Improving parental mental health in the neonatal intensive care unit through screening for post-traumatic stress symptoms

Title: Improving parental mental health in the neonatal intensive care unit through screening for post-traumatic stress symptoms

Abstract:

Introduction/Significance: Approximately 25% of parents with infants in a Level IIIB Neonatal Intensive Care Unit (NICU) at a mid-size community hospital in the United States are met face-to-face to assess their psychosocial and mental health needs. Objective observations of NICU parents revealed parents demonstrating physical signs of stress, tension, irritability, poor sleep, avoidance behaviors, and feelings of guilt, shame, and blame. Assessment of the organization revealed a lack of mental health screening for parents, and one social worker (SW) was designated to evaluate and address the complex needs of 200-300 NICU parents annually while covering three additional maternal-child health units.

Purpose: A quality improvement project (QI) was implemented to identify NICU parents experiencing posttraumatic stress symptoms (PSS) as a result of having an infant in the NICU using a valid and reliable screening tool and providing resources or offering a referral to in-house behavioral health services for individualized mental health care, an evidence-based, research-supported practice change.

Methods: In consultation with key stakeholders of approximately four neonatologists, twenty-four registered nurses (RN), two SWs, one referral coordinator, and one psychiatrist, the project lead (PL) identified a valid and reliable screening measure, the Impact of Events Scale-Revised (IES-R), and eligible parents, integrated the screening into SW consultation with NICU parents and RN engagement during parent visitation, established RN incentives for implementation uptake, and methods of communication. Accessible QR codes for the IES-R, visual aids, educational materials, and mental health resources were generated to support voluntary and confidential parent participation, enhance knowledge, and provide mental health support to approximately 100 parents over 15 weeks. Data collection, tracking, and storage are maintained using REDCap® and monitored weekly by the PL. PL is set to engage weekly with key stakeholders to communicate benchmarks and assist SW in following up on positive screens and initiating referrals.

Preliminary Results: Screening rates, rates of PSS, and behavioral health referrals will be collected between September 1^st, 2024, and December 13^th, 2024. One hundred percent of eligible parents are expected to be screened for PSS using the IES-R. In line with current literature, approximately 30% of eligible parents screened are expected to identify as having clinically significant PSS and be offered a referral to behavioral health services.

Preliminary Conclusion: QI project implementation just began. Recommendations for implementing a routine mental health screening and referral process to identify PSS and improve the mental health of parents with infants in the NICU and considerations for future clinical endeavors will be discussed.

Biography:

Jaime Tomchik is a psychiatric-mental health registered nurse with 10 years of nursing experience and 5 years of experience teaching undergraduate nursing students in the mental health setting. She is scheduled to graduate in May 2025 from the University of Maryland, Baltimore School of Nursing with a Doctor of Nursing Practice in psychiatric-mental health. Jaime spent 9 years of her career working with individuals with complex trauma-related and dissociative disorders at Sheppard Pratt in Towson, Maryland. She plans to expand upon this experience as a psychiatric-mental health nurse practitioner. As a life-long equestrian, she looks to become certified in equine-assisted therapy and incorporate it into her practice to help individuals heal from past trauma and improve their overall mental health and wellness.