Two Part Series – NIDCAP Care as Experienced by Two Nurses, One a Veteran, One a Novice

Part 2. My Impressions as a “Young” NICU Nurse

orna headshot

Orna Netzer, RN

In Hebrew, a new nurse in a unit or ward is often called a “young” nurse; I am then a quite “young” NICU nurse, although I am in my fifties…

I went through a long and colorful journey of education and work before I became a neonatal nurse. I have always taken care of children and babies. In my last professional role, before I went to nursing school, I helped children with special needs to become integrated in the general educational school system, and also gave guidance to their parents. It seems, though, that I have always felt an attraction to the health professions; I was lucky to witness their impact and importance while I volunteered for the non-profit organization “Baby Huggers”, a project that brought me to various hospitals and to so many babies. I was already a mother of three children and not young when I decided I to go to nursing school to become a nurse.

Both during my volunteer work and my nursing practices in different hospital wards, I noticed the complexity of the relationships between patients, families and caregivers. Such a mixture of distress and intense feelings – sadness and often helplessness on the one hand, and happiness, excitement, containment, patience, hope and professionalism on the other.

Yet, there was something different about the NICU at Meir Medical Center that made me feel immediately connected to it. The NIDCAP principles implemented in this unit affect its atmosphere, its characteristics, the caregiving itself, and the relationships between parents and staff. Perhaps the following every-day life sequence may better illustrate what I mean: early morning, I get ready, I prepare sandwiches for my children and for myself, take the shopping list with me, enter the car, listen to the radio – news, elections, tension in the south border of my country, traffic jams ahead, a call home to wake my son up for school, a call to mom to check on her, in a rush to take the lift and to be at the NICU on time, to release my colleagues from the night shift; I open the Unit’s doors and then… the lights are dimmed, the place is quiet, my mobile phone remains in the locker outside. I disconnect myself from the outside world. For eight hours now I will be in a separate universe – in charge of several preterm babies. I have to take care of them; I help ease their experience of being out of the womb before their due date; I provide them with soft and containing touch, I am ever mindful of how important it is to be accurate, to keep a low profile even when I have to be efficient and quick. As I see it, I have to safeguard that developing brain; I have to care for the medical needs of that baby and for the quality of his life to come; to leave as few traces of distress as possible in his inner, still intact “memory-board”. I find my work as a NICU nurse to be a weird and magic combination of intensive care, softness, pampering, containment, serenity and gentle touch.

I put a comforting hand on a mother’s shoulder, I encourage her to touch her baby, to calmly put her hands on his body, and then guide her to hold him skin-to-skin – thus trying to help them bond by little steps. I am part of the parents’ first steps in caregiving; I witness their fear and excitement, and I feel I am fully there to help them conquer the confidence in themselves they so much need. Their bliss and excitement penetrates me and my own happiness grows.

Orna 2 and Michelle 4

Orna, second from left, celebrates Kangaroo Care Awareness Day with her colleagues, including “veteran” nurse, Michelle Julie Meyer, far right.

The work at the NICU has high standards, forever demanding my alertness and skills to work as part of a team. The NIDCAP approach gives me the understanding and the tools to provide care – which can be oftentimes intrusive and distressing – in a soft and sensitive way for both the baby and the family. In my view, our ever growing ability to make this delicate combination possible, is what makes our work with preterm infants so important and fulfilling.



- Orna Netzer, RN
Neonatal Nurse
Israel NIDCAP Training Center
Meir Medical Center
Kfar Saba, Israel

Please see below for the link to the first part of the NIDCAP Care as Experienced by Two Nurses, One a Veteran, One a Novice series: Part 1. My reflections as a veteran nurse on the evolution of NIDCAP Care in our NICU, by Michelle Julie Meyer, RN.

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Two Part Series – NIDCAP Care as Experienced by Two Nurses, One a Veteran, One a Novice

Part 1. My reflections as a veteran nurse on the evolution of NIDCAP Care in our NICU


Michelle Julie Meyer, RN

I retired from work recently. I started my journey as a NICU nurse thirty years ago, when the Neonatal Intensive Care unit (NICU) just opened its doors at Meir Medical Center. After I was discharged from my service in the Army, I worked with adults in Intensive Care, and actually planned to continue in that field. When I was offered to join the new NICU, even though I was scared to make a shift from adult to newborn care, I decided to give it a try and, …. the rest is history.

I remember my first day all too well. Shortly after being guided by the pioneer Neonatologist who founded the NICU, I had to actually start to work and perform as a bedside neonatal intensive care nurse. I was scheduled for the night shift that first day, and worked with her side by side. I recall being very excited and emotional, yet my first shift went along well. During the next months I gradually got used to working with those tiny and fragile babies. I fell in love with them and with the work I did – the proof is I stayed at the NICU for 30 years!

