy and the mental health of mothers of preterm infants: A systematic review. Early Human Development, 142, 104956. https://doi.org/10.1016/j.earlhumdev.2020.104956
- Brett, J., Staniszewska, S., Newburn, M., Jones, N., Taylor, L., & Santos, M. (2021). A systematic mapping review of effective interventions for communicating with, supporting and providing information to parents of preterm infants. BMJ Open, 11(3), e044393. https://doi.org/10.1136/bmjopen-2020-044393
- Chan, G. K., Bitton, J. R., Allgeyer, R. L., Elliott, D., Hudson, L. R., & Mueggenborg, M. G. (2018). Secondary traumatic stress and compassion fatigue in nurses who work with traumatized patients: A literature review. Journal of Trauma Nursing, 25(1), 16–23. https://doi.org/10.1097/JTN.0000000000000335
- Cook, N., Rogowski, J. A., & Smith, L. (2022). The impact of NICU experience on maternal mental health and family functioning: A longitudinal study. Journal of Perinatal & Neonatal Nursing, 36(2), 121–130. https://doi.org/10.1097/JPN.0000000000000629
- Dahlen, H. G., Hastie, C., Andrews, C., & Schmied, V. (2020). Cultural safety in childbirth: An evolving concept to advance respectful maternity care. Women and Birth, 33(3), 197–203. https://doi.org/10.1016/j.wombi.2019.06.004
- Feeley, N., Cossette, S., Côté, J., Héon, M., Stremler, R., Martorella, G., & Grondin, G. (2016). The importance of relationships in understanding the experiences of neonatal nurses in providing end-of-life care: A qualitative study. Palliative and Supportive Care, 14(1), 15–26.
- Flarity, K., Gentry, J. E., & Mesnikoff, N. (2016). The effectiveness of an educational program on preventing and mitigating compassion fatigue in emergency nurses. Advanced Emergency Nursing Journal, 38(2), 147–156. https://doi.org/10.1097/TME.0000000000000109
- Franck, L. S., McNulty, A., & Alderdice, F. (2017). The perinatal-neonatal care journey for parents of preterm infants: What is working and what can be improved. Journal of Perinatal & Neonatal Nursing, 31(3), 244–255. https://doi.org/10.1097/JPN.0000000000000273
- Frost, M., Shaw, R., & Tucker, R. (2021). Experiences of parents of preterm infants in neonatal intensive care units: A meta-synthesis. Journal of Pediatric Nursing, 56, 52–63. https://doi.org/10.1016/j.pedn.2020.08.003
- Geraghty, S., Speelman, C., & Bayes, S. (2019). Fighting a losing battle: Midwives’ experiences of workplace stress. Women and Birth, 32(3), e297–e306.
- Gooding, J. S., Cooper, L. G., Blaine, A. I., Franck, L. S., Howse, J. L., & Berns, S. D. (2021). Family support and family-centered care in the neonatal intensive care unit: Origins, advances, impact. Seminars in Perinatology, 45(6), 151392. https://doi.org/10.1016/j.semperi.2021.151392
- Goodman, M. J., & Schorling, J. B. (2015). A mindfulness course decreases burnout and improves well-being among healthcare providers. International Journal of Psychiatry in Medicine, 50(1), 57–69. https://doi.org/10.2190/PM.50.1.e
- Hall, S. L., Cross, J., Selix, N. W., Patterson, C., Segre, L., Chuffo-Siewert, R., & Goyal, D. (2020). Recommendations for enhancing psychosocial support of NICU parents through staff education and support. Journal of Perinatology, 40(1), 61–68. https://doi.org/10.1038/s41372-019-0524-7
