Task performance, task importance, and educational needs for novice-level nursing tasks as perceived by neonatal intensive care unit nurses with various levels of experience in South Korea: a cross-sectional study.

Nurses in neonatal intensive care units (NICUs) are frequently faced with many stressors, including care for medically complex infants, infant suffering and death, exposure to parental trauma and grief, discordance between multiple disciplines regarding care decisions, and ethical and moral dilemmas. The COVID-19 pandemic has resulted in significant changes and restrictions to neonatal care that have also contributed to stress in both NICU families and nurses. Consequently, NICU nurses are at risk for experiencing secondary traumatic stress (STS), which has implications for their health, well-being, retention, and the quality of care provided. There is a gap in knowledge about the first-hand experiences of STS from the point of view of NICU nurses, particularly in the age of the COVID-19 pandemic. The current study provides an enhanced understanding of STS and coping strategies in NICU nurses through the qualitative analysis of rich narratives and first-hand accounts of their personal experiences, thoughts, and perceptions. Self-report measures were used to collect sociodemographic information, key work-related information, STS symptoms and severity, and level of burnout and descriptive statistics were used to characterize and describe the study sample. The study sample was comprised of 15 female registered nurses (RNs) working in a level-IV NICU in the United States. Participants had high levels of STS (M = 45.07) and moderate levels of burnout (M = 3.70). Qualitative data collection occurred during individual semi-structured interviews with eligible NICU nurses. Interviews were transcribed and coded for thematic content using NVivo 14 qualitative data analysis software. Theoretical thematic analysis resulted in six main themes (e.g., secondary traumas in the NICU, controllability, the impact of STS, coping strategies, the impact of the COVID-19 pandemic, and suggestions for mitigating STS) and 17 related subthemes. The pervasive themes and subthemes derived from this qualitative analysis can inform future empirical studies and intervention development.

Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied. To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift. Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models. NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001). Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress. Strategies are needed for reducing stress in NICU nurses who work night shift.

Objective: To investigate and compare nurses' perceived care-related distress and experiences in end-of-life situations in neonatal and pediatric intensive care units.Study design: Single-center, cross-sectional survey. Administration of an anonymous self-report questionnaire survey to nurses of two tertiary neonatal intensive care units (NICUs), and two tertiary pediatric intensive care units (PICUs) in Berlin, Germany.Results: Seventy-three (73/227, response rate 32.2%) nurses completed surveys. Both, NICU (32/49; 65.3%) and PICU (24/24; 100.0%) nurses, reported “staffing shortages” to be the most frequent source of distress in end-of-life situations. However, when asked for the most distressing factor, the most common response by NICU nurses (17/49) was “lack of clearly defined and agreed upon therapeutic goals”, while for PICU nurses (12/24) it was “insufficient time and staffing”. No significant differences were found in reported distress-related symptoms in NICU and PICU nurses. The interventions rated by NICU nurses as most helpful for coping were: “discussion time before the patient's death” (89.6%), “team support” (87.5%), and “discussion time after the patient's death” (87.5%). PICU nurses identified “compassion” (98.8%), “team support”, “personal/private life (family, friends, hobbies)”, and “discussion time after the patient's death” (all 87.5%) as most helpful.Conclusions: Distress-related symptoms as a result of end-of-life care were commonly reported by NICU and PICU nurses. The most frequent and distressing factors in end-of-life situations might be reduced by improving institutional/organizational factors. Addressing the consequences of redirection of care, however, seems to be a more relevant issue for the relief of distress associated with end-of-life situations in NICU, as compared to PICU nurses.

