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Neonatal nurses' perspectives of family-centred care: A qualitative study
Abstract
The aim of this study is to explore neonatal nurses' perspectives of their role in facilitating family centred care in the neonatal intensive care unit.
The philosophy of family centred care focuses on the health and wellbeing of the newborn and their family, through the development of a respectful partnership between the health care professional and the infant's parents. Many studies report family centred care in the context of paediatric care; however, few studies explore neonatal nurses' perspective of family centred care in the context of neonatal care.
Qualitative interpretative approach.
Four focus groups and five individual face-to-face interviews were conducted with neonatal intensive care nurses (total n=33) currently practicing in a tertiary Neonatal Intensive Care Unit in Australia. Each focus group and face to face interview was audio-taped and transcribed. Data was analysed using thematic analysis.
Four dominant themes emerged from the data: (1) Getting to know parents and their wishes (2) Involving family in the day to day care (3) Finding a 'happy' medium (4) Transitioning support across the continuum.
These findings revealed a general understanding of family centred care principles. Nurses reported the potential benefits and challenges of adopting a family centred care approach to deliver optimal care for neonates and their families. The study highlighted that nurses need ongoing organisation support, guidance and further education to assist them in delivering family centred care effectively.
Family centred care is a central tenet underpinning neonatal care. Understanding neonatal nurses' perspectives will be useful when developing strategies to strengthen family centred care in the neonatal intensive care unit, and potentially improve neonatal care and family outcomes.
... 12 Among nurses, the FCC delivery model contributes to more meaningful work, improved job satisfaction, and feelings of accomplishment. 13,14 Although nurses are the cornerstone in the successful implementation of FCC, some studies have revealed that nurses have difficulty implementing FCC into NICU practices. [15][16][17] Although NICU nurses may be aware of the benefits of parental participation in the care of the neonate, they may hesitate to fully engage the family over concerns about giving up some of their power, control, and responsibilities. 2 Some studies have found that a power struggle may exist between nurses and parents. ...
... 18,19 Research on NICU nurses' perceptions of FCC demonstrates benefits and challenges with translating the philosophy into clinical practice. 2,14,20 There has been little research focus to date on the challenges of FCC implementation in the NICU setting. Limited information is known about the nurses' power struggles surrounding parental involvement in the care of their infant while on the NICU unit. ...
... Some studies found that parents were rarely ever included as a partner in the infant's care. 14,26 Trusting relationships between team members were perceived as necessary before one would relinquish control over the infant's care. Supporting our findings, other researchers have found that through communication, nurses developed harmonious relationships with parents and parents gained more selfconfidence in caring for their infant. ...
Background
Although research has demonstrated positive impacts of family-centered care (FCC), many neonatal intensive care unit (NICU) nurses hesitate to fully engage in its practice. There has been little scientific focus on investigating the challenges of FCC implementation in the NICU setting.
Purpose
The purpose of this study was to generate a grounded theory explaining the process by which neonatal nurses experience facilitators and challenges through engaging in FCC practices in the context of the NICU setting.
Methods
This qualitative, grounded theory portion of a mixed-methods study employed individual, semistructured, video-based dyadic interviews with 20 neonatal nurses.
Results
Successful implementation of FCC by neonatal nurses is affected by various factors. The adage that “it takes a village to raise a child” described this process for the nurse participants. The delivery of FCC involves respectful engagement and participation by multiple internal and external stakeholders. The process of delivering FCC was influenced by factors across 6 categories: equitable relationships, bond of trust, knowledge sharing, empowerment in workplace, environment and culture, and regulations. The findings suggest that FCC implementation is not an individual initiative; rather, it involves a complex set of interrelationships between care team members. NICU nurses may consider these findings when they are proposing a change to a FCC model.
Implications for Practice and Research
Flexibility is necessary by multidisciplinary teams to achieve maximum benefits of FCC and minimize potential harm, despite the unit design. Facilities may support nurses with continuing education programs to expand their FCC knowledge and skills.
... Healthcare professionals understood that effective communication goes beyond relaying information and is critical for cultivating good relationships and negotiating with parents to "[come] to a compromise" (Trajkovski et al., 2012). However, they "[did not] know how to communicate in the right way" (You & Kim, 2020), which highlights that their current communication methods restrict parental decisionmaking and participation (Heermann & Wilson, 2000;Wigert et al., 2007). ...
... Contrarily, healthcare professionals were conflicted about initiating parental engagement. They were empathetic toward parents' desire for involvement and found it "unfair" (Trajkovski et al., 2012) to deprive parents of the opportunity to become competent in infant care in preparation for life after discharge. This left healthcare professionals in an ambiguous position where they had to change their mindset from being sole experts in caring for infants to professionals who also accept parents as partners in rendering care (Heermann & Wilson, 2000;Maatman et al., 2020). ...
... Healthcare professionals also believed that experience would expand their professional capacity. Less experienced healthcare professionals lacked the "maturity" and "expertise" to guide parents (Follett, 2007), but with experience, they gained confidence and became "less scared" (Trajkovski et al., 2012) to involve parents in care (Lim, 2018;Trajkovski et al., 2012). ...
Family-centered care is recognized as the gold standard in pediatric healthcare practice. However, despite the acknowledgment of its benefits and importance, inconsistent and questionable implementation persists in neonatal intensive care units (NICUs) without a consolidated understanding of healthcare professionals’ experiences. Therefore, this review aims to explore and consolidate healthcare professionals’ perspectives on parental participation in the NICU. A systematic review of qualitative studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven electronic databases were searched from their respective dates of inception until December 30, 2020. Twenty-eight studies were included in this review. The analysis was conducted via a framework synthesis approach using Antonovsky's Sense of Coherence theory. Three over-arching themes, guided by Antonovsky's Sense of Coherence theory emerged: (1) “Comprehensibility of parental involvement in family-centered care,” (2) “Manageability of parental involvement in care and decision-making,” and (3) “Meaningfulness of parental involvement in shared decision-making in neonatal care,” with nine corresponding subthemes. Healthcare professionals had mixed views of parental involvement, recognizing the benefits attributed to infants and parents, but were greatly hindered by organizational, environmental, and personal obstacles that weakened their sense of coherence in coping with the situation, making them feel unconfident and unprepared to involve parents in care. To cope, more integrated and formalized support was required. Organizational, environmental, and policy changes, as well as psychological support, were strategies identified to enhance healthcare professionals’ sense of coherence, and consequently, their ability to cope.
... 24 Parent participation in educational programmes providing information and opportunities for sharing has been shown to reduce parental stress and anxiety and improves confidence and competence. 12,23,26 This corresponds to the findings of our study where parents gain more insight in how they could support their infants in an optimal way, which empowered them. To increase learning and to meet the needs of parents, studies have indicated that the use of multiple approaches is important. ...
... These mothers experienced less anxiety and greater social support than mothers who did not participate in the buddy programme. 23,28 Perhaps the synergy of various support programmes in a NICU can contribute to the empowerment and partnership between parents and staff; the whole is greater than the sum of the parts. ...
... Support and personal information are important in making parents feel valued and become active partners. As documented in the literature and in our study, neonatal nurses have an important role in guiding parentsto become comfortable and autonomous.21,23 Previous research emphasized that giving parents the opportunity to perform care routines by themselves and supervising them in a positive way improves the parent-infant relationship, as well as the parent-nurse relationship.24,25 ...
Background
Admission of an infant to a neonatal intensive care unit (NICU) is often a stressful experience for parents and can be associated with feelings of inadequacy to fulfil the desirable parental role. The values, opportunities, integration, control, and evaluation (VOICE) programme was developed to engage parents in care, to decrease stress, and to increase empowerment.
Aim
To explore the experiences of parents regarding involvement in the VOICE programme during admission of their infant to the NICU.
Design
The VOICE programme includes at least five personal structured meetings between parents, nurses, and other health care professionals throughout the pathway from birth, NICU, and follow up. A qualitative design was adopted using semi‐structured interviews. Interviews with 13 parents of 11 infants born at <27 weeks' gestational age were conducted: nine mothers and two couples of father and mother. Thematic analysis was deployed.
Results
The findings have been described in one overarching theme: “parental empowerment.” Parents felt strengthened and were empowered in the development of their role as primary caretaker by the VOICE programme. The parental empowerment theme emerged from four related interpretive themes that were derived: (a) involvement in care, (b) personalized information and communication, (c) transition to a parental role, and (d) emotional support.
Conclusion
The VOICE programme can be a structured approach used to implement family support in a NICU to empower parents to become a partner in the care of their infant and feel confident.
Relevance to clinical practice
This study encourages health care professionals to provide parental support through a structured intervention programme, which contributes to the empowerment of parents in the NICU and encouraged them to participate in care and decision‐making.
... The concept of PCC continues to evolve, notably in the change to 'person' rather than 'patient' in recognition of the whole person, not simply the disease process. Other variables such as Family-centred care are used more in the context of aged care and paediatrics [16,17]. ...
... Power over one's care. The idea of power balance is discussed in the literature and includes the sharing of knowledge [29], respect for decision making and individualised care based on these decisions [28,17]. Further to this is the notion of the person having 'active' involvement in the care process [22,35]. ...
... The need for care systems to be innovative and make a commitment to PCC comes through in the literature [22], as well as the need for the environment to allow for flexibility and to factor time and space to practice PCC [9,36]. This is a significant shift from the traditional biomedical model, whereby emphasis on personal choice [33] and partnerships [17] must be considered within all layers of the healthcare system. Barriers and enablers including workplace culture, leadership [22], policy and practice, organisational systems, environment [28,35], workload, and ward culture [37] were identified. ...
Aim
The aims of this literature review were to better understand the current literature about person-centred care (PCC) and identify a clear definition of the term PCC relevant to nursing practice.
Method/Data sources
An integrative literature review was undertaken using The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Scopus and Pubmed databases. The limitations were English language, full text articles published between 1998 and 2018 within Australian, New Zealand, Canada, USA, Europe, Ireland and UK were included. The international context off PCC is then specifically related to the Australian context.
Review methods
The review adopted a thematic analysis to categorise and summarise themes with reference to the concept of PCC. The review process also adhered to the Preferred Reporting System for Meta-Analysis (PRISMA) and applied the Critical Appraisal Skills Programme (CASP) tools to ensure the quality of the papers included for deeper analysis.
Results
While definitions of PCC do exist, there is no universally used definition within the nursing profession. This review has found three core themes which contribute to how PCC is understood and practiced, these are People, Practice and Power. This review uncovered a malalignment between the concept of PCC and the operationalisation of the term; this misalignment was discovered at both the practice level, and at the micro, meso and micro levels of the healthcare service.
Conclusion
The concept of PCC is well known to nurses, yet ill-defined and operationalised into practice. PCC is potentially hindered by its apparent rhetorical nature, and further investigation of how PCC is valued and operationalised through its measurement and reported outcomes is needed. Investigation of the literature found many definitions of PCC, but no one universally accepted and used definition. Subsequently, PCC remains conceptional in nature, leading to disparity between how it is interpreted and operationalised within the healthcare system and within nursing services.
... 11 Few studies have been conducted that evaluate the staff's view of FCC practices. [11][12][13][14][15] Most of the research conducted in the area of maternal-child medicine has focused on mothers. Although many articles use the word "parent," the subjects may be only mothers. ...
... 24 Understanding the nursing perspective is useful in developing a more thorough picture of the context of the relationship between fathers and nurses and will help guide strategies to improve the care of the father. 15 For the purposes of this article, visitation is defined as time spent in the NICU with the infant. In no way is the term "visitation" meant to imply that fathers should be viewed as a visitor. ...
... On the contrary, fathers who are supported and encouraged properly to care for the infant report positive outcomes such as pride, joy, and self-confidence. 22 Studies on nursing perceptions of FCC to date have mainly focused on 3 main areas: nurses' role in FCC, 5,13,15 facilitators for FCC, 5 and barriers to FCC. 5,14,25 These studies have included nurses' perceptions of both parents, but none have focused solely on the care of the fat her. 5,[13][14][15]25 Of the studies that have been conducted, many were conducted in countries where provision of care may be different from that in the United States. ...
Background:
Father involvement in the neonatal intensive care unit (NICU) is important for outcomes of children and should be encouraged. Neonatal nurses have been identified as a major source of support for fathers; yet, nurses have identified obstacles to family-centered care of the father.
Purpose:
The purpose of this article is to present results that broaden the knowledge of factors that affect time NICU nurses spend with fathers. The information presented here is a portion of results from a larger survey that examined factors affecting NICU nurse caring beliefs of fathers.
Methods:
This survey study included NICU nurses and was administered anonymously online. Content analysis was completed on responses to open-ended questions.
Results:
Questions asked nurses about the time they spend with fathers. Nurses described problems with workflow and encouraged family bonding. Some nurses described spending equal amounts of time with both parents, whereas others focused on either the mother or the father. Paternal attributes that affected time nurses spent with fathers included confidence, motivation, level of competence, beliefs, attitudes, and availability. Maternal factors included culture and gatekeeping. Infant factors were level of illness and tolerance to activity.
Implications for practice:
Unmotivated fathers may benefit from encouragement from nurses to participate in the care of their infants. Nurses can encourage parental partnerships in caring for their infants.
Implications for research:
Factors identified in this study can help guide future studies. Understanding the relationship between NICU fathers and nurses can help improve interactions and communication.
... Often, and unconsciously, nurses will act as gatekeepers between parents and their infant Trajkovski et al., 2012). Nurses' varying communication styles are also a critical factor in the establishment of the nurse/parent relationship . ...
