We want to thank Katherine L. Criswell, MSN, RN, for the thoughtful comments provided in response to our editorial and for continuing the conversation concerning the use of inclusive language. Intent and impact are not always aligned, and this is an opportunity for us to learn and grow. Criswell's points are welcomed and valued. Referring to personal pronouns instead of one's "preferred" pronouns is critical, especially as the identities that individuals experience over the course of their lives are not always personally preferred. The neonatal intensive care unit (NICU) is a high-intensity environment for families and healthcare team members. In such stressful situations, resources are warranted for nurses and all allied professions to be prepared to support trauma-informed care.

We must continually strive to enact trauma-informed healthcare practices in the NICU.1 All health professionals can and should advocate for systems improvement to create a more welcoming environment for the patients and families we serve. Using language that supports and validates individuals and families is one of the simplest and easiest ways we can show respect and increase inclusion. The use of inclusive language as standard practice in the NICU introduces a change in our approaches to communicating with families, and we agree that, in order to reflect a culture of inclusion, it is essential that healthcare providers in the NICU give careful consideration as to how this change is implemented so that at all families "get the same message," not just families selected on the basis of assumptions. This will happen if the people providing the message are actively involved in the planning of this change, rather than being told this is what they must do, especially when the use of the correct terminology is emphasized; fear of not using correct gender-neutral language may result in reluctance to participate in these conversations.

One of the critical considerations in the planning of this change is consideration of when to initiate the discussion of the use of personal pronouns with families. For some families, this may be during initial introductions. However, as neonatal nurses, every interaction we have contains within it a potential for either benefit or harm and introducing a topic that is not immediately relevant to a family has the potential for adding to the stress of having a critically ill infant. One approach to avoiding this may be encouraging healthcare facilities to incorporate pronoun indicators on name badges, which can help normalize conversations regarding pronouns and other gendered terminology.2 This indirect approach includes the benefits of actively involving the staff as well as giving the parent the opportunity to "control" the timing of the conversation. Another approach could be providing written materials that describe the NICU's commitment to inclusion in general and encourage parents to discuss gender-neutral language with the infant's caregivers. The parent(s)' responses can be documented and accessed in the medical record, allowing for consistent adherence among healthcare team members. Making this discussion routine, it becomes a normal part of our introductions to families and thus more natural and comfortable to the participants involved.

-Donna A. Dowling, PhD, RN

Adjunct Professor

Frances Payne Bolton School of Nursing

Case Western Reserve University

Cleveland, Ohio

-Brittany Kyle, BSN, RNC-NIC, C-ELBW,

C-NNIC, C-ONQS, CBC

Clinical Nurse-Pediatrics

Neonatal Intensive Care Unit

Riley Hospital for Children at Indiana

University Health

Indianapolis, Indiana

References