Implementing Family-Centered Care in the Neonatal Intensive Care Unit - A Quality Improvement Initiative

Infant and Family Outcomes and Experiences Related to Family-Centered Care Interventions in the NICU: A Systematic Review

BACKGROUND/OBJECTIVES

Family-centered care (FCC) has been promoted as a model of care in neonatal intensive care units (NICU) for decades. We aimed to synthesize recent evidence about infant and parent outcomes and experiences of FCC interventions in the NICU.

METHODS

Studies were identified through searches of PubMed, CINAHL, Embase, PsycInfo, and Web of Science (2019-2024). We systematically reviewed English language research from peer-reviewed journals. We excluded studies about Family-Integrated Care and Close Collaboration with Parents to avoid redundancy with other recent reviews.

RESULTS

Twenty studies evaluated 19 FCC interventions compared with regular NICU care for a total of 3502 parents/primary caregivers of infants in NICUs in 11 countries. The designs were quantitative (n = 16), qualitative (n = 3), and mixed methods (n = 1). Significant improvements in infant outcomes included feeding (n = 3), weight (n = 1), and length of stay (n = 1). There were no worsened infant outcomes. Significant improvements in parent outcomes included participation, experience, satisfaction, and parent mental health. Two studies had mixed results for parent outcomes, with minimal worsened outcomes. Qualitative findings were also mostly positive.

CONCLUSIONS

Recent research shows positive infant and family outcomes with a range of FCC interventions in the NICU. However, more RCTs comparing interventions and using similar validated outcome measures are needed.

Factors affecting family-centered care practice by nurses: A systematic review

PURPOSE

This study presents a systematic review of the obstacles to and enablers of family-centered care (FCC) implementation by nurses. FCC, which has demonstrated beneficial outcomes, is regarded as a crucial quality measure in certain pediatric units. However, not all nurses incorporate FCC into their practice.

DESIGN AND METHODS

A systematic review was conducted from January to June 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various medical subject heading keywords and terms were used to search electronic databases, with the aim of synthesizing and evaluating the results.

RESULTS

Twenty-three articles were identified for review. Most of these studies were carried out in Western countries. They revealed several facilitators and obstacles to FCC implementation by nurses when caring for sick children. Some of these factors are linked to the personal attributes of the nurses, while others are associated with the characteristics of the families and the healthcare system itself.

CONCLUSION

Nurses face multi-level barriers that hinder their ability to implement FCC practice. This systematic review identifies the need to leverage nurses' attributes, foster effective nurse-client relationships, and promote organizational changes.

PRACTICE IMPLICATIONS

Nurses need to comprehend and work toward altering the factors that influence the delivery of FCC. The findings of this review can be used by healthcare organization leaders and policymakers to customize interventions and allocate resources to promote FCC practice. Further research in diverse cultural contexts is needed to examine the cause-and-effect relationship concerning the influence of the identified barriers and facilitators on FCC practice. In addition, experimental studies are required to evaluate the effectiveness of evidence-based interventions on FCC practice by nurses.

Nurses' practices of children and family-centered care for chronically ill children: A cross-sectional study

PURPOSE

There is limited evidence of children and family-centered care (CFCC) practice in different cultural contexts, particularly regarding the factors that predict it among nurses providing care to chronically ill children. Also, the CFCC's impact on the quality of care has not been well studied. This study aimed to test a hypothesized model in which nurses' attributes and care environments predict CFCC, thereby increasing the quality of nursing care.

DESIGN AND METHODS

A multicenter cross-sectional study recruited a convenience sample of 405 nurses caring for chronically ill children in Saudi Arabia for an online survey between February 2023 and August 2023. Structural Equation Modeling evaluated the hypothesized model.

RESULTS

The hypothesized model fits the data based on the fit indices. Care environment affected CFCC (β = 0.831, p = .000), while nursing attributes only indirectly affected CFCC practices through the mediating effect of the work environment (β = 0.553, p = .000). The CFCC practices positively affect the quality of nursing care (β = 0.636, p = .000).