... This meta-synthesis explores what characterizes a successful partnership and identifies potential barriers or facilitators among parents and nurses in NICU. The resulting knowledge could pave the way for developing strategies to support the establishment of partnerships, thereby achieving successful FCC in NICUs and improving neonatal care and outcomes (Trajkovski et al., 2012). According to Medline, PROSPERO, the Joanna Briggs Database of Systematic Reviews & Implementation Reports and the Cochrane Database of Systematic Reviews, no systematic review is available about this phenomenon. ...
... The nurses preserved trust by demonstrating medical expertise combined with empathy and affection for the infant (Smith, Steelfisher, Salhi, & Shen, 2012). Nurses emphasized openness, honesty and acknowledgement of parents' experiences as being essential elements to build and preserve trust (Fegran & Helseth, 2009;Trajkovski et al., 2012). Even though they valued trusting ...
Aims and objectives
To explore how parents and nurses experience partnership in neonatal intensive care units (NICU) and to identify existing barriers and facilitators to a successful partnership.
Background
Family‐centered care (FCC) is recommended as a frame of reference for treatment and care in NICUs. A key element in FCC is partnership. Such partnerships are characterised by complex interpersonal relationships and interactions between nurses and parents/families. Partnerships therefore appear to present a significant challenge.
Design
A qualitative review and meta‐synthesis.
Methods
Comprehensive searching in ten databases: Cinahl, Pubmed (MEDLINE), Embase, PsycInfo, Scopus and Swemed+, Opengrey, MedNar, Google Scholar and ProQuest Dissertations & Thesis Global. A total of 1,644 studies (after removal of duplicates) were critically assessed and 21 studies fulfilled the inclusion criteria. A meta‐aggregation was used to synthesise the findings from the studies. Methodically quality assessed with QUARI/SUMARI and PRISMA.
Findings
Through a meta‐aggregative approach two synthesised findings were developed: 1) co‐creation of mutual knowledge and 2) developing competencies and negotiating roles. The first synthesis embraced the categories: being respected and listened to, trust, sharing knowledge, and the second synthesis embraced the categories: space to learn with guidance, encouraging and enabling, being in control. In constructing the categories, findings were identified as characteristics, barriers and facilitators to application.
Conclusion
A successful relationship between parents and nurses can be achieved through co‐creation of mutual knowledge as well as development of competencies and negotiation of roles. Neonatal Intensive Care Unit nurses are in a position where they exercise power, but they can change the culture if they are aware of what seems to facilitate or create a barrier to a partnership with parents.
Relevance to clinical practice
This new evidence may inform a change in policies and guidelines which could be integrated into nurses’ clinical practice in NICUs.
This article is protected by copyright. All rights reserved.
... While FCC is recognized globally for enhancing pediatric care quality and family satisfaction, significant variations exist in its implementation across regions. For example, studies have reported differences in nurses' FCC perceptions and practices in countries like the United States [14], Canada [15], and Australia [16], as well as in Jordan [17], Saudi Arabia [18], Turkey [19], Greece [20], Iran [21], South Africa [22], and Malawi [23]. ...
... Conversely, some studies, such as those conducted in Greece, have shown that younger nurses are more likely to adopt FCC practice [20]. These differences may stem from various factors, including organizational policy, care environment, and nurses' confidence in applying for FCC [16,18,19]. The current study's findings align with those of a previous study conducted in Malawi, which indicated that nurses over the age of 40 are more likely to practice FCC [54]. ...
Background/purpose
Nurses play a vital role in providing effective family-centered care (FCC) to enhance the quality of healthcare for children with chronic illnesses and increase family satisfaction. This study aimed to investigate nurses' perceptions and practices of FCC for children with chronic illnesses, and how nursing characteristics influence this relationship.
Method
This multicenter cross-sectional study involved a convenience sample of 405 nurses, each with at least six months of experience caring for chronically ill children, infants, and toddlers in Saudi Arabia. An online survey was conducted between February 2023 and August 2023. A paired sample t-test of differences between nurses’ perceptions and practices of FCC among chronically ill children was performed. Correlations were carried out to test the relationships between nurses’ perceptions and practices of FCC and their sociodemographic factors, including age, gender, marital status, education level, and years of work experience, and attributes of nurses, including professional competence, interpersonal skills, job commitment, and knowing one’s self. Moderation analyses were conducted using the SPSS PROCESS macro version 4.
Results
Nurses’ FCC practice was significantly poorer than their perception. The moderation analysis highlighted that marital status (β = 0.122, p = .014), interpersonal skills (β = 0.131, p = .002), job commitment (β = 0.096, p = .024), and self-awareness (β = 0.127, p < .001) significantly strengthened the relationship between FCC perception and practice.
Conclusions
Nurses’ sociodemographic factors and personal attributes influenced the relationship between their perceptions of FCC and its implementation. Leaders should consider aspects such as marital status, interpersonal skills, job commitment, and self-awareness as these factors affect the strength of this relationship. Further research is needed to assess these impacts through longitudinal design and causal intervention studies to create a conceptual model of FCC for children with chronic illnesses.
... Thus, to overcome the gap in FCC implementation, a positive and cooperative relationship between healthcare professionals may enable cultural shifts to take place within the NICU thereby facilitating collaboration within the FCC. Further, this review highlighted that enhanced communication between the healthcare team and family creates a harmonious relationship leading to reduced strees and increased family confidence in caring for their infant (Trajkovski et al., 2012). Similary, Gephart and McGrath argue that effective and continuous communication enhances collaboration between families and healthcare providers (Gephart et al., 2012). ...
... This is in line with other studies that found nurse shortages limited the time available for nurses to effectively meet the needs of families (Vittner et al., 2022;Epstein et al., 2017). With the lack of adequate human resources, teamwork and organisational support towards FCC principles, healthcare providers, especially neonatal nurses feel anxious about losing control over infant care, potentially leading to negative attitudes toward implementing FCC (Trajkovski et al., 2012;Nyqvist et al., 2009). Based on the findings, it is imperative to restructure organisational culture, management strategies, and operational approaches within healthcare settings to effectively support the implementation of FCC by healthcare providers. ...
... From the studies that have been performed, the impact of FCC on nurses includes improved staff satisfaction and experiencing feelings of reward and accomplishment, as the parents become more competent and confident in their infant's care. 23 Finally, although some nurses believe parental participation results in a greater workload, 24 others believe parental involvement facilitates their FCC practice, whereby reducing their efforts. 25 FCC has not been found to be consistently and effectively implemented into practice, as it depends on the perceptions and responses of healthcare providers, the critical nature of the infant receiving care, and the parents' desire for involvement. ...
... Nurses may also perceive a threat to the safety of infants when they allow parental involvement in the infant's care. 23 In theory, empowered nurses who take too much control over the infant's care may be less likely to engage in FCC practice. This paradoxical relationship between empowerment and FCC has yet to be investigated. ...
Background:
Approximately 7 out of every 100 births in the United States result in admission to the neonatal intensive care unit (NICU), which contributes to a delay in initial physical contact between the parents and their newborn. While family-centered care (FCC) increases opportunities for parent-infant connection, implementation barriers persist in clinical practice. Research has yet to examine whether organizational and nursing factors of empowerment and compassion fatigue (CF) in the NICU are associated with FCC practice.
Purpose:
The aim of this study was to determine the relationship between empowerment, CF, and FCC practices among NICU nurses.
Methods:
This quantitative portion of a mixed-methods study used a cross-sectional, descriptive correlational design. Bedside NICU nurses with at least 6-month experience were recruited to complete an anonymous online survey using established, valid, and reliable instruments.
Results:
Except for organizations with Magnet status, there were no significant differences in FCC practice within individual and institutional characteristics. Hierarchical linear regression model indicated nurse empowerment was a strong predictor of FCC practice (β = 0.31, R2 = 0.35, P < .001). There was only a weak, inverse association between CF and FCC practices (r = - 0.199, P < .001).
Implication for research and practice:
Further qualitative research will integrate these findings to understand the process by which neonatal nurses engage in FCC practices in the context of NICU setting. Future studies should examine facilitators and barriers of FCC practice in the NICU. Strategies (eg, policies and trainings) to increase nurse empowerment and support for FCC implementation should be developed and evaluated.
... Easing financial burdens for families, such as compensation for parking (O'Brien et al., 2015) and the provision of long-term follow-up (Beveridge et al., 2001), were also mentioned. From an ideological standpoint, organizations must also support a shift in philosophy towards nurses as educators and parents as primary providers (Li et al., 2017;Trajkovski et al., 2012). Providing tools and training for educators and managers enables them to support their staff (Asai, 2011). ...
... Parents report a desire for nurses to adopt the role of a facilitator, teacher, and guardian (Reis et al., 2010). However, this requires further clarification as many nurses struggle with the implications of adopting this new role in their working contexts (Jones et al., 2015;O'Brien et al., 2015;Trajkovski et al., 2012). Studies describe power struggles between parents and nurses (Cleveland, 2008;Gibbs et al., 2015) and nurses struggling to understand their role in FCC (Mirlashari et al., 2019). ...
Purpose
Family-centred care (FCC) in the Neonatal Intensive Care Unit (NICU) is an aspect of high-quality neonatal nursing. The aim of this manuscript is to clarify the meaning of FCC in the NICU to inform future research.
Methods
Rodger's evolutionary concept analysis. Three databases were searched, each representing a different discipline: CINAHL, Medline, and PsycINFo.
Results
A total of 188 full-text papers were included. The concept of FCC in the NICU was defined according to its surrogate and related terms, antecedents, attributes, and consequences.
Discussion
Although interdisciplinary in nature, academic literature about FCC in the NICU is dominated by a biomedical perspective. Important conceptual departures, namely developmental care and family-integrated care are discussed.
Conclusion
Considering FCC as a model of care may be too reductionist; it should be regarded as a philosophy. Further work should explore the delivery of FCC for increasingly specialized NICU populations, such as perioperative infants.
... An Australian study aimed to explore neonatal nurses' understanding of the philosophy of family-centred care in the neonatal context and to describe how nurses view their role when delivering FCC (Trajkovski et al. 2012). A qualitative interpretative approach was used to elicit information about perceptions of FCC. ...
... However, this study showed that more experienced nurses felt greater confidence when delivering FCC. This was attributed to their increased knowledge and confidence in performing daily tasks and their ability to shift from these tasks to meeting the social needs of parents (Trajkovski et al. 2012). Nichols (2014) reports the findings of a qualitative investigation using non-participant observation and follow up interviews with key informants aimed at understanding ways in which the clinical environment might influence and impact upon the behaviour and practice of those employed in this environment. ...
The Parenting Premmies Support Program: developing and piloting a mobile health intervention for mothers of preterm infants. The study presented in this thesis aimed to investigate the use of contemporary mobile health technology as a vehicle to support and promote the health and wellbeing of mothers of preterm infants during the transitional time following their infant’s discharge from hospital. An exploratory, mixed methods approach with a three phase design was used to understand maternal experience, challenges and issues in this context, develop an mHealth protocol that formed the program, and finally, pilot the program.
... Studies have shown FCC in the NICU reduces parental stress, increases parent confidence post-discharge, and supports parent-infant bonding [15,17,18]. The FCC delivery model contributes to more meaningful work, improved job satisfaction, and feelings of accomplishment among nurses [19,20]. Although healthcare professionals may be aware of the benefits of FCC, forming an FCC committee with vested healthcare professionals and implementing FCC practices present challenges. ...
Objective
Despite evidence demonstrating the positive impact of family-centered care (FCC) in the neonatal intensive care unit (NICU), FCC is not standard of care. This multi-center, quality improvement initiative aimed to increase the percentage of NICUs with FCC committees and Family Partnership Councils (FPCs).
Study design
Participating NICUs were divided into small groups for collaborative mentoring. A key driver diagram and Pareto charts evaluated barriers to FCC and directed interventions. The primary outcome measure was development of an FCC committee and/or FPC. Process measures were views of bi-monthly educational webinars, evaluated using Statistical Process Control charts.
Result
Across 22 NICUs, the percentage with FCC committees and FPCs increased from 18% to 59% and 18% to 45%, respectively. Average webinar views increased from 28 to 182 views/webinar with clear signal on XmR chart.
Conclusion
A collaborative mentoring model and focused education achieved the goal of increasing NICU FCC committees and FPCs.
... Playing a key role in supporting both parents, nurses are important in the implementation of FCCa central principle in NICU-care involving the whole family and not only the patient [5,9,10,12]. Despite knowledge regarding parents' needs, there are still barriers to FCC implementation [5,[12][13][14], including inadequate training and education in communication skills; fear of losing control over the patient's care; and the nurses' own ideas, beliefs, and behaviors [5,12]. Therefore, the success of an intervention depends on its implementation process, as changes may be effective only if implemented as intended [15], thus the increasing need for organizational changes Abbreviations ...
Objective
Although family-centred care (FCC) is recommended in neonatal intensive care units (NICUs), barriers still exist. This study aimed to identify and understand and nurse-related factors contributing to the implementation of a father-friendly NICU (FF-NICU).
Methods
Eleven pre- and post-implementation focus groups were conducted with 21 nurses. Data were analysed using meaning condensation.
Results
Four pre-implementation themes emerged: 1) fathers' limited presence, 2) worries, vulnerability, and emotions, 3) types of fathers, and 4) involvement of fathers.
Eight themes contributed to the implementation of FF-NICU: 1) Advantage for the infant/family, 2) Presence of fathers, 3) Less work for the nurses, 4) Daily work routines, 5) Taking something from the mother, 6) Different approaches, 7) Creativity and flexibility, and 8) Implementation process.
Conclusion
Important for the implementation of FF-NICU were that the change was necessary, advantageous for the nurses, and beneficial for the families. Still, nurses needed to be flexible and creative in the care of the fathers/families.
Innovation
This study focused on fathers - an underexposed target group. Examining key factors for those executing the intervention and discussing the findings using the theoretical framework of John P. Kotter's implementation strategy, we contribute to a better understanding of implementation processes.
