Parents as primary caregivers in the neonatal intensive care unit (original) (raw)
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Family integrated care: Supporting parents as primary caregivers in the neonatal intensive care unit
Pediatric Investigation, 2021
Family integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minimizing separation, and supporting parent-infant closeness. FICare incorporates psychological, educational, communication, and environmental strategies to support parents to cope with the NICU environment and to prepare them to be able to emotionally, cognitively, and physically care for their infant. FICare has been associated with improved infant feeding, growth, and parent wellbeing and self-efficacy; important mediators for long-term improved infant neurodevelopmental and behavioural outcomes. FICare implementation requires multidisciplinary commitment, staff motivation, and sufficient time for preparation and readiness for change as professionals relinquish power and control to instead develop collaborative partnerships with parents. Successful FICare implementation and culture change have been applied by neonatal teams internationally, using practical approaches suited to their local environments. Strategies such as parent and staff meetings and relational communication help to break down barriers to change by providing space for the co-creation of knowledge, the negotiation of caregiving roles and the development of trusting relationships. The COVID-19 pandemic highlighted the vulnerability within programs supporting parental presence in neonatal units and the profound impacts of parent-infant separation. New technologies and digital innovations can help to mitigate these challenges, and support renewed efforts to embed FICare philosophy and practice in neonatal care during the COVID-19 recovery and beyond. KEYWORDS Family integrated care, Neonatal intensive care, Parent-child, Caregivers address the negative impacts of the NICU environment on infants and their families and puts families at the centre of neonatal care delivery. In this paper we present the importance of minimizing separation between a parent and infant during NICU
Implementing Family-Integrated Care in the NICU
Advances in Neonatal Care, 2013
The purpose of this article is to describe and evaluate how "veteran" parents were engaged as experts in the design and implementation of a family-integrated care program in a Canadian neonatal intensive care unit (NICU). Three parents of preterm infants previously discharged from the NICU participated in the design and implementation of a family-integrated care pilot program. The steering committee for the program included 5 staff members (a physician, a NICU nurse, a parent education nurse, a lactation consultant, and a social worker) and the parent volunteers. This article includes a total of 42 mothers of infants born at 35-week gestation or less were enrolled in the pilot program. A detailed description and qualitative evaluation of the engagement of veteran parents in the design and implementation of the family-integrated care program. The effectiveness of engaging veteran parents in developing this model of care was evaluated by written feedback from the veteran parents and the other steering committee members. In addition, a structured interview at discharge with the 42 mothers enrolled in the pilot study was used to assess their experiences of the peer-to-peer support provided by veteran parents. Veteran NICU parents brought a wealth of wisdom and expertise developed through personal experience to the design and implementation of the family-integrated care program. The veteran parents played a significant role in both the initial development of the program and in the provision of peer-to-peer support during program implementation. Engagement of parents with prior experience of the NICU care environment is a critical step in the design and implementation of a program of family-integrated care.
Involvement of Parents in the Care of Preterm Infants
Pediatric Critical Care Medicine
Objective: To evaluate the effectiveness and safety of a Family-Centered Care (FCC) intervention in a Chinese Neonatal Intensive Care Unit (NICU). Design: Pilot study using a RCT design to inform a main RCT study. Setting: Stand-alone tertiary children's hospital in China with a 60-bed NICU serving as a regional NICU center. Patients: Premature infants (n=61) and their parents (n=110) Interventions: Parent education program followed by parents' participation in care as primary caregiver until discharge for a minimum of four hours per day. Measurements and Main Results: Primary outcomes were infants' weight gain at discharge, length-of-stay, and readmission. Parental outcomes were stress, anxiety, satisfaction, and clinical knowledge. Infants in FCC group (n=31) had higher weight gain (886g vs 542g; p=0.013); less NICU length-of-stay in days (43 vs 46; p=0.937); and decreased readmission rate at one week (41.9 vs. 70.0; p=0.045) and at one month (6.5% vs 50%; p<0.001) compared to the control group (n=30). Total mean parental stress and anxiety scores was lower in the FCC group (42 vs 59; p≤0.007); mean satisfaction rates in FCC group were higher compared to control group (96 vs 90; p<0.001); and parents in the FCC group had better educational outcomes related to neonatal specialized care skills (p<0.05). Conclusion: Involving parents in the care of their infant improved clinical outcomes of infants. FCC also contributed to a better understanding of parent's clinical education, decrease stress levels and increased parental satisfaction. Our study suggests that involving parents in the daily care of their infants is feasible and should be promoted by NICU clinicians.
A Literature Review: Parental Needs in The Neonatal Intensive Care Room
Journal of Maternity Care and Reproductive Health, 2018
Infants’ hospitalization in the neonatal intensive care unit (NICU) adversely affect infants and parents. Many activities have been developed to minimize the negative impact of infants’ hospitalization, one of them is applying the family centered care method. The first step of the method is to identify parent’ needs. This literature review is aimed to identify the needs of parents with critically ill infants in the neonatal intensive care unit. Articles were collected from several databases including Medline, CINAHL, EBSCOhost, Google Scholar, PubMed, and Proquest. The keywords were critically ill infants, family centered care, the needs of parents, and neonatal intensive care unit, qualitative, and quantitative studies. The articles reviewed were only articles with full text, written in English, and published during period 2004 to 2017. The study was criticized by the author using the Critical Appraisal Tool from JBI (Joanna Briggs Institute). 10 articles that related specifically ...