CONCLUSIONS

Nursing attributes impact the work environment, which affects the practice of CFCC and enhances the quality of care for chronically ill children. Investing in nurses' attributes and a positive work environment is crucial for nursing leaders to enhance CFCC practice and the quality of care.

PRACTICAL IMPLICATIONS

The findings of this study can be used to shape policies and develop interventions to improve nursing CFCC practices and promote better quality of care for chronically ill children.

Implementation of Family Centered Care for Neonates Admitted in a Special Care Baby Unit in Sierra Leone

Purpose

To assess the feasibility of implementing family centered care and the impact this would have on parental satisfaction in a special care baby unit in Sierra Leone.

Patients and Methods

A cross-sectional, mixed methods study was conducted at the Rokupa Government Hospital, Sierra Leone. 16 nursing staff of the Special Care Baby Unit and 7 caregivers of neonates admitted in the unit participated in the study. Quantitative data on feasibility was obtained from nursing staff using a five-point Likert scale administered to staff before and after implementation of family centered care in the unit. Qualitative data on perception of impact was obtained through focus group discussions for caregivers whose neonates had received family centered care and a control group who had received standard unit care. Quantitative data was analyzed using univariate analysis and thematic analysis was undertaken for qualitative data.

Results

Before implementation, most nursing staff felt implementation of family centred care was not feasible (87.5%) and more than half of nursing staff either strongly agreed or agreed with each of the negative statements regarding the practice of family centred care indicating a generally negative perception. After implementation there was improvement in nursing staff perception of family centred care, however the majority still doubted the continued feasibility of this practice (68.8%). Qualitative discussions with caregivers demonstrated that caregivers whose babies received family centered care were less distressed and more satisfied during the period of admission than those who received routine care.

Conclusion

Family centered care improved the experiences of caregivers in the unit. Nursing staff also demonstrated a better understanding of the benefits of family centered care after it was implemented. Concerns regarding understaffing and the unit being too small to accommodate caregivers and staff at the same time need to be addressed. There is need to integrate family centered care into hospital policy.

Effect of family-centred care on parental mental health and parent-infant interactions for preterm infants: a systematic review protocol

INTRODUCTION

Unexpected premature delivery and separation from preterm infants are common problems that parents of preterm infants must handle with. Parents of preterm infants may suffer from severe psychological distress. Family-centred care (FCC) can effectively ease parents' psychological distress and strengthen connections between parents and their preterm infants. The purpose of this systematic review will be to systematically review and evaluate the impacts of FCC interventions on the mental health of parents of preterm infants and the parent-infant relationship.

METHODS AND ANALYSIS

This protocol for this systematic review will be conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol. We will search databases including PubMed, Embase, The Cochrane Library, CINAHL, Web of Science, PsycINFO, Scopus and ProQuest, CNKI, SinoMed and Wanfang Data from 1 July 2012 to 1 July 2022. An additional search of OpenGrey will be conducted to identify grey literature. Randomised controlled trials related to FCC inventions for preterm infants≤37 weeks' gestational age and their parents will be included, and the outcome measures will be parental mental health and parent-infant interaction. Two reviewers will independently conduct title and abstract screening, full-text screening, data extraction and study quality assessment. Risk of bias for the studies will be evaluated using the Cochrane Collaboration Risk of Bias V.2.0. Any disagreements will be solved by a third reviewer to reach a consensus. If appropriate, a meta-analysis will be conducted to assess the effect of FCC on parental mental health and parent-infant relationship.

ETHICS AND DISSEMINATION

Research ethics approval will not be required for this review since it will not involve the collection of primary data and will only use published literature. The results will be disseminated in a peer-reviewed journal through publication or by presentation at relevant academic conference.

PROSPERO REGISTRATION NUMBER

CRD42022299203.