Promoting Family and Siblings' Adaptation Following a Preterm Birth: A Quality Improvement Project of a Family-Centered Care Nursing Educational Intervention

Characteristics of intervention studies on family-centred care in neonatal intensive care units: a scoping review of randomised controlled trials

BACKGROUND

Different definitions of family-centred care (FCC) exist in the newborn setting, and many FCC interventions have been tested, while a comprehensive review synthesising characteristics of existing intervention studies is still lacking.

OBJECTIVE

This review aims at summarising the characteristics of randomised controlled trials (RCTs) on FCC interventions in neonatal intensive care units.

METHODS

We searched PubMed, Embase, Web of Science and the Cochrane Library up to 31 January 2022, and reference lists of included studies and other reviews. Interventions were grouped into five categories according to a previous Cochrane review: (1) family support, (2) educational, (3) communication, (4) environmental interventions and (5) family-centred policies. Subgroup analyses by time period (RCTs published before vs after 2016) and by country income (based on the World Bank Classification) were conducted.

RESULTS

Out of 6583 retrieved studies, 146 RCTs met the eligibility criteria, with 53 (36.3%) RCTs published after 2016. Overall, 118 (80.8%) RCTs were conducted in high-income countries, 28 (19.1%) in middle-income countries and none in low-income countries. Only two RCTs were multicountry. Although mothers were the most frequent caregiver involved, fathers were included in 41 RCTs (28.1%). Very few studies were conducted in at-term babies (nine RCTs); siblings (two RCTs) and other family members (two RCTs), maternity care units (two RCTs). The role of health professionals was unclear in 65 (44.5%) RCTs. A large variety of intervention combinations was tested, with 52 (35.6%) RCTs testing more than 1 category of interventions, and 24 (16.4%) RCTs including all 5 categories.

CONCLUSION

There is a large and rising number of RCTs on FCC interventions in neonatal intensive care units, with specific research gaps. The large variety of FCC interventions, their high complexity, the need to tailor them to the local context and major gaps in implementation suggest that implementation research is the current priority.

Effectiveness and family experiences of interventions promoting partnerships between families and pediatric and neonatal intensive care units: a mixed methods systematic review

OBJECTIVE

The objective of this mixed methods review was to examine the effectiveness and family experiences of interventions promoting partnerships between families and the multidisciplinary health care team in pediatric and neonatal intensive care units.

INTRODUCTION

Hospitalization of infants and children in neonatal intensive care units and pediatric intensive care units has a significant effect on their families, including increased stress, anxiety, and depression. Available evidence syntheses focused on specific family-centered care, but not on partnership, which is another aspect that may improve families' outcomes and experiences.

INCLUSION CRITERIA

This review considered studies that focused on effectiveness or family experiences of interventions by health professionals in partnership with families of infants or children hospitalized in an intensive care unit. For the quantitative component of the review, the type of intervention was a partnership between the health care team and the family, and focused on outcomes of stress, anxiety, depression, quality of life, attachment, or satisfaction with family-centered care. For the qualitative component, the phenomenon of interest was family experiences of interventions that included collaboration and partnering with the health care team in the pediatric or neonatal intensive care unit. Quantitative, qualitative, and mixed methods studies, published from 2000 to August 2022 in English or French, were eligible for inclusion.

METHODS

The JBI methodology for convergent segregated mixed methods systematic reviews was followed using the standardized JBI critical appraisal and data extraction tools. Ten databases were searched in December 2019 and again in August 2022. Study selection, critical appraisal, and data extraction were performed by 2 reviewers independently. Findings of quantitative studies were statistically pooled through meta-analysis and those that could not be pooled were reported narratively. Qualitative studies were pooled through meta-synthesis.

RESULTS

This review included 6 qualitative and 42 quantitative studies. The methodological quality varied, and all studies were included regardless of methodological quality. Meta-analyses showed improvements in anxiety, satisfaction with family-centered care, and stress, yet no conclusive effects in attachment and depression. These results should be interpreted with caution due to high heterogeneity. Qualitative analysis resulted in 2 synthesized findings: "Interventions that incorporate partnerships between families and the health care team can improve the family's experience and capacity to care for the child" and "Having a child in intensive care can be an experience of significant impact for families." Integration of quantitative and qualitative evidence revealed some congruence between findings; however, the paucity of qualitative evidence minimized the depth of this integration.

CONCLUSIONS

Partnership interventions can have a positive impact on parents of children in intensive care units, with improvements reported in stress, anxiety, and satisfaction with family-centered care.

REVIEW REGISTRATION

PROSPERO CRD42019137834.

SUPPLEMENTAL DIGITAL CONTENT

A Chinese-language version of the abstract of this review is available at http://links.lww.com/SRX/A50 . A French-language version of the abstract of this review is available at http://links.lww.com/SRX/A51 .

Improving the Implementation of Family-Centered Care Within the Neonatal Care Unit: Empowering Parents to Participate in Infant Care

BACKGROUND

Internationally, approximately 15 million babies are born prematurely every year. In New Zealand, 1 neonatal ward may care for 1000 infants annually. Family-centered care (FCC) is a philosophy used in neonates to enhance positive outcomes for infants, parents, and staff by recognizing the strengths and needs of infants and their families.

OBJECTIVE

This research assessed how a neonatal environment could be improved to ensure parents feel welcomed and empowered to participate in their infant's care.

PARTICIPANTS

Survey data from 67 health professionals and 51 parents of infants who received neonatal care for more than 7 days. Four in-depth interviews with parents and 5 with health professionals.

METHODS

A mixed-methods research design was used. Phase 1 collected quantitative data using the Family-Centered Care Questionnaire. Phase 2 composed of face-to-face interviews with health professionals and parents.

RESULTS

Implementing FCC practices to improve health outcomes for infants, parents, and staff is important. Recommendations for improvement were formulated from the themes.

CONCLUSION

The perspectives of parents and health professionals have enabled the development of recommendations to improve the implementation of FCC practice in the neonatal environment. These may lead to better parental experience and improved infant health outcomes.

Comprehensive and Innovative Clinical Tools for Nurses and Parents to Help Promote Family and Sibling Adaptation in the NICU

Family-centered care (FCC) in NICUs aims to support parents and children facing the distressing experience of a preterm infant's NICU hospitalization. Neonatal nurses must also have proper knowledge of the support interventions for parents' and siblings' adaptation during the NICU hospitalization. This paper describes comprehensive and innovative clinical tools which consist of a clinical reference guide for nurses, a website for parents, and a storybook for siblings to promote families' adaptation, and help parents support their older children during NICU hospitalization. Based on scientific evidence and the family systems nursing approach, these comprehensive and innovative clinical tools for nurses, parents, and siblings contribute, through their development and implementation, to enhancing FCC and the quality of nursing care to families.