... These studies revealed that healthcare providers' communicative behavior does not consistently fulfill this need; a finding supported in systematic reviews on NICU communication [9,10,12]. Nurses sometimes find providing emotional support and dealing with parents' conflicting feelings challenging, due to a reported lack of proper training and guidelines [17]. Moreover, for parents to share their feelings may not be easy, nor self-evident [51]. ...
Objective
The novel concept of Family-Integrated Care (FICare) requires nurses to be parents' partners in neonatal care. We combined analyses of real-life parent-nurse conversations and interviews to elucidate nurses' role in providing psychosocial support to parents. Findings inform the development of communication training on topicalizing parents' feelings.
Methods
Conversation analysis of 15 audio-recorded parent-nurse conversations, and thematic analysis of interviews with 2 nurses.
Results
In parent-nurse conversations, nurses showed a “balancing act” in formulating parents' feelings, revealing the complexities of addressing parents' feelings. Overall, parents confirmed nurses' formulations, but also expanded or modified them, or indicated restricted conversational space. In the interviews, nurses discussed four purposes of conversations with parents, emphasizing elaborating on parents' feelings, while discussing associated challenges.
Conclusion
Our conversation analysis revealed a continuum of nurses' formulations of parents' feelings, and nurses' reflections illuminated how and when the formulations were used to invite parents' “feelings talk”.
Innovation
This study is the first to use conversation analysis to analyze parent-nurse conversations. Additionally, it pioneers combining these analyses with interviews, inviting nurses to reflect on how to incorporate the findings into FICare. This combination strongly informs the development of tailored communication training, drawing from real-life conversations and nurses' articulated needs.
... The emotional toll of working in the NICU on nurses themselves can be considerable but may be insufficiently recognized [8,9]. Constant interactions with parents, with their diverse situations and needs, can be both a satisfaction and a strain for nurses [10]. In Sweden, these interactions are particularly frequent since both parents have parental leave during the hospitalization of their newborn infant, allowing them to maximize the amount of time they spend with their infant in the NICU. ...
Objectives:
To assess the effects of a new communication course for neonatal intensive care unit (NICU) nurses on nurses' confidence in communicating with families, and to explore communication-related issues experienced by the nurses and their relationship to burnout.
Study design:
Twenty-nine nurses participated in an interactive course based on communication cases from the NICU. Participants' experience of communication with parents was assessed. They completed the Maslach Burnout Inventory. Self-reported communication skills were assessed before and after the course and at four-month follow-up.
Results:
Only one nurse reported previous nursing-related communication training. High burnout scores were associated with communication-related difficulties, especially lack of time for communication. The course improved participants' confidence in their communication skills in challenging situations, including those where parents express distress or ask questions the nurse cannot answer. Participants found the course highly interesting, useful and necessary for their work.
Conclusion:
Interactive, learner-centered training addressing issues specific to communication at the NICU was effective and highly appreciated.
Innovation:
The course centered on a unique variety of reality-based communication cases from the NICU, relevant to the nurses' work and stimulating their reflection. An innovative feature was the emphasis on nurses' perspective and the importance of communication for their coping.
... 30 31 Previous studies have also acknowledged the initial phase of staff getting to know parents and their preferences, which in turn informs how practices need to be adapted to meet parental needs, personality traits, and cultural preferences. 40 From the Inner Setting, participants spoke about a tension for change to standard delivery of care models and described AB-FICare as compatible with their organisational values. The implementation climate, leadership Open access engagement, access to knowledge and information, and available resources were central implementation influences. ...
Objective
To evaluate the barriers and facilitators to implementing Alberta Family Integrated Care (AB-FICare [2019 Benzies]), a model of care for integrating parents into level II neonatal intensive care units (NICUs) care teams, from the perspective of healthcare providers (HCP) and hospital administrators.
Design
Qualitative process evaluation substudy.
Setting
Ten level II NICUs in six cities across Alberta, Canada.
Participants
HCP and hospital administrators (n=32) who were involved in the cluster-randomised controlled trial of AB-FICare in level II NICUs.
Methods
Post-implementation semi-structured interviews were conducted via phone or in-person. The Consolidated Framework for Implementation Research was used to develop interview guides, code transcripts and analyse data.
Results
Key facilitators to implementation of AB-FICare included (1) a receptive implementation climate, (2) compatibility of the intervention with individual and organisational practices, (3) available resources and access to knowledge and information for HCP and hospital administrators, (4) engagement of key stakeholders across the organisation, (5) engagement of and outcomes for intervention participants, and (6) reflecting and evaluating on implementation progress and patient and family outcomes. Barriers were (1) design quality and packaging of the intervention, (2) relative priority of AB-FICare in relation to other initiatives, and (3) learning climate within the organisation. Mixed influences on implementation depending on contextual factors were coded to eight constructs: intervention source, cost, peer pressure, external policy and incentives, staff needs and resources, structural characteristics, organisational incentives and rewards, and knowledge, beliefs and attitudes .
Conclusions
The characteristics of an organisation and the implementation process had largely positive influences, which can be leveraged for implementation of AB-FICare in the NICU. We recommend site-specific consultations to mitigate barriers and assess how swing factors might impact implementation given the local context, with the goal that strategies can be put in place to manage their influence on implementation.
Trial registration number
NCT02879799 .
... When these models are employed, HCPs provide care based on the diagnosis and the department's guidelines for the organization of care rather than tailored to the individual needs of the child and her/his family. Support from the organization (35,36) as well as education about FCC comprising the core concepts and the overall goal of the care model (27,37) are required for the successful implementation of FCC. ...
Purpose: To describe parents' views of family-centered care at a pediatric intensive care unit.
Design and Methods: A qualitative descriptive study with a deductive and inductive approach was conducted based on the principles of family-centered care. Inclusion criteria were parents of children cared for at a pediatric intensive care unit for at least 48 h. Parents of children who died during the hospital stay were excluded. The sample consisted of spontaneous responses from 70 parents to five open questions in the EMpowerment of PArents in THe Intensive Care questionnaire, which was completed at discharge. The spontaneous responses were analyzed using thematic analysis.
Results: The analysis of the parents' statement illuminated that partnership, the essence of family-centered care, appeared incomplete. Partnership was particularly evident regarding parents' experiences of being treated with empathy and respect. It also seemed prominent in situations where the professional team provided support to the child, parents, and family. Based on the parents' statements there was potential for development of the family-centered care approach in aspects such as decision-making concerning care and treatment, as well as improving person-centered communication on order to capture parents' experiences and needs in the highly technological pediatric intensive care unit environment.
Conclusions: Although in general parents were satisfied with the care, areas for improvement were identified such as participation in decision-making about care and treatment as well as person-centered communication. The results can contribute to future quality improvement interventions focusing family centered care at pediatric intensive care units.
... Models of care used in children's hospices are grounded in familycentred care philosophy (Tatterton & Walshe, 2019b), with almost equal emphasis placed on the needs of family members as there is on the referred child (Together for Short Lives, 2017). Developing partnerships with families is considered to be an important element of family-centred care by practitioners (Trajkovski et al., 2012) and provides practitioners with a degree of job satisfaction. This correlates with the findings of this study regarding experienced members of staff, however more junior practitioners found this added to their experience of emotional challenge. ...
Care after the death of a child and support of their bereaved family is an important element of the services offered by children’s hospices in the United Kingdom. The study aims to explore the emotional challenges of those delivering care to families of children in hospice cool rooms. An internet-based questionnaire was sent to all practitioners to explore their perspectives of providing care to bereaved families whilst the child’s body was in the hospice, as well as caring for a child’s body after death. In total, 94.9% (n = 56) of staff responded. Two key themes were identified that represent the emotional challenges perceived by staff: the impact of deterioration of a child’s body; and witnessing the acute grief of families. Practitioners seek to provide care that recognises the importance of family and demonstrates family-centred care, as well as supporting families to deal with the changes that occur after death. Organisations can support practitioners to deliver care in cool rooms by providing training and education on anticipating and managing the pathophysiological changes that occur after death as well as training in grief and loss, and how to support a bereaved family.
... One of the challenges in establishing a positive partnership is that the nurses need to shift their professional role from an expert to a guide who supports the parents throughout the NICU journey. Accordingly, nurses need both education and training to succeed in this role change (37). ...
Aim: To describe fathers’ lived experiences of caring for
their preterm infant at the neonatal unit and in hospitalbased neonatal home care after the introduction of an individualised parental support programme. Method: Seven fathers from a larger study were included due to their rich narrative interviews about the phenomenon under study. The interviews took place after discharge from neonatal home care. The theoretical perspective was descriptive phenomenology. Giorgi’s outlines for phenomenological analysis were used. Findings The general structure of the phenomenon was described by the following four themes: The partner was constantly present in the fathers’ minds; The fathers’ were occupied by worries and concerns; The fathers felt that they were an active partner to the professionals and Getting the opportunity to take responsibility. The fathers were satisfied with the
support and treatment during their infant’s hospitalisation. However, there were times when they felt excluded and not fully responsible for their infant. The fathers prioritised the mother, thus ignoring their own needs. Furthermore, they worried about their infant’s health and the alteration of their parental role. Neonatal home care was experienced as a possibility to regain control over family life. Conclusion: The general structure of fathers’ experiences highlights the importance of professionals becoming more responsive to fathers’ needs and to tailoring support to fathers by focusing on their individual experiences and needs.
Keywords: preterm infant, fathers, experiences, NICU,
hospital-based neonatal home care, interviews,
phenomenology
... One of the challenges in establishing a positive partnership is that the nurses need to shift their professional role from an expert to a guide who supports the parents throughout the NICU journey. Accordingly, nurses need both education and training to succeed in this role change (37). ...
Aim
To describe fathers’ lived experiences of caring for their preterm infant at the neonatal unit and in hospital‐based neonatal home care after the introduction of an individualised parental support programme.
Method
Seven fathers from a larger study were included due to their rich narrative interviews about the phenomenon under study. The interviews took place after discharge from neonatal home care. The theoretical perspective was descriptive phenomenology. Giorgi’s outlines for phenomenological analysis were used.
Findings
The general structure of the phenomenon was described by the following four themes: The partner was constantly present in the fathers’ minds; The fathers’ were occupied by worries and concerns; The fathers felt that they were an active partner to the professionals and Getting the opportunity to take responsibility. The fathers were satisfied with the support and treatment during their infant’s hospitalisation. However, there were times when they felt excluded and not fully responsible for their infant. The fathers prioritised the mother, thus ignoring their own needs. Furthermore, they worried about their infant’s health and the alteration of their parental role. Neonatal home care was experienced as a possibility to regain control over family life.
Conclusion
The general structure of fathers’ experiences highlights the importance of professionals becoming more responsive to fathers’ needs and to tailoring support to fathers by focusing on their individual experiences and needs.
... Die familienzentrierte Pflege wird gemeinhin als der Goldstandard im Hinblick auf die Gesundheitsversorgung von Kindern angesehen [1] und kommt in der Kinderkrankenpflege weltweit in einer Vielzahl von Settings und Situa tionen zum Einsatz [2][3] [4][5] [6]. Die bisher unangefochtene Annahme, dass die familienzentrierte Pflege zwangsläufig die beste und einzige Art der Kinderkrankenpflege sei, wird nun jedoch infrage gestellt. ...
Bernie Carter ist Professorin für Kinderkrankenpflege in Großbritannien. Ihre Forschung ist auf Kinder und junge Menschen fokussiert, deren Leben eingeschränkt wird durch Schmerz, Krankheit oder Behinderung. Im Folgenden setzt sich die Wissenschaftlerin kritisch mit den Modellen der familienzentrierten Pflege und der kindzentrierten Pflege auseinander – und gibt uns Lesern damit viele Infos zum Nachdenken.
... The FCC is a model of infant care in the NICU, nurses involve parents in caring the sick babies based on guidance and direction from nurses (Mattsson, Forsner, Castre'n, & Arman, 2013). This model was developed based on a philosophy that parents have a significant influence on children's health (Mundy, 2010;Trajkovski, Schmied, Vickers, & Jackson, 2012;Hiromi, 2012). In this model, the child is seen as part of an inseparable parent (Mattsson et al., 2013). ...
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 to parental needs were discovered. Needs of parents with critically ill infants, including the needs to (1) have a positive acceptance and caring attitude of nurses towards infant and parents; (2) get an accurate information, effective communication, and parents’ involvement in decision making regarding to the condition of the infant; (3) have confident and believe that infant get the best care; (4) have an adequate contact with infant; (5) have opportunity in caring for the infant with the guidance and supervision of nurses; and (6) obtain comfortable neonatal intensive care unit environment. Each parent has a different priority of their needs. This needs identification would help nurses in integrating parents' need for the family centered care approach. As a result, parents would meet their needs, feel satisfied, and improved the infants’ quality of life.Keywords: Neonatal Intensive Care Unit, Parental Needs
... Family-centred care (FCC) is an approach that recognises the importance of the family as participants in caregiving (5). Related to the neonatal intensive care unit (NICU), the FCC has been introduced as a central tenet underpinning the care of babies and families (6). This involves collaboration with healthcare providers with parents as partners in the care of the hospitalised infant (7). ...
