How to Implement Family-Integrated Care

 

If you have followed this topic for the last few months, you may still be skeptical of the idea of family-integrated care (FIC). You may be asking yourself how practical it is to implement such a change in practice and culture. You may be saying, “A parent could not do what we do.” Or, you may be really excited about trying this out or implementing this concept into your unit.

You may, as I did, have a laundry list of questions rolling through your mind about the steps to take to begin this journey. Well, put your worries aside. There is some guidance to help us integrate this concept into practice.

Creating a family-integrated care team

First things first, as with any process improvement project or practice change initiative, it is important to assemble a multidisciplinary team to ensure that all levels are included in the implementation.

In addition to the hospital team, it would be essential to include past NICU families in this conversation. That may be current families, former patient’s families, a family counsel, or even a mix of these. The family is an essential part in this change. They can provide valuable insight on their experiences and how they can be a more integral part of the care of their baby.

Ready for work

Once the team is assembled, the work can begin.

Understanding the temperature of the unit culture related to this initiative will help to design the steps taken to implementation. Coming to agreement on how the family will be integrated into the care team and what tasks they can participate in, as well as how the nursing staff will coach and support, would be the next steps to take. Additionally, deciding which tasks should be completed only by the nursing staff would be important.  Agreeing on these standards of care will help everyone work successfully within the team.

I have learned in my career that education is the key to success. Understanding the who, what, where, why, and when is vital to any change that is implemented in the NICU. Developing an educational program for the unit staff will aide developing a supportive culture.

Fortunately, there are wonderful programs already assembled, including the article written by Galarza-Winton et al (2013),1 that discusses this very topic. In addition, there is a lovely program developed by Dr. Sue Hall (www.mynicunetwork.com), and sponsored by Medela, that covers all aspects of providing comprehensive psychosocial support to NICU families and the staff caring for them. These resources will help build a supportive culture.

Lastly, we have all seen a parent walk into the NICU and be completely overcome with the magnitude of their situation. How many of us have done all the discharge teaching for a family on the day the baby goes home? Then we send them out and see the overwhelmed glaze on their faces.

That is one of the advantages in a FIC environment. We have an opportunity to educate, coach, support, and mentor NICU families, to help them feel very prepared to provide daily care in the hospital and to feel more confident when taking their baby home.

When considering an FIC environment, an education program for families should be discussed. There is an article written by Bracht, et al (2013)2 that talks in depth about an education program for the families involved in this type of care. The article discusses the evidence behind this model, as well as timing and curriculum information.  I enjoyed reading this article as it opened my mind to how we can achieve this paradigm, regardless of our demographics or culture.

5 steps for family-integrated care

Let’s review the steps to implementing a family-integrated care culture:

1. Create a family-integrated care team
2. Outline the family-integrated care team responsibilities and tasks
3. Plan how nursing staff will coach and support
4. Decide which tasks will be completed by nursing staff only
5. Prepare an education program for families

Family-integrated care is helping us to bring family centered care to a new level. As the studies show, there are positive outcomes to implementing this concept of care.

Wherever you are in this journey, I applaud you for entertaining the concept. I encourage you to continue to marinate on this cutting edge idea, and ask that you continue to be aware of how your unit can embrace a more family-integrated approach.

Has your unit taken steps to adopt family-integrated care? What worked best for you to help make it successful? Tell us in the comments below!

 

References:

1. Galarza-Winton, M., Dicky, T., O’Leary, L. et al. (2013). Implementing Family-Integrated Care in the NICU:  Educating Nurses. Advances in Neonatal Care. 13:5. 335-340.
2. Bracht, M., O’Leary, L., Lee, S. et al. (2013). Implementing Family-Integrated Care in the NICU: A Parent Education and Support Program.  Advances in Neonatal Care. 13:2. 115-126
3. O’Brien, K, Bracht, M., Macdonell, K., et al. (2013). A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit. BMC Pregnancy & Childbirth. 13:S12.
4. D’Agata, A., McGrath, J. (2016). A Framework of Complex Adaptive Systems:  Parents as Partners in the Neonatal Intensive Care Unit.  Advances in Nursing Science.  39:3. 244-256.