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Improving infant outcomes through implementation of a family integrated care bundle including a parent supporting mobile application
Abstract
Objective
The aim of the Integrated Family Delivered Care (IFDC) programme was to improve infant health outcomes and parent experience through education and competency-based training.
Design
In collaboration with veteran parents’ focus groups, we created an experienced co-designed care bundle including IFDC mobile application, which together with staff training programme comprised the IFDC programme. Infant outcomes were compared with retrospective controls in a prepost intervention analysis.
Main outcome measures
The primary outcome measure was the length of stay (LOS).
Results
Between April 2017 and May 2018, 89 families were recruited; 37 infants completed their entire care episode in our units with a minimum LOS >14 days. From a gestational age (GA) and birth weight-matched retrospective cohort, 57 control infants were selected. Data were also analysed for subgroup under 30 weeks GA (n=20).
Infants in the IFDC group were discharged earlier: median corrected GA (36 ⁺⁰ (IQR 35 ⁺⁰ –38 ⁺⁰ ) vs 37 ⁺¹ (IQR 36 ⁺³ –38 ⁺⁴ ) weeks; p=0.003), with shorter median LOS (41 (32–63) vs 55 (41–73) days; p=0.022). This was also evident in the subgroup <30 weeks GA (61 (39–82) vs 76 (68–84) days; p=0.035). Special care days were significantly lower in the IFDC group (30 (21–41) vs 40 (31–46); p=0.006). The subgroup of infants (<30 weeks) reached full suck feeding earlier (median: 47 (37–76) vs 72 (66–82) days; p=0.006).
Conclusion
This is the first reported study from a UK tertiary neonatal unit demonstrating significant benefits of family integrated care programme. The IFDC programme has significantly reduced LOS, resulted in the earlier achievement of full enteral and suck feeds.
... Since the start of the model's implementation the focus has almost universally been the stable preterm infant who had no or low level respiratory support. [1][2][3][4][5][6] The rationale of reducing the stress and anxiety in families and improving their empowerment to behave as parents was behind. Up to now, this model of care has demonstrated numerous benefits that include increased breastfeeding rates and weight gain, [1][2][3]7,8 earlier exclusive enteral and oral nutrition, 5,7 decreased nosocomial infection, 3,4,8 shorter duration of supplemental oxygen and mechanical ventilation, 3,5,7,9 or shorter length of hospital stay. ...
... [1][2][3][4][5][6] The rationale of reducing the stress and anxiety in families and improving their empowerment to behave as parents was behind. Up to now, this model of care has demonstrated numerous benefits that include increased breastfeeding rates and weight gain, [1][2][3]7,8 earlier exclusive enteral and oral nutrition, 5,7 decreased nosocomial infection, 3,4,8 shorter duration of supplemental oxygen and mechanical ventilation, 3,5,7,9 or shorter length of hospital stay. 3,5,6,9 Although most of the studies were designed to improve short-term results, some of them have also reported on the long-term benefits in neurobehaviour at 18 months, consisting on lower dysregulation scores indicating better self-regulation skills, 10 and higher motor scores assessed by the Bayley-III Motor Scales. ...
... [1][2][3][4][5][6] The rationale of reducing the stress and anxiety in families and improving their empowerment to behave as parents was behind. Up to now, this model of care has demonstrated numerous benefits that include increased breastfeeding rates and weight gain, [1][2][3]7,8 earlier exclusive enteral and oral nutrition, 5,7 decreased nosocomial infection, 3,4,8 shorter duration of supplemental oxygen and mechanical ventilation, 3,5,7,9 or shorter length of hospital stay. 3,5,6,9 Although most of the studies were designed to improve short-term results, some of them have also reported on the long-term benefits in neurobehaviour at 18 months, consisting on lower dysregulation scores indicating better self-regulation skills, 10 and higher motor scores assessed by the Bayley-III Motor Scales. ...
Background
FICare model has been evaluated mostly on the stable preterm infant.We have scaled the model to two implementation levels(basic/advanced),making it suitable for all high-risk neonates.We report on the short- and mid-term outcomes of infants enrolled in a pilot on FICare implementation at our NICU.
Methods
During 52 months study period,families were invited to join the program if their newborns’ admission required neonatal specialized care for at least 3 weeks,and trained according to the program’s curricula.Following a rigorous sequential admission order,each case(FICare group:134 < 34 weeks;52 term newborns)was matched by a contemporary control(CC:134 < 34 weeks;52 term newborns)and 2 historical controls born within the 3 years prior to FICare site implementation(HC:268 < 34 weeks;104 term newborns),cared as usual
Results
FICare intervention started by the end of first week of postnatal life.Rates of breastfeeding during admission and at discharge,and direct breastfeeding upon discharge were higher in FICare compared to CC and HC.Duration of intermediate care hospitalization(preterm and term cohorts)and total hospital length of stay (term cohorts)were shorter in FICare group.Use of Emergency Services after discharge was also lower in the FICare group
Conclusions
Short and mid-term efficacy of FICare on health outcomes and family empowerment in a broader and highly-vulnerable neonatal population supports its generalization in complex healthcare neonatal services.
Impact statement
Scaling the FICare model to the critically ill, unstable premature and term infant is feasible and safe.
The early intervention shows similar benefits in the short- and mid-term infants’ outcomes in the whole spectrum of neonatal specialized care.
... These findings were further supported in a clusterrandomised controlled trial [2], as well as in subsequent studies highlighting the positive effects of the model in accelerating maturation processes [3] (earlier full enteral nutrition [3,4]) shorter duration of mechanical ventilation and hospital length of stay [5][6][7][8][9], decreased rates of late-onset sepsis [5,6], and improvements in neurobehaviour at 18 months [7]. Recently, Moreno-Sanz [8] described the successful adaptation and implementation of FICare policies also in the unstable, critically ill premature infant and the high-risk neonate with complex medical or surgical conditions, suggesting the potential for generalising the FICare model as the standard of care in NICUs. ...
... These findings were further supported in a clusterrandomised controlled trial [2], as well as in subsequent studies highlighting the positive effects of the model in accelerating maturation processes [3] (earlier full enteral nutrition [3,4]) shorter duration of mechanical ventilation and hospital length of stay [5][6][7][8][9], decreased rates of late-onset sepsis [5,6], and improvements in neurobehaviour at 18 months [7]. Recently, Moreno-Sanz [8] described the successful adaptation and implementation of FICare policies also in the unstable, critically ill premature infant and the high-risk neonate with complex medical or surgical conditions, suggesting the potential for generalising the FICare model as the standard of care in NICUs. ...
... Each item is rated on a 4-point Likert scale. The PHQ-4 sum score is classified as none (0-2), mild (3)(4)(5), moderate (6-8) and severe (9-12) symptoms of general/ unspecific anxiety and depression. Its scores have shown adequate construct and factorial validity. ...
Background
Family Integrated Care (FICare) has demonstrated positive outcomes for sick neonates and has alleviated the psychological burden faced by families. FICare involves structured training for professionals and caregivers along with the provision of resources to offer physical and psychological support to parents. However, FICare implementation has been primarily limited to developed countries. It remains crucial to assess the scalability of this model in overcoming social-cultural barriers and conduct a cost-effectiveness analysis. The RISEinFAMILY project aims to develop an adapted FICare model that can serve as the international standard for neonatal care, accommodating various cultural, architectural, and socio-economic contexts.
Methods
RISEinFAMILY is a pluri-cultural, stepped wedge cluster controlled trial conducted in Spain, Netherlands, the UK, Romania, Turkey, and Zambia. Eligible participants include infant-family dyads admitted to the Neonatal Intensive Care Unit (NICU) requiring specialised neonatal care for a minimum expected duration of 7 days, provided there are no comprehension barriers. Notably, this study will incorporate a value of implementation analysis on FICare, which can inform policy decisions regarding investment in implementation activities, even in situations with diverse data.
Discussion
This study aims to evaluate the scalability and adaptation of FICare across a broader range of geographical and sociocultural contexts and address its sustainability. Furthermore, it seeks to compare the RISEinFAMILY model with standard care, examining differences in short-term newborn outcomes, family mental health, and professional satisfaction.
Trial registration
ClinicalTrials.gov NCT06087666. Registered on 17 October 2023. Protocol version: 19 December 2022; version 2.2.
... After reviewing the included articles, the general description of papers such as study purpose, number of participants, used tools, and platform for implementing the mobile application and evaluation method were extracted and displayed in Table 1. Among the included studies, three were mixed method (11,25,32), two were case control (31,36), two were descriptive cross-sectional (34,35), and only one had been performed as RCT (30). Although no time constraint had been applied for the search of studies and all papers up to 18 May 2021 were searched, the distribution of studies across different years was initiated from the 2016 year. ...
... Although no time constraint had been applied for the search of studies and all papers up to 18 May 2021 were searched, the distribution of studies across different years was initiated from the 2016 year. In the 2016 year only one paper (30), in 2017 and 2018 years two papers each (11,25,31,33), and in the 2019 year four related articles (32,(34)(35)(36) were identified. Most studies (n=4) had been performed in the United States (11,25,32,37) followed by two studies in Denmark (33,34), and then only one study in Iran (35) and the UK (36). ...
... In the 2016 year only one paper (30), in 2017 and 2018 years two papers each (11,25,31,33), and in the 2019 year four related articles (32,(34)(35)(36) were identified. Most studies (n=4) had been performed in the United States (11,25,32,37) followed by two studies in Denmark (33,34), and then only one study in Iran (35) and the UK (36). In 7% of the cases, the neonates had gestational age (GA) <37 wk and were premature (11,(30)(31)(32)(33)(34)36). ...
Background
Integration of healthcare services for preterm neonates at home and hospital by mobile technology is an economical and convenient intervention, which is being increasingly applied worldwide. We aimed to classify the outcomes of mobile applications tailored to parents of premature infants.
Methods
This systematic review was conducted by searching the six main databases until May 2021. Mobile applications tailored to parents of premature infants and the reported outcomes of this technology were identified and classified. Quality of screened articles checked by MMAT tool.
Results
Overall, 10703 articles were retrieved, and after eliminating the duplicated articles, 9 articles were reviewed ultimately. Identified outcomes were categorized into three groups parental, application, and neonatal outcomes. In the parental outcomes, maternal stress/stress coping, parenting self-efficacy, satisfaction, anxiety, partnership advocacy/improved parent-infant relationship, feeling of being safe, reassurance and confidence, increase awareness, as well as discharge preparedness, were identified. In the application outcomes, application usage, ease of use/user-friendly, and usability of the designed application were placed. Finally, the neonatal outcomes include health and clinical items.
Conclusion
Mobile applications can be useful in prematurity for educating pregnant mothers, managing stress and anxiety, supporting families, and preparing for discharge. Moreover, due to the coronavirus condition, providing remote services for parents is an appropriate solution to reduce the in-person visits to neonatal care centers. Development of tailored apps can promote the neonates’ health and reduce their parents’ stress.
... Silva (20) Dentre os aplicativos disponíveis nas lojas online, foram identificados 758, sendo selecionados 150. A síntese narrativa dos 16 estudos selecionados aponta como principal temática abordada: apoio aos pais de RN, cuidados com RN (15)(16)(17)(18)(19)(20)(21) , aleitamento materno (AM) (22)(23)(24)(25) , febre (26,27) , desenvolvimento infantil (28) , crescimento (29) e identificação de doenças neonatais (30) . Ainda, 11 produções científicas foram apresentadas em forma de artigo e 5 dissertações e foram publicados entre 2017 e 2021. ...