The relationship between healthcare providers and parents of infants in neonatal intensive care unit is based on trust and constitutes a core measure of family‐centred care and health. The aim of the present qualitative study was to explore mothers and nurses experiences of trust in one another around the caregiving of the hospitalised infant in intensive neonatal care unit. Focused ethnographic research study conducted through observations and in‐depth interviews with 20 mothers and 16 nurses in NICU of Tabriz (Iran) in 2017. Two main themes of ‘gradual and fragile trust of mother‐to‐nurse’ (subthemes: Primary trust‐mistrust, mother's trust to responsible nurse, mother trust Increase with skilful nurse performance, and vulnerability to trust) and ‘gradual and fragile trust of nurse‐to‐mother’ (subthemes: Nurse's initial assessment of trust to mother's readiness to participate, Development of trust to mother, and vulnerability of nurse's trust to mother) were obtained. The present study revealed that mutual trust between the nurse and the mother in the care of the infant was a gradual and progressive process that was achieved over time. Complexities around the care of a hospitalised infant influenced how fragile or vulnerable the trust became between nurse and mother. Findings from this research can be used in supporting increased maternal participation in infant care and improvement of family‐centred care in the neonatal intensive care unit.
... 7 Ancak yapılan çalışmalarda hemşirelerin, ailenin çocuğun bakımına katılımı ve hastanede çocuklarıyla birlikte olabilmesi ilgili olumlu bir düşünceye sahip oldukları belirlenmiştir. 7,28 Coats yaptığı nitel çalışmada; ailenin gün içinde sürekli çocuklarının yanında olmasının "rahatsız edici" ve "yorucu" olabileceği, özellikle de kritik bir hastaya bakım verirken ailelerin durmadan soru sorarak hemşireleri meşgul ettikleri belirtilmiştir. Bir hemşirenin de açıkladığı gibi, "Aileler sadece durmadan konuşuyorlar ve yaptığınız her şeyi bilmek istiyorlar. ...
ocuğun fizyolojik, psikolojik, bilişsel, spiritüel ve sosyokültürel yönden sağ-lıklı birey olarak yetişmesinde, birincil ve sürekli bakım verici olan ailenin rolü oldukça önemlidir. Temeli sevgiye dayanan güçlü ve destekleyici aile ilişkileri çocuk için en önemli destek kaynağıdır. Aile çocuk arasındaki ilişkinin çe-şitli sağlık problemleri nedeniyle kesintiye uğraması çocuğun sağlıklı büyüme ve gelişmesini olumsuz etkiler. 1,2 Aile merkezli bakım (AMB), sağlık profesyonelleri ile çocukların aileleri arasında sağlık hizmetinin planlanması, sunulması ve değerlendirilmesinde iş birliğine dayalı bir bakım modelidir. 3 AMB'nin amacı, ailelerin sağlık profesyonelleri ile sağlıklı ve uygun bir ilişki kurmasını sağlamak, aile ile bilgi alışverişinde bulunmak ve ailenin çocuk ile ilgili alınacak kararlar hakkında görüşlerini almaktır. 4 Genel hedefi ise, çocuk ve aileye yönelik sağlık hizmetlerinin kalitesini arttırmak, ailelerin ve sağlık profesyo-nellerinin memnuniyetini arttırmak, personelin etkin kullanımını sağlamaktır. 5 Hemşireler genellikle aileler ile ilk temas eden ve çocukla en fazla vakit geçi-ren sağlık profesyonelleridir. Bu nedenle AMB'nin başarılı bir şekilde uygulanma-sında kritik role sahiptirler. 6 AMB çerçevesinde hemşirelerin ve ailelerin sürekli etkileşimi, aile üyelerinin baş etme yeteneklerini arttırmakta, ihtiyaçlarının ve ter-5 Pediatri Hemşireliğinde Aile Merkezli Bakımın Önemi ve Bakım Kalitesini Geliştirmedeki Değeri Ö ÖZ ZE ET T Aile merkezli bakım, ailenin çocuk için birincil güç ve destek kaynağı olduğu anlayışına da-yanmaktadır. Aile merkezli bakım modelinde, aile ve çocukların bilgi ve görüşleri klinik karar verme sürecinde önemlidir. Bu makalede modelin içeriği, tarihsel süreci ve temel prensipleri anla-tılmaktadır. Literatür sonuçları doğrultusunda çocuk, aile ve sağlık profesyonelleri açısından mo-delin değerlendirilmesi yapılmaktadır. Aile merkezli bakımın pratikte uygulanmasının aile, çocuk ve sağlık kuruluşu açısından faydaları ve aile merkezli bakımın uygulanmasında karşımıza çıkan en-geller açıklanmaktadır. Sonuç olarak sağlık kuruluşlarında ve toplumda aile merkezli bakımın nasıl entegre edilebileceği ile ilişkili önerilerde bulunulmaktadır. A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Çocuk hemşireliği; çocuk; aile hemşireliği; sağlık hizmeti kalitesi A AB BS S T TR RA AC CT T Family-centered care is based on the understanding that families are the primary source of power and support for children. In the family-centered care model, family and children's knowledge and opinions are important in clinical decision process. The historical process and basic principles of the model are explained in this article. In line with the literature, the model is evaluated in terms of children, family and health professionals. The benefits of family-centered care for the family, child and health professionals and obstacles to implementation of family-centered care are explained in the article. As a result, suggestions are made related with how family-centered care can be implemented in the community and health care institutions. K Ke ey yw wo or rd ds s: : Pediatric nursing; child; family nursing; quality of health care
... [3] When the attachment is not established within the first few weeks after birth, or when there is an interruption in the attachment process, there is a higher risk of abuse and neglect of the baby in future. [22] The authors demand the need for parents to be present in the NICU to engage in the care of their neonates, thus prevent the negative neuro-behavioural. ...
Neonatal Intensive Care Units (NICU) plays a major role in providing care for premature neonates, sick neonates or neonates require surgery very soon following delivery. The experience of being a parent of a baby in NICU is more stressful especially if there is a little support or no support rendered from the nursing staff. Parents need support from the nursing staff to gain knowledge and understanding about the neonate’s illness, treatment measures and hospital rules. However, no studies about this issue have been conducted in Namibia. The aim of this study was to investigate the perception of parents related to the nursing support rendered by nurses to parents whose neonates were admitted to NICU at a state hospital in Windhoek, Namibia. A quantitative, cross sectional survey was used to identify and describe parents’ perceptions related to the nursing support rendered by nurses to parents whose neonates were admitted to NICU. The study results indicated that the majority of the participants perceived that they got the good support from the nurses. However, not all parents received needed support from nurses which could increases their stress level. The findings of this study could be used to improve the parents support to reduce stress among parents and neonates and to promote positive coping with regard to the stressful situation of newborns hospitalization.
... A study of interaction between health care professionals and parents demonstrated that health care professionals were unprepared for or lacked training in handling social aspects around the family (Trajkovski, Schmied, Vickers, & Jackson, 2012). Other research has described situations where health care professionals believed that the parents spoke the local language, but language barriers became evident during conversation. ...
Purpose: Family-centred neonatal care views parents and child as a unit, and aims to support each family on the basis of its specific needs. Good communication can increase parents’ satisfaction and reduce tension, and is necessary to create a mutual trustful relation, but is influenced by language barriers. We aimed to describe communication between neonatal health care professionals and parents in the presence of language barriers.
Methods: A field study using a hermeneutic lifeworld approach, participative observation, and interviews with parents and health care professionals.
Results: The main theme, endeavouring to understand the meaning behind the words, comprised three themes. Wanting to speak for oneself meant that parents wanted to speak for themselves or call on a friend or multilingual health care professionals, in contrast to the health care professionals wish to use an interpreter. Being aware of cultural keys meant that some wards had access to a “cultural broker” to assist health care professionals and parents with both language translation and understanding of the Swedish health care environment. Understanding one another in the employees’ arena reflected varying language skills among health care professionals. The health care professionals had the power to decide the level of access to communication, and decided both the intensity and the frequency of the conversations.
Conclusions: Health care professionals preferred to use an interpreter when communicating with parents, while parents wished to be independent and speak for themselves. If an interpreter was used, parents preferred this to be a friend or health care professionals; this option was less popular among health care professionals.
... Research involving fathers in the NICU has been conducted in Canada (Feeley, Sherrard, Waitzer, & Boisvert, 2013;Feeley, Waitzer, Sherrard, Boisvert, & Zelkowitz, 2013), Israel (Tikotzky et al., 2011), Sweden (Blomqvist, Rubertsson, Kylberg, Jöreskog, & Nyqvist, 2012, Turkey (Kardaş Özdemir & Küçük Alemdar, 2017), Denmark (Noergaard et al., 2017), Italy (Ionio et al., 2016Provenzi & Santoro, 2015) and Poland (Aftyka et al., 2017); demonstrating international interest in helping fathers of preterm infants. Nurses have expressed the importance of family-centered care in the NICU and research has indicated that NICU nurses believe parental wishes and involvement to be major factors in appropriate family-centered care (Trajkovski, Schmied, Vickers, & Jackson, 2012). ...
Objective:
The study aim was to describe factors associated with father involvement in the Neonatal Intensive Care Unit (NICU) using the Heuristic Model of the Dynamic of Parental Behavior and Influence on Children over Time. .
Background:
Research shows that infants with involved fathers have better cognitive development, fewer crying episodes after caesarean birth, improved breast-feeding exclusivity and duration, and more regular sleep patterns. Preterm infants with involved fathers have improved cognitive development.
Design:
This cross-sectional exploratory study used survey methodology to explore factors associated with father involvement in the NICU.
Methods:
The STROBE checklist for cross-sectional studies was used (see supplementary File 1). Biological fathers of infants in a 97-bed NICU in the southern United States completed a survey which asked about their involvement with their hospitalized infants and factors which affected that involvement. Eighty fathers completed the survey.
Results:
Age ranged between 20 and 53 with 43% first time fathers. Compared to less involved fathers, fathers who were more involved were younger, married or living with the mother, performed kangaroo care, or fathers of multiple gestation. Fathers who had attended the delivery were more likely to bathe their infants than those who had not attended the delivery and fathers who performed kangaroo care felt more confident than those who did not. Compared to fathers who visited less often, fathers who visited more often were younger, had infants with a shorter hospitalization time and lower acuity and had fewer children in the family.
Conclusions:
Fathers are involved with their NICU infants in many ways. Factors were identified that affect involvement in the NICU.
Relevance to clinical practice:
Results can help nurses in NICU's worldwide facilitate father-infant interaction, identify fathers at risk for decreased involvement, and advocate for institutional policy development for supporting NICU father involvement. This article is protected by copyright. All rights reserved.
Aims
To examine immigrant and minority parents' experiences of having a newborn infant in the neonatal intensive care unit and explore healthcare professionals' experiences in delivering care to immigrant and minority families.
Design
A meta‐ethnographic review informed by eMERGe guidelines.
Methods
We conducted a systematic literature review. Studies were included if they explored immigrant or minority parent experiences in neonatal intensive care units and health professional experiences delivering care to immigrant and minority families in neonatal intensive care. Reporting followed ENTREQ guidelines.
Data Sources
Database searches included CINAHL, MEDLINE, PubMed, PsycINFO, Scopus and Google Scholar. Boolean search strategies were used to identify qualitative studies. No limitations on commencement date; the end date was 23rd August 2022. PRISMA guidelines used for screening and article quality assessed using Joanna Briggs Institute criteria for qualitative studies.
Results
Initial search yielded 2468 articles, and nine articles met criteria for inclusion. Three overarching themes were identified: (1) Overwhelming Emotions, (subthemes: Overwhelming Inadequacy; Cultural Expressions of Guilt; Not Belonging), (2) Circles of Support, (subthemes: Individual Level‐Spirituality; External Level‐Connecting with Family; Structured Peer‐to‐Peer Support), (3) Negotiating Relationships with Healthcare Professionals (subthemes: Connecting; Disconnected; Linguistic Barriers). Interactions between healthcare professionals and immigrant and minority parents were the strongest recurring theme.
Conclusions
There can be a mismatch between immigrant and minority families' needs and the service support provided, indicating improvements in neonatal intensive care are needed. Despite challenges, parents bring cultural and family strengths that support them through this time, and many neonatal intensive care staff provide culturally respectful care.
Implications for the Profession and/or Patient Care
Professionals should be encouraged to identify and work with family strengths to ensure parents feel supported in the neonatal intensive care unit. Findings can inform policy and practice development to strengthen health professionals capabilities to support immigrant and minority families in neonatal units.
Reporting Method
The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses checklists were used to report the screening process.
Background
Family-centered care is founded upon collaboration between parents and healthcare professionals, caring for a child and parents as one entity. The unfamiliar neonatal environment and complexity of care can make family-centered care challenging.
Purpose
To explore neonatal nurses' perceptions of family-centered care and parents' cultural needs.
Methods
This was a qualitative descriptive study using interviews to gather data from registered nurses, and analyzed using inductive content analysis.
Results
Ten neonatal nurses participated in online interviews, lasting an average of 25 minutes. Parents' cultural needs were poorly understood and assumed synonymous with family-centered care. While all acknowledged the importance of family-centered care, most described tasks to parent–infant bonding, rather than a broader embodiment of family-centered care. In time of uncertainty, emergent clinical priorities took priority over a family-centered approach to care. Cultural care was poorly understood, and care tasks associated with supporting parent–infant bonding suggest further work is necessary to promote embodiment of family-centered care beyond individual tasks. While emergent clinical priorities and neonate well-being will always be the priority, finding a way to respond that concords with the ethos of family-centered care is also essential.
Implications for Practice and Research
Clear and consistent leadership is needed to demonstrate greater embodiment of family-centered care, which includes cultural care for parents. Strong leadership and targeted education are key to supporting this change. Further research is warranted to examine and observe practice, in particular how parents' cultural needs are assessed and integrated into family-centered care in neonatal settings.
Background
Implementing family-centered care (FCC) presents challenges to parental-healthcare provider partnership and collaboration in newborn care in neonatal intensive care units (NICUs).
Aims
To explore NICU nurses' perceptions of FCC (respect, collaboration, and support) during the COVID-19 pandemic and to compare these between nurses working in secondary and tertiary/higher care settings.
