Overhauling Family-Centered Care

It was a long time ago when I first stepped foot into a NICU.

In my nursing school program, we did not have a rotation in the NICU because the closest one was 80 miles away. When I was fortunate enough to get a job as a new graduate nurse in this particular NICU, I felt like I had hit the jackpot.

I learned quickly and easily to care for those infants. My transition to the new world was seamless, and I knew I was home. However, those little bundles of joy came with parents, grandparents, and family that I wasn’t quite sure how to work with. I was a young, single woman with little frame of reference to support the families of the tiny patients I was caring for. I felt ill equipped for that part of my job, and my preceptors also struggled in some moments.

I venture to say many of you felt the same way. We struggled and learned over time how to interact with the families we cared for in a multitude of situations. We learned how to listen, support, and empower as we cared for each patient.

And now, a long way into my career, I will say that part of my job became my passion. It provided some of the most rewarding moments and gave me a more holistic perspective of the work we do.

I was fortunate to “grow up” in a NICU that valued parent interaction. Thankfully, to overcome our trepidation, we were taught appropriate techniques to integrate the family in the care we were providing.  As well, we were given the family perspective on dealing with the NICU environment.

In our unit, the family became paramount to the work we did, and they were encouraged to participate in any capacity they wanted. As I continued along my career, I encountered NICUs that were not as forward thinking, and some that were initially closed off to that idea.

Family-centered to “family integrated”

Among the general NICU culture, it is widely agreed that we should provide “family-centered care.” But as I experienced, the guidelines of that practice vary on a broad spectrum of parental involvement, nursing acceptance, and implementation of that belief.

As well, the practice is fairly restrictive to the family. It puts them in a supportive role, and often, they are asking permission to care for their own baby. The theory and heart behind family-centered care is a good one.

Essentially, family-centered care is all about parent-infant interaction. However, family integrated care involves (guided) parental involvement in almost all care of the infant, with the exception of advanced medical care.

So, what if we gave it a little tweak, a little adjustment, and opened our minds to a family integrated care model? What if we, as NICU caregivers, empowered our families to provide the majority of the care for their baby?

What if we treated the NICU environment as a home away from home, and created a safe space for parents to fully learn how to care for their preemie? Would they have better outcomes?

The answer is yes.

Now, don’t misunderstand me. There are tasks that must be completed by a healthcare professional.  There is still nursing care required. I would, however, challenge all of us to reconsider what we have thought for years, and consider a different way.

I recently encountered a NICU that is embracing this concept, and their nursing and family satisfaction is extremely high. Their outcomes are wonderful, and they are proud of the culture they are building.  I was in awe at how they have redefined this model of care.

In closing

The thought of family-integrated care is not original to me. I’m merely challenging our status quo.

So, what has been published on this subject? As you can see from the reference list, there is a lot of data to support such a thought as family integrated care. And the outcomes of these studies are enough to make one think twice about this model.

In one particular study, O’Brien et al (2013) found that babies with parents participating in this care model gained more weight than the control group, had a higher incidence of breastfeeding at discharge, and the parents had lower stress levels when discharged.

Those are the kind of outcomes that make me want to think twice about changing my model of practice.

In the coming months, I will continue this discussion and share some tools that are available to help us make this change. Until then, I would love to hear your thoughts on this subject and would love to hear from those units that are using this model for care. Share your comments below!

 

REFERENCES:

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.

Broom, M., Parsons, G., Carlisle, H., et al. (2017). Exploring Parental and Staff Perceptions of the Family-Integrated Care Model:  A Qualitative Focus Group Study.  Advances in Neonatal Care. 17:6. E12-E19.

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.

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.

Hall, S., Cross, J., Selix, NW., et al. (2015). Recommendations for enhancing psychosocial support of NICU parents through staff education and support.  Journal of Perinatology. 35. S29-36

Macdonell, K., Christie, K., Robson, K., et al. (2013). Implementing Family-Integrated Care in the NICU: Engaging Veteran Parents in Program Design and Delivery.  Advances in Neonatal Care. 13:4. 262-269

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.

O’Brien, K., Bracht, M., Robson, K., et al. (2016). Evaluation of the Family Integrated Care model of neonatal intensive care:  a cluster randomized controlled trial in Canada and Australia. BMC Pediatrics. 15:210.