Background: Moral distress in neonatal intensive care unit (NICU) nurses predicts burnout, the hospital ethical climate, and considering leaving the position. However, the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate remain unexamined in these nurses. Objectives: The aim of this study was to examine the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate in NICU nurses. Methods: This is an observational, multicentre, self-report questionnaire study of NICU nurses currently providing direct newborn care on 6 Level 3–4 NICUs in New South Wales, Australia. Results: Of the estimated 585 eligible nurses, 136 (23%) participated in the study. Twenty-one percent of the nurses were considering leaving. After controlling for the other predictor variables, moral distress did not predict considering leaving (p = 0.651). Burnout (odds ratio [OR] 4.25, p < 0.001) and the hospital ethical climate (OR = 0.29, p = 0.020) were significant predictors of considering leaving. The direct effect of moral distress on considering leaving was not significant, but the indirect effects mediated by burnout (B = 0.32, 95% confidence interval [CI] [0.147–0.611]) and the hospital ethical climate (B = 0.19, 95% CI [0.085–0.382]) were significant. Conclusions: The support of NICU nurses considering leaving should include preventing and resolving moral distress, managing burnout, and enriching the ethical climate of the hospital. This support may reduce psychological distress in NICU nurses and maintain or enhance the standard of care for sick newborns.

Preterm infants' outcomes improve when fed their mothers' milk. Low percentages of neonatal intensive care unit (NICU) nurses support mothers facing barriers to establishing and sustaining adequate milk supplies. Nurses' motivations and attitudes are instrumental, but understudied, factors in their intention to promote maternal lactation. Using the Theory of Reasoned Action, this study explored (1) NICU nurses' attitudes, social pressures, feelings of preparedness, perceptions of comfort, and intention to support lactation; and (2) magnitude of relationships among these concepts before and after undertaking an educational module. A descriptive pre-/postintervention design included a sample of 24 NICU nurses who completed a module, including general lactation and hands-on expressing information. The Nursing Support for Breastfeeding Questionnaire was administered before and after completing the module. Attitudes, social norms, perception of preparedness, and intention were moderate to high before and after completion of the module. Perception of comfort was moderate. When comparing pre- and postintervention, effect sizes for intention and perception of comfort were moderate. Magnitude of the relationship between attitudes and intention was strong before intervention and moderate after intervention. Subjective norms demonstrated stronger relationships with attitudes and intention after intervention. Preparedness and comfort had stronger relationships with attitudes than with intention both before and after intervention. Nurses' attitudes, perception of preparedness, and comfort are modifiable considerations in developing strategies to support evidence-based lactation techniques. Additional studies are needed with fully powered and stronger designs to validate findings to guide interventions for nurse support for NICU mothers to optimize lactation.

We aimed to investigate whether there was a correlation between the clinical judgement of comfort by neonatal intensive care unit (NICU) nurses and the daily stress exposure in the first 28 days of life in extremely to very preterm infants born before 30 weeks' gestation.We included 45 infants born <30 weeks' gestation and/or <1,000 g of birth weight in an observational cohort study. Nurses' clinical judgement of comfort was based on a 10-point numeric rating scale. We quantified exposure to neonatal stress using the Neonatal Infant Stressor Scale. We calculated Spearman's correlation coefficients to determine the strength of the association between the two for each day between birth and 28 days of life.Average clinical judgement scores ranged from 4 to 10, with means mainly between 7 and 8. Days 1 to 3 were excluded because of missing data. For days 4 to 20, we found moderate to high correlation coefficients. After day 21, we did not identify significant correlations anymore, possibly due to less variance in data.Clinical judgment of comfort in preterm infants by NICU nurses adequately reflects neonatal stress exposure. Our findings call for more research into the best measure of neonatal stress that encompasses both exposure to stressors and experience of stress. · Measuring neonatal stress is difficult, and exposure may not be the same as experience.. · NICU nurses' judgement of stress and comfort accurately reflects exposure to stress.. · Exposure to stress and experience of stress are therefore related.. · Future studies should focus on creating a gold standard for measuring neonatal stress..