Methods
A multicenter, cross-sectional exploratory online survey design study was conducted to identify Thai NICU nurses' perceptions. The online survey of the Perceptions of Family-Centered Care—Staff (PFCC-S) was distributed via a Web page and professional networks between July and September 2022.
Results
Of the 187 survey respondents, most NICU nurses worked in the NICU for less than 16 years and were employed in tertiary care/higher care settings in southern Thailand. There was a significant difference in perceptions of support subscale between NICU nurses in secondary (mean: 3.32, SD ± 0.53) and tertiary/higher care settings (mean: 3.17, SD ± 0.46) ( P < .05).
Conclusion
Despite the challenges of the visitation restriction of COVID-19 in Thailand, nurses' perceptions of the value of FCC were maintained.
Relevance to Clinical Practice
Further research is recommended to investigate how FCC can be implemented where there is a lack of material and infrastructure resources and staff shortage.
ABSTRACT
Introduction: Family Participatory Care (FPC) is a unique concept which involves parents in caregiving to their admitted babies. It helps in defining the family's role in clinical care delivery to newborns along with doctors and nurses. The Neonatal Intensive Care Unit (NICU) is the ideal area for FPC to take place because of the unique and vulnerable nature of the mother-neonate relationship as neonates that are admitted, face immense trials from their first day of life.
Aim: To know the effect of FPC on outcome of admitted neonates, analyse the impact of this model on breastfeeding rate and to compare the rate of Kangaroo Mother Care (KMC) being given to neonates at follow-up.
Materials and Methods: It was a non randomised interventional study done from August 2020 to April 2021, in the NICU at Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India. Two hundred neonates, who were sequentially admitted and later discharged, were taken into account, out of which, first 100 were taken as controls and next 100 were taken in the intervention group. Routine treatment and care were given to all the admitted neonates. In addition to this, parents of the study group of newborns were given education through four audio-visual sessions, comprising hygiene measures for entry into nursery, correct method of breastfeeding, KMC and then care at home after discharge. Follow-up was done after one week of discharge and at six weeks of age. Outcome measures were breastfeeding rate and KMC rate which were compared between two groups, at discharge and at follow-up of six weeks of age.
Results: The mean birth weight of neonates, mean gestational age and the socioeconomic status were comparable in both the groups. Mean duration of hospital stay was 7.13 (±4.95) days in study group and 8.06 (±5.40) days in control group (p=0.206). Mean weight at discharge and that at six weeks was similar in both groups. However, the average weight gain per day was significantly higher (25.61 g) in the study group than the control group (18.92 g). At discharge, 92 in the control group and 87 in the study group were given exclusive breastfeeding or expressed breast milk with spoon feeding. At six weeks follow-up, this number was 91 in the study group and 70 infants in the control group (p=0.001). KMC was given to all the neonates at discharge who had birth weight less than two kg. Among them, at the time of follow-up, 33/36 in the case group and 5/37 in the control group were receiving KMC (p-value 0.001).
Conclusion: FPC is feasible and effective model in terms of better neonatal outcome.
Drawing upon diverse methodological and contextual inquiry, this chapter provides insights into parents’ experiences in neonatal intensive care settings following preterm birth. Parents’ experiences after preterm birth are generally viewed as stress provoking. These stresses arise from several sources including infant health, physical and cultural environment of the neonatal unit, challenges to pre-existing identity and assumptions, and how they are supported and prepared for parenthood transitions. How parents react to and cope with these stresses is moderated by the individual personality, gender-based assumptions about appropriate responses, and how parents are integrated into neonatal unit and infant care activities. Improved communication with health professionals, feeling listened to, having their needs for emotional support understood, getting involved in infant care, and developing deeper understandings of their baby’s expected behaviour and developmental trajectory empower parents, reduce their anxieties, and help them to establish robust responses to the challenges mothers and fathers face following preterm parenthood.
Background
Neonatal nurses play an important role in the development of effective partnerships, as they have more consistent interactions with the patients' parents and can encourage parental involvement. This study aimed to identify factors influencing neonatal intensive care unit (NICU) nurses' development of partnerships with parents of high-risk infants in South Korea based on King's interacting systems theory.
Methods
We collected data utilizing a structured questionnaire, which included the following variables: developmental supportive nursing competency, empowerment, emotional intelligence, patient-centered communication skills, interpersonal competence, nursing work environment, and nurse-parent partnership. The participants were 140 pediatric nurses with at least one year of NICU experience in South Korea. We used SPSS/WIN 26.0 to analyze the data.
Findings
Of the factors evaluated, empowerment (β = 0.35, p < 0.001), patient-centered communication skills (β = 0.25, p < 0.01), interpersonal competence (β = −0.27, p = 0.001), emotional intelligence (β = 0.25, p = 0.005), age (β = −0.15, p < 0.01), and gender (β = 0.12, p = 0.03) explained 62.4% of the total variance of the nurse-parent partnership. Our results identify the factors affecting NICU nurses' development of partnerships with parents of high-risk infants.
Implications for practice
Strategies and efforts to enhance the nurse-parent relationship must consider improving nurse empowerment, intelligence, and interpersonal factors.
The experiences of families receiving family centred care and of healthcare professionals providing family centred care in Australian neonatal units were evaluated by online surveys, distributed to families and healthcare professionals across Australia. Parents rated experience of partnerships, information sharing, coordinated care and respectful care in the moderate range. Healthcare professionals rated capacity to provide family centred care as moderate for interpersonal sensitivity, information sharing and treating people respectfully. Neonatal units providing moderate acuity care showed greater capacity to provide family centred care than intensive care or low acuity care units. These data provide a baseline and indicate room for improvement. Reasons for varying levels of family centred care provided by healthcare professionals in different neonatal settings require further investigation. Education of all staff on family centred care is required and targeted collection of data from parents at intervals will indicate progress in providing a higher level of family centred care.
Family-centered care (FCC) in NICUs aims to support parents and children facing the distressing experience of a preterm infant’s NICU hospitalization. Neonatal nurses must also have proper knowledge of the support interventions for parents’ and siblings’ adaptation during the NICU hospitalization. This paper describes comprehensive and innovative clinical tools which consist of a clinical reference guide for nurses, a website for parents, and a storybook for siblings to promote families’ adaptation, and help parents support their older children during NICU hospitalization. Based on scientific evidence and the family systems nursing approach, these comprehensive and innovative clinical tools for nurses, parents, and siblings contribute, through their development and implementation, to enhancing FCC and the quality of nursing care to families.
Aim
This study aimed to improve nurses’ attitudes towards parental engagement and to examine the impact of implementing nursing interventions related to family-centred care on neonatal and parental outcomes in a university hospital in Turkey.
Methods
A quasi-experimental, nonequivalent, and post-test research design was used. Using convenience sampling, the study was completed with 128 preterm infants and their parents, including 64 in the experimental group and 64 in the control group at a neonatal intensive care unit of a university hospital. The control group data were collected from medical records and parents before practising family-centred nursing interventions developed for the experimental group. In addition, nurses were given a four hour training session aimed to improve their attitudes towards parental participation in care, with the nurses’ attitudes measured before, immediately after, and one month after the training. The experimental group data were collected from medical records and parents after 10 nursing interventions based on family-centred care supported by managers began to be implemented by trained nurses in the neonatal intensive care unit. The Parent-Preterm Infant Characteristics Form, Maternal Attachment Inventory, Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N), and Parental Engagement Attitude Scale were used for the data collection.
Findings
While nurses’ scores of attitudes toward parental participation obtained immediately after and one month after the training were higher than those before the training, the scores one month after were lower compared to those immediately after. The results indicated that discharge weight gain of infants in the experimental group were significantly higher than those in the control group and that there was no significant difference between the groups in length of stay at neonatal intensive care unit. The maternal attachment and satisfaction scores of the parents in the experimental group were significantly higher than those in the control group.
Conclusion
Implementing family-centred nursing care interventions, developed based on unit needs and supported by managers, with trained neonatal intensive care nurses positively impacted parent-infant attachment, parent satisfaction, and infant weight gain.
Purpose: Neonatal nurses are expected to have clinical competency to provide qualified and safe care for high-risk infants. An educational intervention to enhance nurses’ clinical competence is often a priority in the nursing field. This study was conducted to explore nurses’ perceived importance and performance confidence of nursing care activities in neonatal intensive care units.Methods: One hundred forty-one neonatal nurses from seven hospitals across South Korea participated in the online survey study. The scale of neonatal nursing care activity consisted of 8 subdomains including professional practice (assessment, diagnosis, planning, intervention, evaluation, education, research, and leadership). The Importance-Performance Matrix was used to analyze the importance of and confident performance in each of the nursing subdomains.Results: Both importance and performance confidence increased as nurses’ age (p=.042 and p<.001) and clinical experience (p=.004 and p<.001). Participants scored relatively higher in importance and performance confidence in the professional practice subdomains (assessment, intervention, evaluation), but scored lower in the education and research subdomains.Conclusion: To provide evidence-based nursing care for high-risk infants in neonatal intensive care units, educational interventions should be developed to support nurses based on the findings of the research.
Background: Parental involvement in their newborn’s neonatal intensive care reduces stress and helps with the parent-child attachment, transition to home, and future development. However, parents’ perspectives are not often sought or considered when adapting family-centered care in neonatal intensive care units (NICUs).
Aim: To identify what parents believe helps or hinders their involvement in their newborn’s care when admitted to our Level 3B NICU.
Methods: Between August and October 2018, nine mothers and one father were interviewed during three 60- to 90-minute audiotaped focus groups using a semi-structured interview tool. From the content analysis of the verbatims, three reviewers identified key themes that affected how involved parents could be in their newborn’s care.
Results: Parents provided examples of factors that facilitated or restricted their involvement. The analysis identified themes: 1) parent-staff interactions, 2) supportive/trustworthy healthcare professionals, 3) consistency in care and caring staff, 4) family, couple, and peer support, 5) newborn status, 6) resources and education for parents, 7) the NICU environment, and 8) academic and research participation.
Conclusion: We identified a conceptual framework to allow our NICU team to prioritize working strategies to strengthen parental involvement in newborn care. In addition to implementing ways to involve parents, we need to address parents’ satisfaction with their participation. These findings may help other investigators explore parents’ expectations toward their NICU experience.
Neonatal nurses frequently encounter neonatal ethical issues related to provision of safe and quality care and communication in the NICU setup. This article discusses the hypothetical case of baby John diagnosed with neonatal sepsis. The ethical perspectives related to care and communication with the family members while their baby is receiving treatment in the NICU will be explored through the application of the QUAR framework.
Health service is a complex social implementation because it engages in services that involve various professional groups. In realizing a healthy paradigm, health services with a family approach are developed. The family approach is an approach that empowers the potential of the family in dealing with family health problems independently by paying attention to physical, biological, social, economic and cultural aspects, especially on the health and well-being of mothers, infants, toddlers, adolescents, PUS, and the elderly. The purpose of this study was to explore the implementation of family centered care by health workers in postpartum mothers. Method: This research was a qualitative research with a case study approach. Semi-structure interview was used to interview 12 informants. Results: Based on the thematic analysis of the results of in-depth interviews and processed with NVIVO 12 Plus, 3 (three) main themes were obtained which were supported by the categories explaining the implementation of family centered care by health workers in postpartum mothers. The first theme is the responses from health workers regarding the implementation and benefits of family centered care in health services for postpartum mothers which are supported by two sub-themes, namely; (a) the form and principles of implementing family centered care by hospitals according to health workers and (b) the benefits of family centered care according to the opinion of health workers. The second theme is the opinions of patients and families about the implementation of family centered care by health workers in postpartum mothers supported by two sub-themes, namely: (a) responses and (b) the benefits of family centered care. The third theme is the obstacles to the implementation of family centered care supported by two sub-themes, namely: (a) internal barriers and (b) external impacts. Conclusions: Overall, the implementation of family centered care by health workers in postpartum mothers had a good response from health workers, the patient and the patient's family.
Background and problem
A Family-Centered Care (FCC) quality improvement project was implemented with nurses to promote families' and siblings' adaptation during the NICU hospitalization of a preterm infant. The objective of this quality improvement project was to compare the nurses' knowledge and perceptions as well as their implementation of nursing practices to facilitate the families' and siblings' adaptation during NICU hospitalization before and after they received the FCC educational intervention.
Methods and intervention
A pre- and post-intervention evaluation design was used in this quality improvement project. A convenience sample of 20 nurses was initially recruited and completed the pre-intervention, while 13 completed the post-intervention. The educational intervention included a reflective practice exercise and a face-to-face training session. Nurses completed a self-administered questionnaire with two subscales assessing their knowledge, perceptions, as well as their implementation of nursing practices related to family and sibling adaptation in the NICU.
Results
The paired samples t-test shows Paired-samples t-test showed that the nurses' knowledge, perceptions and implementation of nursing practices were more favorable following the FCC educational intervention.
Conclusions
Findings of this quality improvement project reinforce the value of supporting NICU nurses with educational training programs to enhance their practice. This educational intervention represents an effort to foster the implementation of FCC in NICUs.
As frontline caregivers, nurses play a central role in the coordination and delivery of family-centered care (FCC) in neonatal intensive care units (NICUs). Nurses see first-hand the fear, uncertainty, and anxiety parents experience due to unfamiliar and intimidating elements of neonatal care and the NICU environment. This study examines the sensegiving strategies nurses use to help families make sense of their NICU experience. In-depth, semi-structured interviews were conducted with 14 NICU nurses at a mid-size nonprofit hospital. Findings reveal nurses utilize four sensegiving strategies to influence parents’ understanding of, response to, and participation in neonatal care practices: educate parents, personalize information, promote open communication, and encourage meaningful involvement. Overall, nurses rely on communication to align parents’ meaning construction with FCC features and goals. Hospital administrators and nurse managers should integrate this study’s findings into nurse training and professional development opportunities to teach nurses about parental sensemaking, factors that affect nurse sensegiving efforts, how to create effective sensegiving strategies, and sensegiving challenges they may face. Healthcare leaders should also provide organizational structures, resources, and continuing education programs that help nurses cope with the emotional demands of sensegiving. Moreover, nurses should talk to colleagues or supervisors and participate in self-care activities if sensegiving starts to impact their well-being or ability to provide effective FCC.
