سامانه همایش های دانشگاه آزاد اسلامی واحد نجف آباد

صفحه اصلی / اولین همایش بین المللی تحول خدمات سلامت: تلفیق مراقبت، درمان، بازتوانی و امیدبخشی

Trauma-Informed Care in the Neonatal Intensive Care Unit: A Literature Review

نویسندگان :

Somaye Pouy¹ Latif Panahi² Zahra Tavakolnia³ Mona Hoseinzadeh Seyghalani⁴

1- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. 2- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. 3- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. 4- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.

کلمات کلیدی :

Trauma-Informed Care،Neonatal Intensive Care Unit،Neurodevelopmental Care،Family-Centered Care

چکیده :

Introduction: The Neonatal Intensive Care Unit (NICU) is a high-acuity, technology-driven environment often characterized by unavoidable stressors, such as intrusive procedures, constant noise, and artificial lighting. While these life-saving interventions are essential, they can inadvertently contribute to a “traumatic” experience for both the developing brain of the neonate and the psychological well-being of the family. Trauma-Informed Care (TIC) has emerged as a critical paradigm shift in nursing, emphasizing a shift from a disease-centered model to one that prioritizes safety, relationship-building, and neurodevelopmental protection. Understanding how to mitigate stress in this setting is vital for long-term health outcomes. Aim: The objective of this literature review was to provide a systematic synthesis of the current knowledge regarding the integration of TIC in neonatal nursing, highlighting the challenges of clinical implementation and proposing evidence-based strategies to foster a healing, patient-centered, and family-integrated environment. Methods: A systematic literature search was performed across PubMed, Scopus, Embase, Web of Science, and Google Scholar, in addition to relevant Iranian databases (SID, IranDoc, and Magiran). The search strategy incorporated key terms: “Trauma-Informed Care,” “Neonatal Intensive Care Unit,” “Neurodevelopmental Care,” “Family-Centered Care,” “Neonatal Stress,” “Nursing Intervention,” “Environmental Modifications,” and “Post-Traumatic Stress.” Selection criteria were limited to peer-reviewed articles published between 2018 and 2025. The review specifically sought studies that utilized qualitative and quantitative analysis-reflecting the methodologies used in current nursing research (e.g., thematic analysis and clinical outcomes)-to examine the impacts of TIC on neonatal stress markers (e.g., cortisol levels, behavioral states, and heart rate variability) and parental psychological adjustment. Results: The review categorizes TIC interventions into three fundamental domains: physical environment, care-coordination, and relational engagement. Regarding the physical environment, the evidence strongly supports “nesting” techniques, light/noise reduction, and protected sleep periods to prevent developmental disruption. In the domain of care-coordination, the literature emphasizes the importance of minimizing painful procedures through “clustered care” and effective pain management protocols. However, the most profound findings relate to relational engagement: the inclusion of parents as partners in care. TIC significantly reduces parental anxiety and postpartum depression, and by extension, creates a more stable, calming presence for the infant. Despite these clear advantages, the literature identified significant barriers to implementation, including the rigid culture of traditional medical models, lack of institutional policy, high staff turnover, and the emotional burden on nurses who provide this care. Many nurses reported a lack of specific training on how to handle the trauma of families experiencing end-of-life care or long-term neonatal illness, suggesting a gap in professional competency. Conclusion: Trauma-Informed Care is not merely an optional addition to NICU care but a fundamental necessity for improving neonatal neurodevelopmental and parental outcomes. The shift toward TIC requires more than bedside interventions; it demands a cultural change within neonatal units, characterized by policy support, dedicated educational programs for nursing staff, and a move toward family-integrated care models. By transforming the NICU into a trauma-informed environment, we can protect the fragile developmental trajectories of neonates and support families through the complexities of NICU hospitalization. Future nursing research should concentrate on the cost-effectiveness and long-term longitudinal impacts of TIC protocols on school-age outcomes.