Back then no one spoke, in our milieu, about Developmental Care, nor NIDCAP. All babies in need of assisted ventilation were cared for in open radiant beds at that time; in order to keep their body temperature stable, we partially covered them with a loose transparent polyethylene sheet. Those preterm babies used to lay untucked on their backs, often with their arms and legs away from their bodies. Fluorescent light illuminated the room and it was not possible to dim them. Everything took place in one long room – the caregiving, the numerous staff rounds and huddles, parents going in and out, … it was quite a hectic and noisy place. I recall we bathed the babies during the night shift, very quickly, as the bath “ought to be done”. Surprisingly enough, babies were weighed on a fixed schedule in the morning hours; there was no awareness, at that time, to cluster some of the caregiving according to the baby’s needs.

Some years later, a new, gentle and sensitive nurse talked about an advanced approach to preterm infant care called Developmental Care, and introduced the concept of NIDCAP to our NICU. It was certainly difficult to introduce this approach at first, and I believe it was quite a long and very quiet “revolution” that would not have thrived nor succeeded without her and without the support and vision of our managers and the openness of our staff. Initially, I thought it would be very hard for us to change our care in such a way; it was only when I delved deeper into the concept of individualized developmental care that I understood its meaning and importance.

During those years I gave birth to a 34-week-old little girl. The developmental care approach in our hospital was in its infancy and just beginning to emerge. Looking back, I feel my daughter and I had so many missed opportunities. If I knew better, I would have managed the whole experience differently. I think she lacked being held skin-to-skin, and I did not succeed in breastfeeding her.

Therefore, as a professional I gradually became very supportive of Developmental Care and found it crucial for preterm infants. The very essence of it is – in my view – to try to emulate in the NICU the womb’s conditions so as to diminish the potentially adverse neurological, physical, psychological and developmental effects the baby and family might experience. I am not able to envision today another way of caring for them, and feel deep sorrow when I hear about babies and families that are not cared for in this nurturing and supportive approach.

Orna 2 and Michelle 4

Michelle (far right) and her colleagues celebrate International Kangaroo Care Awareness Day

Persistent work was certainly necessary to implement the NIDCAP approach in our NICU’s everyday life; we had to learn and be guided, and we had to engage the whole caregiving team. I believe that our very special and sensitive team, with the support given by the NICU’s managing team, was decisive in transforming the unit into one where the NIDCAP approach to care has become second nature. We were lucky enough to have part of our staff trained by Dr. Heidelise Als and Dr. gretchen Lawhon, and to finally become the Israel NIDCAP Training Center at Meir Medical Center in October 2018. Caregivers from many other NICUs in our country participate in the Center’s courses and the NIDCAP word is now spreading in Israel.

I changed profoundly over those years. The developmental approach to care guided by NIDCAP gives support to parents in that sensitive period when the baby is in the NICU. I gradually was able to see the baby and his/her parents as a “unit”, and realized that our caregiving is meant to be for the family as a whole. It was important to me to be close and around the parents. I became more empathetic. It became important to me to really support the parents, to be a good listener, to encourage their presence at the bedside and to explain to them how their very presence diminishes the stress that their baby might experience in the NICU environment. I realized that separating the preterm baby from the mother right after birth is traumatic for them and therefore bodily contact between them is crucial. I could tell the difference between a baby whose parents were with him/her most of the time and a baby that is left alone for hours.

I like to think of our NICU as a shelter for babies and parents who go through a very difficult period. Looking into the future, I would like to see in my country more continuity of care between the NICUs and follow-up care in the community.

- Michelle Julie Meyer, RN
Retired Neonatal Nurse
Israel NIDCAP Training Center
Meir Medical Center
Kfar Saba, Israel

Please watch for the second part of the NIDCAP Care as Experienced by Two Nurses, One a Veteran, One a Novice series: Part 2. My impressions as a “young” NICU nurse, by Orna Netzer, RN.

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Why I joined the NIDCAP Federation International

Jennifer Degl

Jennifer Degl

I joined the NIDCAP Federation International in 2017 after attending their annual NIDCAP Trainers Meeting in Edmonton, Canada.

NIDCAP stands for Newborn Individualized Developmental Care and Assessment Program and the NFI stands for the NIDCAP Federation International.