- Holditch-Davis, D., White-Traut, R. C., Levy, J. A., O'Shea, T. M., Geraldo, V., & David, R. J. (2019). Maternal mental health and neurobehavior of infants born preterm. Early Human Development, 91(4), 207–212. https://doi.org/10.1016/j.earlhumdev.2015.01.006
- Hunter, B., & Warren, L. (2019). Midwives’ experiences of workplace resilience. Midwifery, 79, 102552. https://doi.org/10.1016/j.midw.2019.102552
- Hynan, M. T., Mounts, K. O., & Vanderbilt, D. L. (2018). Screening parents of high-risk infants for emotional distress: Rationale and recommendations. Journal of Perinatology, 35(1), S10–S16. https://doi.org/10.1038/jp.2015.144
- Kim, H., Sefcik, J. S., & Bradway, C. (2022). Burnout and related factors among neonatal intensive care unit nurses: A systematic review. Journal of Pediatric Nursing, 62, 71–79. https://doi.org/10.1016/j.pedn.2021.07.018
- Kinman, G., Teoh, K., & Harriss, A. (2020). Supporting the well-being of healthcare workers during and after COVID-19. Occupational Medicine, 70(5), 294–296. https://doi.org/10.1093/occmed/kqaa096
- Linton, K. F., Shafer, K., & Shonkoff, E. T. (2021). Parenting during the COVID-19 pandemic: The role of social support and virtual connections. Journal of Child and Family Studies, 30, 2820–2831. https://doi.org/10.1007/s10826-021-02080-9
- Manning, J. C., Hemingway, P., Redsell, S. A., & Sidhu, R. (2022). Neonatal death: A qualitative study of the experiences of neonatal nurses and midwives. BMC Pregnancy and Childbirth, 22(1), 68. https://doi.org/10.1186/s12884-021-04337-5
- Maslach, C., & Leiter, M. P. (2017). Understanding burnout: New models. In C. L. Cooper & J. C. Quick (Eds.), The handbook of stress and health: A guide to research and practice (pp. 36–56). Wiley Blackwell. https://doi.org/10.1002/9781118993811.ch3
- Mealer, M., Jones, J., & Moss, M. (2017). A qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses. Intensive Care Medicine, 38(9), 1445–1451. https://doi.org/10.1007/s00134-012-2600-6
- Melnyk, B. M., Feinstein, N. F., Alpert-Gillis, L., Fairbanks, E., Schultz-Czarniak, J., Hust, D., & Gross, S. J. (2021). Reducing premature infants' length of stay and improving parents' mental health outcomes with the COPE NICU program: A randomized controlled trial. Pediatrics, 118(5), e1414–e1427. https://doi.org/10.1542/peds.2005-2580
- Meyer, R. L., Crawford, M. E., & Ortega, D. B. (2022). Maternal stress and its long-term impact on child behavior: A NICU perspective. Infant Mental Health Journal, 43(2), 168–182. https://doi.org/10.1002/imhj.21937
- Minshawi, F., Shaw, R. J., & Ong, M. W. (2017). Mindfulness-based interventions in pregnancy and the postpartum period: A systematic review and meta-analysis. Psychiatry Research, 257, 758–770. https://doi.org/10.1016/j.psychres.2017.08.056
- Muniraman, H., Ali, M., Coad, J., & Lakhanpaul, M. (2019). Parental perceptions of neonatal care in neonatal units in the UK: A systematic review. BMJ Open, 9(7), e025478. https://doi.org/10.1136/bmjopen-2018-025478
- Obeidat, H. M., Bond, E. A., & Callister, L. C. (2020). The parental experience of having an infant in the newborn intensive care unit. Journal of Perinatal Education, 18(3), 23–29. https://doi.org/10.1624/105812409X461199
- Onasoga, O. A., Ogbebor, A. E., & Osaji, T. A. (2019). Coping strategies of nurses working in tertiary hospitals in South-West Nigeria. International Journal of Caring Sciences, 12(2), 1171–1180.