♦ Aris C, et al. Adv Neonatal Care. 2006;6:281 -294[OpenUrl][1][PubMed][2] . Neonatal intensive care unit (NICU) nurses often provided discharge instructions regarding infant sleep position that conflicted with the Back to Sleep recommendations, according to a survey of 252 nurses. Infants in

Skin-to-skin contact (SSC) consists of positioning the diaper-clad infant against the parent's chest and is considered a nursing practice rooted in family-centered care (FCC).1 SSC implies simultaneous parental presence and helps to facilitate their involvement from the earliest hours of their preterm infants' lives as this intervention is delivered by parents.1 FCC has gained worldwide popularity in recent years to promote parental presence and active participation of parents in care during neonatal intensive care units (NICUs) hospitalization.2 Both practices relate to developmental care (DC), which regroups specific interventions aimed at reducing stress and improving infant neurological development.3 It is well recognized that promoting SSC and FCC are recommended in the NICU, given its many health benefits for preterm infants and parents. SSC has been found to favor maternal attachment, enhance paternal role achievement and interactive behavior, reduce maternal and paternal anxiety, and promote infants' long-term cognitive development.4, 5 On the other hand, FCC can improve the clinical outcomes of preterm infants such as greater weight gain, as well as the psychological well-being of the parents.6 More specifically, parental involvement in NICU care is associated with reduced infants' length of hospital stay and collaboration with professionals increased parental satisfaction.7 Daily maternal presence during NICU hospitalization is associated with a decrease in emotional and behavioral problems in school-age children.8 Noteworthy, parental presence during NICU hospitalization with more frequent holding of their infant in their arms, is associated with better infants' neurobehavioral development, such as better quality of movements and reduced arousal, at term equivalent age.9 Given their benefits and driven by the DC philosophy, nurses should encourage SSC as well as FCC to provide parents with opportunities for collaboration and care involvement in the NICU. Yet, significant barriers may impede nurses from implementing SSC and FCC in the NICU, namely the lack of adequate training for nurses about SSC.10 As optimal implementation of FCC and SSC may depend on the nurses' perceptions of these DC practices, along with the training and education about these practices provided in the NICU, the aim of this manuscript is to explore the association between NICU nurses' perceptions about SSC and FCC and their unit's ability to provide FCC and SSC. Secondary analysis was performed from a larger comparative international study that was conducted between October 2017 and July 2018, where 202 NICU nurses completed paper or online questionnaires on their perceptions about their unit provision of FCC and SSC.11 Prior to the beginning of the study, ethical approval was obtained in both Canada (MP-21-2018-1854) and France (20181306005 and CNIL 2211490 v0). Nurses were recruited from four level III university-affiliated NICUs (intensive and intermediate care) in Canada and France admitting infants born between 23 and 40 weeks of gestational age. Total number of beds ranged from 30 to 65 in Canada and from 26 to 54 in France. The number of nurses working in the NICUs in France varied from 60 to 100 and in Canada from 113 to 190. Nurses' mean age was 33.9 ± 9.1 years, and they had a mean of 8.1 ± 7.0 years of neonatal care experience, and a mean of 7.1 ± 6.9 years on the sampled unit. Most were women (97.5%, 197/202) and almost half of the sample worked during the day (49.7%, 94/189) followed by the night (27.0%, 51/189), the evening (7.9%, 15/189), and rotation across the three shifts (15.30%, 29/189). Eighty-five nurses (42.1%, 85/202) in our sample had completed a bachelor's degree. The SSC questionnaire evaluated NICU nurses' attitudes and knowledge about SSC as well as their perception of their unit's SSC training and education in addition to implementation.12 It contained 20 items with a five-point Likert scale ranging from 1 "never" to 5 "always". It is separated into four subscales: knowledge (five items), personal attitudes and beliefs (four items), staff training and education (five items), as well as the unit-level implementation of SSC (six items). Training and education, and implementation refer to several aspects of the practice of SSC, including the availability of guidelines for its practice, proper training of health care professionals in SSC, interdisciplinary collaboration in supporting SSC, and adequate implementation on the unit.12 Higher scores reflect more favorable perceptions. The FCC questionnaire inquires as to the nurses' perceptions of whether the unit staff respects families, collaborates with them, and provides support.13 It included 20 items with a four-point Likert scale ranging from 1 "never" to 4 "always" divided among three subscales: respect (six items), collaboration (nine items), and support (five items). Scores of the subscales could vary from 6 to 24 (respect), 9 to 36 (collaboration), and 5 to 20 (support) while the total score could range from 20 to 80. Higher scores on each subscale in addition to the total score indicate more favorable perceptions that their unit is providing these aspects of FCC. Both questionnaires had adequate validity and reliability in French and English versions.12-14 Descriptive analyses (mean, standard deviation) were calculated for the subscales of each questionnaire as well as for the FCC questionnaire total score. Associations between subscale and