A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit.

BACKGROUND: We have developed a Family Integrated Care (FIC) model for use in a neonatal intensive care unit (NICU) where parents provide most of the care for their infant, while nurses teach and counsel parents. The objective of this pilot prospective cohort analytic study was to explore the feasibility, safety, and potential outcomes of implementing this model in a Canadian NICU. METHODS: Infants born ≤ 35 weeks gestation, receiving continuous positive airway pressure or less respiratory support, with a primary caregiver willing and able to spend ≥ 8 hours a day with their infant were eligible. Families attended daily education sessions and were mentored at the bedside by nurses. The primary outcome was weight gain, as measured by change in z-score for weight 21 days after enrolment. For each enrolled infant, we identified two matched controls from the previous year's clinical database. Differences in weight gain between the two groups were analyzed using a linear mixed effects multivariable regression model. We also measured parental stress levels using the Parental Stress Survey: NICU, and interviewed parents and nurses regarding their experiences with FIC. RESULTS: This study included 42 mothers and their infants. Of the enrolled infants, matched control data were available for 31 who completed the study. The rate of change in weight gain was significantly higher in FIC infants compared with control infants (p < 0.05). There was also a significant increase in the incidence of breastfeeding at discharge (82.1 vs. 45.5%, p < 0.05). The mean Parental Stress Survey: NICU score for FIC mothers was 3.06 ± 0.12 at enrolment, which decreased significantly to 2.30 ± 0.13 at discharge (p < 0.05). Feedback from the parents and nurses indicated that FIC was feasible and appropriately implemented. CONCLUSIONS: This study suggests that the FIC model is feasible and safe in a Canadian healthcare setting and results in improved weight gain among preterm infants. In addition, this innovation has the potential to improve other short and long-term infant and family outcomes. A multi-centre randomized controlled trial is needed to further evaluate the efficacy of FIC in the Canadian context.

Implementing family-integrated care in the NICU: educating nurses.

The purpose of this study was to develop, implement, and evaluate a nursing education program to support family-integrated care in a Canadian neonatal intensive care unit (NICU). A total of 44 nurses volunteered to take part in the family-integrated care program, 35 of whom received additional education in the form of a 4-hour workshop. Of the 35 nurses who attended, 21 were interviewed regarding the impact and content of the workshop. The study design included the development, implementation, and qualitative assessment of the nursing education component of a family-integrated care program. The multidisciplinary program team conducted a literature review and then designed and conducted a survey to assess the educational requirements of nurses regarding family-integrated care. A nursing workshop was then developed on the basis of the literature review, staff survey responses, and discussions with staff and parents who had experienced having an infant in the NICU. Six months into the program, the contribution of the nursing workshop content to nurses' participation in the family-integrated care program was evaluated using individual structured interviews. Nurses who were interviewed described the workshop as valuable and reported that the information provided on nursing versus parental responsibilities in infant care, the parent experience in the NICU, and developmental care strategies was the most useful. Interviewees also identified the need for ongoing staff mentoring to maximize their ability to facilitate family-integrated care. Specific education for nurses facilitates family-integrated care in the NICU.