- O’Reilly, J. A., Peters, K., & Beale, B. (2021). Nurses’ experiences of working in neonatal intensive care: An integrative review. Journal of Neonatal Nursing, 27(4), 200–208. https://doi.org/10.1016/j.jnn.2020.11.003
- Pezaro, S., Clyne, W., & Fulton, E. (2017). A systematic mixed-methods review of interventions, outcomes and experiences for midwives and student midwives in work-related psychological distress. Midwifery, 50, 163–173. https://doi.org/10.1016/j.midw.2017.04.003
- Patel, N., Ball, K., & Carter, B. (2022). Mothers of NICU babies: Stress, coping, and the struggle for normality. Journal of Neonatal Nursing, 28(4), 205–213. https://doi.org/10.1016/j.jnn.2022.01.007
- Scheer, J. R., Tkachuck, M. A., & Crosswell, A. D. (2020). Religious coping and psychological well-being in mothers of children admitted to NICUs. Psychology of Religion and Spirituality, 12(2), 138–146. https://doi.org/10.1037/rel0000262
- Shaw, R. J., Bernard, R. S., DeBlois, T., Stahl, S. M., & Oppenheim, D. (2021). The relationship between acute stress disorder and posttraumatic stress disorder in the neonatal intensive care unit. Psychosomatics, 62(2), 200–208. https://doi.org/10.1016/j.psym.2020.10.004
- Shields-Poë, D., & Pinelli, J. (2020). Variables associated with maternal stress in the neonatal intensive care unit. Neonatal Network, 39(3), 157–165. https://doi.org/10.1891/0730-0832.39.3.157
- Wallbank, S., & Robertson, N. (2018). Midwives’ experiences of traumatic perinatal events: A qualitative study. British Journal of Midwifery, 26(8), 504–511. https://doi.org/10.12968/bjom.2018.26.8.504
- Wang, L. L., Ma, J. J., Meng, H. H., & Zhou, J. (2021). Mothers’ experiences of neonatal intensive care: A systematic review and implications for clinical practice. World Journal of Clinical Cases, 9(24), 7062–7072.
- Zhu, X., Zhang, H., Lo, C. K. M., Li, W., & Li, M. (2018). Mindfulness-based stress reduction for pregnant women: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice, 33, 6–12. https://doi.org/10.1016/j.ctcp.2018.07.001
- Zwack, J., & Schweitzer, J. (2019). If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Academic Medicine, 88(3), 382–389. https://doi.org/10.1097/ACM.0b013e318281696b
References
Adama, E. A., Sundin, D., & Bayes, S. (2016). Parents’ experiences of caring for preterm infants after discharge from neonatal intensive care unit: A meta-synthesis of the literature. Journal of Neonatal Nursing, 22(1), 27–51. https://doi.org/10.1016/j.jnn.2015.07.006
Aftyka, A., Rozalska-Walaszek, I., Rosa, W., Wrobel, A., & Samardakiewicz, M. (2021). Perceived stress, marital satisfaction, and parental sense of competence in parents of preterm-born children. BMC Psychology, 9(1), 44. https://doi.org/10.1186/s40359-021-00547-6
Benzies, K. M., Mychasiuk, R., Tough, S., Edwards, N., & Donnelly, C. (2020). Maternal self-efficacy and the mental health of mothers of preterm infants: A systematic review. Early Human Development, 142, 104956. https://doi.org/10.1016/j.earlhumdev.2020.104956
Brett, J., Staniszewska, S., Newburn, M., Jones, N., Taylor, L., & Santos, M. (2021). A systematic mapping review of effective interventions for communicating with, supporting and providing information to parents of preterm infants. BMJ Open, 11(3), e044393. https://doi.org/10.1136/bmjopen-2020-044393
Chan, G. K., Bitton, J. R., Allgeyer, R. L., Elliott, D., Hudson, L. R., & Mueggenborg, M. G. (2018). Secondary traumatic stress and compassion fatigue in nurses who work with traumatized patients: A literature review. Journal of Trauma Nursing, 25(1), 16–23. https://doi.org/10.1097/JTN.0000000000000335
Cook, N., Rogowski, J. A., & Smith, L. (2022). The impact of NICU experience on maternal mental health and family functioning: A longitudinal study. Journal of Perinatal & Neonatal Nursing, 36(2), 121–130. https://doi.org/10.1097/JPN.0000000000000629
Dahlen, H. G., Hastie, C., Andrews, C., & Schmied, V. (2020). Cultural safety in childbirth: An evolving concept to advance respectful maternity care. Women and Birth, 33(3), 197–203. https://doi.org/10.1016/j.wombi.2019.06.004
Feeley, N., Cossette, S., Côté, J., Héon, M., Stremler, R., Martorella, G., & Grondin, G. (2016). The importance of relationships in understanding the experiences of neonatal nurses in providing end-of-life care: A qualitative study. Palliative and Supportive Care, 14(1), 15–26.
