Family Centered Care in the NICU

Roughly 12.5% of all babies born in the United States each year are premature (Archibald, 2006). That is a about half a million children being born before the 37th week of gestation is complete.

While in the hospital, new parents need an advocate. That advocate can be the registered nurse. The role of the RN is that of a care provider for the neonate. However, it is also one of an educator and facilitator of communication for the needs of the family. Too often families are made to feel like visitors in special areas of the hospital like the NICU (neonatal intensive care unit). By implementing the three strategies of incorporating a family centered care plan, unrestricted access to the child and treatment participation, and developing good communication skills with full information sharing, the RN can help the families become contributors, rather than spectators, in the care of their neonate.
When a newborn and parents are separated, the necessary bonding time is greatly diminished. According to Wong (2006), infants begin to develop a sense of trust as they learn the feel, sound, and smell of their parents. When their parents are gone, the neonate must learn to trust the nurses. However, the nurse is also associated with pain as well as comfort. It is important for the parents to be enveloped in the care of their child so that the neonate does not begin to associate pain with their care provider. During this time, the parents also discover the personality of their infant and how to recognize their needs by the behavioral cues displayed. When their time is limited in the NICU, the personalities go undiscovered and these cues go unlearned. When the previously mentioned strategies are put into practice, these developmental tasks can be completed successfully.
The first strategy is to create a family centered care plan (FCC). By incorporating family centered care into the unit, those stresses can be alleviated tremendously. FCC is creating a partnership between the parents and the hospital staff. There are four main concepts to FCC. They are dignity and respect, information sharing, family participation, and family collaboration (Cisneros, 2003). Though implementing family centered care can be difficult, it brings positive outcomes for both the family and the child. There is not a single way that all neonatal units must operate their family centered care. Each location is different depending on the needs of the staff and patients. The facility begins with a vision and a philosophy. It is suggested that the staff in the neonatal unit participate in developing these documents. Sharing of ideas and reviewing all feedback allows for a clear and well developed vision to emerge. Families are also an integral part of developing FCC. Those who have the experience of having a child in the neonatal intensive care unit are a valuable resource to consult when making changes to the program.
The second strategy is finding ways to involve parents in the care of their child. Parents are no longer seen as visitors but as critical components in the care plan of the child. Unlimited access to their baby at any time of the day is essential. It is important for the parents to be able to be there to comfort their child and learn ways to ease their tensions and pain. The nurse is the educator for the parents. He or she provides the information and guidance to help the parents through this difficult time. Two important areas that the nurse needs to help the mother in are kangaroo holding and breastfeeding. Kangaroo holding is skin to skin contact between mother and baby. These things are necessary, not only for the development of the infant, but also as a way for the mother and child to bond. Parents are encouraged to participate in the care of their child while they are in the NICU. Physical contact, especially kangaroo holding, has been shown to help the baby thrive as well as promote bonding between child and parent (Johnson, 2005). They show the parents how to take part in the infants care so that they may spend as much time as they wish with their baby. Many infants in the NICU have feeding problems or are unable to digest properly. The NICU nurse aids the mothers in breast and bottle feeding. The nurse takes time to show the parents how to read monitors, adjust equipment, and explain difficult medical jargon so that they are comfortable and understand clearly. Parents leave the NICU with a bond to the staff that cared for their child. Some even bring the baby back to show that they are thriving. “It’s a great reminder that the NICU isn’t a horrible place. Most babies leave here and grow into happy, healthy kids. You’d never know that they ever had a health problem” (American Baby, 2007).
The third strategy is developing good communication with the families. The largest contribution to family-centered care is the participation of the families. The NICU nurse is not only a caregiver and educator, but he or she must be an excellent communicator. As a result of being informed of every detail, the parents feel a sense of involvement and control in their decision making. By providing explanations and honest answers, the nurse helps the parents to build confidence in their abilities. Being this close allows the parents to make better decisions regarding the care of their baby and gives them the opportunity to become more connected to the child. Daily communication between the nurse, the other hospital staff, and the parents keeps the flow of family centered care moving. If the parents do not feel included in their infants care plan, then family centered care has not been achieved. “To support the philosophy of FCC, attention must be paid to teaching and supporting nurses’ communication skills, and relationship building with self, peers, and families” (Griffin, 2006).
While taking care of the half a million children born prematurely each year, the role of the RN is that of a care provider for the neonate and an educator and facilitator of communication for the needs of the family. The purpose of FCC is to provide the parents with a greater role in the care of their infant. By implementing the three strategies of incorporating a family centered care plan, unrestricted access to the child and treatment participation, and developing good communication skills with full information sharing, the RN can help the families become contributors, rather than spectators, in the care of their neonate.
Archibald, C. (2006, Mar-Apr) Job satisfaction among neonatal nurses.
Pediatric Nursing. Pitman: Vol. 32, Iss. 2, p. 162, 176-179.

