Improving family-centered care in the neonatal intensive care unit

parents at their infant's side in the neonatal intensive care unit
Family care in neonatal intensive care units is a model that sees the infant’s family as a partner in caregiving. This approach includes family members in infant caregiving and decision making and provides support to families so they can be present and active in their infant’s care. Despite evidence that family-centered care improves infant and family outcomes, there isn’t agreement on the best way to implement it.

New research led by Linda Franck reports on the differences in current and best practices of family-centered care in NICUs and shares insights from frontline healthcare professionals working in NICUs on things that support or impede delivering family-centered care. Several key themes emerged:

  • Language translation. Staff highlighted a need for in-person, multilanguage translation. Many complained about inadequate interpreter staffing, phone interpretation as a poor substitute, and the need to translate materials for educating parents.
  • Communications between staff and families. It was difficult for families when there was a lack of timely communication about changes to their infant’s plan of care or inconsistency in what they were told.
  • Staffing and workflow. Frontline workers highlighted that their facilities didn’t have enough staff to fully deliver family-centered care. Nurses need to invest more time and have more flexibility in parent-focused activities like teaching, while they were also focused on delivering direct care to critically ill infants. They needed more support from staff providing services like social work and lactation support, especially on nights and weekends.
  • Team culture and leadership support. Staff shared comments about the need for “buy-in” and better policies to define and support family-centered care. They also needed support to prevent burnout.
  • Staff and parent education. NICU staff asked for empathy and communications training and more education regarding how to support families, where to find resources, and other topics related to family-centered care.
  • The physical environment. Issues like lack of space around infants’ bedsides for family members to be present created barriers to the best care.

It’s essential for NICUs to assess their own family-centered care practices, including strengths, weaknesses, resources and gaps. The healthcare professionals interviewed offered actionable recommendations for improvements. They noted that family-centered care in the NICU requires greater investment in staffing, including nursing and availability of interpretation for families. They identified limitations in the physical environment that will require investment to improve. These findings suggest the need for analysis of how the investment in people and space improve outcomes and the quality of family-centered care. Franck and colleagues also recommend that NICU healthcare professionals receive ongoing surveys of their views on family-centered care and that the results be used to inform education and practice change. They emphasize that partnership with current and former NICU families is essential to developing successful approaches to improve family-centered care, especially now that COVID-19 related restrictions on family presence in NICUs are being reassessed.