Enhancing Parental Participation within the NICU

Enhancing Parental Participation within the NICU

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Family centred care (FCC) encompasses the concept of parental participation in their infants care (Franck and Callery 2004). It aims to place the needs of the infant in the context of the family (Saunders et al 2003). FCC is adopted within many neonatal units and is considered the gold standard of care aiming to underpin and guide neonatal care towards the partnership between health professionals and parents (Hutchfield 1999). Subsequent to the interruption of the bonding process between infant and family when a baby is admitted to the Neonatal Intensive Care Unit (NICU) it is suggested that the NICU provides an ideal opportunity for FCC practice (Allerman Beck et al 2009) as nurses and parents are compelled to develop an effective relationship in order to satisfy the infants care needs (Reis et al 2009). However a study by Higman & Shaw (2008) found that it appears to be more difficult to achieve on the neonatal unit as FCC is reliant on the family’s relationship with the child. In order to deliver effective FCC neonatal nurses need an understanding of parents needs and how to address them. Mundy (2010) in a study researching the assessment of family needs in neonatal Intensive Care Units found that assumptions of parent’s needs were often made by healthcare professional’s resulting in unfounded and inappropriate conclusions. The importance of treating each family as individual is paramount when assessing how best to involve parents in the care of their infants (Higman & Shaw 2008). Review of the literature shows a lack of research into these assessments and highlights that enhancing family centred care requires appropriate assessments of family needs and the incorporation of this into individualised plans of care. A study into nurse’s perceptions about the delivery of FCC by Higman and Shaw (2010) supports this view, throughout the study it is apparent that although nurses realise the importance of FCC it is not always consistent within their own practice. Peterson et al (2004) suggests reasons for these inconsistencies could be the deficiency of adequate training and, the stress implementing FCC can impose on nursing staff due to an already demanding workload, potentially creating negative attitudes towards the relevance and practicalities of its delivery. The consensus view of FCC is positive although limitations to its execution are manifested throughout the literature. Staff shortages are suggested to hinder the performance of FCC within the clinical area, creating time constraints with nurses having very little opportunity to build good relationships with the families (Higman and Shaw 2008).

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Carter (2008) and Lambert (2009) both argue that nurses rather than accepting FCC as the gold standard of best practice (Hutchfield 1999) should be questioning what it actually means in relation to their nursing practice and interactions with parents. Higman and Shaw’s (2008) study further highlighted that nurses generally relied heavily on nursing experience rather than research to guide their practice. Only a small sample size was used within this study which raises difficulties regarding generalisation to other welsh and UK neonatal units. Cisneros Moore et al (2003) a study which incorporated benchmarking, self analysis and review of the literature established FCC was more superior in units where parents were viewed as an integral part in their children’s care (Stinson and Stinson 1983). Acknowledging parents as primary care givers rather than visitors to infants (Cisneros Moore et al 2003) is viewed with great importance and supported by research from Griffin (2003), Franck and Spencer (2003) and Fenwick et al (2008a), although many neonatal units claim to adopt open visiting policies to parents, many are asked to leave for medical ward rounds, nursing report, admissions and emergency situations. Adhering to patient confidentiality guidelines is often used as justification when requesting parents leave the unit however this can significantly restrict the amount of time parents are able to spend with their infant. (Griffin 2003) recognises the importance of nurses finding innovative ways around the problems of visiting policies that are flexible, meet the needs of parents and contribute to opportunities for them to participate in their infant’s care so that FCC can work effectively.
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