total scale scores of FCC and SSC questionnaires were explored using Pearson's correlations. Descriptive analyses were also computed to describe the demographic data of the sample. Statistical analysis was done using SPSS v.26 with an alpha of 0.05. The nurses' mean scores for all subscales and total scores of the SSC and FCC questionnaires were shown in Table 1 and the correlations among these scores were shown in Table 2. Nurses' total FCC score (64.79/80), in addition to their SSC attitude subscale score (18.24/20) and knowledge subscale score (21.53/25) were high (Table 1). Results show that the nurses' FCC total score was significantly correlated with all SSC subscales scores, ranging from weak (0.17) to moderate (0.30) correlations (Table 2). Our findings indicated that the nurses' favorable perceptions that their unit is providing FCC are minimally associated with greater SSC personal knowledge (0.17) and attitudes (0.19), as well as with their better perceptions of their unit performance in terms of training and education (0.24) along with SSC implementation (0.30). Among all subscales of both practices, the highest correlations were found between the nurses' perceptions of their NICU providing support to families (FCC support subscale score) and SSC available training and education (0.29) as well as between the FCC support subscale score and SSC implementation on their unit (0.31). In addition, a similar association (0.30) was found between the nurses' perceptions of their unit's implementation of SSC and the total score of care being family-centered in their NICU. This secondary analysis offers an exploration of how nurses' perceptions about their NICU's ability to provide FCC are associated with SSC and brings new knowledge to guide neonatal practice. Overall nurses considered that their unit performed well with respect to FCC and their knowledge and attitudes about SSC were favorable. It is interesting to note the associations between the nurses' perceptions that their NICU provides support to parents and the staff training and education as well as implementation of SSC in the NICU. These findings might be interpreted to indicate that when SSC training and education are available and provided to nurses in addition to being well implemented in their neonatal unit, nurses have more favorable perceptions that their NICU supports FCC and vice versa. Enhancement of DC practices not only requires positive nurses' perceptions but also high professional competency in addition to favorable organizational structures which can be maintained through educational nursing training on DC as well as proper management support.15 A recent study showed that a virtual education program can improve NICU nurses' DC perceptions and knowledge.16 Accordingly, fostering the implementation of these practices in NICU settings could be accomplished through implementation science research related to either FCC or SSC. Nurses embracing favorable perceptions regarding their unit performance of FCC and SSC might translate into positive health outcomes for preterm infants and their parents. Interventions during NICU hospitalization such as SSC should be implemented in addition to other DC practices as these interventions encourage parents' presence and involvement in the care of their infant.17 As our study nurses worked mostly on the day shift, our findings may be explained by possibly greater parental presence and care involvement during the day where parents may request these practices, which in return may facilitate FCC and support nurses' favorable attitudes towards SSC. The nurses' knowledge and favorable attitudes concerning SSC may also be accounted for by their educational level as a higher degree of education has been associated with more SSC knowledge and favorable attitudes18 and close to 45% of our sample of nurses had completed a bachelor's nursing degree. As one component of FFC, SSC is credited as one of the most powerful interventions that is performed by parents with benefits for both parents and preterm infants.1 Although SSC and FCC could be considered as separate practices in DC, this secondary analysis shows that NICUs promoting one of those practices appear to also support the other. Hence, nurses who perceive that their unit performs well in providing FCC to parents also perceive their unit implements SSC and provides training and education about SSC. Highlighting this relationship is essential from theoretical and practical perspectives to better understand DC as a concept with integrated rather than independent components. This view of DC philosophy could guide neonatal clinical practices and encourage nurses to promote one intervention by supporting the other. As such, nurses who would aim to help parents achieve SSC in NICU are also supporting FCC, and therefore expose infants and parents to the combined known benefits of both practices. Noteworthy, an intervention about teaching staff how to work collaboratively with parents was found to increase parental presence in the NICU and SSC19 in addition to the quality of FCC according to both parents' and nurses' perceptions.20 Accordingly, focusing on training nurses to be able to work in collaboration with parents to provide care and enhance the implementation of DC practices. Future research should also consider investigating the relationship between any of these DC practices to build on evidence to support this unified view of DC interventions. The ethical approval was obtained in both Canada (MP-21-2018-1854) and in France (20181306005) and CNIL 2211490 v0). Thank you the Réseau de recherche en interventions infirmières du Québec/Quebec Network on Nursing Intervention Research [RRISIQ] for funding. The authors declare no conflict of interest.