... Os estudos foram produzidos no Brasil (19)(20)(21)25,27) , Estados Unidos da América (24,26) , Reino Unido (15) , Países Baixos (28) , Singapura (16) , Austrália (22) , Tailândia (29) , Irã (17) , Uganda (30) , Nova Zelândia (18) e Espanha (23) (Quadro 2). ...
... Dentre os temas identificados, destacam-se os cuidados ao RN em diferentes contextos, envolvendo cuidados hospitalares (15,18,21) , domiciliares (16,17,(19)(20)(21) e a amamentação (22,23,25) , achados que convergem aos App disponíveis nas lojas online (23,99% e 18% respectivamente). A maioria dos App analisados, relacionados ao cuidado do bebê, referem-se a cuidados diários, para registros pessoais e de tarefas como banho, troca de fraldas, alimentação, entre outros. ...
Objective
To map and describe studies available in the literature about mobile applications to support parents in newborn care and data from applications accessible in online stores.
Method
This is a scoping review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The searches were carried out in theses and dissertations databases and portals, in September 2021, and articles, theses, and dissertations were included. An independent search was performed in online stores of applications for operating systems Android and iOS, in October and December 2021, and applications with content to support parents of newborns were selected.
Results
A total of 5,238 studies and 757 applications were found, and of these, 16 and 150, respectively, composed the sample. The topics discussed in the studies were: care, breastfeeding, fever, identification of neonatal diseases, child growth and development. In the applications, the themes found were care, breastfeeding, growth, immunization, development, sleep, tips, and guidelines.
Conclusion
Applications are important support tools for parents, as they are an innovative means and accessible to a large part of the population.
DESCRIPTORS
Infant; Newborn; Mobile Applications; Parents; Access to Information; Smartphone
... The narrative synthesis of the 16 studies selected points to the main theme addressed: support for the parents of NBs, care of NBs (15)(16)(17)(18)(19)(20)(21) , breastfeeding (BF) (22)(23)(24)(25) , fever (26,27) , child development (28) , growth (29) , and identification of neonatal diseases (30) . Barros (19) 2020 ...
... In addition, 11 scientific productions were presented in the form of articles and 5 dissertations and were published between 2017 and 2021. The studies were produced in Brazil (19)(20)(21)25,27) , United States of America (24.26) , United Kingdom (15) , Netherlands (28) , Singapore (16) , Australia (22) , Thailand (29) , Iran (17) , Uganda (30) , New Zealand (18) , and Spain (23) (Chart 2). ...
... Among the themes identified, care for the NB in different contexts, involving hospital (15,18,21) and domestic care (16,17,(19)(20)(21) , and breastfeeding (22,23,25) are highlighted, findings that converge with Apps available in online stores (23.99% and 18% respectively). Most of the Apps analyzed, related to baby care, refer to daily care, for personal records and tasks such as bathing, changing diapers, feeding, among others. ...
Objective
To map and describe studies available in the literature about mobile applications to support parents in newborn care and data from applications accessible in online stores.
Method
This is a scoping review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The searches were carried out in theses and dissertations databases and portals, in September 2021, and articles, theses, and dissertations were included. An independent search was performed in online stores of applications for operating systems Android and iOS, in October and December 2021, and applications with content to support parents of newborns were selected.
Results
A total of 5,238 studies and 757 applications were found, and of these, 16 and 150, respectively, composed the sample. The topics discussed in the studies were: care, breastfeeding, fever, identification of neonatal diseases, child growth and development. In the applications, the themes found were care, breastfeeding, growth, immunization, development, sleep, tips, and guidelines.
Conclusion
Applications are important support tools for parents, as they are an innovative means and accessible to a large part of the population.
DESCRIPTORS
Infant; Newborn; Mobile Applications; Parents; Access to Information; Smartphone
... eHealth programs aimed to give access to on-demand health information and resources, communication and tailored feedback intended to support families in building confidence, familiarity, knowledge and awareness in health promotion and illness prevention activities (Banerjee et al., 2020;Baron et al., 2018;Cramer et al., 2018;Doherty et al., 2019;Fontein-Kuipers et al., 2016;Shorey et al., 2018;Spargo & Vries, 2018;Strand et al., 2021;Wierckx et al., 2014). Patients had more convenient communication experiences with their health professionals, timely information through feedback and self-monitoring modalities, and could lead content and timing of communication (Dalton et al., 2018;Doherty et al., 2019;Herring et al., 2019;Holm et al., 2019). ...
... short message service (SMS) (Globus et al., 2016), and infant care and collaboration training using education and coaching applications (Banerjee et al., 2020;Platonos et al., 2018). Women and their families received new access to the care team from remote locations which supported timely appropriate care, in many cases from the comfort of their own homes (Doherty et al., 2020;Garne et al., 2016;Gund et al., 2013;Holm et al., 2019;Payakachat et al., 2020;Shorey et al., 2018;Strand et al., 2021;Triebwasser et al., 2020). ...
... • Perinatal eHealth users want to have communication and perform teamwork with professional caregivers using eHealth modalities, but this was not used in the program due to objections from providers (Krishnamurti et al., 2017). Interactions between perinatal patients and the eHealth modalities provided new forms of support to supplement face-to-face visits (Banerjee et al., 2020;Danbjørg et al., 2015;Doherty et al., 2020;Herbec et al., 2014;Himes et al., 2017;Hirshberg et al., 2018;Holm et al., 2019;Ledford et al., 2017;Shorey et al., 2018;Soltani et al., 2015;Strand et al., 2021;van der Wulp et al., 2014;Yee et al., 2021). ...
Background:
There is a gap in knowledge about how perinatal eHealth programs function to support autonomy for new and expectant parents from pursuing wellness goals.
Objectives:
To examine patient engagement (access, personalization, commitment and therapeutic alliance) within the practice of perinatal eHealth.
Design:
Scoping review.
Methods:
Five databases were searched in January 2020 and updated in April 2022. Reports were vetted by three researchers and included if they documented maternity/neonatal programs and utilized World Health Organization (WHO) person-centred digital health intervention (DHI) categories. Data were charted using a deductive matrix containing WHO DHI categories and patient engagement attributes. A narrative synthesis was conducted utilizing qualitative content analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 'extension for scoping reviews' guidelines were followed for reporting.
Results:
Twelve eHealth modalities were found across 80 included articles. The analysis yielded two conceptual insights: (1) The nature of perinatal eHealth programs: (1) emergence of a complex structure of practice and (2) practising patient engagement within perinatal eHealth.
Conclusion:
Results will be used to operationalize a model of patient engagement within perinatal eHealth.
... The Family-Integrated Care (FICare) model has emerged as a well-defined yet flexible model of parentpartnered NICU care that has been shown to improve infant and parent outcomes in clinical trials and quality improvement evaluations across high-and middleincome countries and levels of neonatal care [7][8][9][10][11][12][13][14][15]. FICare has four main pillars: NICU environment, NICU team education and support, parent education, and parent support [16]. ...
... FICare has four main pillars: NICU environment, NICU team education and support, parent education, and parent support [16]. Clinical trials have demonstrated improved weight gain [9][10][11], breastfeeding at discharge [9][10][11], shorter lengths of stay [9,10,12,13], and lower rates of sepsis [10,13] for infants in FICare versus FCC NICUs. Longer-term outcomes include better mental and psychomotor development at 18 months for infants from FICare versus FCC NICUs [8,10,14]. ...
... Mobile technology has been proposed to enhance FICare delivery by providing parents with greater access to educational content and encouragement, as well as promoting partnership between parents and NICU staff [12]. Mobile technology may also aid in the research process by improving participant data collection efficiency and experience. ...
Background
Family Integrated Care (FICare) benefits preterm infants compared with Family-Centered Care (FCC), but research is lacking in United States (US) Neonatal Intensive Care Units (NICUs). The outcomes for infants of implementing FICare in the US are unknown given differences in parental leave benefits and health care delivery between the US and other countries where FICare is used. We compared preterm weight and discharge outcomes between FCC and mobile-enhanced FICare (mFICare) in the US.
Methods
In this quasi-experimental study, we enrolled preterm infant (≤ 33 weeks)/parent dyads from 3 NICUs into sequential cohorts: FCC or mFICare. Our primary outcome was 21-day change in weight z-scores. Our secondary outcomes were nosocomial infection, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and human milk feeding (HMF) at discharge. We used intention-to-treat analyses to examine the effect of the FCC and mFICare models overall and per protocol analyses to examine the effects of the mFICare intervention components.
Findings
253 infant/parent dyads participated (141 FCC; 112 mFICare). There were no parent-related adverse events in either group. In intention-to-treat analyses, we found no group differences in weight, ROP, BPD or HMF. The FCC cohort had 2.6-times (95% CI: 1.0, 6.7) higher odds of nosocomial infection than the mFICare cohort. In per-protocol analyses, we found that infants whose parents did not receive parent mentoring or participate in rounds lost more weight relative to age-based norms (group-difference=-0.128, CI: -0.227, -0.030; group-difference=-0.084, CI: -0.154, -0.015, respectively). Infants whose parents did not participate in rounds or group education had 2.9-times (CI: 1.0, 9.1) and 3.8-times (CI: 1.2, 14.3) higher odds of nosocomial infection, respectively.
Conclusion
We found indications that mFICare may have direct benefits on infant outcomes such as weight gain and nosocomial infection. Future studies using implementation science designs are needed to optimize intervention delivery and determine acute and long-term infant and family outcomes.
Clinical Trial Registration
NCT03418870 01/02/2018.
... To reach proficiency, parents undergo specific training by professionals who act as teachers and guides. Short-term clinical benefits have been reported (23)(24)(25)(26)(27) in addition to decreased levels of stress and anxiety in their families (23,24). The empowerment of parents allows them to feel more secure in caring which in turn will reduce hospital stay and use of emergency services after discharge. ...
... Therefore, not only benefits in health are expected but also socioeconomic benefits (28)(29)(30)(31). Up to date, reports on FICare model implementation are almost limited to stable preterm infants admitted to NICUs (23)(24)(25)(26)(27)(28)(29)(30)(31). However, turning parents into true experts in child care and development, as well as a source of love, protection, and support, is a path that should not be followed without careful planning. ...
... This is the first study reporting on the feasibility of FICare model implementation in a complex, level IIIC NICU, that gathers surgical and non-surgical processes involving both, the preterm and term infant. The scaling up of the FICare model explored in this work included two levels of care: training parents in the basic tasks, as reported previously (23)(24)(25)(26)(27)(28)(29)(30)(31), and the advanced level, which introduces additional tasks that pertain ...
Background: Family Integrated Care (FICare) integrates parents in the direct care of their child while the healthcare personnel act as teachers and guides. To this date, most reports on the feasibility of this model refer to stable preterm infants admitted to Neonatal Intensive Care Units (NICUs).
Objectives: To scale up and adapt FICare to make it suitable in level IIIC NICUs, which care for extreme prematurity and other complex medical or surgical neonatal conditions.
Materials and Methods: Step 1 was the creation of the FICare implementation team (FICare-IT) and baseline analysis of current procedures for critical care to identify needs, wishes, and requirements; we aimed for protocol elaboration tailored to our cultural, architectural, and clinical context (March 2017 to April 2018). Step 2 as a dissemination strategy by FICare-IT acting as primary trainers and mentors to ensure the education of 90% of nursing staff (May 2018 to July 2018). Step 3 involved piloting and evaluation with the aim to refine the procedure (July 2018 to December 2020).