When babies are born too early or medically fragile, they are forced to spend the first months of their lives in a hospital, instead of in the comforts of their home. In the Neonatal Intensive Care Unit (NICU), these babies are kept in a plastic box and attached to tubes and wires, all of which make them extremely uncomfortable. Many of these tiny babies also experience a great deal of pain due to medical procedures and surgeries. Research shows that the NICU stimuli may interfere with a baby’s normal neurological development, and can cause a myriad of issues as the child grows.

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Jennifer’s daughter at 3 days old

My daughter was born at 23 weeks gestation in 2012 at just 575 grams (1 lb 4 oz) and was not even as long as a ruler. She spent 121 days in the NICU and endured more pain and medical procedures than most healthy adults experience in their entire lifetime. I would have given anything to reduce her pain and keep her comfortable during her time in the hospital. The practices of NIDCAP and the NFI would have been so helpful to me back then, if I only knew they existed.

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Why Partnering with Parents in the Neonatal Unit is the Key to Everything

Nadine Griffiths, RN, MEd

Nadine Griffiths, RN, MEd

Admission to the neonatal unit occurs during a sensitive period of development. The first 1,000 days of life from conception to age three is considered an open and critical, singular window of opportunity (UNICEF 2018). During this period, children’s brains can form 1,000 neural connections every second, this period of rapid neurodevelopment occurs at a once in a lifetime pace which is never matched. The connections formed are considered the building blocks of every child’s future, contributing to children’s brain function and learning, they lay the foundation for their future health. A lack of nurturing care during this period which includes adequate nutrition, stimulation, love and protection from stress can impede the development of these critical connections. The importance of this period of development is highlighted in a UNICEF global promotion known as #earlymomentsmatter. For babies in the neonatal unit the buffer against known stressors in this setting and the source of consistent nurturing care is their parents.

Parents make not only ‘a’ difference, they are ‘the‘ difference and biggest influence on outcomes of neonates who experience an NICU stay. Recent research has found that increased holding of babies by parents in the neonatal unit is related to better reflex development at term, with parent skin to skin holding increasing infant reflexes and gross motor development at 4-5years of age (Pineda et al 2018). The authors of this research suggested these findings highlight the importance of engaging families in the NICU.


Father supporting his baby in surgical intensive care

Yet parenting for both mothers and fathers in the neonatal unit is a unique and challenging experience. Researchers have found that up to 64% of mothers in the neonatal unit experience psychological distress both within and beyond the NICU. With mothers who experienced psychological distress demonstrating less confidence in parenting than mothers without psychological distress (Harris et al 2018). Whilst fathers in the neonatal setting have described parental role alteration, infant appearance, NICU environment, and staff communication as stressors (Prouhet et al 2018). Universally engaging parents during their NICU hospitalization is seen as a strategy that improves parenting confidence and reduces parental role alteration. Family involvement is essential to facilitate early and long lasting positive effects on their baby’s physical, cognitive and psychosocial development (Craig et al 2015).

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Partnering with families on a Developmental Round in PICU

Whichever philosophy or model of care is utilised in your neonatal unit, parents should be at the centre of all you are trying to achieve. NIDCAP is a model of care that has been partnering with parents for the past 36 years. NIDCAP Certified Nurseries, Professionals and Training Centres are focussed on supporting relationships between neonates and their parents, health professionals and parents within system in which we both exist. We recognise that what works for us as healthcare professionals and the families may not be the same thing. For staff engaged with NIDCAP the neonatal unit is seen as the families’ space, when we enter we are walking into their home, this place is their everyday, it is where their baby lives, sometimes it will be the only space where they are existing.  These concepts remind us to respect babies and families by the way we behave, speak and go about our day in the NICU, encouraging us to support them and the connections they would foster in a home environment. Families should not be made to conform to the rules or language of a hospital system instead we need to make the system work for them, for each different family and their diverse needs. This approach requires a commitment to understanding the needs of infants and families, whilst investing in staff and a culture which seeks to embrace and support parents in an environment that they may have never heard of or imagined.

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Siblings welcomed in the surgical NICU setting

Recently the ‘Eight principles of patient-centred and family centred care for newborns in the neonatal intensive care unit’ has been promoted by clinicians in Europe (Roué et al 2017). The authors advocate additional research or evidence is not required to implement these strategies due to the breadth of the existing body of evidence. Unsurprisingly the first principle recommended is free 24 hours a day parental access with no limitations due to staff shift or medical rounds. We would argue that this should be extended to siblings, as parents often struggle to meet the needs of a toddler or child and their baby in the neonatal unit. Asking them to choose between their children’s needs is cruel and as evidenced by the literature and lack of infections related to sibling access in the neonatal setting unnecessary (Horikoshi  et al 2018). Infants’ and families’ needs during the neonatal period are viewed as universal; therefore, an effort to implement principles that engage families and support them within this setting is needed in all units and countries.

