Not forgetting the fathers: A qualitative narrative review exploring the involvement and psychological well-being of fathers in the neonatal intensive care unit.

Abstract
Background
Despite policy commitments to family-centred care, neonatal services often remain implicitly structured around maternal presence. Fathers, although increasingly acknowledged as vital to early child development, frequently experience feelings of exclusion throughout the neonatal journey, from antenatal care through to the neonatal intensive care unit.
Aim
This review explores how fathers experience involvement and psychological wellbeing during their infant’s admission to a neonatal intensive care unit.
Methods
A narrative review of qualitative studies was conducted using the SPIDER framework to guide the search strategy. The nine included studies, which met the inclusion criteria were identified via searching the databases CINAHL, PubMed, and PsycINFO. Studies were appraised using the CASP (2018) checklist, and findings were synthesised thematically.
Results
Thematic synthesis identified four key themes: ‘Exclusion from the NICU Environment’; ‘Emotional Suppression and Psychological Strain’; ‘Reclaiming Fatherhood Through Caregiving’ and ‘Coping and Support Mechanisms’. Findings highlight how fathers navigate a system not designed with their needs in mind, often suppressing their own emotions whilst seeking meaningful ways to engage.
Conclusion
Fathers often remain peripheral within neonatal care, shaped not only by entrenched gender norms but also by structural barriers that limit their involvement and emotional expression Without deliberate shifts in practice and policy, fathers risk continued exclusion, with implications for their wellbeing and the wider family dynamic. There is a pressing need for more inclusive and emotionally responsive care practices that recognise fathers as equal partners in neonatal care.
Keywords: NICU, fathers, involvement, wellbeing, qualitative