Banner with preemie infant image and health care professionals for "Because of Nursing Research" series.

Because of nursing research, there is a program to help the parents of a premature infant learn about prematurity. As a result, they feel less stressed and anxious while their infant is in the hospital. This program empowers parents to be more involved in their infant's care, leading to better infant outcomes.

The problem of premature births

Each year in the U.S., over half a million infants are born prematurely (before 37 weeks gestation). These infants are often very small, and may weigh as little as one pound. Most have not been able to put on the expected layers of "baby fat," so they tend to look very thin. Their skin is often shiny and translucent. In addition, their nervous systems have not had time to develop, and their behaviors and reactions may be very limited.

Premature infants often face immediate life-and-death concerns and require highly specialized care in a Newborn Intensive Care Unit (NICU). Even after they leave the hospital, their health may remain fragile throughout infancy. In the long term, they are at risk for a wide range of physical and developmental problems as they grow and develop.

Parental stress and anxiety

Most expectant parents look forward to the arrival of a healthy, well-developed baby. A premature birth drastically alters this expectation. The parents will have immediate worries about their infant's survival. They are unfamiliar with the thin and frail appearance of a premature infant. Rather than taking their new baby home to a quiet nursery, they must deal with the noisy, busy, and technical environment of the NICU. As time passes, new concerns often arise about the effects of prematurity on the health and growth of their child.

Many parents of premature infants experience high levels of stress, depression, and anxiety. Some may respond by avoiding the NICU or refraining from touching or holding their infant. Others may try to over-stimulate their infant in hopes of getting a reassuring response. Such parental behaviors may interfere with normal parent-infant bonding and hinder the growth and development of the infant.

A solution from nursing research: helping parents cope

Dr. Bernadette Melnyk

In studying the reactions of parents to a premature birth, nurse scientist Dr. Bernadette Melnyk (pictured, left) found that they are often overwhelmed, and feel lost and helpless in the NICU. They typically do not know how best to parent their preemies in the NICU or how to touch, comfort, or soothe their infant.

Dr. Melnyk and her associates designed a program called Creating Opportunities for Parent Empowerment, or COPE. COPE helps parents gain the knowledge, skills, and confidence needed to improve their caregiving abilities, as a way to alleviate stress. Her reasoning was simple, "If we can decrease depression and anxiety symptoms for the parents, then the outcomes of the children should be better."

The COPE program provides the parents with a series of CDs and workbooks that provide information on the typical physical characteristics, developmental stages, and behaviors of premature infants. Nurses work with the parents in the NICU to help them understand this information and how it relates to their own infant. For instance, the nurses can teach the parents to read behavioral cues – open eyes and an attentive gaze often signals the infant is alert and ready to interact, while blinking or closed eyes and turning away indicates the infant is tired and needs to rest.

Does COPE work?

To test the effects of COPE, Dr. Melnyk conducted a clinical trial involving over 200 families of premature infants. She found that the use of COPE improved the knowledge and beliefs parents had about their premature infants. This helped the parents to interact with their infant in a more positive way, appropriate to the infant’s developmental level. Fathers in the COPE program tended to be more involved in the infant's care in the NICU than fathers not in the program; while mothers in the COPE program had lower stress in the NICU and lower anxiety and depressive symptoms after the infant came home than mothers who did not receive COPE.

When compared with standard care, this intervention decreased the length of NICU hospitalization for the infants by about 4 days, which translated to reduced associated hospital costs of about $4,800 per infant. In infants under 32 weeks gestation, the net savings was about 8 fewer days in the NICU per infant, or nearly $10,000.

Discussions with the NICU staff indicated two possible reasons for these shortened hospital stays: the infants had improved growth and development, and the parents were better prepared and more confident to provide care at home.

The impact of COPE

After publishing these results, Dr. Melnyk received calls about COPE from neonatal units across the country looking to improve their care. If more widely used, the program could help premature infants and their parents across the country, and result in a large savings in health care costs related to prematurity. Meanwhile, Dr. Melnyk and her team are continuing to follow these infants, to examine the impact of COPE on long-term developmental and behavioral outcomes.

According to Dr. Melnyk, "The COPE program helps parents feel more confident with their special babies and interact more appropriately with them to facilitate their development. This translates to less stress, less depression, better parenting, and healthier children."

This research was supported by a grant from the National Institute of Nursing Research: R01 NR05077

For more information about COPE, please contact:
Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN
Associate Vice President for Health Promotion
University Chief Wellness Officer
Dean, College of Nursing
The Ohio State University

Additional resources for information on COPE:

American Academy of Nursing, Edge Runners profile:
"Creating Opportunities for Parent Empowerment (COPE): Reducing Parent Stress and Hospital Costs for Preterm Infants Through Parent Education and Skills Building."
Available at:

COPE for Hope
Information available at:


COPE: Creating Opportunities for Parent Empowerment, a nurse-led educational and parenting skill building program for parents of a premature infant.

Premature (or preterm) birth: The birth of an infant before 37 weeks of gestation. The normal length of pregnancy is around 40 weeks of gestation. Premature infants are at high risk for a wide range of physical, developmental, and behavioral problems.

Newborn Intensive Care Unit, or NICU: A highly specialized and technical hospital unit for the care of premature infants.