Adopting a philosophy where we learn from parents and their experiences in the neonatal unit is essential when developing services to meet current and future needs. Hearing what parents have to say of their time in the neonatal setting can be unexpected, unsettling and challenge the beliefs you hold in relation to your own practice and the service your unit provides. The experience of being open to and learning from parent’s experiences offers an incredible platform for personal, professional and unit development.

Some of the lessons I have learned personally as a nurse in the neonatal unit from families about how we can place them at the centre of caregiving include:

  • My job is to advocate for you and your family on a journey that is uniquely yours
  • We all have work to do, this is not about perfection
  • Little things to me, might mean everything to you
  • Not every family wants or needs the same thing, they should all be offered the same opportunities and respect
  • Celebrate everything the big, the little, the in-between – life is too short
  • You the mum, the dad, the baby can teach me (the healthcare professional)
  • These babies in this place are always yours, my job is to support you in an environment that is unfamiliar and often unimagined
  • We all have good and bad days, we can be at our best or our worst, tomorrow is another opportunity to try again
  • Saying I am sorry this is terrible, means more than trying to justify something
  • Perspective is everything and we are all coming from a different direction
  • Telling a family to take a break and get some rest doesn’t help them. Getting a comfortable chair, a glass of water or cup of tea and a blanket not asking them to go anywhere means more
  • It is rare to be untouched and unaffected in the neonatal unit as either a parent or staff member. We all carry different pieces of our journeys or those journeys we have witnessed with us – what we see changes us.

NIDCAP Trainer working collaboratively with a family

As health care professionals we are in a unique position to learn from parents and their babies, where ultimately our role is to advocate for caregiving in partnership with and led by them. Placing families at the centre of quality improvement activities, research, staff training, clinical guidelines, practice initiatives and all that we do in the neonatal unit is the key to our success. We are responsible for what families achieve during their journey and beyond the neonatal unit. Asking ourselves how we can continue to improve their experience and learn from them is something we should ask ourselves before every interaction and at every opportunity.


Nadine Griffiths
Clinical Nurse Consultant
NIDCAP Trainer, Australasian NIDCAP Training Centre



Craig JW, Glick C, Phillips R, Hall SL, Smith J, & Browne J (2015) Recommendations for involving the family in developmental care of the NICU baby. J Perinatol. 35(Suppl 1): S5–S8.

Harris R, Gibbs D, Mangin-Heimos K, & Pineda R. (2018) Maternal mental health during the neonatal period: Relationships to the occupation of parenting. Early Human Development 120: 31–39

Horikoshi Y, Okazaki K, Miyokawa S , Kinoshita K , Higuchi H, Suwa J, Aizawa, Y &Fukuoka, K. (2018), Sibling visits and viral infection in the neonatal intensive care unit. Pediatrics International, 60: 153-156. doi:10.1111/ped.13470

Pineda R, Benderc J, Halla B, Shaboskya L, Anneccaa A & Smith J (2018) Parent participation in the neonatal intensive care unit: Predictors and relationships to neurobehavior and developmental outcomes. Early Human Development 117: 32–38

Prouhet PM, Gregory MR, Russell CL & Yaeger LH. (2018) Fathers’ Stress in the Neonatal Intensive Care Unit: A Systematic Review. Advances in Neonatal Care. 18(2):105–120

Roué J-M, et al.(2017) Arch Dis Child Fetal Neonatal Ed;102:F364–F368. doi:10.1136/archdischild-2016-312180

UNICEF (2018) Early moments matter

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What NIDCAP meant to my NICU experience…


Latoshia Rouse

Just 7 days earlier, I had an OBGYN visit. After a great visit, I asked other moms of multiples if they thought I would make it to 36 weeks. My doc seemed very confident that I would, but I wanted to talk to moms who had accomplished it. We laughed and giggled at the possibility of me breaking the record for triplet birth weights. Everything was going great! This day I was super tired. I was beginning to struggle with standing for short periods of time. I was seeing the toll this pregnancy was having on my body. I decided to lay down and rest, but I needed to go to the bathroom first. Once I got in there, I realized my water had broken. Within an hour I was in the emergency room. I still was not sure what all this meant, but I knew I was not going back home until I had them. I had a 3 year old at home and I was not able to be with him. I was so torn. Everything was messed up. My body was failing the babies I was carrying and I was not able to parent the baby that was here. This was a Tuesday and after the steroids/ magnesium, I delivered my babies on Friday morning. They were 26 weeks 6 days. 2lbs 10oz, 2lbs 8oz, and 2lbs 3oz of perfection. It was a whirlwind. I had 4 kids. From 1 kid to 4 kids in about 29 mins. Continue reading

