Abstract
Background: Infants in the Neonatal Intensive Care Unit (NICU) are exposed to a variety of stressors based on their health condition and length of hospital stay. Stress has also been associated with negative neurodevelopmental outcomes.1 Cumulative measures of NICU stress exist.2 Yet, stress caused by specific nurse caregiving activities are poorly understood.
Purpose: The purpose of this study was to categorize the intrusiveness of nurse caregiving activities to inform “clustered nurse caregiving” with a goal of minimizing cumulative stress experienced by infants in the NICU.
Methods and Results: Assessment of intrusiveness was developed in 3 Phases. In Phase 1, 11 neonatal developmental experts responded to a survey on the intrusiveness of 64 nursing care activities. They were asked to agree or disagree with the intrusive classification. When > 2 experts disagreed with an activity categorization, it was reviewed and revised by a second group of experts and researchers. From this consensus, final agreement led to modification of 9 activities and clarification of 3 others.
Two groups of infants were recruited from a level IV NICU for Phases 2 and 3. In Phase 2, 5 preterm infants born at 24-29-weeks’ gestation were videotaped continuously for the first 14 days of life. Thirty none/mild intrusive and 34 moderate/severe intrusive activities were identified using the categorization schema in Phase 1. In Phase 3, 47 activities were identified during 604 observations of 46 stable infants born at ≤32 weeks gestation from a larger study.3 A revised categorization was based on infant physiological instability during the activity defined as a mean VS value (heart rate, respiratory rate, oxygen saturation) ≥1 standard deviation ± from the mean value 90 minutes before the start of nurse caregiving. The new categorization utilized a 0-3 categorization (0=not intrusive, 1=mildly intrusive, 2=moderately intrusive, 3=severely intrusive) and was based on the percentage of observations with physiological instability in which the activity occurred.
Conclusions: These findings provide a better understanding of intrusiveness of nurse caregiving activities. Assessment of intrusiveness in real time could decrease NICU stress over time. Activities that were categorized as severely intrusive are consistent with the cumulative measurement of NICU stress. However, many of the moderately intrusive and none of the mildly intrusive activities are represented in the cumulative measure.
Notes
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References:
1. Nist MD, Ford A, Packer C, Griffith T. Validity and use of the Neonatal Infant Stressor Scale: An integrative review. Early Hum Dev. 2024 Dec;199:106146. doi: 10.1016/j.earlhumdev.2024.106146.
2. Nist MD, Ford A, Packer C, Griffith T. Validity and use of the Neonatal Infant Stressor Scale: An integrative review. Early Hum Dev. 2024 Dec;199:106146. doi: 10.1016/j.earlhumdev.2024.106146.
3. Brandon DH, Hatch D, Barnes A, Vance AJ, Harney J, Voigtman B, Younge N. Impact of diaper change frequency on preterm infants' vital sign stability and skin health: A RCT. Early Hum Dev. 2022 Jan;164:105510. doi: 10.1016/j.earlhumdev.2021.105510.
Sigma Membership
Beta Epsilon
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Instrument and Tool Development, Acute Care, Neonatal Intensive Care Units, Physiological Stress, Nurse-Patient Relationships
Recommended Citation
Brandon, Debra, "Measuring Stress of Nurse Caregiving in the NICU: Development of Measure to Inform Practice" (2026). International Nursing Research Congress (INRC). 342.
https://www.sigmarepository.org/inrc/2026/presentations_2026/342
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-09-30
Funder
Duke University School of Nursing
Second Funder
National Institute of Health
Third Funder
Kimberly Clark, Inc.
Measuring Stress of Nurse Caregiving in the NICU: Development of Measure to Inform Practice
Toronto, Ontario, Canada
Background: Infants in the Neonatal Intensive Care Unit (NICU) are exposed to a variety of stressors based on their health condition and length of hospital stay. Stress has also been associated with negative neurodevelopmental outcomes.1 Cumulative measures of NICU stress exist.2 Yet, stress caused by specific nurse caregiving activities are poorly understood.
Purpose: The purpose of this study was to categorize the intrusiveness of nurse caregiving activities to inform “clustered nurse caregiving” with a goal of minimizing cumulative stress experienced by infants in the NICU.
Methods and Results: Assessment of intrusiveness was developed in 3 Phases. In Phase 1, 11 neonatal developmental experts responded to a survey on the intrusiveness of 64 nursing care activities. They were asked to agree or disagree with the intrusive classification. When > 2 experts disagreed with an activity categorization, it was reviewed and revised by a second group of experts and researchers. From this consensus, final agreement led to modification of 9 activities and clarification of 3 others.
Two groups of infants were recruited from a level IV NICU for Phases 2 and 3. In Phase 2, 5 preterm infants born at 24-29-weeks’ gestation were videotaped continuously for the first 14 days of life. Thirty none/mild intrusive and 34 moderate/severe intrusive activities were identified using the categorization schema in Phase 1. In Phase 3, 47 activities were identified during 604 observations of 46 stable infants born at ≤32 weeks gestation from a larger study.3 A revised categorization was based on infant physiological instability during the activity defined as a mean VS value (heart rate, respiratory rate, oxygen saturation) ≥1 standard deviation ± from the mean value 90 minutes before the start of nurse caregiving. The new categorization utilized a 0-3 categorization (0=not intrusive, 1=mildly intrusive, 2=moderately intrusive, 3=severely intrusive) and was based on the percentage of observations with physiological instability in which the activity occurred.
Conclusions: These findings provide a better understanding of intrusiveness of nurse caregiving activities. Assessment of intrusiveness in real time could decrease NICU stress over time. Activities that were categorized as severely intrusive are consistent with the cumulative measurement of NICU stress. However, many of the moderately intrusive and none of the mildly intrusive activities are represented in the cumulative measure.
Description
Assessment of the intrusiveness of nurse caregiving activities included in clustered care events in the Neonatal Intensive Care Unit (NICU) can inform modifications in care that can reduce cumulative NICU stress known to negatively impact infant neurodevelopmental outcomes. This study provides evidence-based data of the intrusiveness of specific care activities of both acutely ill and stable preterm infants.