Introduction
For this podcast episode, I was very honored to be joined by Ms. Mary Coughlin. Mary is a Neonatal Nurse Practitioner, but also a published author of several pieces of work. She is well-known in the neonatal world for her development of the core measures for developmentally supportive care, but most recently with her published work and creation of the trauma-informed professional certification program as well as additional programs, workshops and masterclasses through Caring Essentials Collaborative.
I was so honored to be able to sit down and discuss Mary’s work experience that led her to the transformational work she is doing today. Just listening to Mary is transformational!
As NICU clinicians, Mary reminds us of the importance of our role and why it is so crucial for us to embrace our vulnerability, take our armor down and truly connect with one another on a human level. Trauma-informed care is not about doing more as a clinician, it is about being more of your loving, compassionate self so you can make a difference by fully showing up for your patient and their family.
We also discussed the trauma that is so common for NICU parents throughout their NICU journey and in the years to follow. So many NICU parents feel alone and isolated in the process, yet it is common to so many. We discussed the word trauma and why it is often downplayed or not spoken openly about it NICUs like it should be. And most importantly, we share the importance of working through and moving through your trauma, which will be difficult but is essential for the well-being of the entire family unit.
Trauma-informed care is a concept that has been applied to several areas of medicine and patient care, but its application to the NICU is still emerging. Mary learned about trauma-informed care and knew that she had to introduce it into the NICU world.
Not only does trauma-informed care in the NICU directly affect the baby, but it also addresses the family as well as the clinicians who are caring for the infant and family. Mary explains why the personal journeys we all go through and each of our stories play into an intricate web that involves each and every one of us. It is through this that we can all more intimately connect and heal one other.
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Episode 31
Meet Our Guest
Ms. Mary Coughlin, MS, NNP, RNC-E
Ms. Mary Coughlin’s Biography
Ms. Coughlin is a published author with credits that include the seminal paper introducing the concept of core measures for developmentally supportive care, the 2011 Clinical Practice Guidelines for Age-Appropriate Care of the Premature and Critically Ill Hospitalized Infant for the National Association of Neonatal Nurses (NANN); Transformative Nursing in the NICU: Trauma-Informed, Age-Appropriate Care, First and 2nd Editions, and Trauma-Informed Care in the NICU: Evidence-Based Practice Guidelines for Transdisciplinary Neonatal Clinicians endorsed by the NANN
and recognized by the National Association of Neonatal Therapists and the Council for International Neonatal Nurses as the definitive resource for evidence-based, best practices in neuroprotective, developmentally supportive care for hospitalized infants and families.
In her role as president of Caring Essentials Collaborative, Ms. Coughlin has educated, inspired, and empowered close to 10,000 interdisciplinary NICU clinicians from over 14 countries to transform the experience of care for the hospitalized infant and family in crisis. From speaking engagements and keynote presentations to individual coaching, master classes, and unit-based/organizational quality-improvement initiatives, Mary leads the team at Caring Essentials Collaborative.
Ms. Coughlin was born and raised in Boston, Massachusetts. The mother of six and grandmother to eight beautiful children, Mary and her husband, Dan, live in Boston, Massachusetts, with their dog, George.
Mary Coughlin’s nursing experience
United States Air Force Nurse Corp
As Mary Coughlin now reflects back on her nursing career, everything makes sense and it aligns, but she admits that when she was in that moment of navigating each career change, she had no idea what direction she was going.
Mary started her nursing career in the United States Air Force Nurse Corp where she spent 7 years in active duty in Texas, California, and New Hampshire prior to transferring into civilian nursing. While in the military, she cared mostly for adults until her last tour of duty when she was introduced to the NICU. She fell madly in love with caring for NICU babies and knew that was where she wanted to go once she started her civilian nursing career.
Neonatal Intensive Care Unit
She accepted her first position at Brigham and Women’s Hospital in Boston. She loved bedside nursing and eventually became a charge nurse. She developed the itch to try something new and became a NNP and had some amazing experiences. But, it did not fulfill her wandering intellect.
Mary left Brigham and Women’s Hospital in search for education. She started working with Children’s Medical Ventures focusing on developmentally supportive care products. The opportunity afforded her the opportunity to work closely with an interdisciplinary team full of clinicians from around the country. The job eventually morphed into something else that did not align with her goals so she started looking for new opportunities.
The Turning Point in Her Career
Mary ended up accepting a position in a very small community hospital close to her home. She was mesmerized by the job title of Director of Professional Practice Education and Research. But, she had some reservations regarding the position because it was in an adult-only hospital. Now looking back on it, she realizes that it became a turning point in her career.
