Staff-Family Communications in the NICU: An Expert Interview With Liza Cooper, LMSW

Elizabeth McGann, DNSc, RN

September 28, 2010

September 28, 2010 — Editor's note: According to the March of Dimes, 1 in every 10 babies born in the United States is admitted to a neonatal intensive care unit (NICU) because of prematurity or other medical conditions. Having a baby hospitalized in a NICU can be frightening, confusing, and overwhelming for parents and families. Staff–family communication is crucial. A discussion of this topic was featured at the National Association of Neonatal Nurses (NANN) 26th Annual Educational Conference, held September 19 to 22 in Las Vegas, Nevada.

To find out more about the critical role of family–staff communication in the NICU, Medscape Medical News interviewed Liza Cooper, LMSW. Ms. Cooper is the director of the March of Dimes, NICU Family Support. She has extensive experience as a social worker in the area of newborn intensive care and high-risk obstetrics. Ms. Cooper is the creator of NICU Family Support, a nationwide program that provides information and support to families in crisis and educational opportunities for professional NICU staff. The presentation was delivered at NANN by Ms. Cooper's colleague, Laura Miller, manager, March of Dimes, NICU Family Support.

Medscape: What interpersonal skills are essential in neonatal intensive care unit (NICU) staff–family interactions?

Ms. Cooper: For me, the most important ingredient is genuine empathy. Often, I ask NICU professionals to recall a moment in their lives when they were a patient or a family caregiver and they felt particularly vulnerable, a time when the words or actions of a healthcare professional are forever etched in their memories, because the words were so tender and caring or because they were so hurtful and cold. It is these moments we must keep in mind when a family stands before us desperately worried about their baby, scared, helpless, and vulnerable. The empathy with which we introduce a family to their child and their child's medical situation, deliver difficult news, or guide them through complex decisions can make an enormous difference to that family's experience and overall functioning.

Medscape: How can NICU staff–family interactions be improved?

Ms. Cooper: Effective NICU staff–family interactions enable parents to be the best advocates for their child, to attach and bond with their baby, to make informed decisions about their baby's treatment, and to feel comfortable, respected, and valued in the NICU environment. 

The March of Dimes conducts an educational session for nurses — entitled Overheard: What We Say, What We Mean, What Families Hear — through our NICU Family Support Seminars in hospitals across the country, and most recently at the NANN conference in Las Vegas. The premise of this interactive workshop is that the words professionals use when speaking with families might be said with a positive intent, but are sometimes heard by a parent with a negative impact. For example, a nurse might inform a mother who is holding her baby that she is holding her incorrectly and that the baby is uncomfortable. While the nurse may have wanted to ensure the baby's well-being, the words themselves may make the mother feel incompetent and even harmful. . . . It is important to consider intent and impact as we choose the most sensitive words with which to approach families.

Sometimes a healthcare provider might meet with a family and deliver an overwhelming amount of information. Parents might understand but only remember only a fraction of it. They might feel stunned, confused, intimidated, and helpless. I call it the "fire-hose method." . . . Instead, I suggest a dialogue, in which the provider gives important information while a parent shares their own observations about their baby, concerns, and questions. The provider can ask the parent their understanding of what has been shared and add clarity when needed. It is also valuable to enable the family to titrate or modulate how much information they get at that moment.

Body language, including posture and eye gaze, can tell a provider how a parent is coping with what they are hearing. Don't ignore those signals; check in with how parents are handling the information and situation from an emotional perspective. When speaking to a parent who is sitting at a baby's bedside, it is helpful to crouch or kneel down to be at eye level, rather than speaking from an elevated, standing position. This can put the parent at ease and help form a genuine connection. Eye contact, common language, and face-to-face interactions certainly help; however, genuine empathy and warmth are the most powerful in making a connection and fostering good communication.

Medscape: Are there any specific communication challenges?

Ms. Cooper: It is very natural for providers and families to see things differently from time to time. They may want different treatment approaches for their baby. They may have different cultural perspectives or speak English as a second language. It is common for this to bring up emotions, judgment, and frustration from both sides. Critical to resolving these communication challenges is a professional's self-awareness of his or her own beliefs and attitudes, and the subsequent acknowledgment that healthy interactions between staff and families will optimize the outcomes for the baby. Rather than viewing interactions with families as "us vs them," it is advisable to work toward a common understanding and a common goal. Viewing staff and families as being on the same rather than opposing sides will help lead to the best outcome for the entire family system.

Medscape: Are there any national guidelines available?

Ms. Cooper: While the March of Dimes does not provide national guidelines on communicating with families, its NICU Family Support Licensing Seminars provide staff with experiential, innovative sessions aimed at making family–staff interactions more sensitive, empowering, and family-centered.

Medscape: What suggestions do you have for staff development and the implementation of evidence-based communication protocols?

Ms. Cooper: While hospitals are welcome to contact the March of Dimes about the NICU Family Support License Program, leadership is also encouraged to support their staff's attendance at conferences, such as the Gravens Conference on the Physical and Developmental Environment of the High Risk Infant, in collaboration with the March of Dimes, or the Institute for Patient- and Family-Centered Care seminars that focus on improving the patient's and family's healthcare experience.

Medscape: What is the most important take-home point about NICU staff–family interactions?

Ms. Cooper: Empathy, empathy, empathy. Imagine you are in the parents' shoes. What could be the impact of your words? Try to find the best way to share important information that simultaneously is supportive, encouraging, and facilitative of a positive staff–family relationship.

For information about the NICU Family Support License Program, contact Laura Miller, Manager, NICU Family Support License Program, at

Ms. Cooper has disclosed no relevant financial relationships, but is affiliated with the nonprofit organization March of Dimes.

National Association of Neonatal Nurses (NANN) 26th Annual Educational Conference: Poster 303. Presented September 21, 2010.


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