Flarity, K., Gentry, J. E., & Mesnikoff, N. (2016). The effectiveness of an educational program on preventing and mitigating compassion fatigue in emergency nurses. Advanced Emergency Nursing Journal, 38(2), 147–156. https://doi.org/10.1097/TME.0000000000000109
Franck, L. S., McNulty, A., & Alderdice, F. (2017). The perinatal-neonatal care journey for parents of preterm infants: What is working and what can be improved. Journal of Perinatal & Neonatal Nursing, 31(3), 244–255. https://doi.org/10.1097/JPN.0000000000000273
Frost, M., Shaw, R., & Tucker, R. (2021). Experiences of parents of preterm infants in neonatal intensive care units: A meta-synthesis. Journal of Pediatric Nursing, 56, 52–63. https://doi.org/10.1016/j.pedn.2020.08.003
Geraghty, S., Speelman, C., & Bayes, S. (2019). Fighting a losing battle: Midwives’ experiences of workplace stress. Women and Birth, 32(3), e297–e306.
Gooding, J. S., Cooper, L. G., Blaine, A. I., Franck, L. S., Howse, J. L., & Berns, S. D. (2021). Family support and family-centered care in the neonatal intensive care unit: Origins, advances, impact. Seminars in Perinatology, 45(6), 151392. https://doi.org/10.1016/j.semperi.2021.151392
Goodman, M. J., & Schorling, J. B. (2015). A mindfulness course decreases burnout and improves well-being among healthcare providers. International Journal of Psychiatry in Medicine, 50(1), 57–69. https://doi.org/10.2190/PM.50.1.e
Hall, S. L., Cross, J., Selix, N. W., Patterson, C., Segre, L., Chuffo-Siewert, R., & Goyal, D. (2020). Recommendations for enhancing psychosocial support of NICU parents through staff education and support. Journal of Perinatology, 40(1), 61–68. https://doi.org/10.1038/s41372-019-0524-7
Holditch-Davis, D., White-Traut, R. C., Levy, J. A., O'Shea, T. M., Geraldo, V., & David, R. J. (2019). Maternal mental health and neurobehavior of infants born preterm. Early Human Development, 91(4), 207–212. https://doi.org/10.1016/j.earlhumdev.2015.01.006
Hunter, B., & Warren, L. (2019). Midwives’ experiences of workplace resilience. Midwifery, 79, 102552. https://doi.org/10.1016/j.midw.2019.102552
Hynan, M. T., Mounts, K. O., & Vanderbilt, D. L. (2018). Screening parents of high-risk infants for emotional distress: Rationale and recommendations. Journal of Perinatology, 35(1), S10–S16. https://doi.org/10.1038/jp.2015.144
Kim, H., Sefcik, J. S., & Bradway, C. (2022). Burnout and related factors among neonatal intensive care unit nurses: A systematic review. Journal of Pediatric Nursing, 62, 71–79. https://doi.org/10.1016/j.pedn.2021.07.018
Kinman, G., Teoh, K., & Harriss, A. (2020). Supporting the well-being of healthcare workers during and after COVID-19. Occupational Medicine, 70(5), 294–296. https://doi.org/10.1093/occmed/kqaa096
Linton, K. F., Shafer, K., & Shonkoff, E. T. (2021). Parenting during the COVID-19 pandemic: The role of social support and virtual connections. Journal of Child and Family Studies, 30, 2820–2831. https://doi.org/10.1007/s10826-021-02080-9
Manning, J. C., Hemingway, P., Redsell, S. A., & Sidhu, R. (2022). Neonatal death: A qualitative study of the experiences of neonatal nurses and midwives. BMC Pregnancy and Childbirth, 22(1), 68. https://doi.org/10.1186/s12884-021-04337-5
Maslach, C., & Leiter, M. P. (2017). Understanding burnout: New models. In C. L. Cooper & J. C. Quick (Eds.), The handbook of stress and health: A guide to research and practice (pp. 36–56). Wiley Blackwell. https://doi.org/10.1002/9781118993811.ch3
Mealer, M., Jones, J., & Moss, M. (2017). A qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses. Intensive Care Medicine, 38(9), 1445–1451. https://doi.org/10.1007/s00134-012-2600-6