Background: Approximately 10% of all births worldwide are preterm. Often these infants are admitted at a Neonatal Intensive Care Unit (NICU). The NICU environment with periods of unnatural light, noise and repeated disturbances is very stressful for infants admitted to the NICU. In addition separation of parents causes stress for both infant and parents. A way to support and include parents in the care for their infants is Family-Centered Care (FCC). FCC is an approach of planning, delivery and evaluation of healthcare, based on a partnership between healthcare professionals and families of patients. Parents of infants who were admitted to an FCC unit were less stressed compared to parents at a Standard Care unit.
Aim: Although FCC is beneficial to families and patients, implementation can be challenging. Therefore it is important to know which factors can contribute or withhold the implementation of FCC. This study explored factors that influence implementation of FCC in NICU's according to healthcare professionals that work in a NICU with the concept FCC.
Method: A descriptive generic qualitative design with semi-structured interviews and inductive thematic analyses was used. This international multi-center study was conducted in three hospitals in three European countries: Sweden, Norway, and The Netherlands.
Results: Seven neonatal care nurses, one nurse assistant, five neonatologists, and three managers participated in this study. Four aspects were identified, when analyzing the data, namely: Behavioral change in staff, Family needs, Environment, and Communication. Most important is that almost all healthcare professionals described that the mind-set of the professional influences the implementation of FCC.
Conclusion: The mind-set of healthcare professionals in seeing parents as primary caregiver influences the way FCC is practiced and how parents are involved in the care for their infant.
This study aims to synthesise and critically review the research on Family-Centred Care interventions in Neonatal Intensive Care Units and neonatal special care units across international, and thereby cross-cultural, settings. An integrative literature review approach was used, with seven databases searched. The search generated 1,741 articles, with forty-eight meeting the inclusion criteria. Physical participation and involvement of families within neonatal care was the most common intervention and was included in studies across most countries, while the concepts of bedside/medical rounds, interdisciplinary family conferences, and partnership were the interventions least reported. Although clinical, family and health service outcomes were measured across studies, they were varied and diverse. Further research on Family-Centred Care interventions and their relevance globally is needed to provide a greater understanding of Family-Centred Care within different contexts.
The progress that has been made in neonatology is associated with an increasing number of painful procedures constantly being performed on the neonate. Additionally, prolonged hospitalization of premature neonates in NICUs isolates the family from their child. Parents may state that they do not have any parental feelings and cannot communicate with their newborns. The FCC (Family-Centered Care) initiative responded to emerging reports about the adverse consequences ensuing from the lack of parental access to hospitalized children. The FCC should be understood as care based on partner relations between families and health professionals, which is supposed to lead to health and well-being for both the children and their parents. The FCC should become standard practice in all neonatal intensive care units.
In this article, the authors describe how they used a hybrid process of inductive and deductive thematic analysis to interpret raw data in a doctoral study on the role of performance feedback in the self-assessment of nursing practice. The methodological approach integrated data-driven codes with theory-driven ones based on the tenets of social phenomenology. The authors present a detailed exemplar of the staged process of data coding and identification of themes. This process demonstrates how analysis of the raw data from interview transcripts and organizational documents progressed toward the identification of overarching themes that captured the phenomenon of performance feedback as described by participants in the study.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
This paper explores the use of 'chat' or 'social talk' as an important clinical tool that can assist nurses achieve family-centred care in neonatal nurseries.
The study was undertaken to increase knowledge of women's experiences of mothering in the neonatal nursery and the relationship they share with nurses.
The discussion presented is elicited from a grounded theory analysis of over 60 hours of interview data with 28 women, a thematic analysis of 50 hours of interviews with 20 nurses and a content analysis of 398 tape-recorded interactions between nurses and parents.
The analysis identifies the importance of the nurse-mother relationship and demonstrates that it is both the context and method by which nursing care is delivered. We found the verbal exchanges that take place between nurse and mother influence a woman's confidence, her sense of control and her feelings of connection to her infant. It appears from the data that the nurse's ability to effectively 'engage' the mother is dependent on the use of language that expresses care, support and interest in parents.
The data suggests that 'chatting' is the strategy and the process through which positive interactions are initiated, maintained and enhanced. This study confirms that nurses' language acts as a powerful clinical tool that can be used to assist parents in gaining confidence in caring for their infants and in becoming 'connected' to infants resident in nurseries.
To compare the psychosocial functioning of the parents (mother and father) of infants admitted to a neonatal intensive care unit (NICU) with the parents of infants born at term and not admitted to the NICU.
Random sample of NICU parents and term non-NICU parents were assessed across a variety of psychiatric and psychosocial measures shortly after the birth of their infant.
Christchurch Women's Hospital, New Zealand. Labour ward and level III NICU.
A total of 447 parents (242 mothers; 205 fathers) with an infant admitted to a regional NICU during a 12 month period; 189 parents (100 mothers; 89 fathers) with infants born at term and not requiring NICU admission.
Depression and anxiety symptoms, psychosocial functioning.
Overall, levels of anxiety and depression were low in both parent groups. Compared with control parents, a higher percentage of NICU parents had clinically relevant anxiety and were more likely to have had a previous NICU admission and be in a lower family income bracket. Infant prematurity was associated with higher levels of symptomatology in both NICU mothers and fathers.
Specific interventions are not needed for most parents who have an infant admitted to the NICU as they appear to adapt relatively successfully. Infant prematurity impacts negatively on the father as well as the mother. Consequently these parents may benefit from increased clinical attention.
The aim of this first paper of two about partnership working with clients is to define and clarify partnership as it is practised within health visiting, by identifying the central notions of partnership working in practice. The aim of the second paper will be to describe an evaluation of a training course in partnership working for health visitors. Partnership is a word in common usage within the health professions but its meaning is ill-defined. A literature search was undertaken to identify ways in which previous authors have used the concept within nursing, counselling and health visiting. Rodgers' approach to concept analysis was undertaken to seek clarity for the concept. This revealed the ways in which various authors have used the word, an analysis of its defining attributes, surrogate terms, antecedents, consequences and a concluding definition. The results showed that partnership with clients in health visiting can be defined as a respectful, negotiated way of working together that enables choice, participation and equity, within an honest, trusting relationship that is based in empathy, support and reciprocity. It is best established within a model of health visiting that recognises partnership as a central tenet. It requires a high level of interpersonal qualities and communication skills in staff who are, themselves, supported through a system of clinical supervision that operates within the same partnership framework.
To explore the effects of a guided participation (GP) intervention on mothers' development of competencies in relating to their preterm infants in neonatal intensive-care units.
Mothers were enrolled in a randomized, longitudinal clinical trial to compare the effectiveness of GP with standard care teaching. Baseline data were collected when the infants were 29 weeks postconceptional age. The intervention (GP or standard care teaching) was administered, and relationship competencies were assessed through observation once per week for the next 6 weeks.
Two neonatal intensive-care units in the Midwest.
A convenience sample of 16 mothers of low-birthweight infants, 8 in each group. Interventions: GP of mothers in relating to their infants in the context of caregiving activities was compared with standard care teaching.
Mothers in the GP group had expectations and intentions that were more attuned and adaptive to their infants' needs. In addition, the GP group was consistently higher in relationship competencies than the standard care teaching group.
GP can effectively support mothers in developing relationships with their preterm infants in the context of neonatal intensive-care unit caregiving activities.
This paper is a report of a concept analysis of partnership within the context of a professional-patient relationship.
The concept of partnership has been previously characterized as immature, with a need for further consensus and consistency. Critical attributes previously reported include relationship, power sharing and negotiation, with empowerment as the primary consequence.
Rodgers' evolutionary method of analysis for concept development was used to re-examine the concept of partnership. Historical documents and previously published conceptual papers were reviewed for context. A search of multidisciplinary literature published between 2000 and 2004 was undertaken using the keywords of 'partnership' and 'partnering', combined with nurse/professional/physician-client relationship. Attributes, uses, antecedents and consequences were inductively derived from the citations analysed (n = 62).
Previous authors affirmed that partnership involves a process and a consistent set of eight attributes. Relationship, shared power, shared decision-making and patient autonomy are attributes that distinguish partnership from other related concepts. Most of the literature, however, consisted of expert opinion or descriptive research. Little progress has been made in applying theory, developing tools to test the process, identifying when partnerships are needed and what specific outcomes occur when they are present.
Partnerships between healthcare providers and patients develop over time. They are created to support patients in having a greater voice in their care and to empower them in self-management. A descriptive model of partnership is proposed to support researchers in generating or applying existing theory to the development of research designs and tools that could test how this process actually works.
The effect of a short-term intervention with parents in the Neonatal Intensive Care Unit (NICU) on their knowledge of infant behavioral cues and confidence in caregiving was examined. Ten sets of parents with a total of 22 premature infants born <32 weeks gestational age admitted to a NICU were enrolled in a time-lag control trial over an 8-month period. The intervention group was given 4 sessions of instructions on preterm infant behavior for a period of 2 weeks. The control group did not receive the instructions. All parents completed two subscales of the Mother and Baby Scale (MABS) at weeks 1 and 3 and a short questionnaire concerning nursing support at week 3. Intervention parents completed a pre- and post-test on knowledge of preterm infant behavioral cues at weeks 1 and 3. There was a significant improvement in the post-test scores concerning knowledge of preterm infant behavioral cues and a higher nursing support score for mothers in the intervention group. Intervention mothers showed no significant improvement in confidence in caregiving. Only half of the intervention group fathers participated in the sessions and there were no significant differences in fathers' scores. While the intervention significantly increased maternal knowledge of infant behavioral cues, there was no significant effect on mothers' confidence in caregiving. Very few fathers participated in the entire intervention. A longer, more intensive program with a larger sample size and finding ways of incorporating more participation from fathers is recommended.
Family-centered care is becoming a standard of care in neonatal intensive care units (NICUs). The purpose of this study was to evaluate the impact of a national program designed to promote family-centered care in NICUs and to provide information and comfort to families during the NICU hospitalization of their newborn.
A quasi-experimental, post-only design was utilized, examining eight March of Dimes NICU Family Support((R)) (NFS) sites. Data were gathered via telephone interviews with NICU administrators and surveys of both NICU staff and NICU families.
NICU administrators interviewed identified benefits of NFS, including culture change and additional support to families. Surveys of NICU staff showed that NFS enhances the overall quality of NICU care resulting in less stressed, more informed and confident parents. Surveys of NICU families showed that NFS both reduced their stress and made them feel more confident as their baby's parent.
March of Dimes NFS has had a positive impact on the stress level, comfort level and parenting confidence of NICU families. In addition, it has enhanced the receptivity of staff to the presence and benefits of family-centered care.
To examine the attitudes of parents and nurses to the model of care delivery on an in-patient children's unit in a regional general hospital.
A review of the literature uncovered research studies relevant to the area under investigation, in addition to many discussion articles.
This descriptive survey of parents' and nurses' attitudes regarding the implementation and practice of a partnership approach to care was undertaken in 2003 on a children's unit in an Irish regional general hospital. The survey consisted of a self-designed questionnaire, which was posted to the sample. The scoring system for the questionnaire format was analysed using Statistical Package for Social Sciences (version 11.0). The sample consisted of parents (n = 100) and nursing staff (n = 44) from the children's unit.
the findings did not suggest major differences between the attitudes of the two groups on the care delivery on the unit. The outcomes of the study showed that, while both parents and nurses viewed family-centred care as appropriate, there were differences between what parents and nurses saw as their roles on the unit. Both groups acknowledged the overall philosophy of care and commented on the actual application of a family-centred, partnership approach to care in practice on the unit.
Both groups agreed that there was a need for improvement of the facilities for resident parents on the unit.
The findings of the research could act as a catalyst for change and development of the service and service providers. It is hoped that it will also contribute to the improved satisfaction of the service provided to sick children and their families by parents and by the nurses who provide the care.
To promote participation by parents in the care of their child in neonatal intensive care units (NICU), health professionals need better understanding of what facilitates and what obstructs participation. The aim was to elucidate conditions for parents' participation in the care of their child in NICUs.
A field study with a hermeneutic lifeworld approach was used and data were collected at two NICUs through participative observations and interviews with representatives of management, staff and parents.
The results point to a number of contradictions in the way parents were offered the opportunity to participate in neonatal intensive care. Management and staff both had good ambitions to develop ideal care that promoted parent participation. However, the care including the conditions for parental participation was driven by the terms of the staff, routines focusing on the medical-technical care and environment, and budgetary constraints.
The result shows that tangible strategies need to be developed in NICUs aimed at optimising conditions for parents to be present and involved in the care of their child.
Neonatal nurses today are challenged not only to provide the best possible developmental care for a preterm infant but also to help the mother through an uncertain motherhood toward a feeling of being a real mother for her preterm baby. An increasing interest in mothers' experiences of having a preterm baby is seen. A meta-synthesis of 14 qualitative research studies on mothers' experiences of having a preterm baby in the neonatal intensive care unit, published from 2000 onward, was conducted. Noblit and Hare's methodological approach was used. The meta-synthesis revealed five metaphors that captured the mothers' experiences. These metaphors centered on reciprocal relationships that consisted of mother-baby relationship ("from their baby to my baby"), maternal development (a striving to be a real normal mother), the turbulent neonatal environment (from foreground to background), maternal caregiving and role reclaiming strategies (from silent vigilance to advocacy), and mother-nurse relationship (from continuously answering questions through chatting to sharing of knowledge). Implications of the meta-synthesis for neonatal nursing are addressed.
