I am humbled and grateful by the work of the authors of this month's article. I could not have imagined the explosion of research and reflection related to the concept of trauma-informed care in the NICU when I first blogged about it in 2011.
It was such a gift to work at the Carney Hospital (2010-2013) where I was introduced to the concept during my brief stint as the Interim Nurse Manager of the Inpatient Adolescent Psychiatric Unit. The amazing mentors and teachers I had opened my eyes to a different way of viewing hospitalization and the NICU.
This trauma-informed paradigm validates the therapeutic value we, as individuals, bring to the patient care encounter. It is at the shared interface of care, where services are rendered and received, that we connect, on a human level, and make a difference - but only if we pay attention, only if we are truly present.
Article of the Month
The authors connect the dots between the lived experience of the NICU infant-family dyad and the biological imperative of social connectedness through an understanding of Stephen Porges Polyvagal Theory.
Toxic stress derails healthy development across the lifespan and is the biological substrate for the Adverse Childhood Experience (ACE) Study. The adversities described in the study included physical, emotional and sexual abuse, neglect (both physical and emotional), as well as a host of household dysfunctions. The study revealed that a child's experience of multiple ACEs is a major determinant of physical and emotional health and wellbeing as an adult.
Sanders & Hall expose the infant's vulnerabilities to toxic stress both in utero and in the NICU, but also invite the reader to view the parent's experience through a Polyvagal lens and adopt a trauma-informed approach to engagement and partnership. NICU parents, whose story may include ACEs, may experience overwhelm or re-traumatization and have difficulty processing what is happening to their family. In creating a safe, relationship-oriented rapport NICU clinicians are able to promote safety and security for parents empowering them to embrace the primacy of their role identity and foster connectedness with their baby.
Operationalizing the six key principles of trauma-informed care for the NICU setting combined with an understanding of the body's response to stress helps NICU clinicians shift from a 'what's wrong with you' perspective to a trauma-informed reflection of 'what happened to you.'
This is truly a BRILLIANT PAPER and a MUST READ!!