In her new position, Mary oversaw education for the adult ICU, adult Med Surg unit, and 3 psychiatric units including an inpatient adolescent unit, an inpatient adult unit, and an inpatient older adult unit. Due to the strong team of clinical nurse specialists surrounding her, she felt very supported in her role and was able to mostly focus on the administrative pieces. One day her role changed when her boss asked her to step in as the interim nurse manager for the adolescent psychiatric unit. Although she was hesitant, she took the role and everything changed. She started to care for critically ill, 12-18 years old children in ways she had never experienced before. They were extremely ill, not on the outside, but on the inside.
The Introduction of the Trauma-informed Paradigm
While she worked in the inpatient adolescent psychiatric unit, they began to adopt the trauma-informed paradigm which was an entirely new concept to her, but one that had been well-grounded in behavioral health. Once she was introduced to it, she had an ah-ha moment! She knew that the trauma-informed paradigm belonged in the NICU as well. Anyone who is sick, or experiencing a critical or life-threatening illness, can be very overwhelmed by the circumstances. The feelings of overwhelm eventually translate into a biological response that we can actually address once we understand the concept.
Applying Trauma-Informed Care into the NICU
An Unexpected Phone Call
Once Mary realized how applicable trauma-informed care was to the NICU, she dove into research, writing, and blogging all about it. She wanted to shout it from the top of a mountain so she could share it with everyone! Suddenly she received a phone call from the Springer Publishing Company in New York. After reading her blogs, they felt that the topic was very cutting edge, and wanted to know if she had ever thought about writing a book. This particular phone call lead to the 1st and 2nd editions of Transformative Nursing in the NICU: Trauma-Informed, Age-Appropriate Care.
Accepting a New Approach to Care in the NICU
Mary felt so prophetic about sharing the idea of trauma-informed care and how it needed to be applied to the NICU population, she started speaking about it at conferences. In doing so, she was asked by the National Association of Neonatal Nurses (NANN) to write guidelines for practice.
Despite the support from a large organization like NANN, there remain some gaps between organizations that are on the pulse of cutting edge topics and the front line clinicians who practice it, especially those surrounding mental health. Although, the COVID pandemic has brought an increased awareness to mental health, its application into practice is not always as easy.
The word “trauma”
Ms. Coughlin has found that some clinicians become defensive when she has spoken about trauma-informed care. She feels that it is likely due to “trauma” being such a loaded word. In the world, and especially as clinicians, she states, that we like to control the language and manage the vibe. We are so immersed in the trauma that we become desensitized to it, in a self-preserving way.
The multiple layers and the intricate web of trauma
Initially, Mary admits that she primarily focused all of her attention on the baby when it came to trauma-informed care, but she quickly realized that an admission in the NICU affects the entire family. She began to look into all of the layers of the NICU family, plus the clinicians as they bare witness to the journey as well. Each of our stories and the journeys we go through play into an intricate web that engulfs everyone involved. The thought of the deep intertwined involvement with everyone and their stories initially felt daunting to Mary, but now, she is in a place of comfort with the task we have before us because she has realized that we can all heal each other.
The power in each of our stories
Our individual stories help us to make connections with other people because we all have stories. Stories, as Mary describes, connect us beyond the intellect. Stories connect us at the heart and allow us to not only see the vulnerability in others, but they allow us to take down our own walls so we can feel our own vulnerability. Stories genuinely help us to reconnect with our shared humanity.
Mary discussed Jean Watson, a nursing theorist, who believes caring regenerates life energies and potentiates our capabilities. By practicing Watson’s caring theory, it allows the nurse to practice the art of caring, to provide compassion to ease the patients’ and families’ suffering, and to promote their healing and dignity but in doing so, it can also contribute to expand the nurse’s own actualization.
Mary shared that the spiritual dimensions of our own humanity are also very important. We all want to feel seen. If someone becomes vulnerable and shares their story with you, it begins to melt away your armor, so you can lean into that experience and use that encounter as a vehicle for healing and metabolizing. If we all just stay on the surface level and talk about trauma, we end up adding an additional layer to that person’s pathology.
Working through trauma
Mary points out that there is not a cure for our experiences or our trauma. To work on our trauma, we need to move through it. But, many people become stuck in their trauma because it is difficult to move through it by yourself.
For NICU families, if we do not acknowledge it or call it trauma, we prevent parents from knowing the proper language so they can begin to metabolize and work through it. Without giving parents the appropriate verbiage, they often feel that there is something wrong with them and everyone else around them is fine.
Many NICU parents often feel that they are alone in their struggles. Although they realize that the NICU journey is a difficult experience, they are unlikely to identify it as trauma. Especially once they move on past the NICU, parents are often confused why they are still having difficulties moving beyond the NICU experience. They wonder why do they feel so short-tempered and sad despite their baby being home. The parents often feel that they should just be happy and get over it. Many parents do not realize that the trauma from their NICU journey will follow them for years to come if they do not work through it.