Results: A rigorous but flexible protocol was edited. The FICare educational manual included two curricula: for healthcare professionals/staff (Training the trainers) and for families (Education of caregivers), the latter being categorized in two intervention levels (basic and advanced), depending on the infant care needs and parent's decision. In total, 76 families and 91 infants (74.7% preterm; 18.7% complex surgery; 6.6% others) were enrolled in the pilot. No differences in acceptance rate (overall 86.4%) or in the number of infant-family dyads in the program per month were observed when considering the pre- and post-Covid-19 pandemic periods. All families, except for one who dropped out of the program, completed the agreed individualized training. Mothers spent more time in NICU than fathers ( p < 0.05); uninterrupted time spent by mothers in NICU was longer during the pre-pandemic period ( p < 0.01). Observed time to reach proficiency by task was within the expected time in 70% of the program contents. The parents revealed educational manuals, workshops, and cot-side teaching sessions as essential for their training, and 100% said they would accept entry into the FICare program again.
Conclusions: The principles of the FICare model are suitable for all levels of care in NICUs. Leadership and continuous evaluation/refinement of implementation procedures are essential components to achieve the objectives.
... 17,19 Quality improvement evaluations in the United Kingdom also suggest improved breast feeding rates, 22 increased parental involvement in infant caregiving and positive feelings about their role in their infant's care, 23 reduced overall lengths of stay and special care days, and shortened time to full oral feeding. 24 Given the strong theoretic and research foundations and absence of adverse effects, FICare is a promising intervention for improving parental partnership in the care of NICU infants and providing effective parental support. ...
... Some NICUs include additional ways of providing parental education for families who cannot be present for in-person group sessions, using Web or mobile app resources. 24,25 Parent education is continued at the infant's bedside, with nurses working individually with parents to help them apply what they have learned to the care of their own infant. Resources and templates for parent education plans are available at: http:// familyintegratedcare.com/ ( Table 2). ...
... The specific methods for audit and quality improvement will depend on the FICare component and NICU quality improvement goals. [22][23][24] Common Challenges with Family Integrated Care Implementation ...
Parent-infant separation is a major source of stress for parents of hospitalized preterm infants and has negative consequences for infant health and development. Family Integrated Care (FICare) uses a strengths-based approach, based on family-centered care principles to promote parental empowerment, learning, shared decision making, and positive parent-infant caregiving experiences. Outcomes of FICare include increased self-efficacy upon discharge and improved parent-infant relationships and infant developmental outcomes. In this article, the authors describe the FICare model and emerging evidence regarding outcomes of FICare for infants and families and discuss challenges and opportunities in implementing and maintaining high-quality FICare.
... One article described the translation and cultural adaptation of an app from English to Portuguese [41]. Finally, two articles were about the apps being tested with families and outcomes measured [3,13]. The Babble app was tested using a between-subjects post-test and a quasi-experimental design compared participants grouped by Babble app use (yes/no). ...
... It showed no significant impact on parents self-evaluated distress or self-efficacy [13]. The IFDC app was tested in an interventional study following a pre-post design and showed a significantly reduced length of stay in the NICU [3]. ...
... FICare has four main pillars: NICU environment, NICU team education and support, parent education, and parent support [4,5]. Mobile technology may further promote FICare delivery [6]. Clinical trials and quality improvement evaluations of FICare in high-and middle-income countries, and at all levels of neonatal care, have shown that parents of preterm infants experience lower stress, greater confidence in infant caregiving and improved communication with the healthcare teams when NICUs adopt the FICare model [6][7][8][9][10][11][12][13][14]. ...
... Mobile technology may further promote FICare delivery [6]. Clinical trials and quality improvement evaluations of FICare in high-and middle-income countries, and at all levels of neonatal care, have shown that parents of preterm infants experience lower stress, greater confidence in infant caregiving and improved communication with the healthcare teams when NICUs adopt the FICare model [6][7][8][9][10][11][12][13][14]. Lower chronic physiological stress at 18 months (child's corrected age) has also been reported for mothers after discharge from NICUs providing the FICare model compared with those provided FCC [15]. ...
Background
Involvement in caregiving and tailored support services may reduce the risk of mental health symptoms for mothers after their preterm infant’s neonatal intensive care unit (NICU) discharge. We aimed to compare Family-Centered Care (FCC) with mobile-enhanced Family-Integrated Care (mFICare) on post-discharge maternal mental health symptoms.
Method
This quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from three NICUs into sequential cohorts: FCC or mFICare. We analyzed post-discharge symptoms of perinatal post-traumatic stress disorder (PTSD) and depression using intention-to-treat and per protocol approaches.
Results
178 mothers (89 FCC; 89 mFICare) completed measures. We found no main effect of group assignment. We found an interaction between group and stress, indicating fewer PTSD and depression symptoms among mothers who had higher NICU-related stress and received mFICare, compared with mothers who had high stress and received FCC (PTSD: interaction β=-1.18, 95% CI: -2.10, -0.26; depression: interaction β=-0.76, 95% CI: -1.53, 0.006). Per protocol analyses of mFICare components suggested fewer PTSD and depression symptoms among mothers who had higher NICU stress scores and participated in clinical team rounds and/or group classes, compared with mothers who had high stress and did not participate in rounds or classes.
Conclusion
Overall, post-discharge maternal mental health symptoms did not differ between the mFICare and FCC groups. However, for mothers with high levels of stress during the NICU stay, mFICare was associated with fewer post-discharge PTSD and depression symptoms.
... Screening Included learning at their own pace. Among the studies, 15 of the education interventions were provided by a nurse [16][17][18][19][20][21]23,26,27,29,30,33,34 , three were self-directed learning 24,25,34 , three were provided by a physical therapist or allied health professional [30][31][32] , and one each by psychologists 32 , midwives 15 , and senior neonatology trainees. 28 Table 2. Articles are organized within categories based upon the appropriate method/approach to education. ...
... Screening Included learning at their own pace. Among the studies, 15 of the education interventions were provided by a nurse [16][17][18][19][20][21]23,26,27,29,30,33,34 , three were self-directed learning 24,25,34 , three were provided by a physical therapist or allied health professional [30][31][32] , and one each by psychologists 32 , midwives 15 , and senior neonatology trainees. 28 Table 2. Articles are organized within categories based upon the appropriate method/approach to education. ...
Introduction: Parenthood brings stress and anxiety to new parents due to the dramatic role transition. Parents who have a newborn in the neonatal intensive care unit (NICU) experience an increased level of stress. Increasing parental competencies in complex infant care compounds stress; therefore, finding the most effective method of parental education may improve parental health, well-being, and quality of life. Enhanced knowledge prepares parents to transition home. The objective of this systematic review is to evaluate the effectiveness of parental education interventions conducted within the NICU. Methods: CINHAL, Medline, PsychInfo, Web of Science, PubMed, and OT Search databases were searched to locate studies focusing on parental education, provided via healthcare workers, as a main intervention for parents with infants in the NICU. Articles were independently reviewed and selected based on defined inclusion criteria. Results: 20 articles were included and synthesized according to the method of education, parental outcomes, and the provider of education. Conclusions: Parental education is an effective way to facilitate positive parental outcomes. Utilizing combined methods to deliver education with repeated, consistent exposure, and checking for parent understanding is the best approach to minimize negative parental outcomes and improve preparedness for discharge.
... [34][35][36][37][38] QI and evaluations of FICare indicate that improved infant, parent, and hospital-level outcomes shown in studies are sustained in real-world implementation. [39][40][41][42] Close Collaboration with Parents ...
... Changing hospital culture can be very difficult, 70 and approaches to change have been previously proposed, 18 and success stories have been shared. [39][40][41][42]50,78 First, attention must be given to how care is delivered at the bedside, listening to parents and staff. Second, all meaningful improvement should be local and tailored to the setting. ...
There is strong evidence that family-centered care (FCC) improves the health and safety of infants and families in neonatal settings. In this review, we highlight the importance of common, evidence-based quality improvement (QI) methodology applied to FCC and the imperative to engage in partnership with neonatal intensive care unit (NICU) families. To further optimize NICU care, families should be included as essential team members in all NICU QI activities, not only FCC QI activities. Recommendations are provided for building inclusive FCC QI teams, assessing FCC, creating culture change, supporting health-care practitioners and working with parent-led organizations.
... 16 In a prepost intervention analysis in the UK, Banerjee et al demonstrated similar benefits, the establishment of earlier enteral and suck feeds and a significantly reduced length of stay. 17 Similarly, a study in the Netherlands involving 1046 infants receiving FICare in single rooms showed lower infection rates, more exclusive breastfeeding and a reduced length of stay. 18 In a pre-post intervention study, He et al investigated the effects of FICare specifically for infants diagnosed with bronchopulmonary dysplasia (BPD) when parents were engaged in care for a minimum of three hours a day. ...
... Use of the app was associated with improved family involvement and outcomes. 17 Franck et al 39 are currently performing a clinical trial to investigate the impact of an interactive FICare mHealth app (We3health TM ) to supplement the delivery of a FICare program and serve as a data collection tool. Video technology has also been investigated to connect families and to support communication with clinical teams. ...
ABSTRACT Family integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minimizing separation, and supporting parent‐infant closeness. FICare incorporates psychological, educational, communication, and environmental strategies to support parents to cope with the NICU environment and to prepare them to be able to emotionally, cognitively, and physically care for their infant. FICare has been associated with improved infant feeding, growth, and parent wellbeing and self‐efficacy; important mediators for long‐term improved infant neurodevelopmental and behavioural outcomes. FICare implementation requires multi‐disciplinary commitment, staff motivation, and sufficient time for preparation and readiness for change as professionals relinquish power and control to instead develop collaborative partnerships with parents. Successful FICare implementation and culture change have been applied by neonatal teams internationally, using practical approaches suited to their local environments. Strategies such as parent and staff meetings and relational communication help to break down barriers to change by providing space for the co‐creation of knowledge, the negotiation of caregiving roles and the development of trusting relationships. The COVID‐19 pandemic highlighted the vulnerability within programs supporting parental presence in neonatal units and the profound impacts of parent‐infant separation. New technologies and digital innovations can help to mitigate these challenges, and support renewed efforts to embed FICare philosophy and practice in neonatal care during the COVID‐19 recovery and beyond.
... Family integrated care model emphasizes the role of family members to preterm infants, through a series of measures to make family members participate in the nursing of preterm infants in hospital, including feeding, touching, changing diapers, wiping bath and other life care, so as to promote the development of preterm infants to obtain professional care and sufficient emotional needs. Sleep is very important for newborns (42,43). During sleep, the secretion of growth hormone in preterm infants increases, their weight and height develop rapidly, and their meridian system continues to develop for a long time after birth, these processes are Transl Pediatr 2025;14(1):14-24 | https://dx.doi.org/10.21037/tp-24-373 ...
Background
The efficacy of family integrated care for preterm infants is not well established. This meta-analysis aims to assess the impact of family-integrated care on preterm infants to inform neonatal clinical practices.
Methods
We conducted a literature search in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Weipu, and Wanfang databases up to August 25, 2024. Two researchers independently screened articles, applying predefined inclusion and exclusion criteria, and performed quality assessments and data extraction. Meta-analysis was conducted using RevMan 5.3 software.
Results
Thirteen randomized controlled trials (RCTs) were included, encompassing 3,005 preterm infants, of which 1,390 received family-integrated care. Family-integrated care significantly improved breastfeeding rates [odds ratio (OR) =5.92, 95% confidence interval (CI): 2.37 to 14.82, P<0.001], weight gain [mean difference (MD) =3.16, 95% CI: 2.51 to 3.80, P<0.001], and sleep duration (MD =3.25, 95% CI: 2.05 to 4.44, P<0.001) in preterm infants and reduced the one-month readmission rate (OR =0.37, 95% CI: 0.22 to 0.61, P<0.001). Egger’s regression test indicated no publication bias among the outcomes (all P>0.05).