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NIDCAP – Mi experiencia personal con trillizos

Mónica Virchez

Tuve la oportunidad de tener a mis trillizos en el año 1999 en Londres, Inglaterra. Nacieron de 29 semanas de gestación en el Hospital Hammersmith y posteriormente los trasladaron al Hospital Saint Mary’s. Los bebés, dos niñas y un niño  pasaron dos meses en la UCI de neonatos de la Winnicott baby Unit. Durante la estancia en UCI recibimos información para poderlos apoyar en su desarrollo en general, sobre todo a nivel físico, psicológico y emocional. Trasladaron a los 3 bebes en una ambulancia especial para prematuros de un hospital a otro junto con una enfermera especializada con la que más tarde tuvimos mucho contacto. Cuando llegamos al segundo hospital encontramos un corcho colgado en la pared en donde venía escrito el nombre del personal sanitario para identificarlo más fácilmente a tanto a los médicos como a las enfermeras.

Instalaron a los bebes en una sala común pues había varios bebes ingresados y la unidad de cuidados intensivos se veía muy activa en ese momento. Continue reading

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When Life Gives you Lemons: A Personal Story from Bulgaria about Pregnancy, Birth, Loss & Family, Part 2

Nina Nikolova head shot 2

Nina Nikolova

In 2008, following the deaths of my children, I went home from the hospital feeling empty and broken-hearted. I simply wanted to close my eyes and die. I physically appeared to look pregnant and friends continued to enquire after the well being of my babies. I did not have the mental strength to deal with the reality of the situation and my husband was left to field the well-meant enquiries.

A number of months later we decided that we were strong enough to try for another pregnancy. The desire to have a family was so strong yet despite not being emotionally ready, we found the strength to embark on another pregnancy journey. Unfortunately the ICSI attempt failed and we had to face the stark reality of waiting for 12 months before we could try again (in Bulgaria families must wait 12 months between fertilization attempts).

Returning to work proved more difficult than I anticipated. While my friends and colleagues so dearly wanted to support and help me, they didn’t know how to speak with me, what questions to ask, or what I needed to help me in my grief. Continue reading

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The Journey Never Ends: A Time to Reflect

Melissa Johnson photo

Melissa Johnson, PhD

This month marks a major transition in my life. I am retiring from WakeMed, where for 30 years I have served as the Pediatric Psychologist in the NICU, in our Special Infant Care Clinic for children 0-3, and in the pediatric inpatient service. I am also a Senior NIDCAP Trainer and now certified as a NIDCAP Nursery Assessment and Certification Program (NNACP) Site Reviewer. Transitions are especially good times for reflection, and I appreciate the opportunity to share some thoughts with the NFI community and beyond. Here are some of the things that come to mind when I look back on 30 years spent working in one of the NICUs that undertook the transition to NIDCAP-based care relatively early in the process… Continue reading

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When Life Gives you Lemons: A Personal Story from Bulgaria about Pregnancy, Birth, Loss & Family, Part 1

Nina Nikolova head shot 2

Nina Nikolova

It was the summer of 2008 and I spent the most wonderful vacation carrying my twin baby girls. At our 21 week antenatal check-up upon our return to Sofia the doctor flagged a “small” problem: one of the babies didn’t appear to have enough amniotic fluid and the doctor recommended frequent checkups and bedrest.

Nina pregnant with her twin girls

At week 22, I experienced some minor bleeding and went to the emergency room of the hospital. I spent two very difficult weeks on total bedrest in the hospital; resting alone in bed and praying. I had some visitors, but the only thing that was important to me was to hold my babies inside of me as long as possible. Continue reading

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Individualized Developmental Care to Improve the Lives of Children with Congenital Heart Disease

Samantha Butler, PhD

As members of the Newborn Individualized Developmental Care Program (NIDCAP) family know all too well, preterm birth is a global challenge with developmental and physical challenges and disabilities which can not be completely explained by medical complications alone. The overexposure to unexpected noxious sensory stimuli and diminished positive experiences in the hospital contribute to the developmental picture for a child born early. NIDCAP, through minimization of the mismatch between the immature brain’s expectations and experiences of stress and pain in the hospital environment, has proven repeatedly to improve outcomes for children born preterm. Despite the research and publications on the positive outcomes for NIDCAP and the increasing availability of NIDCAP training, it is not consistently practiced in every intensive care unit (ICU) caring for fragile infants, though an increasing number of newborn ICUs (NICU) understand the importance of individualized developmental care and provide at least partial support in selected aspect of the NIDCAP model. Continue reading

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