Parental Involvement in Neonatal Comfort Care
Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2012
To explore how parents interact with their infants and with nurses regarding the provision of comfort care in a Neonatal Intensive Care Unit (NICU). Focused ethnography. A regional NICU in the United Kingdom. Eleven families (10 mothers, 8 fathers) with infants residing in the NICU participated in the study. Parents were observed during a caregiving interaction with their infants and then interviewed on up to four occasions. Twenty-five periods of observation and 24 semistructured interviews were conducted between January and November 2008. Five stages of learning to parent in the NICU were identified. Although the length and duration of each stage differed for individual parents, movement along the learning trajectory was facilitated when parents were involved in comforting their infants. Transfer of responsibility from nurse to parents for specific aspects of care was also aided by parental involvement in pain care. Nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; encouragement of parental involvement in comfort care facilitated parental proximity, parent/infant reciprocity, and parental sense of responsibility. Findings suggest that parental involvement in comfort care can aid the process of learning to parent, which is difficult in the NICU. Parental involvement in infant comfort care may also facilitate the transfer of responsibility from nurse to parent and may facilitate antecedents to parent/infant attachment.
Needs of parents in a surgical neonatal intensive care unit
Journal of Paediatrics and Child Health, 2018
Aim: While there is evidence of parental needs in the neonatal intensive care unit (NICU), parents of newborns admitted for general surgery are an under-researched population. This study aimed to identify needs in parents of newborns admitted to the NICU for general surgery and whether health-care professionals meet these needs. Methods: This was a prospective cohort study of 111 parents (57% mothers) of newborns admitted to a surgical NICU for general surgery in Australia from January 2014 to September 2015. Parents completed the Neonatal Family Needs Inventory (NFNI), comprising 56 items in five subscales (Support, Comfort, Information, Proximity, Assurance) at admission and discharge, as well as the Social Desirability Scale (SDS). Data were analysed using parametric and non-parametric techniques. Results: At both admission and discharge, parents rated Assurance (M = 3.8, standard deviation (SD) = 0.24) needs as the most important, followed by Proximity (M = 3.6, SD = 0.32) and Information (M = 3.5, SD = 0.38). Mothers rated Assurance significantly more important than fathers (P < 0.02). Overall, parents' most important needs were having questions answered honestly (M = 3.96, SD = 0.19), seeing their infant frequently and knowing about the medical treatment (both M = 3.95, SD = 0.23). The 10 most important needs were met for more than 96% of parents, with no evidence of response bias. Conclusions: Reassurance is a priority need for parents in the surgical NICU. Mothers' and fathers' needs may be best met by practices based on family-centred, individualised care principles.
The neonatal intensive parenting unit: an introduction
Journal of Perinatology, 2017
This paper describes a paradigm shift occurring in neonatal intensive care. Care teams are moving from a focus limited to healing the baby's medical problems towards a focus that also requires effective partnerships with families. These partnerships encourage extensive participation of mothers and fathers in their baby's care and ongoing bi-directional communication with the care team. The term Newborn Intensive Parenting Unit (NIPU) was derived to capture this concept. One component of the NIPU is familyintegrated care, where parents are intimately involved in a baby's care for as many hours a day as possible. We describe six areas of potentially better practices (PBPs) for the NIPU along with descriptions of NIPU physical characteristics, operations, and a relationship-based culture. Research indicates the PBPs should lead to improved outcomes for NIPU babies, better mental health outcomes for their parents, and enhanced well-being of staff.
Partnering with Parents: Establishing Effective Long-Term Relationships with Parents in the NICU
Neonatal Network: The Journal of Neonatal Nursing, 2006
Advances in health care have led to unprecedented innovation in the care provided to critically ill newborns. One outcome of this new reality is that newborn intensive care units have become “homes” for fragile infants who require long-term hospitalization. Clearly, NICUs were never so envisioned; thus, this reality has resulted in challenges for families and health professionals alike. As the duration of hospitalization increases, relationships between families and health care professionals become increasingly important. Parents of hospitalized newborns face fear, anxiety, and frustration as they struggle to cope with an ill child while developing their parental role. The quality of relationships established between families and health care professionals is crucial to their coping and adaptation. This article addresses challenges faced by families whose infants experience extended hospitalization, applies a model to help health care professionals understand parent perspectives, and...
International Journal of Qualitative Studies on Health and Well-being, 2007
In a neonatal intensive care unit (NICU), the care is carried out not only by health care professionals but also by parents. The aim was to describe from a lifeworld hermeneutics approach, health care professionals' experience of parents' presence and participation in the care of their child in the NICU. Twenty health care professionals in two NICUs were interviewed. The interpretations of four themes indicate that the care personnel in NICU were ambivalent towards the presence of parents and set limits including dictating conditions for parental participation. In the encounter with the parents, they balanced between closeness and distance and had difficulty in meeting worried parents. There was little ability to deal with parents in crisis in the correct manner and sometimes an avoiding attitude was present. The care environment obstructed the personnel's endeavours to involve the parents in the care of their child. The result shows there is a need to train personnel in the art of dealing with parents in crisis. This should include developing the care environment to allow parents to be present and take part in the care of their child but also give personnel the prerequisites to make this possible.