Cisneros-Moore, K., Coker, K., DuBuisson, A. & Swett, B. (2003, April) Implementing potentially better practices for improving family-centered care in neonatal intensive care units: success and challenges. Pediatrics 111. Retrieved Apr. 22, 2007 from www.pediatrics.org.

Griffin, T. (2006, Jan-Mar) Family-centered care in the NICU. Journal of Perinatal & Neonatal Nursing 20. Retrieved Jan. 3, 2007 from Expanded Academic ASAP database.

Johnson-Nagorski, A. (2005, Jan-Feb) Kangaroo holding beyond the NICU. (Updates & Kidbits)(neonatal intensive care unit). Pediatric Nursing 31. Retrieved Jan. 3, 2007 from Expanded Academic ASAP database.

Special babies, special care. American Baby. Retrieved April 13th, 2007 from http://www.americanbaby.com.

Wong, D., Perry, S., Hockenberry, M., Lowdermilk, D., Wilson, D. Maternal Child Nursing Care. St. Louis: Mosby, 2006.
a. Intervention 1 –Incorporating a family-centered care plan
i. Disadvantage 1 – The family-centered care plan that the facility has adopted may not fulfill the needs of each individual family.
Unrestricted access to their infant and treatment participation only may not fulfill the emotional and psychiatric needs of the family. It takes more than just family-centered care to assist the parents. Hospitals that offered a combination of formats for support services: group support, one-to-one support, and telephone support were more effective at meeting the needs of the infant’s parents. (Hurst, 2006). The family-centered care ideology is all too often “cookie-cutter” and not adaptable to the individual family needs.
Hurst, Irene (2006). One size does not fit all: parents' evaluations of a support program in a newborn intensive care nursery. Journal of Perinatal & Neonatal Nursing, 3, 252. Retrieved February 3, 2008 from ProQuest database.
ii. Disadvantage 2 – Support groups are more effective than family-centered care.
Parents often become frustrated when they have a child in the NICU. The unknown environment and language can be overwhelming. Though family-centered care tries to alleviate these issues, it has several hang-ups. It does not leave the parents with an outlet for frustrations. Group support offered more opportunities for families to problem-solve communication issues with nursery personnel and provide information that assisted parents' involvement in their babies' care. Parent support programs offer an important mechanism to assess provider approaches to facilitate family-centered care (Hurst, 2006). By having others to talk with who are going through the same experiences, the families can become more connected and have a place to discuss their fears and concerns.
Hurst, Irene (2006). One size does not fit all: parents' evaluations of a support program in a newborn intensive care nursery. Journal of Perinatal & Neonatal Nursing, 3, 252-255. Retrieved February 3, 2008 from ProQuest database.
b. Intervention 2 –NICU nurses need to develop good communication skills and fully share care information with the family.
i. Disadvantage 1 – Years of experience and clinical work setting influenced both perceptions and practices of family-centered care.
A recent study of sixty-two licensed registered nurses looked at the level of implementation of family-centered care. It covered the necessity of family-centered care and current nurse practices. According to Peterson, Cohen, and Parsons, 2004, scores representing current nursing practice of family-centered care were significantly lower than those representing its necessity (p = .000). Nurses with 10 years or fewer of neonatal or pediatric experience scored significantly higher on both the total Necessary Scale (p = .02) and total Current Scale (p = .017) than did those with 11 years or more. Nurses who work in the NICU scored significantly lower on the total Necessary Scale (p = .013) than did nurses who work in pediatrics or PICU. Although nurses agree the identified elements of family-centered care are necessary, they do not consistently apply those elements in their everyday practice.
Peterson, M., Cohen, J., & Parsons, V. (2004). Family-centered care: do we practice what we preach?. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN., 4, 421-424. Retrieved January 31, 2008 from ProQuest database.
ii. Disadvantage 2 – The fear of the unknown and a lack in trust of the healthcare provider can lead the mother to feel trapped. Heermann, Wilson, and Wilhelm (2005) reported that mothers "struggled to mother" because nursing interactions pushed the mothers to the sidelines and left the mothers feeling unimportant in the life of their child. The power struggles between the mothers and the nurses with each trying to position herself as the 'expert' on the infant. Heermann, Wilson, and Wilhelm (2005) found that mothers attempted to negotiate partnership relationships with professional caregivers but that their actions were frequently misunderstood or unrecognized. Thus, the primary focus in this study was the mother's developing relationship with the infant and ways in which that relationship was affected by interactions with the nurses.
Heermann,J., Wilson,M., Wilhelm, P. (2005). Mothers in the NICU: outsider to partner Pediatric Nursing, 3, 176-183. Retrieved January 31, 2008 from ProQuest database.