Concept analysis is a useful exercise to ensure that professionals ascribe the same meaning to a concept.
■ Concept analysis may be undertaken using various methods.
■ Partnership in care has similarities to family- centred care and participation in care.
■ Negotiation, equality of care between parents and nurses, and the involvement of families in care are essential to providing partnership.
Objective:
To determine nurses' perceptions and practices of identified elements of family-centered care.
Design:
Descriptive.
Setting:
Neonatal intensive care unit (NICU), pediatrics, and pediatric intensive care unit (PICU) in an acute care hospital.
Participants:
Sixty-two licensed nurses, 37 working in the NICU and 25 working in pediatrics or the PICU.
Main outcome measures:
Scores for the Necessary and Current scales of the Family-Centered Care Questionnaire.
Results:
Scores representing current nursing practice of family-centered care were significantly lower than those representing its necessity (p = .000). Nurses with 10 years or fewer of neonatal or pediatric experience scored significantly higher on both the total Necessary Scale (p = .02) and total Current Scale (p = .017) than did those with 11 years or more. Nurses who work in the NICU scored significantly lower on the total Necessary Scale (p = .013) than did nurses who work in pediatrics or PICU.
Conclusions:
Although nurses agree the identified elements of family-centered care are necessary, they do not consistently apply those elements in their everyday practice. Years of experience and clinical work setting influenced both perceptions and practices of family-centered care.
Objective
To examine mothers’ responses to having a premature infant in the neonatal intensive-care unit and to determine the degree to which they appear similar to a posttraumatic stress response.
Design
Mothers were enrolled in this descriptive, correlational study shortly before the infant was discharged from the hospital. Data were collected at enrollment and when the infant was 6 months old, corrected for prematurity.
Participants
A convenience sample of 30 mothers of high-risk premature infants.
Interventions
None.
Main Outcome Measures
A semistructured interview of the mothers was conducted at 6 months corrected age. Interview responses were analyzed to identify three symptoms related to posttraumatic stress disorder: re-experiencing, avoidance, and increased arousal. Other measures focused on maternal psychological well-being—neonatal intensive-care unit stress, depressive symptoms, and worry about the infant—and demographic characteristics. Infant illness severity included birth weight, length of mechanical ventilation, multiple birth, and the severity of neurological insults.
Results
All mothers interviewed had at least one posttraumatic symptom, 12 had two, and 16 had three symptoms. Twenty-six mothers reported increased arousal; re-experiencing and avoidance were reported by 24 mothers each. The number, but not the type, of posttraumatic stress symptoms was related to maternal psychological well-being. Maternal demographic characteristics, except marital status, and infant illness severity, were unrelated to posttraumatic stress symptoms.
Conclusions
These mothers appeared to be experiencing emotional responses similar to posttraumatic stress reactions at 6 months after their child's expected birth date. Since maternal emotional responses may affect the parenting of premature infants, additional nursing research is needed to provide a basis for interventions with these highly vulnerable mothers and infants.
Background. The birth of a preterm infant has a long-term impact on both parents. Mothers report more stress and poor adjustment compared with fathers. Influencing factors, such as family situation and health status of the child, can support or weaken the coping ability of the parents. Studies on experiences of fathers are sparse.
Aim. The aim of this research was to study how mothers and fathers of preterm infants describe their experiences of parenthood during the infant's first 18 months of life.
Methods. Seven consecutively selected sets of parents of preterm infants born at ≤34 weeks of gestation with no serious congenital defects were interviewed 1–2 weeks after the infant's birth and at 2, 6 and 18 months of age, and the findings were analysed using a phenomenological method.
Findings. Internalization of parenthood was described as a time-dependent process, with four syntheses of experiences – alienation, responsibility, confidence and familiarity. Within the syntheses, similarities in how mothers and fathers described their parental roles involved concern for the child, insecurity, adjustment and relationship with the child. Regarding differences, mothers experienced having more responsibility and control of the care and a need to be confirmed as a mother, while fathers described confidence in leaving the care to the staff and wanted to find a balance between work and family life. Important turning points in parenthood experiences often occurred when the infant could be removed from the incubator, discharged from the ward, and when the infant looked normal compared to full-term infants.
Conclusions. The structure of the phenomenon of parenthood was formed by the integration of the syntheses of alienation, responsibility, confidence and familiarity. The structure seems to be based on the parents’ expectations of the parental role, the infant's health condition and the health care environment. These interacting factors are influenced by cultural beliefs.
Parental involvement in their child's care in hospital has undergone great change over the last century. Studies have shown how ‘maternal deprivation’ and ‘separation anxiety’ expressed by children are detrimental to a child's recovery in hospital. Striving efforts have been made to develop family-centred care, promote normality of the family unit and continue with the normal routine of the child's life within the limitations of a hospital environment and the child's illness. Expectations of the parental role in hospital need to be identified and expressed from both the parents and staff to establish an understanding that will ultimately be best for the child. Many studies have highlighted benefits to both parent and child from parental participation in hospital. However, disadvantages have been identified from resident parents who feel captive to their new situation and role. Efforts for family-centred care are highly advocated now. Care-by-Parent units have been set up in some areas to promote this idea and, although many advantages have been identified, they are not without their problems. The success of parental involvement is dependent on both parents’ and staff's attitudes, enthusiasm and willingness to work together.
Family-centered developmental care is an essential element of neonatal intensive care. It is of particular importance when the infant is vulnerable and at greater risk for poor outcomes complicated by a family unit that is easily challenged by the unique needs of the infant. Yet, all infants and their families deserve this philosophy of caregiving. Family-centered developmental care must continue to be tested through research to determine which interventions work, what does not work, and which interventions need further refinement. This article provides a brief history of where we have been in neonatal caregiving, provides definitions for family-centered developmental caregiving and offers some "predictions" about where these practices need to be in the next century. Research questions and strategies are also addressed. As we continue to forge ahead integrating this philosophy into the caregiving arena, it is important to remember that there are many unanswered questions.
This correlational study examined how mother's posttraumatic stress disorder (PTSD) symptoms are related to characteristics of the mother and her infant, as well as to mother-infant interaction and infant development, in 21 mothers of very low birthweight infants. Twenty-three percent of mothers scored in the clinical range on a measure of PTSD. How ill the infant was during the NICU hospitalization was related to mothers' PTSD symptoms. Mothers with greater PTSD symptoms were less sensitive and effective at structuring interaction with their infant.
The purposes of this article were to summarize the development of family-centered pediatric care, review the current state of nursing research in this area, and recommend directions for future study. A literature review of 30 nursing research studies between 1995 and 2006 was conducted. Results revealed that evidence of consistent provision of family-centered pediatric care is lacking. Many areas of research remain undeveloped, but there is a solid foundation for moving forward in conducting research focused on assisting nurses in implementing this basic philosophy of practice in all settings and situations in which children receive health care.
Aim:
This paper is a report of a study to explore the development of relationships between parents and nurses in a neonatal intensive care unit.
Background:
As increasingly smaller premature babies survive, the prolonged hospitalization that follows makes relationships between parents and nurses crucial. A collaborative partnership in which all the family members' needs are acknowledged is suggested as the best approach.
Method:
A hermeneutic approach was adopted, using overt participant observation (160 hours) and in-depth interviews to study interactions between parents and nurses. The participants were six mothers, six fathers, and six nurses from a 13-bed Norwegian neonatal intensive care unit. Data were obtained over 27 weeks from 2003 until 2004.
Findings:
A partnership between parents and nurses developed in three phases: the acute critical phase, the stabilizing phase, and the discharge phase. The stabilizing phase seemed the most challenging. As exhausted parents expressed the importance of maintaining the trusting relationship with their primary nurses to become confident when assuming more responsibility and adjusting to the new situation, nurses purposely withdrew and reduced their contact with parents, facilitating their independence and confidence as caretakers. Parents and nurses rarely seemed to discuss with each other the discrepancy in their understanding of the detachment process.
Conclusion:
Acknowledging the need for parents and nurses to discuss the processes of involvement and detachment may contribute positively to the development of family-centred care in neonatal intensive care units.
The purpose of this study was to examine the anxiety responses of 5- to 11-year-old children (N = 52) during and after hospitalization from their perspective. Change in anxiety over time was examined, as was the relationship between children's anxiety and age, sex, length of hospitalization, previous admission, and parental anxiety. Children demonstrated a decrease in anxiety from admission to discharge, whereas anxiety remained fairly constant from discharge to posthospitalization. Younger children (5 to 7 years), boys, and children not previously admitted were more anxious and did not show a decrease in anxiety over time. Findings of this study have implications for practice and further research.
Twenty-five children's nurses were interviewed and asked to select and describe two relationships, one satisfying and one dissatisfying, that they had had with parents of hospitalized children. The data were analyzed using interpretive strategies, and five types of parent-nurse relationships were identified: negotiated, reciprocal, adversarial, asynchronous, and ineffective. It seemed that the nurses' relationships with parents were social rather than professional, and that the nurses had difficulty caring for certain parents. The nurses' descriptions indicated that they either did not have knowledge of communication skills, conflict management and family-centered care to provide therapeutic, goal-oriented care for parents, or had difficulty utilizing that knowledge in practice. Various factors in the environment may have contributed to these difficulties. This descriptive study was conducted to provide some understanding of the interpersonal difficulties that often exist in relationships between nurses and the parents of hospitalized children.
The concept of family-centred care is such a cherished tenet of paediatric nursing to be almost above critique. Yet a close examination of the place and meaning-in-practice of family-centred care is long overdue if the term is not to lapse into mere cliché or slogan.
A descriptive study was undertaken to determine whether parents were able to participate in the care of their hospitalized child and work in partnership with the nurses. The study utilized method triangulation and was conducted in two phases. In phase one a postal survey of 65 nurses was undertaken in three children's wards within an NHS trust hospital, while in the second phase, 12 in-depth interviews were completed with parents in their own homes following their child's discharge from hospital. The quantitative data were analysed using descriptive statistics and the qualitative data were subjected to content analysis. The data suggested that parents were willing to be involved in caring for their hospitalized child yet experienced difficulties as a result of inadequate information and the nurses' reluctance to relinquish control of the nursing care. These findings demonstrated that nurses and parents had different perceptions of their individual roles. Consequently, the nurse/parent relationship was not always conducive to a partnership approach, which has implications for both nurse education and clinical practice.
This article reports an ethnographic study that examines the context and nature of the interactions between health professionals and parents in two Australian level II nurseries: 724 observations were recorded over an 18-week period. Analysis revealed that although the presence of mothers in the nursery was high, registered nurses remain the primary caretakers of the infants. The interactions between registered nurses and mothers were found to be action- or task-oriented with communication largely being described as "instrumental." The results of this pilot work suggest that the emphasis of clinical practice in level II nurseries remains focused on caring for the infant and teaching the mother. This is in contrast to the current body of literature that identifies the need for a family-centered approach to care that aims to support parents as they develop confidence, attach to their baby, and become skilled in providing care themselves.
Little sociological research has sought to investigate the ways in which women with hospitalized newborn infants construct and practice motherhood. This article seeks to address this lacuna, using data from a qualitative research project based in two Australian neonatal nurseries. Thirty-one mothers of hospitalized newborns and 20 neonatal nurses were interviewed, and other data were obtained via observations of the nurseries, tape-recorded verbal interactions between parents and nursery staff and casual conversations with mothers and nurses. The data revealed that while the mothers' and nurses' discourses on what makes a 'good mother' in the context of the neonatal nursery converged to some extent, there were important differences. The mothers particularly emphasized the importance of physical contact with their infants and breastfeeding, while the nurses privileged presence in the nursery and willingness to learn about the infant's condition and treatment. There was evidence of power struggles between the mothers and nurses over the handling and treatment of the infants, which had implications for how the mothers constructed and practised motherhood. The mothers attempted to construct themselves as 'real mothers', which involved establishing connection with their infants and normalizing them. In time, many of the mothers sought to position themselves as the 'experts' on their infants. For their part, the nurses attempted to position themselves as 'teachers and monitors of the parents', 'protectors of the infants' and 'experts' by virtue of their medical training and experience. Differences in defining the situation resulted in frustration, resentment and anger on the part of the mothers and disciplinary and surveillance actions on the part of many of the nurses, both covert and overt. The nurses' attitude to and treatment of the mothers was integral in the development of the mothers' relationship with their infants in the nurseries, and this influence extended beyond discharge of the infants.
To examine mothers' responses to having a premature infant in the neonatal intensive-care unit and to determine the degree to which they appear similar to a posttraumatic stress response.
Mothers were enrolled in this descriptive, correlational study shortly before the infant was discharged from the hospital. Data were collected at enrollment and when the infant was 6 months old, corrected for prematurity.
A convenience sample of 30 mothers of high-risk premature infants.
None.
A semistructured interview of the mothers was conducted at 6 months corrected age. Interview responses were analyzed to identify three symptoms related to posttraumatic stress disorder: re-experiencing, avoidance, and increased arousal. Other measures focused on maternal psychological well-being--neonatal intensive-care unit stress, depressive symptoms, and worry about the infant--and demographic characteristics. Infant illness severity included birth weight, length of mechanical ventilation, multiple birth, and the severity of neurological insults.
All mothers interviewed had at least one posttraumatic symptom, 12 had two, and 16 had three symptoms. Twenty-six mothers reported increased arousal; re-experiencing and avoidance were reported by 24 mothers each. The number, but not the type, of posttraumatic stress symptoms was related to maternal psychological well-being. Maternal demographic characteristics, except marital status, and infant illness severity, were unrelated to posttraumatic stress symptoms.
