The COPE NICU Program

An Evidence-Based Educational-Behavioural Intervention Program for Parents of Preterm Infants

The COPE (Creating Opportunities for Parent Empowerment) NICU Program enables parents to cope effectively with a preterm birth. Begun during the first few days after birth, COPE teaches parents what to expect from their preterm infant during the NICU stay and for nine months after discharge. It describes how to identify their infant's characteristics, developmental cues, and milestones. COPE teaches parents how to interact with their preterm infant in ways that enhances growth and development. The program helps parents understand the workings of the NICU unit and encourages their active engagement with the NICU staff.

Reduced Length of Stay and Decreased Readmission Rates

The COPE program facilitates the development of critical parenting skills and contributes to a wide variety of evidence-based positive outcomes including: a four to eight day reduced length of stay in the NICU for preterms; decreased hospital readmission for premature babies after discharge from NICU; less stress and greater satisfaction with the NICU stay for parents; a higher level of confidence in their ability to care for their infants; greater readiness for their infant's discharge from the NICU; and less parental depression following discharge from the NICU. (These results are supported by over 20 years of research.)

NICU Staff Trained Onsite

NICU personnel are trained how to deliver the program to the parents; the training is conducted onsite by COPE faculty. In addition, staff receive implementation consultations by phone and a copy of the COPE NICU Program Implementation Training Manual.

COPE Program Materials Encourage Parental Engagement

The NICU receives program materials to provide to parents including: an audio CD; a professionally-printed 56-page book with developmental information and parent/infant activities; three large refrigerator magnets that list three-, six-, and nine-month development milestones paired with suggested parent activities to help stimulate the baby's development. (English, Spanish, French and German versions of the audio CD, the 56-page book and the refrigerator magnets are available.)

Supported by Randomized Controlled Trials

Outcomes of the COPE NICU Program were established by randomized controlled trials. The full-scale trial with 260 preterm babies and their parents was supported by National Institutes of Health/National Institute of Nursing Research and published in PEDIATRICS, the official journal of the American Academy of Pediatrics. (Click here for references.)

Improved Infant Outcomes:

  • 66 day shorter length of NICU stay for preterm infants under 27 weeks
  • Decreased readmission rate within 30 days after NICU discharge for preterm infants under 27 weeks
  • 4 day shorter length of NICU stay for preterm infants 26–34 weeks
  • 8 day shorter length of NICU stay for preterm infants under 32 weeks

Improved Parent Outcomes:

  • Less stress in the NICU
  • Stronger belief in and confidence of their ability to care for their preterm infants
  • More developmentally sensitive interactions with their preterm infants
  • Less depression and anxiety symptoms during and after NICU stay
  • Greater satisfaction with the NICU stay
  • Higher readiness for their infant's discharge from the NICU

Parents Will Learn:

  • How their premature baby may look and act
  • How they can care for their baby in the NICU
  • How to feel comfortable being with their child in the NICU
  • How to experience less stress in the hospital
  • How to develop a relationship with their infant
  • How to be ready to take care of their infant at home
  • How to have a positive outlook after baby comes home

Educational information and parent/child activities are organized in a phased sequence from early days following NICU admission until weeks after discharge:

  • PHASE ONE, 2–4 DAYS AFTER NICU ADMISSION: Helping your premature baby to grow and develop
  • PHASE TWO, 4–8 DAYS AFTER NICU ADMISSION: Helping yourself and your baby: The early NICU days
  • PHASE THREE, 1–7 DAYS BEFORE DISCHARGE FROM THE NICU: Getting ready to go home together
  • PHASE FOUR, 1–2 WEEKS AFTER DISCHARGE FROM THE NICU: Adjusting to life at home with your baby

COPE NICU Parent Program References

Melnyk, B.M., & Feinstein, N.F. (2009). Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parents and premature infants: An analysis of direct healthcare neonatal intensive care unit costs and savings. Nu rsing Administration Quarterly, 33(1), 32-37.*

Melnyk, B.M., Crean, H., Feinstein, N.F., Fairbanks, E. (2008). Maternal anxiety and depression following a premature infants' discharge from the NICU: Explanatory effects of the COPE Program. Nursing Research. 57(6), 383-394.*

Melnyk, B.M., Feinstein, N.F., Alpert-Gillis, L., Fairbanks, E., Crean, H., Sinkin, R.A., et al. (2006). Reducing premature infants' length of stay and improving parents' mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) Neonatal Intensive Care Unit Program: A randomized controlled trial. Pediatrics, 118, e414-e1437. *

Melnyk, B.M., Feinstein, N.F., & Fairbanks, E. (2006). Two decades of evidence to support implementation of the COPE program as standard of practice with parents of young hospitalized/critically ill children and premature infants. Pediatric Nursing, 32, 475-481.

Melnyk, B.M., Feinstein, N. F., & Fairbanks, E. (2002). Effectiveness of informational/behavioral interventions with parents of low birth weight (LBW) premature infants: an evidence base to guide clinical practice. Pediatric Nursing, 28, 511-516.

Melnyk, B.M., Feinstein, N.F., Alpert-Gillis, L., Fairbanks, E., Crean, H., Sinkin, R.A., et al. (2001). Improving cognitive development of low- birth-weight premature infants with the COPE program: A pilot study of the benefit of early NICU intervention with mothers. Research in Nursing & Health, 24, 373-389.*

Additional Pertinent COPE Parent Program References:

Melnyk, B., Crean, H., Feinstein, N. F., Fairbanks, E., & Alpert-Gillis, L. October 24, 2006. Testing the theoretical framework of the COPE Program for mothers of critically ill children: An integrative model of young children's post-hospital adjustment behaviors. Journal of Pediatric Psychology. doi:10.1093/jpepsy/js1033.

Melnyk, B.M., Alpert-Gillis, L., Feinstein, N., Crean, H., Johnson, J.E., Fairbanks, E., et al. (2004). Creating Opportunities for Parent Empowerment: Program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics (Electronic Pages), 113, e597-607. *

Melnyk, B. M., & Feinstein, N. F. (2001). Mediating functions of maternal anxiety and participation in care on young children's post-hospital adjustment. Research in Nursing & Health, 24, 18-26.*

Melnyk, B.M., & Alpert-Gillis, L.J. (1998). The COPE program: A strategy to improve outcomes of critically ill young children and their parents. Pediatric Nursing, 24, 521-527.

Melnyk, B.M., Alpert-Gillis, L.J., Hensel, P.B., Cable- Beiling, R.C., & Rubenstein, J.S. (1997). Helping mothers cope with a critically ill child: A pilot test of the COPE intervention. Research in Nursing and Health, 20, 3-14.*

Melnyk, B.M. (1995). Coping with unplanned childhood hospitalization: The mediating functions of parental beliefs. Journal of Pediatric Psychology, 20, 299-312.*

Melnyk, B.M. (1995). Parental coping with childhood hospitalization: A theoretical framework to guide research and clinical interventions. Maternal Child Nursing Journal, 23, 123-131.

Melnyk, B.M. (1994). Coping with unplanned childhood hospitalization: effects of informational interventions on mothers and children. Nursing Research, 50-55.*

Vulcan, B.M [Melnyk], & Nikulich-Barrett, M. (1988). The effect of selected information on mothers' anxiety levels during their children's hospitalizations. Journal of Pediatric Nursing, 3, 97-102*

Vulcan, B. (1984). Major coping behaviors of a hospitalized 3-year-old boy. Maternal Child Nursing Journal, 13, 113-123.*

*Randomized Controlled Trials