Kangaroo Mother Care (KMC) is an evidence-based intervention proven to reduce neonatal mortality by 36% and improve maternal-infant bonding. However, implementation remains inconsistent in low-resource settings like Palestine due to systemic barriers. This study assessed KMC knowledge levels among neonatal intensive care unit (NICU) nurses in Palestinian governmental hospitals and identified predictors of knowledge. A cross-sectional study surveyed 190 NICU nurses using a validated 20-item questionnaire (CVI = 0.92; α = 0.84). Demographic variables included age, gender, education, work experience, and prior KMC training. Knowledge levels were categorized using Bloom's taxonomy (low: < 60%, moderate: 60-79%, high: ≥ 80%). Data were analyzed via descriptive statistics, t-tests, ANOVA, and multiple linear regression. The mean knowledge score was 56.8% (SD = 19.5), with 44.4% scoring low. Significant predictors included prior KMC training (B = 16.656, p < 0.001), higher education (B = 6.365, p < 0.001), and older age (B = 9.934, p < 0.001). Male nurses scored lower than females (B = -4.852, p = 0.002). The model explained 81.4% of variance (R2 = 0.814). Suboptimal KMC knowledge among Palestinian NICU nurses highlights the urgent need for structured training programs, curriculum integration, and policy reforms. Future research should address cultural and institutional barriers to improve implementation.

Targeted educational program improves infant positioning practice in the NICU

To study the levels of perceived stress in Neonatal Intensive Care Unit (NICU) nurses and its association with professional quality of life domains viz. compassion satisfaction, burnout and secondary trauma. In this multicenter, cross sectional study, data was collected by surveying 129 nurses from nine NICUs across six cities of Gujarat, India using demographic questionnaire, Perceived Stress Scale (PSS14) and Professional Quality of Life Scale (ProQOL5) during July to September 2013. Descriptive statistics, correlation coefficient and multiple regression were used for analysis. The mean (SD) age of participants was 28.37 (8.20) y. Most were single, satisfied with salary benefits and reported 'good' to 'excellent' relationships at work. The mean (SD) duration of duty hours was 8.12 (0.76) h and 43.6% were attending to more than 4 patients/shift. The mean (SD) perceived stress level was 22.19 (7.17) [Range: 3 to 39]. High compassion satisfaction, high burnout, and high secondary traumatic stress were reported by 25 (19.4%), 30 (23.3%) and 30 (23.3%) nurses respectively. PSS14 was negatively correlated with compassion satisfaction (r = -0.28) and positively correlated with burnout (r = 0.43) and secondary traumatic stress (r = 0.24). Most of the nurses (91, 70.5%) were identified as perceiving moderate to high stress. Professional quality of life domains correlated with perceived stress. There is further need to study domains influencing NICU nurses' professional QOL. Identifying stress and QOL issues in NICU nurses can help formulate relevant policies.

The concept of developmentally supportive care in preterm infants is of considerable significance in the neonatal intensive care unit (NICU) setting with regard to preventing complications from preterm birth and promoting optimal growth and development. To provide high-quality developmentally supportive care, NICU nurses must possess high levels of knowledge, importance, perception, and competence. The purpose of this study was to investigate South Korean NICU nursing staff's level of knowledge concerning developmentally supportive care, as well as the perceived importance, perception, and perceived competence regarding this concept. This study employed a cross-sectional descriptive design. Between June 1 and 19, 2020, 160 nurses completed a self-report questionnaire pertaining to developmentally supportive care, which covered the aspects of knowledge, perceived importance, perception (including attitudes, perceived behavioral control, subjective norms, and intentions), and perceived competence. The levels of knowledge, attitude, and intention as a subfactor of perception, and perceived competence pertaining to developmentally supportive care were not high. There was no significant difference in the knowledge and perceived competence of skilled nurses compared with novice nurses. However, skilled nurses recognized that they could provide better developmentally supportive care than novice nurses. Perceived competence was positively correlated with perceived importance and perception. Systematic educational programs that can enhance developmentally supportive care competence should be provided to NICU staff nurses. These must clarify the importance of developmentally supportive care and improve NICU nurses' knowledge, attitudes, self-efficacy, and intentions.