Melnyk, B. M., Feinstein, N. F., Alpert-Gillis, L., Fairbanks, E., Schultz-Czarniak, J., Hust, D., & Gross, S. J. (2021). Reducing premature infants' length of stay and improving parents' mental health outcomes with the COPE NICU program: A randomized controlled trial. Pediatrics, 118(5), e1414–e1427. https://doi.org/10.1542/peds.2005-2580
Meyer, R. L., Crawford, M. E., & Ortega, D. B. (2022). Maternal stress and its long-term impact on child behavior: A NICU perspective. Infant Mental Health Journal, 43(2), 168–182. https://doi.org/10.1002/imhj.21937
Minshawi, F., Shaw, R. J., & Ong, M. W. (2017). Mindfulness-based interventions in pregnancy and the postpartum period: A systematic review and meta-analysis. Psychiatry Research, 257, 758–770. https://doi.org/10.1016/j.psychres.2017.08.056
Muniraman, H., Ali, M., Coad, J., & Lakhanpaul, M. (2019). Parental perceptions of neonatal care in neonatal units in the UK: A systematic review. BMJ Open, 9(7), e025478. https://doi.org/10.1136/bmjopen-2018-025478
Obeidat, H. M., Bond, E. A., & Callister, L. C. (2020). The parental experience of having an infant in the newborn intensive care unit. Journal of Perinatal Education, 18(3), 23–29. https://doi.org/10.1624/105812409X461199
Onasoga, O. A., Ogbebor, A. E., & Osaji, T. A. (2019). Coping strategies of nurses working in tertiary hospitals in South-West Nigeria. International Journal of Caring Sciences, 12(2), 1171–1180.
O’Reilly, J. A., Peters, K., & Beale, B. (2021). Nurses’ experiences of working in neonatal intensive care: An integrative review. Journal of Neonatal Nursing, 27(4), 200–208. https://doi.org/10.1016/j.jnn.2020.11.003
Pezaro, S., Clyne, W., & Fulton, E. (2017). A systematic mixed-methods review of interventions, outcomes and experiences for midwives and student midwives in work-related psychological distress. Midwifery, 50, 163–173. https://doi.org/10.1016/j.midw.2017.04.003
Patel, N., Ball, K., & Carter, B. (2022). Mothers of NICU babies: Stress, coping, and the struggle for normality. Journal of Neonatal Nursing, 28(4), 205–213. https://doi.org/10.1016/j.jnn.2022.01.007
Scheer, J. R., Tkachuck, M. A., & Crosswell, A. D. (2020). Religious coping and psychological well-being in mothers of children admitted to NICUs. Psychology of Religion and Spirituality, 12(2), 138–146. https://doi.org/10.1037/rel0000262
Shaw, R. J., Bernard, R. S., DeBlois, T., Stahl, S. M., & Oppenheim, D. (2021). The relationship between acute stress disorder and posttraumatic stress disorder in the neonatal intensive care unit. Psychosomatics, 62(2), 200–208. https://doi.org/10.1016/j.psym.2020.10.004
Shields-Poë, D., & Pinelli, J. (2020). Variables associated with maternal stress in the neonatal intensive care unit. Neonatal Network, 39(3), 157–165. https://doi.org/10.1891/0730-0832.39.3.157
Wallbank, S., & Robertson, N. (2018). Midwives’ experiences of traumatic perinatal events: A qualitative study. British Journal of Midwifery, 26(8), 504–511. https://doi.org/10.12968/bjom.2018.26.8.504
Wang, L. L., Ma, J. J., Meng, H. H., & Zhou, J. (2021). Mothers’ experiences of neonatal intensive care: A systematic review and implications for clinical practice. World Journal of Clinical Cases, 9(24), 7062–7072.
Zhu, X., Zhang, H., Lo, C. K. M., Li, W., & Li, M. (2018). Mindfulness-based stress reduction for pregnant women: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice, 33, 6–12. https://doi.org/10.1016/j.ctcp.2018.07.001
Zwack, J., & Schweitzer, J. (2019). If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Academic Medicine, 88(3), 382–389. https://doi.org/10.1097/ACM.0b013e318281696b