These mothers appeared to be experiencing emotional responses similar to posttraumatic stress reactions at 6 months after their child's expected birth date. Since maternal emotional responses may affect the parenting of premature infants, additional nursing research is needed provide a basis for interventions with these highly vulnerable mothers and infants.
The terms family-centred care (FCC) and family-centred services (FCS) are used interchangeably across the continuum of children's healthcare to encompass concepts of: parental participation in children's healthcare; partnership and collaboration between the healthcare team and parents in decision-making; family-friendly environments that normalize as much as possible family functioning within the healthcare setting; and care of family members as well as of children. However, authors from different professional and policy perspectives have used different definitions and literatures when arguing the evidence for FCC and FCS.
A critical literature review and theoretical discussion exploring common concepts and issues forming the basis for a research agenda further strengthening of the evidence base for FCC. A systematic identification of constructs, concepts and empirical indicators is developed and applied to exemplars in pain and asthma that span the continuum of children's healthcare across acute and community settings.
The extent to which the concepts are supported by research and applied in practice remains unclear. We propose that re-thinking of FCC is required in order to develop a more coherent programme of research into the application of FCC theory in children's healthcare.
This paper presents findings from the first phase of a research study focusing on implementation and evaluation of emancipatory practice development strategies.
Understanding the culture of practice is essential to undertaking effective developments in practice. Culture is a dominant feature of discussions about modernizing health care, yet few studies have been undertaken that systematically evaluate the development of effective practice cultures.
The study intervention is that of emancipatory practice development with an integrated evaluation approach based on Realistic Evaluation. The aim of Realistic Evaluation is to evaluate relationships between Context (setting), Mechanism (process characteristics) and Outcome (arising from the context-mechanism configuration). This first phase of the study focuses on uncovering the context (in particular the culture) of the Special Care Nursery in order to evaluate the emancipatory practice development processes and outcomes. Data collection methods included survey, participant observation and interview. Cognitive mapping, constant comparative method and coding were used to analyse the data. Findings. Four key categories were identified: Teamwork, Learning in Practice, Inevitability of Change and Family-Centred Care and collectively these formed a central category of Core Values and Beliefs. A number of themes were identified in each category, and reflected tensions that existed between differing values and beliefs within the culture of the unit.
Understanding values and beliefs is an important part of understanding a workplace culture. Whilst survey methods are capable of outlining espoused workplace characteristics, observation of staff interactions and perceptions gives an understanding of culture as a living entity manifested through interpersonal relationships. Attempts at changing workplace cultures should start from the clarification of values held among staff in that culture.
To describe how mothers of premature or sick mature babies, experienced the care and their own state of health after birth in postnatal care in a neonatal co-care ward.
A Husserlian phenomenology method inspired by Giorgi was used. Six mothers were interviewed using a semi-structured, open-ended interview guide.
A neonatal ward using a concept of co-care for premature or sick mature babies and their mothers.
In essence, mothers felt that, whatever the circumstances, they wanted to be close to their babies. It was the mother's experience that the organisation, staff or other circumstances prolonged the separation from her baby. The mother experienced the separation from the baby intensely during the first days after birth (even for a short period of time); after returning home, they had still not come to terms with it. The mothers regarded the entire stay in hospital as one event; they did not differentiate between wards or ward staff in the delivery, maternity or neonatal wards. All mothers in the study had, therefore, also experienced part-care for shorter or longer periods when separated from their baby, being then later reunited in co-care.
This study can be used as a basis for discussion on more individualised care through co-operation and organisation between delivery, maternity and neonatal wards, in order to reduce the amount of time mother and baby are separated.
The emerging care delivery model for Neonatal Intensive Care Units (NICU) is family-focused, developmentally supportive care. The purpose of this study was to explore and describe mothers' experience of becoming a mother while their infants were receiving care in the NICU. A qualitative research design was used. Interviews with 15 mothers whose infants were in a Level III NICU were analyzed using Spradley's domain analysis approach. Mothers developed from outsider to engaged parent along four continua: (1) focus: from NICU to baby; (2) ownership: from their baby to my baby; (3) caregiving: from passive to active; and (4) voice: from silence to advocacy. Mothers entered the continua at different points and moved at different rates toward "engaged parenting." The final stage, partnering, required active participation of nurses. Mothers' development evolved in predictable patterns. The results of this study can be considered in implementation and evaluation plans for NICUs moving to family-focused developmental care.
Parents of critically ill small children have received quite a lot of attention in nursing and allied health literature. However, no documented studies were found from Danish paediatric or neonatal contexts. The aim of the study therefore was to identify Danish parents' lived experiences during a newborn or small child's critical illness. The study was undertaken in a human caring perspective assuming that caring is primary and relational, and that persons are concerned when things matter to them. Thirteen parents were interviewed twice, and data were analysed following Van Manen's phenomenological methodology. The findings revealed that being a parent when a newborn or small child is critically ill resembled being in another world, alien from what they knew and had earlier experienced. The parents wanted to be close to the child, they were seeking for an understanding of what happened, and they felt inexperienced and insecure but at the same time they were attentive and vigilant. The sub-themes that were more prominent were 'a need to be there', 'What is going on?', 'being vigilant', 'being a spectator to your own life', and 'oscillating between hope and hopelessness'. The study implies that the staff needs to help the parents perceive some kind of meaning of what is going on, to instill hope despite not knowing the outcome, and to accept and respect the parents' style of coping with stress and concern for their sick child.
Parent participation is viewed as a pivotal concept to the provision of high quality nursing care for children and their families. Since the 1990's, the term 'partnership with parents' has increasingly been reported in the literature and adopted as a philosophy of care in most paediatric units in the United Kingdom.
To explore children's, parents', and nurses' views on participation in care in the healthcare setting.
Using grounded theory, data were collected through in-depth interviews, and participant observation. Sample consisted of eleven children, ten parents and twelve nurses from four paediatric wards in two hospitals in England.
Most nurses assumed that parents would participate in care and viewed their role as facilitators rather than 'doers'. Nurses reported that the ideology of partnership with parents did not accurately reflect or describe their relationships with parents. Parents could never be partners in care as control of the boundaries of care rested with the nurses. Parents felt compelled to be there and to be responsible for their children's welfare in hospital.
The pendulum of parent participation has swung from excluding parents in the past to making parents feel total responsibility for their child in hospital. It is argued that the current models or theories on parent participation/partnership are inappropriate or inadequate because they do not address important elements of children's, parents' and nurses' experiences in hospital.
The authors examined the prevalence of acute stress disorder (ASD) in parents of infants hospitalized in the neonatal intensive care unit (NICU). Forty parents were assessed after the birth of their infants. Parents completed self-report measures of ASD, parental stress, family environment, and coping style: 28% of parents developed symptoms of ASD. ASD was associated with female gender, alteration in parental role, family cohesiveness, and emotional restraint. Family environment and parental coping style are significantly associated with the development of trauma symptoms. Results from this study suggest potential interventions to help minimize psychological distress in parents.
To review systematically qualitative studies, which were found during a literature search for a Cochrane systematic review of the use of family centred care in children's hospitals.
Family centred care has become a cornerstone of paediatric practice, however, its effectiveness is not known. No single definition exists, rather a list of elements that constitute family centred care. However, it is recognized to involve the parents in care planning for a child in health services. A new definition is presented here.
The papers were found in wide range of databases, by hand searching and by contacting the authors where necessary, using terms given in detail in the protocol in the Cochrane Library, in 2004. Qualitative studies could not be used for statistical analysis, but are still important to the review and so are described separately in this paper.
Negotiation between staff and families, perceptions held by both parents and staff roles influenced the delivery of family centred care. A sub-theme of cost of family centred care to families and staffs was discovered and this included both financial and emotional costs.
Further research is needed to generate evidence about family centred care in situations arising from modern models of care in which family centred care is thought to be an inherent part, but which leave families with the care of sick children with little or no support.
Family centred care is said to be used widely in practice. More research is needed to ensure that is it being implemented correctly.
To review research published in the past 15 years about how children's nurses' negotiate with parents in relation to family-centred care.
Family-centred care is a basic tenet of children's nursing and requires a process of negotiation between health professionals and the family, which results in shared decision-making about what the child's care will be and who will provide this. The literature highlights inconsistencies in the degree to which nurses are willing to negotiate with parents and allow them to participate in decisions regarding care of their child. There is need to explore further the extent to which nurses communicate and negotiate shared care with children and their parents.
Three themes emerged from this review of the literature relating to whether role negotiation occurred in practice, parental expectations of participation in their child's care and issues relating to power and control. Parents wanted to be involved in their child's care but found that nurses' lack of communication and limited negotiation meant that this did not always occur. Nurses appeared to have clear ideas about what nursing care parents could be involved with and did not routinely negotiate with parents in this context.
For family-centred care to be a reality nurses need to negotiate and communicate with children and their families effectively. Parents need to be able to negotiate with health staff what this participation will involve and to negotiate new roles for themselves in sharing care of their sick child. Parents should be involved in the decision-making process. However, research suggests that a lack of effective communication, professional expectations and issues of power and control often inhibit open and mutual negotiation between families and nurses.
To evaluate the relationship between enteral water infusion for hypernatremia and significant intestinal morbidity in infants <or=1000 grams.
This is a retrospective study of 321 infants <or=1000 g birth weight. Infants were grouped by the highest serum sodium (mmol/l) during the first 14 days of life as follows: <150 (normal control), >or=150 (high sodium control), >or=150 and treated with sterile water (study group). Significant intestinal morbidity was defined as probable or proven necrotizing enterocolitis or spontaneous intestinal perforation. Statistical analysis included Student's t test for continuous variables and chi(2) with Yeats correction for frequency variables. Multivariate logistic regression analysis was then performed to evaluate confounding variables among groups.
The incidence of intestinal morbidity was significantly higher in the high sodium-water treated group compared to each of the other groups (13/33 (38%) for high sodium-water versus 16/100 (16%) for high sodium control and 18/188 (10%) for normal sodium control, P<0.01 chi(2)). Logistic regression analysis indicated that enteral water and hydrocortisone were risk factors for significant intestinal morbidity.
Enteral sterile water for hypernatremia appears to be associated with significant intestinal morbidity in infants <or=1000 g. Hydrocortisone is also a risk factor.
When a child comes into hospital, the whole family is affected. In giving care, nurses, doctors and those caring for the child must consider the impact of the child's admission on all the family members. 'Family-centred care' (FCC) has developed as one way of caring for children in hospital. FCC means that during a hospital admission, care is planned by the health staff around the whole family, not just the individual child. However, with the way family structures are changing in society, questions are being asked about how care is best delivered. To make sure that children are cared for in ways that minimise emotional trauma and assist in recovery, it is important that such ways of delivering care are measured to see if they are effective. This review has tried to do that by examining research about family-centred care. We assessed potentially-relevant studies against criteria that identify important parts of FCC. Despite extensive searching we found no studies we could include in this review which would allow us to measure the effectiveness of FCC. We did find 13 studies which described, using qualitative research, aspects of FCC, and we have written a separate paper about these. Our main conclusion from this review, however, is that more research, using factors which can be measured, is needed to assess whether FCC really works to improve a child's experience of hospitalisation.
This study examined mothers' and fathers' perceptions of effective and ineffective communication by nurses in the neonatal intensive care unit (NICU) environment, using communication accommodation theory (CAT) as the framework.
Twenty mothers and 13 fathers participated in a semi-structured interview about their perceptions of effective and ineffective communication with nurses when their infant was in the NICU. The interviews were coded for using the CAT strategies.
Descriptions of effective and ineffective communication differed in terms of the strategies mentioned with effective communication about shared management of the interaction and appropriate support and reassurance by nurses. Ineffective communication was more about the interpretability strategy, particularly for fathers, and these interactions were seen as more intergroup. Mothers emphasised more being encouraged as equal partners in the care of their infant.
Effective communication by nurses was accommodative and more interpersonal while ineffective communication was generally under-accommodative and more intergroup.
The findings provide a framework for communication skills training for nurses that identifies both effective and ineffective communication strategies to use with mothers and fathers.
Being in an alien world. Parents lived experiences when a small or newborn child is critically ill
- Eoc Hall
Hall EOC (2005) Being in an alien world.
Parents lived experiences when a small
or newborn child is critically ill. Scandinavian Journal of Caring Sciences 19,
179-185.
Post traumatic stress symptoms in mothers of premature infants
- D Holditch-Davis
- Tr Barlett
- Al Blickman
- Ml Miles
Holditch-Davis D, Barlett TR, Blickman AL
& Miles ML (2003) Post traumatic
stress symptoms in mothers of premature infants. Journal of Obstetric,
Gynecology & Neonatal Nursing 32,
161-171.
Family-centered care: do we practice what we preach
- M Petersen
- J Cohen
- V Parsons
Petersen M, Cohen J & Parsons V (2004)
Family-centered care: do we practice
what we preach? Journal of Obstetric,
Gynecology & Neonatal Nursing 33,
421-427.
Children Nursing in Practice: The Nottingham Model
- F Smith
Smith F (1995) Children Nursing in Practice: The Nottingham Model. Blackwell
Science, Oxford.
Conditions for parents' participation in S Trajkovski et al. Ó 2012 Blackwell Publishing Ltd the care of their child in the neonatal intensive care unit
- H Wigert
- A Hellstrom
- M Berg
Wigert H, Hellstrom A & Berg M (2008)
Conditions for parents' participation in
S Trajkovski et al.
Ó 2012 Blackwell Publishing Ltd the care of their child in the neonatal
intensive care unit. BioMed Central
Pediatrics 8, 1-9.