Simulation education is essential for the development of nurses' practical skills. This study evaluated the impact and duration of simulation-based neonatal resuscitation education on the knowledge, self-confidence, and performance ability of neonatal intensive care unit (NICU) nurses. This quasi-experimental study was conducted in South Korea and included 35 NICU nurses working in tertiary hospitals between August and October 2021. Simulation-based neonatal resuscitation education (NRE) was provided for 80 minutes, and its effectiveness was measured in terms of nurses' knowledge, self-confidence, and performance ability. Data collection was conducted before, 1 week after, 3 weeks after, and 5 weeks after the training, and the collected data were calculated and analyzed using a t test and repeated measures analysis of variance. Simulation-based NRE improved knowledge, self-confidence, and performance in neonatal resuscitation. Performance ability showed greater improvement than knowledge or self-confidence, and all three areas showed significant differences in score changes over time. The duration of the training effect should be considered an important factor. [J Contin Educ Nurs. 2024;55(2):79-86.].

This sequential mixed-method study explores neonatal intensive care unit (NICU) nurses' awareness, attitudes, and perceptions regarding do-not-resuscitate (DNR) orders. Quantitative surveys were conducted among 50 neonatal nurses, supplemented by qualitative focused group discussions involving 10 participants. Data collection included structured questionnaires assessing awareness and attitudes toward DNR orders, alongside qualitative interviews to capture their perceptions. The mean age of the participants was 33.88±8.60years, predominantly females (98.0%), young adults (44.0%), and holding degree in nursing (68.0%). Findings indicated that over half of the neonatal nurses had poor awareness (52%) and negative attitudes (50%) toward DNR orders. Factors such as being unmarried (adjusted odds ratio [AOR]=0.01, confidence interval [CI]=0.01-0.27), <5years of NICU experience (AOR=0.04, CI=0.00-0.53), and not attending refresher course on End of Life Care (AOR=0.87, CI=0.00-0.99) significantly reduced odds of good awareness. Additionally, being Christian (AOR=0.01, CI=0.00-0.40), unmarried (AOR=0.05, CI=0.00-0.51), and <5years of NICU experience (AOR=0.03, CI=0.00-0.38) were associated with significantly lower odds of positive attitude toward DNR orders. Qualitative insights highlight emotional challenges and feelings of inadequacy among nurses during DNR order discussions with parents. The study highlights a need for comprehensive training and support for NICU nurses in navigating DNR order discussions effectively. Hospitals must prioritize regular nurse training on DNR orders. NICU settings need counseling support. Nurses' training should emphasize empathy and effective communication for sensitive DNR discussions. Most neonatal nurses lacked awareness and positive attitudes toward DNR orders, influenced by factors like marital status and NICU experience. Qualitative insights revealed emotional challenges in discussing DNR with parents.

For mothers in the postpartum period, admission of their newborn to a neonatal intensive care unit (NICU) is often an unanticipated experience that can be shocking and traumatic, and can elevate maternal risk for psychiatric symptoms, including posttraumatic stress. In this chapter, the NICU experience, psychosocial implications, mental health consequences, and screening tools that have been used to identify maternal psychiatric symptoms in this setting will be reviewed. Psychosocial interventions and programs addressing the stress and psychological reactions of mothers with an infant in a NICU will be introduced, as will recently developed interdisciplinary recommendations for the support of NICU families and a nurse training program to promote optimal communication between NICU nurses and parents. The chapter concludes with future clinical and research directions to continue improving maternal adjustment and mental health during a child’s NICU hospitalization.