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The Needs of Fathers in the NICU: A Literature Review

Linda Merritt, MSN RNC-NIC

In the United States, one in 10 infants is born prematurely (March of Dimes Foundation, 2015). Parents often are unprepared for the news that their baby is coming early (Lasuik, Comeau, & Newburn-Cook, 2013; Linden, Paroli, & Doron, 2000). They are forced to turn the care of their child over to virtual strangers in a strange environment called the neonatal intensive care unit (NICU; Linden et al.). Research has shown that parents see the NICU as alien, frightening, and stressful (DeRouck & Leys, 2009; Hollywood & Hollywood, 2011; Lasuik et al.; Linden et al.; Pepper, Rempel, Austin, Ceci, & Henderson, 2012; Sullivan, 1999).

Fathers frequently are the first to enter the NICU (Arockiasamy et al., 2008). Often, the mother must stay in labor and delivery for the first few hours after birth to be closely monitored for complications, regardless of the mode of delivery (Arockiasamy et al.; McKinney, James, Murray, & Ashwell, 2009). Research has shown that fathers can vividly recall their experiences of having a child in the NICU and call this period in their lives traumatic and overwhelming (Alexander, 2011; Thomas, Feeley, & Grier, 2009). The sounds of the equipment frighten them, and they struggle to understand what all the equipment does (Pohlman, 2009).

Fathers fear losing control because they have been conditioned to show little emotion and maintain control under any circumstances (Pohlman, 2009). Thus, they tend to hide their feelings from the staff and their spouses. They believe that by showing emotions, they are not being manly and will further upset the baby's mother (Pohlman, 2003). Inside, though, they are struggling with what they want to feel, what they are actually feeling, and how they perceive others are expecting them to feel and act (Hugill, Letherby, Reid, & Lavender, 2013).

Most fathers return to work shortly after the birth of their child, unlike the mothers who often stay at home to recover from the delivery. Therefore, fathers are only able to spend a few precious hours with their child at the bedside each day (Fidler, 2002). When the fathers do visit, they report feeling neglected by the staff. The NICU environment generally is designed with mothers in mind. When both parents are at the bedside, the focus is usually on the mother, not the father. Fathers also feel that, at times, they are not included in the decisions being made for their child’s care (Lundqvist, Westas, & Hallström, 2007).

An extensive integrative review of literature involving the search terms “fathers,” “neonates,” and “premature infants” revealed 20 studies from 2002 to 2013 that focused exclusively on fathers. The studies were conducted in eight countries; seven were conducted in the United States. The total number of fathers was 387 with sample sizes ranging from five to 111 subjects.

The studies show that fathers of preterm babies have three important needs. The first is the need for proximity; fathers want to be near both their spouse and the neonate. They want to hold their child just as mothers do. Fathers also want to participate in their child’s care, but only when they feel they are ready for this step (Feeley, Waitzer, Sherrard, Boisvert, & Zelkowitz, 2013; Lindberg et al., 2008).

The second need that emerged is the need for support. Fathers want to be acknowledged and supported by the staff. They want to feel they are being cared for and that the staff understands their unique experiences. Fathers also want the time to articulate their thoughts and feelings (Fidler, 2002; Hollywood & Hollywood, 2011; Hugill et al., 2011; Mackley, Locke, Spear, & Joseph, 2010; O’Brien & Warren, 2008; Pohlman, 2005, 2009).

Finally, fathers have a need for information. They want to be able to observe the staff, understand how things are done, and then participate in the care of their child. Fathers want healthcare professionals to teach them how to take care of their child. They also want to receive consistent information from one primary healthcare provider and one nurse so they can have a better dialogue with healthcare professionals. With better communication, they can be more involved in the decision making for their child.

In addition, fathers want interventions developed specifically for them (Arockiasamy et al., 2008; Feeley et al., 2013; Hollywood & Hollywood, 2011; Joseph et al., 2007; Lee, Wang, Linn, & Kao, 2013; Lindberg et al., 2008; Lundqvist et al., 2007; Lundqvist & Jakobsson, 2013; Pohlman, 2003).

These studies reveal that fathers have different needs and experiences than mothers. It is no longer acceptable to use interventions based on research with mothers only in the NICU. Further research should be done to identify the needs most important to fathers so that interventions can be developed specifically for them. This research will help nurses assess and address what is important to fathers and improve the care they receive in the NICU. No longer will the father feel he is being neglected, but rather that he is a true partner in his child’s care.

References
Alexander, A. (2011). The experience of fathering a preterm infant: A phenomological study (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No. 3471059)

Arockiasamy, V., Holsti, L., & Albersheim, S. (2008). Fathers’ experiences in the neonatal intensive care unit: A search for control. Pediatrics, 121(2), e215–e222. doi: 10.1542/peds.2007-1005

DeRouck, S., & Leys, M. (2009). Information needs of parents admitted to a neonatal intensive care unit: A review of literature (1990–2008). Patient Education and Counseling, 76(2), 150–173. doi: 10.1016/j.pec.2009.01.014

Feeley, N., Waitzer, E., Sherrard, K., Boisvert, L., & Zelkowitz, P. (2013). Fathers’ perceptions of the barriers and facilitators to their involvement with their newborn hospitalized in the neonatal intensive care unit. Journal of Clinical Nursing, 22(3-4), 521–530. doi: 10.1111/j.1365-2702.2012.04231.x