Conclusions
Family-integrated care markedly improves breastfeeding rates, promotes weight gain, and extends sleep duration in preterm infants, while concurrently reducing the likelihood of hospital readmission. This approach offers substantial benefits to both the preterm infants and their families, highlighting its potential for wider implementation in neonatal nursing practice.
... Parents in our study had mixed reviews about the added value of the app technology, mostly related to the limitations in the beta version of the app. Other studies have shown positive views of parent app technology to support FICare [21,22]. The app used in our study was designed in partnership with parents and had several new interactive features, rather than solely passive content. ...
Objective
The Family Integrated Care (FICare) model improves outcomes for preterm infants and parents compared with family-centered care (FCC). FICare with mobile technology (mFICare) may improve uptake and impact. Research on FICare in the United States (US) is scarce and little is known about parents' experience.
Methods
We conducted qualitative interviews with nine parents, exploring their NICU experiences, participation in and perceptions of the mFICare program. A directed content analysis approach was used, and common themes were derived from the data.
Results
Overall, parents had positive NICU experiences and found mFICare helpful in meeting three common parenting priorities: actively caring for their infant, learning how to care for their infant, and learning about the clinical status of their infant. They described alignment and misalignment with mFICare components relative to their personal parenting priorities and offered suggestions for improvement. Nurses were noted to play key roles in providing or facilitating parent support and encouragement to participate in mFICare and parenting activities.
Conclusion
The mFICare program showed potential for parental acceptance and participation in US NICUs.
Innovation
The mFICare model is an innovation in neonatal care that can advance the consistent delivery of NICU family-centered care planning and caregiving.
Clinical Trial Registration:NCT03418870 01/02/2018.
... Each section also includes educational information about the NICU and/or preterm babies, informed by the Integrated Family Delivered Neonatal Care app (created by Imperial College Healthcare in the UK) [33] and written by a Starship Child Health NICU clinician. Educational content includes common premature baby medical conditions, treatments used in the NICU, and premature baby cues and behaviours. ...
... In a study comparing FICare and standard care, it was stated that the time of parents' hugging their infants for the first time and the time of transition to full enteral feeding took place earlier in the FICare group [21]. In another study conducted in the UK, it was concluded that premature infants who received FICare were discharged from the NICU earlier, and breastfeeding and full enteral feeding were started earlier [22]. In the randomized controlled trial conducted in 11 NICUs in China, it was found that premature infants in the FICare group stayed in the hospital for a shorter time, resulting in reduced medical expenditures, faster weight gain, lower infection, and antibiotic use rate, and higher rates of breastfeeding and breast milk intake [23]. ...
Objective
The study was designed as a randomized controlled experimental trial to determine the effect of the Family Integrated Care (FICare) model on the readiness of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) for discharge and home care of the infants.
Study design
Parents in the intervention group received FICare, and parents in the control group received standard care.
Results
The total mean score of the mothers and fathers in the intervention group regarding readiness for discharge and home care was higher than that of the control group, and a significant difference was observed. A statistically significant difference was found in terms of discharge weight, the day of first enteral feeding, and first breast milk.
Conclusion
The FICare model was observed to enhance the readiness of mothers and fathers for discharge and home care and positively affect the infant’s weight gain, the status of breastfeeding and the continuation of nutrition.
Clinical trial registration
Registered on ClinicalTrials.gov (Identifiers: NCT04478162 Unique Protocol ID: 16214662/050.01.04/14) on 17/07/2020.
... 4 FICare has been associated with improved weight gain during hospitalisation, reduced length of stay and reduced nosocomial infections. [5][6][7][8] We adapted FICare to a neonatal hospital unit in Uganda. In a pre-post pilot study, we found that mothers were able to participate in the medical monitoring of their hospitalised infants. ...
Aim
Family Integrated Care (FICare) was developed in high‐income countries and has not been tested in resource‐poor settings. We aimed to identify the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda.
Methods
Maternal focus groups and healthcare provider interviews were conducted at Uganda's Jinja Regional Referral Hospital in 2020. Transcripts were analysed using inductive content analysis. An adaptation team developed Uganda FICare based on the identified facilitators and constraints.
Results
Participants included 10 mothers (median age 28 years) and eight healthcare providers (seven female, median age 41 years). Reducing healthcare provider workload, improving neonatal outcomes and empowering mothers were identified as facilitators. Maternal stress, maternal difficulties in learning new skills and mistrust of mothers by healthcare providers were cited as constraints. Uganda FICare focused on task‐shifting important but neglected patient care tasks from healthcare providers to mothers. Healthcare providers learned how to respond to maternal concerns. Intervention material was adapted to prioritise images over text. Mothers familiar with FICare provided peer‐to‐peer support to other mothers.
Conclusion
Uganda FICare shares the core values of FICare but was adapted to be feasible in low‐resource settings.
... This quality improvement project is designed as an international, multi-centre, pluri-cultural prospective stepped-wedge cluster controlled trial. Five non-FICare-experienced NICUs from Netherlands, Turkey, Romania, United Kingdom and Zambia (sites [1][2][3][4][5], and 2 clinical sites who have recently implemented FICare from Spain and Netherlands (sites 6 and 7) are expected to be recruiting infants into this trial that will include at least 552 babies during a thirty two-months period. The stepped wedge cluster design was selected due to the nature of the intervention, which involves changes to unit-level provision of care and interaction between participants, with a risk of cross-contamination. ...
Background
Family Integrated Care (FICare) has demonstrated positive outcomes for sick neonates and has alleviated the psychological burden faced by families. FICare involves structured training for professionals and caregivers along with the provision of resources to offer physical and psychological support to parents. However, FICare implementation has been primarily limited to developed countries. It remains crucial to assess the scalability of this model in overcoming social-cultural barriers and conduct a cost-effectiveness analysis. The RISEinFAMILY project aims to develop an adapted FICare model that can serve as the international standard for neonatal care, accommodating various cultural, architectural, and socio-economic contexts.
Methods
RISEinFAMILY is a pluri-cultural, stepped wedge cluster controlled trial conducted in Spain, Netherlands, United Kingdom, Romania, Turkey and Zambia. Eligible participants include infant-family dyads admitted to the Neonatal Intensive Care Unit (NICU) requiring specialised neonatal care for a minimum expected duration of 7 days, provided there are no comprehension barriers. Notably, this study will incorporate a value of implementation analysis on FICare, which can inform policy decisions regarding investment in implementation activities, even in situations with diverse data.
Discussion
This study aims to evaluate the scalability and adaptation of FICare across a broader range of geographical and sociocultural contexts and address its sustainability. Furthermore, it seeks to compare the RISEinFAMILY model with standard care, examining differences in short-term newborn outcomes, family mental health, and professional satisfaction.
Trial registration
ClinicalTrials.gov, ID: NCT06087666 Registered on 17.10.2023. Protocol version: 19 December 2022; version 2.2.
... In a study comparing FICare and usual care, it was stated that the time of parents' hugging their infants for the rst time and the time of transition to full enteral feeding took place earlier in the FICare group [21]. In another study conducted in the UK, it was concluded that premature infants who received FICare were discharged from the NICU earlier, and breastfeeding and full enteral feeding were started earlier [22]. In the randomized controlled trial conducted in 11 NICUs in China, it was found that premature infants in the FICare group stayed in the hospital for a shorter time, resulting in reduced medical expenditures, faster weight gain, lower infection, and antibiotic use rate, and higher rates of breastfeeding and breast milk intake [23]. ...
OBJECTIVE:The study was designed as a randomized controlled experimental trial to determine the effect of the Family Integrated Care(FICare) model on the readiness of parents whose infants were hospitalized in the Neonatal Intensive Care Unit(NICU) for discharge and home care of the infants.
STUDY DESING:The sample group of the study consisted of 68 parents,34of whom were in the intervention group with infants hospitalized in the NICU and34 in the control group.Parents in the intervention group received FICare,and parents in the control group received usual care.
RESULTS:The total mean score of the mothers and fathers in the intervention group regarding readiness for discharge and home care was higher than that of the control group,and a significant difference was observed.
CONCLUSION:The FICare model was observed to enhance the readiness of mothers and fathers for discharge and home care and positively affect the infant's weight gain,thestatus of breastfeeding and the continuation of nutrition.
... The term has been used in reference to several initiatives involving parent empowerment and integration into the care team. 3,[13][14][15][16][17] Furthermore, FICare has been described as a model, 3,5,6,14,18,19 program, 20,21 ethos, 22 and philosophy of care. 23,24 An ethos or philosophy of care represent values and guiding principles and may be broadly interpreted, as has been reported with Patient and Family Centered Care (PFCC). ...
... 48 E-health-based follow-up can be a new model of follow-up that reduces the difficulty of implementation, saves time and cost of follow-up, and is more convenient to use in practice during the COVID-19 pandemic. 49 However, there are still many uncertainties in the follow-up intervention studies of e-health. Horizontal comparisons of different e-health interventions are lacking. ...
Background
After preterm birth, parents often conformed with difficulties such as negative emotions, lack of care knowledge and skills, and insufficient professional support. As a remote health guidance method, e-health can provide a series of support for premature infants and their parents during the transition period from neonatal intensive care unit (NICU) to home care.
Objectives
To determine the efficacy of e-health interventions in discharged preterm infants as well as their parents, and to describe the process outcomes and elements of these e-health interventions to inform the effective design of future interventions.
Methods
The systematic review of the randomized and non-randomized controlled trials on the follow-up effect of e-health on preterm infants and their parents discharged from NICU between the inception to May 2023 will be electronically searched in the following nine databases: Web of Science, CINAHL Complete (EBSCO), PubMed, Embase, the Cochrane Library, Ovid MEDLINE, China National Knowledge Infrastructure, WANFANG DATA, and SinoMed. Quality will be appraised, respectively, via the revised tool to assess risk of bias (RoB 2) and the tool for risk of bias in non-randomized studies of interventions (ROBINS-I). The main outcome indicators of preterm infants are breastfeeding rate, readmission rate, neurobehavioral development, and premature infant's body mass. The outcome indicators for parents of premature infants are anxiety, depression scale, and parenting competency scale. The RevMan 5.4 software provided by the Cochrane Collaboration will be used for statistical analysis of the data.
Conclusion
The results of this study may provide future development opportunities for e-health follow-up prevention in preterm infants and may support evidence-based decision-making for e-health interventions of post-discharge developmental support in preterm infants.
PROSPERO registration number
CRD42023410334.
... Provider and newborn outcomes of providers' sensitization training sessions were presented to hospital leadership in order to create a paradigm shift in the organizational approach to the care of newborns. In a NICU study(Banerjee et al., 2019), the cost savings from decreased length of stay among infants enrolled in the Integrated Family Delivered Care programme provided the impetus for a remodelling of nursing staff structure at the study sites; however, the authors acknowledged that changing culture and beliefs of direct care providers was the biggest challenge to implementing the programme. ...
Aim
To create a programme theory of family engagement in paediatric acute care to explicate the relationships between contexts and mechanisms of family engagement that align with family, direct care providers and healthcare organization outcomes.
Design
Realist review and synthesis.
Data Sources
PubMed, CINAHL, PsycINFO and Web of Science searches for the 2.5‐year period (July 2019–December 2021) following our 2021 scoping review.
Review Methods
Following methods described by Pawson and Rycroft‐Malone, we defined the scope of the review, searched for and appraised the evidence, extracted and synthesized study findings and developed a supporting narrative of our results.
