Creating Effective Parent-Provider Communication in the NICU

By: Joanna B. Wolfson, Ph.D., ABPP & Robert M. Gordon, Psy.D.

For parents and family caregivers, navigating a child’s medical condition can be the most stressful of life experiences. When a child begins their life in the Neonatal Intensive Care Unit (NICU), caregivers are often catapulted into feelings of uncertainty, fear, and powerlessness. No one anticipates that having a new baby will involve being in a hospital indefinitely relying on physicians and nurses for lifesaving care. Sensitive and compassionate parent-provider interactions are critical for parents to develop feelings of safety, trust, and hope during this overwhelming period.

Even brief interactions at the NICU bedside may make or break a caregiver’s sense of self-efficacy and confidence in caring for their babies (Labrie et al., 2021). A 2021 meta-analysis by Labrie and colleagues revealed that these frequent moments with providers have far-reaching impacts on parents’ coping ability, their understanding of their baby’s condition, their participation and satisfaction with care, and their ability to attach to and bond with their newborn. Most importantly, these effects were often related to routine bedside interactions – not solely to structured conversations at family conferences.

Personal experiences

The authors are both psychologists who have worked in medically complex settings with patients across the lifespan. The perspectives and tips are based on working with patients experiencing unexpected medical adversity as well as personal experience.

Joanna: Six years ago, my son spent the first month of his life in the NICU following an unexpected birth trauma, leading to a sudden loss of blood and oxygen. Waiting for medical updates felt unbearable. It was as though the MRI machine and medical team held the key to our family’s future. Emotions fluctuated like a rollercoaster from shock and numbness, to anxiety, anger, grief, and – eventually – hope.

Occasionally, in an effort to manage our expectations, health care team members reminded my husband and me of how “medically fragile” our son was at birth. These “warnings” tended to overshadow positive news and made me question my gut sense that our baby would get well. I preferred updates on even the smallest steps our son made: hearing that he moved his tongue slightly when given a drop of breastmilk felt uplifting.

Simple, previously taken-for-granted events were deeply felt on a visceral level. When the elevator was out of order and the physician walked me up the stairs from the NICU to my own hospital floor, his support and kindness deepened the level of trust in the entire treatment team. My obstetrician standing patiently and quietly beside me at our son’s NICU crib provided immense comfort. Oftentimes, silence, presence, and accompaniment are the most healing interventions.

No matter how much time has passed, these patient-provider verbal and nonverbal communications remain imprinted in the memories of NICU parents and caregivers.

Bedside manner

“Bedside manner” has long been held as an important virtue of effective medical care. Ancient Greek writing urged providers to be “sober, not a winebibber” and to act “not with head thrown back (arrogantly).” Teachings have evolved over time and have been incorporated into medical school education. Despite this development, issues of time, financial pressures, and the complexity and urgency of medical needs due to advances in technology may interfere with effective patient-provider communication.

Current healthcare education highlights the importance of listening to the entire message or question from the patient or family caregiver without interruption, showing genuine interest through nonverbal gestures including tone of voice, using understandable, non-jargon language, providing comfort, and putting oneself in the patient’s shoes to cultivate empathy (Deepak, 2024).

Examples of unhelpful vs. helpful communication

Unhelpful

• Opening with, “I have some bad news,” which can lead to catastrophic thinking
• Using jargon such as “We need to do a needle stick,” which can evoke an upsetting image
• Describing the situation as “very severe,” even if true

Helpful

If appropriate, starting with, “Your baby is okay, but I wanted to share that…”

Using accurate language such as “We need to draw some blood.”

Using specifics like, “The blood transfusion is helping your baby with the blood loss,” provides a degree of hope, even in dire times

Tips for fostering effective communication in the NICU

These tips apply to communication with mothers, fathers, other caregivers, and integral supports. Including all caregivers in communications can help ensure the whole family feels seen and acknowledged as important to the baby’s care.

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Medical professionals can optimize communication and bedside manner by:

• Validating that what caregivers are experiencing is scary and difficult.
• Using comforting nonverbal communication: sitting down, giving full attention and listening deeply to the family’s concerns and questions, and using a calming, reassuring touch when appropriate.
• Letting family members know that providers are available and how to reach them.
• Acknowledging that uncertainty exists while also expressing specific efforts to make things better.

Family and friends can further enhance a sense of support by:

• Listening without offering advice. It is natural to want to lighten the mood or “fix” a problem. However, active listening and acknowledging how things are may be what the caregiver needs.
• Checking in after the baby leaves the hospital. Support may be strong at the beginning but tends to taper. However, parents may struggle with the adjustment to life after the NICU.

Psychology providers working with caregivers in the NICU can help by:

• Collaborating to make a list of questions or script in advance of medical appointments to ensure that concerns are addressed.

In navigating these challenging encounters with the medical team, caregivers can utilize the following communication strategies:

• Taking initiative in asking specific questions to convey self-efficacy and active hope.
• Making time to interact with their partner or other supports outside the hospital setting. Separation from the NICU and having conversations about other topics is a healthy way to cope.

Lessons learned

Just as parents/caregivers need to be highly attuned to subtle cues to develop secure attachments to their babies, the suggested communication tips highlight the importance of nonverbal communication. Voice tone, posture, eye contact, deep listening, and presence foster feelings of security and agency in the receiver.

As a psychologist who ended up on the receiving end of care, my own patients’ stories now resonate more deeply. Beyond what I could possibly learn in graduate school, the personal experience has informed the clinical wisdom of sitting calmly, presently, holding space for patients to discover their unformulated feelings, and being human to whatever emerges. I choose my words carefully – for they may never be forgotten.

Joanna B. Wolfson, Ph.D. ABPP, is a Clinical Assistant Professor of Rehabilitation Medicine at the NYU Grossman School of Medicine and a Senior Psychologist at the NYU Langone Health-Rusk Rehabilitation. She is board certified in Clinical Health Psychology. She is a member of the Medicine & Addictions workgroup (established. by 14 divisions of the American Psychological Association) that sponsor this blog. Robert M. Gordon, Psy.D., is a Clinical Associate Professor at the NYU Grossman School of Medicine. He is a member of the Medicine & Addictions workgroup.