Fidler, S.W. (2002). The premature birth of a child: The impact on a man’s transition to fatherhood (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses Database. (UMI No. 3057542)

Garten, L., Nazary, L., Metze, B., & Bührer, C. (2013). Pilot study of experiences and needs of 111 fathers of very low birth weight infants in a neonatal intensive care unit. Journal of Perinatology, 33(1), 65–69. doi: 10.1038/jp.2012.32

Hollywood, M., & Hollywood, E. (2011). The lived experiences of fathers of a premature baby on a neonatal intensive care unit. Journal of Neonatal Nursing, 17(1), 32–40. doi: 10.1016/j.jnn.2010.07.015

Hugill, K., Letherby, G., Reid, T., & Lavender, T. (2013). Experiences of fathers shortly after the birth of their preterm infants. Journal of Obstetric, Gynecologic & Neonatal Nursing, 42(6), 655–663. doi: http://dx.doi.org/10.1111/1552-6909.12256

Joseph, R. A., Mackley, A. B., Davis, C. G., Spear, M. L., & Locke, R. G. (2007). Stress in fathers of surgical neonatal intensive care unit babies. Advances in Neonatal Care, 7(6), 321–325. doi: 10.1097/01.ANC.0000304973.77202.1b

Lasiuk, G. C., Comeau, T., & Newburn-Cook, C. (2013). Unexpected: An interpretive description of parental traumas associated with preterm birth. BMC Pregnancy & Childbirth, 13(S1), S13. doi: 10.1186/1471-2393-14-313

Lee, T. Y., Wang, M. M, Lin, K. C., & Kao, C. H. (2013). The effectiveness of early intervention on paternal stress for fathers of premature infants admitted to a neonatal intensive care unit. Journal of Advanced Nursing, 69(5), 1085–1095. doi: 10.1111/j.1365-2648.2012.06097.x

Lindberg, B., Axelsson, K., & Öhrling, K. (2008). Adjusting to being a father to an infant born prematurely: Experiences from Swedish fathers. Scandavian Journal of Caring Science, 22(1), 79–85. doi: 10.1111/j.1471-6712.2007.00563.x

Linden, D. W., Paroli, E. T., & Doron, M. W. (2000). Preemies: The essential guide for parents of premature babies (2nd ed.). New York, NY: Pocket Books.

Lundqvist, P. & Jakobsson, L. (2003). Swedish men’s experiences of becoming fathers to their preterm infants. Neonatal Network, 22(6), 25–31. doi: http://dx.doi.org/10.1891/0730-0832.22.6.25

Lundqvist, P., Westas, L, & Hallström, I. (2007). From distance toward proximity: Fathers’ lived experience of caring for their preterm infants. Journal of Pediatric Nursing, 22(6), 490–497. doi: 10.1016/j.pedn.2007.04.008

Mackley, A. B., Locke, R. G., Spear, M. L., & Joseph, R. (2010). Forgotten parent: NICU paternal emotional response. Advances in Neonatal Care, 10(4), 200–203. doi: 10.1097/ANC0b013e318e946f0

March of Dimes Foundation (2014). Your premature baby. Available at www.marchofdimes.org/baby/premature-babies.aspx. Accessed February 29, 2016.

McKinney, E. S., James, S. R., Murray, S. S., & Ashwell, J. W. (2009). Maternal-child nursing (3rd ed.) (pp. 470–477).  St. Louis, MO: Saunders Elsevier.

O’Brien, C. K. & Warren, P. L. (2014). Fathers’ perceptions of neonatal nursing support. Journal of Neonatal Nursing, 20(5), 236–241. doi: 10.1016/j.jnn.2013.11.002

Pepper, D., Rempel, G., Austin, W., Ceci, C., & Henderson, L. (2012). More than information: A qualitative study of parents’ perspectives on neonatal intensive care at the extremes of prematurity. Advances in Neonatal Care, 12(5), 303–309. doi: 10.1097/ANC.0b0103e318265b3d5

Pohlman, S. (2003). When worlds collide: The meanings of work and fathering among fathers of premature infants (Doctoral dissertation). Retrieved from ProQuest Dissertation and Theses database. (UMI No. 3102919)

Pohlman, S. (2005). The primacy of work and fathering preterm infants: Findings from an interpretive phenomenological study. Advances in Neonatal Care, 5(4), 204–216. doi:  10.1016/j.adnc.2005.03.002

Pohlman, S. (2009). Fathering premature infants and the technological imperative of the neonatal intensive care unit: An interpretive inquiry. Advances in Nursing Science, 32(3), E1–E16. doi: 10.1097/ANS.0b013e3181b0d68c

Sloan, K., Rowe, J., & Jones, L. (2008). Stress and coping in fathers following the birth of a preterm infant. Journal of Neonatal Nursing, 14(4), 108–115. doi: 10.1016/j.jnn.2007.12.009

Sullivan, J. R. (1999). Development of father-infant attachment in fathers of preterm infants. Neonatal Network, 18(7), 33–39. doi: http://dx.doi.org/10.1891/0730-0832.18.7.33

Thomas, J., Feeley, N., & Grier, P. (2009). The perceived parenting self-efficacy of first-time fathers caring for very low birth weight infants. Issues in Comprehensive Pediatric Nursing, 32(4), 180–199. doi: 10.3109/01460860903281366

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