Results
Of 316 initial citations, 101 were included in our synthesis of the final programme theory. Contexts included family and direct care provider individualism, and the organizational care philosophy and environment. Mechanisms were family presence, family enactment of a role in the child's care, direct care providers facilitating a family role in the child's care, unit/organizational promotion of a family role, relationship building and mutually beneficial partnerships. Outcomes were largely family‐focussed, with a paucity of organizational outcomes studied. We identified four context–mechanism–outcome configurations.
Conclusion
This realist review uncovered underlying contexts and mechanisms between patients, direct care providers and organizations in the family engagement process and key components of a mutually beneficial partnership. Given that successful family engagement requires direct care provider and organizational support, future research should expand beyond family outcomes to include direct care providers, particularly nurses and healthcare organization outcomes.
Impact
The final programme theory of family engagement in paediatric acute care provides a roadmap for clinicians to develop complex interventions to engage families and evaluate their impact. The components of our final programme theory reflect family engagement concepts that have been evolving for decades.
Patient or Public Contribution
The team conducting this review included members from the practice setting (JT & KG). In the future, as we and others use this model in practice, we will seek input for refinement from clinicians, patients and caregivers.
... Banerjee et al. analyzed several infant outcomes, including length of stay (LOS) in the NICU, to evaluate an Integrated Family Delivered Care (IFDC) program for parents of NICU babies (26). This program in the United Kingdom was based on other randomized controlled trials in Canada and Australia, which had demonstrated significant benefit from similar Family Integrated Care (FIC) programs. ...
Background and objective:
Among the unique challenges for parents in the transition of infant care from neonatal intensive care unit (NICU) to home are the medical complexity of their babies and the psychological burden of caring for this special patient population. Despite the increased use and accessibility of smartphones, mobile applications (apps) intended for use by families during this transition remain underdeveloped and understudied. Apps to support parents of infants in the NICU represent an accessible potential solution to mitigate existing disparities in follow up. Through this Narrative Review, we intend to describe the characteristics of and development process for apps intended to address the challenges parents with NICU babies may face, and to provide recommendations for further development of apps for this purpose.
Methods:
We conducted a review of articles published between November 2012 to November 2022. This search spanned three major databases, PubMed, Embase, and CINAHL, using a controlled vocabulary and keywords for mobile apps and the NICU. These three databases generated 473 articles for review. Utilizing the online primary screening and data extraction tool Covidence, we ultimately included eight articles in this narrative review.
Key content and findings:
There are few existing mobile apps intended to ease the transition home for parents of babies in the NICU. There are even fewer apps that have been critically evaluated using acceptable methods and produced with contribution from healthcare practitioners. Among the existing articles on app solutions to benefit education and socioemotional support for parents, many emphasized the importance of including key stakeholders during the app development process and highlighted both qualitative and quantitative measures for assessing relative success of these apps in a clinical setting.
Conclusions:
Although the experiences of parents with infants admitted to the NICU have been well-studied, there remain relatively few existing apps to provide educational and socioemotional support to this population. Future studies should focus on an iterative process of app development whereby both parents and providers are closely involved, in combination with critical appraisal of the app to assess for appropriate support and education of caregivers.
... Studies conducted in those countries, as well as in others with similar healthcare systems, reported numerous positive effects of FICare participation including increased infant weight gain and exclusive breastfeeding rates, reduced length of stay, improved parent confidence and increased involvement in newborn care, better parental-newborn bonding, as well as lower parental stress, lower anxiety and lower paternal depressive symptoms [20,[22][23][24][25][26]. Similarly, follow-up studies showed improved behavioral skills and outcomes, improved neurodevelopmental outcomes, and lower maternal stress scores at 18 months post-conceptual age [27][28][29][30]. There were no reported adverse effects [20,[22][23][24][25][26]. ...
Objectives
(1) Assess effects of a modified Family Integrated Care (FICare) model on U.S. Neonatal Intensive Care Unit (NICU) parents; (2) Evaluate NICU nurses’ perspectives.
Design
Case -control design with parental stress assessed before and after NICU-wide FICare implementation using Parent Stressor Scale: NICU (PSS:NICU) questionnaire. In addition, stratification by degree of participation evaluated associations with parental stress, parental-staff communication and discharge readiness. Questionnaires captured nursing perspectives on FICare.
Results
79 parents (88%) participated prior to FICare; 90 (90%) after. Parent stress was lower (p < 0.001) with FICare. Parents learning 5–15 infant-care skills had lower stress compared to those learning <5 (p = 0.008). Parent utilization of an educational app was associated with improved communication frequency (p = 0.007) and quality (p = 0.012). Bedside NICU nurses reported multiple positive associations of FICare for parents and staff.
Conclusions
Any degree of FICare participation decreases parental stress; increased participation has multiple positive associations.
... The literature describes various programmes to educate parents in a clinical setting (Banerjee et al., 2020;Kadivar et al., 2017;Lebel et al., 2020;Platonos et al., 2018;Puthussery et al., 2018). ...
Aims/Objectives
The aim of this study was to appraise health professionals' self‐reported practices in educating parents of hospitalised newborns from the perspective of competency‐based education and to identify areas for improvement of parental learning.
Background
Patient education is essential to achieve autonomy in parents of hospitalised newborns. The literature provides descriptions of the use of various components of competency‐based education in patient education. This suggests that competency‐based education is a valuable concept for patient education.
Design
A case‐based qualitative study.
Methods
Three focus group discussions were conducted and 28 semi‐structured interviews with 45 health professionals who practice in a hospital setting that is designed to empower parents. The data were analysed with a framework analysis approach, using a framework of competency‐based education themes for a combined inductive and deductive content data analysis. The recommendations of the Standards for Reporting Qualitative Research checklist were followed.
Findings
Two themes of competency‐based education emerged as evidently operationalised: (1) ‘Learning climate’ and (2) ‘Role modeling’. Five themes emerged as incompletely operationalised: (1) ‘Parent curriculum based on inter‐professional consensus’; (2) ‘Transparency about the competencies needed’; (3) ‘Access to teaching’; (4) ‘Assessing and reporting results’; and (5) ‘Proficiency statements based on autonomy expectations’. Two themes did not emerge: (1) ‘Empowering parents to be active learners’ and (2) ‘Evaluation and improvement of the education program’.
Conclusions
Parent education is at risk of being merely on a master‐apprentice model and may be more effective if it is designed on competency‐based education principles. Identified areas for improvement are empowering parents to be ‘active learners’ and by involving them in the evaluation and improvement of the educational program. Parent education in neonatal health care may benefit from an appraisal based on competency‐based education themes.
Relevance to clinical practice
Appraising parent education based on competency‐based education principles is feasible for improving the learning process towards parent autonomy.
... There are hundreds of parenting apps on any given topic (Banerjee et al., 2019;Davis et al., 2017;Zhao et al., 2017). Several app reviews on the topic revealed an abundance of poor-quality and irrelevant apps available for parents that makes the process of finding a desirable app difficult (Jake-Schoffman et al., 2017;Richardson et al., 2019;Shorey et al., 2017). ...
... Assumptions are being made that remote meetings and online surveys are a more environmentally friendly choice than paper surveys and in-person meetings. Further, remote monitoring and mobile communications are making it increasingly possible for clinicians to meet with clients without making physical contact (Ganapathy et al., 2016;Banerjee et al., 2020). However, little is known about the actual resource implications of the various stages of the supply chain of electronic devices being used to contain and collect data. ...
Background: The concept of sustainability suggests development should maintain protective environments for current and future generations. Healthcare practice and research within the Baltic Sea Region, and around the world, have not implemented sustainable development indicators to complement broader existing international goals. In the summer of 2019, European doctoral students attended the fourth annual Baltic Sea Region Network in Personalized Health Care summer school, themed ‘Environmental Sustainability of Healthcare Research’.
Aim: This critical reflection focuses on doctoral students’ discussions related to sustainable development in healthcare and science, exploring a shift in approach in the context of technology use and travel.
Conclusion: Doctoral students became self-aware and critical of current practices in healthcare and science in terms of sustainability. Existing goals for sustainable development have not been paired with clear indicators to guide clinical and academic practices.
Implications for practice:
Incorporating collaboration and participation into healthcare and science cultures can promote sustainable innovation
Research should be conducted to uncover the environmental and economic impacts of current practices in these fields
Clinicians and health researchers should be given indicators of sustainable development in order to achieve existing sustainable development goals
... Of note, the FICare protocol in this study did not include peer-to-peer support from parents of former preterm infants and required parents to be in the hospital 3 h per day instead of 6 h per day. A FICare-based intervention bundle called Integrated Family Delivered Neonatal Care (IFDC) in the UK was shown to reduce overal length of stay and special care days and to shorten the time to full suck feeding compared with historical controls [50]. The IFDC bundle differed from FICare in that parents received additional support from IDFC coordinators and access to a free mobile app with educational information and a diary. ...
Background:
Family Centered Care (FCC) has been widely adopted as the framework for caring for infants in the Neonatal Intensive Care Unit (NICU) but it is not uniformly defined or practiced, making it difficult to determine impact. Previous studies have shown that implementing the Family Integrated Care (FICare) intervention program for preterm infants in the NICU setting leads to significant improvements in infant and family outcomes. Further research is warranted to determine feasibility, acceptability and differential impact of FICare in the US context. The addition of a mobile application (app) may be effective in providing supplemental support for parent participation in the FICare program and provide detailed data on program component uptake and outcomes.
Methods:
This exploratory multi-site quasi-experimental study will compare usual FCC with mobile enhanced FICare (mFICare) on growth and clinical outcomes of preterm infants born at or before 33 weeks gestational age, as well as the stress, competence and self-efficacy of their parents. The feasibility and acceptability of using mobile technology to gather data about parent involvement in the care of preterm infants receiving FCC or mFICare as well as of the mFICare intervention will be evaluated (Aim 1). The effect sizes for infant growth (primary outcome) and for secondary infant and parent outcomes at NICU discharge and three months after discharge will be estimated (Aim 2).
Discussion:
This study will provide new data about the implementation of FICare in the US context within various hospital settings and identify important barriers, facilitators and key processes that may contribute to the effectiveness of FICare. It will also offer insights to clinicians on the feasibility of a new mobile application to support parent-focused research and promote integration of parents into the NICU care team in US hospital settings.
Trial registration:
ClinicalTrials.gov, ID NCT03418870. Retrospectively registered on December 18, 2017.
Background
Flexible approaches to parenting training interventions in the neonatal intensive care unit (NICU), including family integrated care (FICare) models, are urgently needed across the globe. Many FICare trials inadvertently exclude parents with low resources who cannot commit to daily infant care (eg, 4-8 hours/day). Preemie Progress (PP) is a fully automated, video-based training program that allows parents to choose when and where they learn, without requiring parent bedside presence.
Objective
This study aims to examine the feasibility of recruitment, retention, fidelity, and changes in outcomes during a pilot randomized controlled trial of PP, a video-based intervention aimed at training mothers of very preterm infants in evidence-based family management skills in the NICU.
Methods
Mothers of infants born between 25 weeks and 0 days to 31 weeks and 6 days of gestation were enrolled in an NICU in the Midwestern United States. Electronic surveys were sent to collect maternal outcomes (Patient-Reported Outcomes Measurement Information System [PROMIS] 8a depression and anxiety scales) at baseline (T1), 14 days (T2) and 28 days (T3) after T1, and 30 days after NICU discharge (T4). Infant electronic health records were extracted to collect infant (ie, weight gain velocity at 36 weeks and receipt of mother’s milk) and health care outcomes (ie, NICU length of stay as well as readmissions and emergency department visits within 30 days of discharge).
