Stress Beyond the NICU Discharge: Implications to Outcome

Purpose: The high risk family experience in the NICU is a major stress event that is not necessarily resolved with discharge.  Many families report worry and stress for up to a year beyond the birth of their NICU infant, yet this is not currently a focus of assessment for this population.  Because stressors can induce behavioral, physiological, and biochemical changes to such a degree that family adaptation is challenged, resolving the stress before discharge and supporting the family with collaborative follow-up care should be a nursing priority.  The purpose of this study was to examine the relationship between unresolved family stress and high risk family experiences.

Methods:  This cross-sectional correlation design had fifty-four mothers of infants 6 months of age or older enrolled in a University child care setting.  The Family Emotion Expressiveness (FEE) tool was completed by the mothers at the time of enrollment.  This tool measures the emotional climate of the family, indicating high and low emotions and yields information on infant behaviors and adaptation.  Data was analyzed using Pearson correlation coefficients to determine relationship between variables.

Results:  The initial findings of this pilot study demonstrated a positive correlation between NICU admissions and family stress (r= .88) and high risk primiparous births without NICU admissions and family stress (r= .72).  Of interest, previous studies have used positive correlations of FEE as predictors of infant and toddler behavior patterns as a response to the family emotions.

Significance of Findings:  The findings illustrate a lasting unresolved family stress well beyond the birth of the baby. It appears that the NICU admission is much more stressful than the high risk pregnancy, and that the majority of the NICU admissions were not for extremely premature infants.  Because stress seems to have become the “normal” for these families at more than 6-months out from the birth, clearly early identification of at risk families and collaborative interventions to normalize stress is indicated.  This might, in fact, make us rethink discharge teaching.

Conclusion:  Identifying and providing support for at risk families as an early intervention before discharge can enhance infant and family outcome through transformative nursing practice changes.  These changes serve families locally, but can transform outcome regionally while prioritizing family needs as a global quality indicator.