NURSE DRIVEN ASSESSMENT OF MATERNAL-INFANT ATTACHMENT IN THE NEONATAL INTENSIVE CARE UNIT

The purpose of this project is to develop and implement an assessment tool for nurses to use to assess mother-infant attachment in the Neonatal Intensive Care Unit (NICU). In this setting, the infant’s medical needs often interfere with bonding behaviors. There was concern that nurses did not recognize attachment and bonding behaviors so that parents and infants exhibiting poor attachment could be referred to the psychologists in order to improve parental infant attachment. Training was provided to help nurses increase awareness of the characteristics associated with positive and negative behaviors of attachment. This training allowed the bedside nurses to notify the social workers and psychologists if any negative behaviors were noted. The goal of this project is to increase the number of referrals to the psychology team. The Plan Do Study Act (PDSA) framework was utilized to guide this project. The assessment tool was piloted in Zone One of the NICU and inter-rater reliability was established. A 30 day pilot was conducted to evaluate the use of the tool. Once the 30 day pilot was completed, a survey was sent to the 125 nurses who were identified as working in Zone One during the pilot to determine nurses’ opinion about the usefulness of the training on the attachment assessment tool. The survey was completed by approximately 23% of the nurses who were sent the survey via email. There were 21 (91.3%) nurses who felt reported the education and training were adequate. There were 23 (100%) nurses who noted that the tool was easy to iv use and that the information was applicable to their job. There were six (27%) nurses who knew about the psychologists, with seven (31.8%) somewhat familiar with their presence. There were nine (40.9%) nurses who were unaware of the psychologists being used in the NICU. Most of the nurses surveyed stated that the information gathered from the tool and from the education would assist them in initiating a referral to the psychology team (73.9%). Only two nurses stated that they would not be so apt to make a referral based on the information provided. The completion rate was low, however, this may have been the result of the survey being sent out by the nurse scientist. This was done in order to avoid any possible issues with coercion, since the project author was a nurse manager on the unit. There were no referrals to the psychology team in Zone One prior to the pilot implementation. In contrast, there was an increase in the total NICU referral rate during the month following the project pilot. This may have been due to the increased familiarity with the protocol and increased confidence in making referrals. An additional PDSA cycle will be initiated in an attempt to gain a better understanding of the maternal-infant attachment and the characteristics that can be associated with poor attachment. The psychologists are on board with assisting in educating the staff nurses and are hopeful that referrals will increase as nurses become more aware of attachment behaviors