Results
Of 123 eligible mothers, 64 (52%) were randomly assigned to 1 of 2 arms (PP: n=33, 52%; attention control [AC]: n=31, 48%). Loss to follow-up was 30% (10/33) in the PP arm and 13% (4/31) in the AC arm. PP mothers watched a mean 17.8 (SD 18.9) of 49 videos. PP retention was linked to higher fidelity. PP mothers showed trends toward greater reductions in anxiety 30 days after discharge (mean −7.54, SD 1.93; 95% CI −11.32 to −3.76) compared to AC mothers (mean −4.67, SD 1.59; 95% CI −7.80 to −1.55). PP infants trended toward greater receipt of exclusively mother’s milk 28 days after baseline (PP: 14/26, 54%; AC: 10/28, 36%) and decreased NICU stay (PP: 57.2 days; AC: 68.3 days) but higher readmissions (PP: 4/33, 12%; AC: 2/31, 6%).
Conclusions
We were able to recruit a diverse sample of mothers from a range of socioeconomic backgrounds, including mothers experiencing barriers to bedside presence. Recruitment goals were met. PP showed promising trends in improving maternal, infant, and health care outcomes. Additional studies are needed to optimize PP and study procedures to improve retention and fidelity. PP has the potential to support parent training outside of traditional FICare models or serve as a complement to structure the parent education pillar of adapted FICare models.
Trial Registration
ClinicalTrials.gov NCT04638127; https://www.clinicaltrials.gov/study/NCT04638127
Family integrated care (FICare) represents a contemporary approach to health care that involves the active participation of families within the healthcare team. It empowers families to acquire knowledge about the specialised care required for their newborns admitted to neonatal intensive care unit (NICU) and positions them as primary caregivers. Healthcare professionals in this model act as mentors and facilitators during the hospitalisation period. This innovative model has exhibited notable enhancements in both short‐ and long‐term health outcomes for neonates, alongside improved psychological well‐being for families and heightened satisfaction among healthcare professionals. Initially designed for stable premature infants and their families, FICare has evolved to include critically ill premature and full‐term infants. Findings from recent studies affirm the safety and feasibility of FICare as a NICU‐wide model of care, benefiting all infants and families. The envisioned expansion of FICare focusses on sustainability and extending its implementation, recognising the necessity for tailored adaptations to suit varying diverse cultural and socio‐economic contexts.
Aim:
This study aimed to summarise the views and experiences of the participants in the workshop of the XIII International Conference on Kangaroo Mother Care (KMC).
Methods:
The results of the discussions held during the workshop of the XIII International Conference on KMC were summarised. There were 152 participants from 47 countries. Four main KMC topics were discussed: good practices, immediate implementation, nutrition and basic ventilation.
Results:
Several agreements were reached, namely that professional societies and governments should develop official recommendations to promote KMC as standard care for preterm and low birth weight infants and that parents should be involved as active caregivers in neonatal care units. Moreover, the criteria for referring community-born infants to KMC require standardisation. Important inequalities in resource availability among high-, middle- and low-income countries were recognised for all topics. Specific needs were identified for parenteral nutrition and fortifiers, nasal continuous positive airway pressure (nCPAP) and oxygen blenders, which are rarely available in low- and middle-income countries. Immediate implementation of KMC was discussed as a new concept. Its benefits were recognised, but its application has some variability.
Conclusion:
Adequate preterm care requires a basic neonatal package, including KMC, nCPAP, immediate management protocols and adequate nutrition and feeding strategies. The differences in resources among high-, middle- and low-income countries highlight the wide disparities in neonatal care according to the place of birth.
Aims:
The aims are to describe the key components of family integrated care intervention for preterm infants in the neonatal intensive care unit (NICU) and assess the impact on breastfeeding outcomes for those infants.
Design:
A scoping review.
Methods:
We conducted a systematic study search based on the databases, including PubMed, Scopus, Cochrane, Web of Science, MEDLINE, CINAHL, CNKI and Wanfang Database in December 2022. The search time ranged from database establishment to 31 December 2022. Papers by manual searching were also listed on the references. We adopted Joanna Briggs Institute Reviewer's Manual methodology and followed the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) to conduct the review. Two independent reviewers filtered the papers, extracted data and synthesized the findings. A table was used to extract data and synthesize results.
Results:
After systematic searching, 11 articles that implemented family integrated care (FIcare) were finally included in this scoping review. By analysing the implementation of this nursing model, we identified seven main components: NICU staff training, parent education, parent participation in infants' care, parent involvement in medical plans, peer support, NICU environmental support and mobile app for parents. Based on the extracted breastfeeding data, this scoping review concludes that family integrated care shows a positive effect on increasing breastfeeding rates at discharge. Through this scoping review, we find that family integrated care is feasible and it can support breastfeeding of preterm infants. Further studies will be needed to provide more evidence that family integrated care could facilitate breastfeeding of preterm infants.
Impact:
This scoping review provides evidence for the positive role of family integrated care on breastfeeding outcomes. The analysis may contribute to the implementation of family integrated care.
No patient or public contribution:
No further public or patient contribution was made in view of the review-based nature of the research.
Background: Family Integrated Care (FICare) is a model of care developed in a Canadian Neonatal Intensive Care Unit that engages parents to be active participants in their infant’s care team. FICare has the potential to have the greatest impact in low-income countries, where the neonatal mortality rate is disproportionately high and the health workforce is severely strained.
This manuscript details the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda
Methods: Focus groups of ten mothers and interviews of eight workers were conducted to identify facilitators and constraints to the implementation of FICare in Uganda. Transcripts were analyzed using inductive content analysis. An adaptation team of key stakeholders developed Uganda FICare in the Special Care Nursery in Jinja Regional Referral Hospital based on the results from the focus groups and interviews.
Results: The potential to reduce the healthcare provider workload, the desire to empower mothers and the pursuit to improve neonatal outcomes were identified as key facilitators. Maternal difficulty in learning new skills, lack of trust from healthcare providers and increased maternal stress were cited as potential barriers. Uganda FICare focused on task-shifting important but often neglected patient care tasks from healthcare providers to mothers. Healthcare providers were taught how to respond to maternal concerns. All intervention material was adapted to prioritize images over text. Mothers familiar with FICare were encouraged to provide peer-to-peer support and guidance to mothers with newly hospitalized infants.
Conclusions: Engaging stakeholders to identify the facilitators and constraints to local implementation is a key step in adapting an intervention to a new context. Uganda FICare shares the core values of the original FICare but is adapted to enhance its feasibility in low-resource settings.
Zusammenfassung
Zielsetzung Mithilfe familienintegrierender Behandlungspfade konnte bereits mehrfach eine Reduktion der initialen Krankenhausverweildauer nachgewiesen werden. Wie sich dies auf die Ausgaben der Kostenträger auswirkt, blieb bisher unklar.
Methodik Um das Einsparungspotenzial durch eine Verkürzung der Verweildauer zu veranschaulichen, wurden eine grobe Hochrechnung und eine Budget-Impact-Analyse durchgeführt.
Ergebnisse Basierend auf den Ergebnissen eines Modellvorhabens konnte die durchschnittliche Verweildauerreduktion von einer Woche jährliche Kosteneinsparungen von rund 60 Millionen € bewirken.
Schlussfolgerung Selbst wenn weitere Einsparungspotenziale wie indirekte Kosteneinsparungen durch die Prävention psychischer Belastungen der Eltern nicht einkalkuliert werden, hat der Einbezug der Familien in die Versorgung Frühgeborener ein weitreichendes Potenzial für Kostenträger.
Objetivo: Identificar na literatura quais as evidências sobre a prática do Cuidado Centrado na Família na saúde da criança. Métodos: Trata-se de revisão integrativa realizada em seis fases, sendo elas: identificação do tema e elaboração da pergunta de pesquisa, critérios de inclusão e exclusão, busca na literatura dos estudos primários, extração dos dados, avaliação crítica dos estudos incluídos e síntese do conhecimento evidenciado. A busca ocorreu nas bases de dados LILACS, BDENF e MEDLINE, via portal da Biblioteca Virtual em Saúde, no mês de setembro de 2022. Resultados: Foram identificados 533 estudos, dos quais 24 foram eleitos. A abordagem da prática do CCF foi evidenciada em serviços de saúde em UTI (n=9), no âmbito hospitalar, enfermaria e setores especializados (n=11) e na atenção primária à saúde (n=2), bem como no domicílio das famílias (n=2). A abordagem dos estudos foi direcionada para a família (n=14), cuidadores familiares (n=1), pais e profissionais simultaneamente (n=1) e para a equipe profissional incluindo a enfermagem (n=8). Considerações finais: A prática do CCF ainda não é realizada e vivenciada em sua totalidade pelas famílias assistidas. Assim, sugere-se novos estudos e estratégias para a sensibilização de profissionais quanto aos pressupostos da filosofia do CCF e sua aplicabilidade.
Objetivo: Identificar na produção científica as experiências dos pais sobre as vivências na Unidade de Terapia Intensiva Neonatal durante a pandemia Covid-19. Metodologia: Revisão integrativa da literatura realizada nas bases Biblioteca Virtual em Saúde, PubMed, LILACS, e Scopus no período de maio a junho de 2022. Os achados foram extraídos, analisados e sintetizados de forma narrativa. Resultados: Recuperou-se um total de 1.096 estudos; desses, 12 foram selecionados para a revisão. Prevaleceram estudos qualitativos, com nível de evidência VI. Os pais vivenciaram momentos de restrições de visitas aos seus filhos, desencadeando medo, ansiedade e estresse. Conclusão: Os pais de bebês hospitalizados na Unidade de Terapia Intensiva Neonatal durante a pandemia Covid-19, vivenciaram momentos de estresse, medo, ansiedade e que foram preditores para outros problemas emocionais. Destaca-se ainda, que durante esse período de restrições da permanência dos pais, ocorreram impactos negativos na amamentação, limitação do apoio social após a alta, dificuldades de interação com profissionais de saúde, dificuldades de cuidados e contato físico com o bebê.
This study aims to examine the influence of hospital experience factors on parental discharge readiness, accounting for key background characteristics. Parents/guardians of infants 33 weeks of gestation or less at birth receiving neonatal intensive care at 6 sites were enrolled from April 2017 to August 2018. Participants completed surveys at enrollment, 3 weeks later, and at discharge. Multiple regression analysis assessed relationships between parental experience, well-being, and perceived readiness for infant discharge, adjusting for socioenvironmental, infant clinical, and parent demographic characteristics. Most (77%) of the 139 parents reported high levels of readiness for their infant's discharge and 92% reported high self-efficacy at discharge. The multiple regression model accounted for 40% of the variance in discharge readiness. Perceptions of family-centered care accounted for 12% of the variance; measures of parent well-being, anxiety, and parenting self-efficacy accounted for an additional 16% of the variance; parent characteristics accounted for an additional 9%; and infant characteristics accounted for less than 3% of the variance. Parental perceptions of the family-centeredness of the hospital experience, anxiety, and parenting self-efficacy accounted for a substantial proportion of the variance in readiness for discharge scores among parents of preterm infant. These influential perceptions are potentially modifiable by nursing-led interventions.