As clinicians, we need to ensure that parents do not feel alone in the process, but also acknowledge their trauma so they are more prepared to work through it. If NICU parents do not work through their trauma, it will negatively impact their ability to nurture and bond with their baby ultimately affecting their baby’s long-term trajectories. Additionally, trauma that is not dealt with will also negatively affect all of their relationships with significant others, friends, and family.
Bessel van der kolk has written several books on surviving trauma and Mary discussed how he described the effects that our traumatic experiences have in creating cellular memories. If we do not talk about our trauma or identify why we are so short-tempered, depressed, or feeling a heightened sense of anxiety, the trauma will get trapped in our body and later be unexpectedly triggered.
Mary referenced the book, What Happened to You by Dr. Bruce Perry and Oprah Winfrey. They write about the misconception of being able to talk someone out of their trauma. Rather, we should use our stories to build connections, which helps to regulate their autonomic system, so we can begin to relate on a human to human level allowing them to open up and work through it.
Mary states that there is wisdom within our experiences. You have to move through the experience and know that you will have scars but you will also have gained wisdom in the process.
Responsibility of healthcare providers
As healthcare providers, we have a responsibility to prepare families for the trauma they are likely to endure. We need to support them through it, but also provide ample resources within the systems and as part of the processes. The healthcare system must consider the families’ mental health and well-being while they are in the hospital and in the years to follow so they can nurture all of their relationships.
With every encounter we touch lives and impact lifetimes by showing up to each encounter with intention
Caring Essentials Collaborative, 2022
Transforming our typical routines into meaningful moments
As clinicians, we have such an opportunity to create meaningful moments for our NICU families. It’s a paradigm shift of moving away from a biomedical approach to an approach where we embrace a relationship-based model, or a human-based paradigm. We as clinicians must realize that every single thing we do, from a look, to a sigh, or a full-on conversation has meaning to the parents and the baby.
Many clinicians have been cultured into believing some of the commonly used terms like “externalized fetus” or “premature baby” or “immature” which are all accurate on a biological level, but not at all from a human perspective. They are still living beings and we need to recognize it. Although a huge retraining and reawakening needs to occur, it will not fix it all. Really, it is about people opening up their hearts. By really doing a deep reflection and making authentic connections with the humanity of another living human being, we are able to create meaningful moments.
Trauma-informed care is not about doing more, it is about being more of your loving, compassionate self. We need to let go of the old school mantra where we were encouraged to not get emotionally involved. We often become so immersed in the exciting, new technology, that we forget the human connection.
What can we do to be more impactful?
The transformational piece for us as clinicians is as simple as pausing and aligning yourself before you put your hands on your patient. Mary likes the work that Joan Halifax, a Zen Buddhist teacher has done with end of life palliative care nurses. She reminds us that if you distance yourself and put on your armor, it will actually increase the likelihood of burnout. It is about taking off your armor and connecting with that lived experience. Yes, the experience is going to touch your heart, it could even break your heart, but your heart will heal just in the knowing that you made a difference by showing up fully for this other person.
By using the acronym G.R.A.C.E. it reminds us to bring compassion into each of our interactions.
Gathering attention: focus, grounding, balance
Recalling intention: the resource of motivation
Attuning to self/other: affective resonance
Considering: what will serve
Engaging: ethical enactment, then ending
(Upaya Zen Center, 2012)
Ultimately, Mary reminds us that it does not matter what tool we use, what nipple you try, what positioning device you use, it is how you show up as a loving, compassionate human being. By being truly present and engaged in that moment with the baby and their family, you can make a monumental impact on their NICU journey.
Trauma-Informed Care Programs available through Caring Essentials Collaborative
Caring Essentials Collaborative offers cultural transformational projects, individual programs, workshops, and/or masterclasses through their website. The classes are for individuals or entire units who are interested in learning more about trauma-informed care. They also offer a Trauma-Informed Professional Certificate Program that meets the accreditation requirements of the institute for credentialing excellence. The certificate program is primarily a hybrid course composed of self-paced online models plus attendance at a masterclass.
At Caring Essentials Collaborative, they believe that how you show up personally and professionally should be as an integrated whole in every moment of life that unfolds.
Contact Ms. Mary Coughlin at: mary@caringessentials.net
Closing
Thank you for listening! Ms. Mary Coughlin is so fascinating! Using her passion and knowledge, she is paving the way to get trauma-informed developmentally supportive care into our NICUs for the infants, their families, and us as providers. It is essential and will impact our families in so many ways.
We all have a story, and it is what we have learned and metabolized through each of our individual journeys that connects us all on a human to human level. Thank you so very much to Ms. Mary Coughlin for joining me, you are truly inspiring.
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