Background: A novel virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started spreading through Italy and the world from February 2020, and the pandemic threatened the family-centred care (FCC) model used in the neonatal intensive care unit (NICU). Teleconferences and video calls were employed to keep parents in contact with their babies. This study aimed to evaluate satisfaction and stress levels between parents in the telematic family-centred care group (T-FCC) versus the FCC group and the no Family-Centred Care (N-FCC) group. Methods A prospective cohort pilot study was carried out from April to May 2020. A parental stressor scale and the NICU satisfaction questionnaire were administered to parents at the time of discharge of their newborns. Parents in T-FCC group could see their newborns via video calls, while those in the FCC and N-FCC groups were extracted from our previously published database. Results Parents in the T-FCC group were more satisfied and less stressed than those in the N-FCC group. Experiences of the mothers and fathers in the T-FCC group were similar. However, the FCC group showed the best results. Conclusion The T-FCC group showed satisfaction with the quality of information received about their babies and felt that their privacy was considered and respected by the medical staff. Parents were also less stressed because they could monitor what happens to the baby through a video, however, they could not intervene if there was a problem. Data support the use of video calls to improve insight into clinical conditions and communication between doctors, nurses, and parents during the pandemic.
Background:
Family Integrated Care (FICare) is an innovative model that encourages parents to assume the role of primary caregivers during the neonatal period.
Purpose:
To conduct a survey of neonatal intensive care unit (NICU) nurses and physicians on a national scale to determine their perceptions and attitudes toward FICare.
Methods:
Data on 3 domains were collected: demographic characteristics, FICare perceptions, and attitudes. The survey included 299 NICU nurses and physicians from 31 tertiary-level NICUs across China (response rate = 96.5%).
Results:
The respondents showed a positive attitude toward implementing FICare and recognized its positive impact on infants. However, some respondents raised concerns regarding its feasibility and limitations of the NICU setting. The respondents' perceptions and attitudes of FICare varied based on their personal characteristics, such as marital status and day/night work shifts.
Implications for practice and research:
Most NICU nurses and physicians reported that FICare can benefit infants. Despite some constraints related to the NICU environmental conditions, most NICU leaders felt positive about implementing FICare in China. Therefore, establishing key strategies for performing FICare, selecting appropriate personnel, and educating the staff regarding FICare are useful approaches to promote FICare implementation. FICare requires the team's collaborative effort with the support of NICU leaders to overcome system and setting barriers. Nurses should serve as navigators to guide its implementation. More studies on healthcare setting policies, parents' perceptions, and approaches for healthcare professionals to perform FICare in China are required.
Zusammenfassung
Zielsetzung Dieser Scoping-Review soll einen Überblick über die gesundheitsökonomische Bewertung von Behandlungseffekten familienintegrierter/familienzentrierter Versorgungsmodelle von Frühgeborenen geben. Kern der Arbeit bildet die Analyse der Verweildauer, deren Auswertungsmethoden sowie deren Beeinflussung durch Stichprobeneigenschaften. Ebenso wurden Rehospitalisierungsraten und Kostenanalysen berücksichtigt.
Methodik In einer Literaturrecherche gemäß Scoping-Review-Methodik und vordefinierten Kriterien wurden 14 Studien eingeschlossen.
Ergebnisse Mittelmaßdifferenzen und Adjustierungsverfahren zählten zu den häufigsten Analyseverfahren. Fünf Studien berichteten zudem die Rehospitalisierungsraten. Eine Beeinflussung der Effekte durch Stichprobeneigenschaften zeigte sich nicht.
Schlussfolgerung Familienintegrierte/familienzentrierte Konzepte sind vielversprechende Versorgungsansätze für Frühgeborene. Weitere gesundheitsökonomische Analysen sind notwendig, um die gesamtgesellschaftlichen Auswirkungen beurteilen zu können.
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 .
Background:
Parent involvement in neonatal care is beneficial to families and infant outcomes. Few studies have explored parental experiences of neonatal therapy participation.
Purpose:
This study had 2 purposes: (1) to explore parental attitudes and beliefs about participating in neonatal therapies and (2) to identify barriers and facilitators to parental involvement and suggest ways to optimize neonatal therapy services.
Methods:
The study design and data analysis were informed by constructivist grounded theory methods. Semistructured telephone interviews were conducted with 9 mothers of children who had received neonatal therapy.
Findings:
After an early period of fear and powerlessness, a transition point occurred where the survival of their infant became more certain and parents were able to consider the future. At this point, participation in therapies was perceived to be more relevant. Therapy participation was experienced as a means of regaining autonomy and control in a context of trauma, but parents encountered barriers related to accessing therapists and external demands on their time.
Implications for practice:
Parental participation is best facilitated by frequent and flexible access to neonatal therapists and staffing levels should reflect this. On commencing therapy, parents should be given therapists' contact details to maximize opportunities for face-to-face encounters.
Implications for research:
Future research is needed to explore parental readiness to participate in therapies in the neonatal intensive care unit. Research exploring the impact of parental involvement in therapies over a longer time frame would be beneficial. Finally, there is a need to determine efficacy and effectiveness of parent-delivered neonatal therapies.
Objective:
To evaluate the parent and staff experience of a secure video messaging service as a component of neonatal care.
Design:
Multicentre evaluation incorporating quantitative and qualitative items.
Setting:
Level II and level III UK neonatal units.
Population:
Families of neonatal inpatients and neonatal staff.
Intervention:
Use of a secure, cloud-based asynchronous video messaging service to send short messages from neonatal staff to families. Evaluation undertaken July-November 2019.
Main outcome measures:
Parental experience, including anxiety, involvement in care, relationships between parents and staff, and breastmilk expression.
Results:
In pre-implementation surveys (n=41), families reported high levels of stress and anxiety and were receptive to use of the service. In post-implementation surveys (n=42), 88% perceived a benefit of the service on their neonatal experience. Families rated a positive impact of the service on anxiety, sleep, family involvement and relationships with staff. Qualitative responses indicated enhanced emotional closeness, increased involvement in care and a positive effect on breastmilk expression. Seventy-seven post-implementation staff surveys were also collected. Staff rated the service as easy to use, with minimal impact on workload. Seventy-one percent (n=55) felt the service had a positive impact on relationships with families. Staff identified the need to manage parental expectations in relation to the number of videos that could be sent.
Conclusions:
Asynchronous video messaging improves parental experience, emotional closeness to their baby and builds supportive relationships between families and staff. Asynchronous video supports models of family integrated care and can mitigate family separation, which could be particularly relevant during the COVID-19 pandemic.
Neonatal staff education is critical to the successful implementation of Family Integrated Care (FIC) to support the shift in the focus of care giving for the baby to working with parents as part of the unit of care, treating them as equal and active members of the team in the care of the baby. Education should include an understanding of the parent experience to enable sensitive and effective communication required for partnership working. Effective staff education supports an understanding of the differences of FIC, what is required of staff, provides an opportunity to address hopes and fears and makes sure staff are up to date and confident in their clinical knowledge and skills to up-skill parents. Opportunities to educate staff can be hard to find with the challenges of staffing and acuity on a neonatal intensive care unit, this requires adaptability and innovative ideas to be successful.
Family integrated care is delivered in a supportive environment where parents are supported with education and competency based training and the neonatal unit policies and guidelines are conducive to providing such care and nurturing such approach. Use of digital technology has revolutionised and shaped the modern world. Use of mobile-based application can help parents to develop their knowledge and confidence; cameras and videos can help parents to stay in touch with the vulnerable infants even when they are not next to their loved ones. In this article we glance through the innovative ways of breaking through the barrier of staff and parent education, communication and access of the parents to the cotside using innovative ideas and digital technologies.
Preterm birth remains a major contributor to infant mortality and morbidity including neurodevelopmental delay and childhood disability. Mothers experiencing a preterm birth are at risk for maternal mental health issues, inclusive of depression and posttraumatic stress disorder (PTSD), which may affect mother-infant attachment and infant development. Depression and PTSD, frequently comorbid, following preterm birth and relationships between these symptoms, maternal-infant attachment, and infant development are reviewed. Assessments and interventions potentially capable of benefitting mother and infant are noted. The need for healthcare professionals to intervene prenatally and at postpartum is significant as maternal distress remains one of the most consistent factors related to infant development. Although depression has received much attention in the literature as a risk factor for preterm birth, impaired attachment, and delayed infant development, some of the consequences of PTSD have only recently gained research attention. A few studies support the role of PTSD in impaired maternal-infant attachment; yet, it is unclear whether preterm infants of mothers experiencing symptoms of PTSD following birth are at a higher risk for motor development problems. Because early mother-infant interactions are influenced by prematurity as well as maternal mental health, consideration for home interventions that stimulate infant development and encourage mother-infant relationships concurrently are important. Directed interventions may be beneficial for infant development and aid in strengthening the mother-infant relationship, potentially reducing depression and PTSD symptoms in the mother.
We have developed a Family Integrated Care (FIC) model for use in a neonatal intensive care unit (NICU) where parents provide most of the care for their infant, while nurses teach and counsel parents. The objective of this pilot prospective cohort analytic study was to explore the feasibility, safety, and potential outcomes of implementing this model in a Canadian NICU.
Infants born ≤35 weeks gestation, receiving continuous positive airway pressure or less respiratory support, with a primary caregiver willing and able to spend ≥8 hours a day with their infant were eligible. Families attended daily education sessions and were mentored at the bedside by nurses. The primary outcome was weight gain, as measured by change in z-score for weight 21 days after enrolment. For each enrolled infant, we identified two matched controls from the previous year's clinical database. Differences in weight gain between the two groups were analyzed using a linear mixed effects multivariable regression model. We also measured parental stress levels using the Parental Stress Survey: NICU, and interviewed parents and nurses regarding their experiences with FIC.
This study included 42 mothers and their infants. Of the enrolled infants, matched control data were available for 31 who completed the study. The rate of change in weight gain was significantly higher in FIC infants compared with control infants (p < 0.05). There was also a significant increase in the incidence of breastfeeding at discharge (82.1 vs. 45.5%, p < 0.05). The mean Parental Stress Survey: NICU score for FIC mothers was 3.06 ± 0.12 at enrolment, which decreased significantly to 2.30 ± 0.13 at discharge (p < 0.05). Feedback from the parents and nurses indicated that FIC was feasible and appropriately implemented.
This study suggests that the FIC model is feasible and safe in a Canadian healthcare setting and results in improved weight gain among preterm infants. In addition, this innovation has the potential to improve other short and long-term infant and family outcomes. A multi-centre randomized controlled trial is needed to further evaluate the efficacy of FIC in the Canadian context.
A mother-infant neonatal unit was established in 1979 at Tallinn Children's Hospital in Estonia to provide medical and nursing care to newborn and premature babies and their mothers. Its leading principles are 24-hour care by the mother, minimal use of technology, and little contact between the baby and medical and nursing staff. The unit was based on a conceptual model of the “psychological and biological umbilicus,”which proposes that this connection binds the mother and infant together during the early weeks of life. Separation of mother and baby disrupts this important tie and may have adverse consequences for both. This paper presents data comparing weight gain during the first 30 days of life for a group of 159 preterm and full-term infants who were admitted to the unit between 1988 and 1989. Eighty-seven infants were cared for by their mothers, and 72 by nurses because their mothers were unwilling or unable to stay with the infants in the hospital. The holistic, humanistic approach used in the unit represents a truly baby-friendly hospital.
Parental involvement in the care of preterm infants in NICUs is becoming increasingly common, but little is known about its effect on infants' length of hospital stay and infant morbidity. Our goal was to evaluate the effect of a new model of family care (FC) in a level 2 NICU, where parents could stay 24 hours/day from admission to discharge.
A randomized, controlled trial was conducted in 2 NICUs (both level 2), including a standard care (SC) ward and an FC ward, where parents could stay from infant admission to discharge. In total, 366 infants born before 37\raisebox{1ex}{0}\!\left/ \!\raisebox{-1ex}{7}\right. weeks of gestation were randomly assigned to FC or SC on admission. The primary outcome was total length of hospital stay, and the secondary outcome was short-term infant morbidity. The analyses were adjusted for maternal ethnic background, gestational age, and hospital site.
Total length of hospital stay was reduced by 5.3 days: from a mean of 32.8 days (95% confidence interval [CI]: 29.6-35.9) in SC to 27.4 days (95% CI: 23.2-31.7) in FC (P = .05). This difference was mainly related to the period of intensive care. No statistical differences were observed in infant morbidity, except for a reduced risk of moderate-to-severe bronchopulmonary dysplasia: 1.6% in the FC group compared with 6.0% in the SC group (adjusted odds ratio: 0.18 [95% CI: 0.04-0.8]).
Providing facilities for parents to stay in the neonatal unit from admission to discharge may reduce the total length of stay for infants born prematurely. The reduced risk of moderate-to-severe bronchopulmonary dysplasia needs additional investigation.
'Mother is the best nurse' and 'Breast milk is the best milk', have remained mere slogans in the field of neonatal intensive care. The mother's nursing ability is often underestimated and deficiencies of human milk are overemphasized when it comes to the care of a low birth weight baby. We have utilized the mother's milk and nursing skills in the care of high-risk neonates with satisfactory results.
The reported influences on the bonding phenomenon and attendant controversies in affluent societies regarding the importance of mother-infant interaction are reviewed. In the 3rd world countries where the concept of a mother with a high risk infant is not new an extension of the hospital neonatal special care unit (NSCU) in which mothers stay with high risk infants has been reserved for years. Some advantages of the NSCU maternal extension include more personal attention and emotional support as well as the method of supplying human milk to the high risk around the clock. The main identified advantage relate to non-emotional aspects namely maternal education on the care of the infant provision of human milk and promotion of breastfeeding as well as aid to inadequate healt staff. However inadvertant entry of mothers with major infections may result in problems in babies. Maintenance of cleanliness may be hampered. 7 brief guidelines are given regarding the practical organization of the maternal extension of the NSCU. The need to establish early mother-infant interaction is indisputable even on a worldwide basis. The influencing factors priorities for intervention and short and long-term outcome and benefits however may vary in advanced industrialized centers and in developing countries.
To evaluate the outcome of active involvement of mothers/mother substitutes in day-to-day care of high risk neonates admitted in a level II newborn care unit.
An observational study was carried out over a period of eleven years incorporating active participation of mothers/substitute in the day to day care of their sick neonates. The outcome is assessed in terms of mortality due to the three major illnesses (asphyxia, sepsis and prematurity) during this phase. The data is compared with that of a similar level II care centre where conventional neonatal care is practised.
There is a significant and sustainable reduction in neonatal mortality due to the three major illnesses when the mothers are also involved in the neonatal care, in spite of a considerable increase in the number of admissions during this period.
The concept of active participation of mother/substitute in neonatal nursery ensures 1:1 care at all times. It is a cheap and effective alternative to inadequacy of bed:nurse ratio (BNR).
Background
Despite evidence suggesting that parent involvement was beneficial for infant and parent outcomes, the Family Integrated Care (FICare) programme was one of the first pragmatic approaches to enable parents to become primary caregivers in the neonatal intensive care unit (NICU). We aimed to analyse the effect of FICare on infant and parent outcomes, safety, and resource use.
Methods
In this multicentre, cluster-randomised controlled trial, we stratified 26 tertiary NICUs from Canada, Australia, and New Zealand by country and size, and assigned them, using a computer-generated random allocation sequence, to provide FICare or standard NICU care. Eligible infants were born at 33 weeks' gestation or earlier, and had no or low-level respiratory support; parents gave written informed consent for enrolment. To be eligible, parents in the FICare group had to commit to be present for at least 6 h a day, attend educational sessions, and actively care for their infant. The primary outcome, analysed at the individual level, was infant weight gain at day 21 after enrolment. Secondary outcomes were weight gain velocity, high frequency breastfeeding (≥6 times a day) at hospital discharge, parental stress and anxiety at enrolment and day 21, NICU mortality and major neonatal morbidities, safety, and resource use (including duration of oxygen therapy and hospital stay). This trial is registered with ClinicalTrials.gov, number NCT01852695.
Findings
From Oct 1, 2012, 26 sites were randomly assigned to provide FICare (n=14) or standard care (n=12). One site assigned to FICare discontinued because of poor site enrolment. Parents and infants were enrolled between April 1, 2013, and Aug 31, 2015, with 895 infants being eligible in the FICare group and 891 in the standard care group. At day 21, weight gain was greater in the FICare group than in the standard care group (mean change in Z scores 1·58 [SD 0·51] vs 1·45 [0·49]; p<0·0001). Average daily weight gain was significantly higher in infants receiving FICare than those receiving standard care (mean daily weight gain 26·7 g [SD 9·4] vs 24·8 g [9·5]; p<0·0001). The high-frequency exclusive breastmilk feeding rate at discharge was higher for infants in the FICare group (279 [70%] of 396) than those in the standard care group (394 [63%] of 624; p=0·016). At day 21, parents in the FICare group had lower mean stress scores than did parents in the standard care group (2·3 [SD 0·8] vs 2·5 [0·8]; p<0·00043), and lower mean anxiety scores (70·8 [20·1] vs 74·2 [19·9]; p=0·0045). There were no significant differences between groups in the rates of the secondary outcomes of mortality, major morbidity, duration of oxygen therapy, and duration of hospital stay. Although the safety assessment was not completed, there were no adverse events.
Interpretation
FICare improved infant weight gain, decreased parent stress and anxiety, and increased high-frequency exclusive breastmilk feeding at discharge, which together suggest that FICare is an important advancement in neonatal care. Further research is required to examine if these results translate into better long-term outcomes for families.
Funding
Canadian Institutes of Health Research Partnerships for Health System Improvement, and Ontario Ministry of Health and Long-Term Care.
Parent education is one of the main "pillars" of Family Integrated Care (FIC); therefore it was considered central point in our Integrated Family Delivered Care (IFDC) programme. If parents are to be enabled, empowered to be "experts" in their baby's care and participate in the care team as equal partners, they will need to receive consistent and high quality information as well as a supportive education programme that has been tailored to meet their needs under their special circumstances in the neonatal unit. As part of the IFDC project, a complex experience co-designed training material was created which consist of several different learning opportunities from chapters in the mobile app, to one-to-one training, competency assessments and small group teaching based on a rolling weekly programme.
Clinical care of infants with a very low birth weight (less than 1500 g) in developing countries can be labour intensive and is often associated with a prolonged stay in hospital. The Aga Khan University Medical Center in Karachi, Pakistan, established a neonatal intensive care unit in 1987. By 1993-4, very low birthweight infants remained in hospital for 18-21 days.
A stepdown unit was established in September 1994, with mothers providing all basic nursing care for their infants before being discharged under supervision.
We analysed neonatal outcomes for the time periods before and after the stepdown unit was created (1987-94 and 1995-2001). We compared these two time periods for survival after birth until discharge, morbidity patterns during hospitalisation, length of stay in hospital, and readmission rates to hospital in the four weeks after discharge.
Of 509 consecutive, very low birthweight infants, 494 (97%) preterm and 140 (28%) weighing < 1000 g at birth), 391 (76%) survived to discharge from the hospital. The length of hospitalisation fell significantly from 1987-90, when it was 34 (SD 18) days, to 16 (SD 14) days in 1999-2001 (P < 0.001). Readmission rates to hospital did not rise, nor did adverse outcomes at 12 months of age.
Our results indicate that it is possible to involve mothers in the active care of their very low birthweight infants before discharge. This may translate into earlier discharge from hospital to home settings without any increase in short term complications and readmissions.
Venepuncture-related blood loss is a common cause of neonatal anemia. Currently, this is the only way to obtain hemoglobin levels. This causes distress for the infant but can also lead to the need for blood transfusions. Recently, a new technique for measuring hemoglobin levels non-invasively has been developed to reduce iatrogenic blood loss and pain.
To compare hemoglobin levels obtained using a transcutaneous spectroscopic device (Mediscan 2000, MBR Optical Systems, Wuppertal, Germany) with venous or capillary blood samples in neonates. Methods: Single-center prospective cohort study of term and preterm infants. The white light spectroscopic device was placed on the forearm for 60 s to measure hemoglobin content within 4 h of venous or capillary blood sampling. Pain reactions of the infants were assessed by using a neonatal pain assessment tool. Results were analyzed by Bland-Altman comparison and Wilcoxon signed-rank test.
80 infants (mean gestational age 29.8 +/- 3.8 weeks, mean birth weight 1,300 +/- 690 g) were enrolled into the study. A total of 313 spectroscopic recordings within 2 h of a clinically indicated blood sample (181 capillary, 142 venous) were taken. The correlation coefficient R(2) was 0.96 for capillary/spectroscopic and 0.99 for venous/spectroscopic pairs. Pain scores were significantly less for the spectroscopic measurements (p < 0.01).
The results show good correlation between the hemoglobin blood levels and spectroscopic measurements. The slightly lower correlation coefficient for the capillary samples demonstrates a naturally higher variance in these values due to the laboratory method.
The morbidity and mortality of low birth weight babies continues to be high in developing countries. After discharge from Special Care, their future survival depends largely on the mother's ability to feed and manage these infants. This ability is impaired when the infant's stay in hospital is prolonged for purposes of gaining weight and is undermined by frequent bouts of infection, overcrowding, understaffing, a disturbed mother-infant relationship and failure of breast-feeding. Hence mothers should be encouraged to participate in the care and feeding of infants as early as possible and once a satisfactory mother-infant relationship is established, the infants are discharged irrespective of body weight and followed up subsequently in a special clinic. This study is an analysis of the progress and outcome of such infants discharged over a period of one year. The mean weight on discharge was 1580 g with a range of 1100 to 1800 g. Our results revealed that 82 per cent came for follow up out of which 53 per cent were doing well and gaining weight rapidly while 38 per cent fared moderately and only 9 per cent did poorly requiring readmission with a 5 per cent mortality. One significant factor determining a favourable outcome was the ability of the mother to breast feed her infant.
Leading excellence in perinatal care strategy 2017-2020: British Association of Perinatal Medicine
- A Fenton
- G Menon
Fenton A, Menon G. Leading excellence in perinatal care strategy 2017-2020: British
Association of Perinatal Medicine. 2017 https://www. bapm. org/ sites/ default/ files/
files/ BAPM% 20Strategy% 202017-2020. pdf.
Development and implementation of an integrated family delivered neonatal care model including a parent support mobile app
- J Banerjee
- Aloysius A Platonos
Banerjee J, Aloysius A, Platonos K, et al. Development and implementation of
an integrated family delivered neonatal care model including a parent support
mobile app. In: Selected abstracts of the 2nd Congress of Joint European Neonatal
Societies (jENS 2017);
Session "Quality Improvement, Parent centred care
October 31-November 4, 2017; Session
"Quality Improvement, Parent centred care.". J Pediatr Neonat Individual Med
2017;6:e060248.
National Neonatal Audit Programme 2017 Annual Report on 2016 data. Royal College of Paediatrics and Child Health on behalf of the MAP project board
- A Greenough
Greenough A, et al. National Neonatal Audit Programme 2017 Annual Report on
2016 data. Royal College of Paediatrics and Child Health on behalf of the MAP
project board; 2018.
British association of perinatal medicine: categories of care
- E Draper
Draper E. British association of perinatal medicine: categories of care 2011, 2011.