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Waddington C, van Veenendaal NR, O’Brien K, Patel N. Family integrated care: Supporting parents as primary caregivers in the neonatal intensive care unit. Pediatr Investig 2021; 5:148-154. [PMID: 34179713 PMCID: PMC8212757 DOI: 10.1002/ped4.12277] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/21/2021] [Indexed: 01/19/2023] Open
Abstract
Family integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minimizing separation, and supporting parent-infant closeness. FICare incorporates psychological, educational, communication, and environmental strategies to support parents to cope with the NICU environment and to prepare them to be able to emotionally, cognitively, and physically care for their infant. FICare has been associated with improved infant feeding, growth, and parent wellbeing and self-efficacy; important mediators for long-term improved infant neurodevelopmental and behavioural outcomes. FICare implementation requires multi-disciplinary commitment, staff motivation, and sufficient time for preparation and readiness for change as professionals relinquish power and control to instead develop collaborative partnerships with parents. Successful FICare implementation and culture change have been applied by neonatal teams internationally, using practical approaches suited to their local environments. Strategies such as parent and staff meetings and relational communication help to break down barriers to change by providing space for the co-creation of knowledge, the negotiation of caregiving roles and the development of trusting relationships. The COVID-19 pandemic highlighted the vulnerability within programs supporting parental presence in neonatal units and the profound impacts of parent-infant separation. New technologies and digital innovations can help to mitigate these challenges, and support renewed efforts to embed FICare philosophy and practice in neonatal care during the COVID-19 recovery and beyond.
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Affiliation(s)
| | - Nicole R. van Veenendaal
- OLVGAmsterdamthe Netherlands
- Emma Children’s HospitalAmsterdam UMCUniversity of AmsterdamVrije UniversiteitAmsterdamthe Netherlands
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Benzies KM, Aziz K, Shah V, Faris P, Isaranuwatchai W, Scotland J, Larocque J, Mrklas KJ, Naugler C, Stelfox HT, Chari R, Soraisham AS, Akierman AR, Phillipos E, Amin H, Hoch JS, Zanoni P, Kurilova J, Lodha A. Effectiveness of Alberta Family Integrated Care on infant length of stay in level II neonatal intensive care units: a cluster randomized controlled trial. BMC Pediatr 2020; 20:535. [PMID: 33246430 PMCID: PMC7697372 DOI: 10.1186/s12887-020-02438-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background Parents of infants in neonatal intensive care units (NICUs) are often unintentionally marginalized in pursuit of optimal clinical care. Family Integrated Care (FICare) was developed to support families as part of their infants’ care team in level III NICUs. We adapted the model for level II NICUs in Alberta, Canada, and evaluated whether the new Alberta FICare™ model decreased hospital length of stay (LOS) in preterm infants without concomitant increases in readmissions and emergency department visits. Methods In this pragmatic cluster randomized controlled trial conducted between December 15, 2015 and July 28, 2018, 10 level II NICUs were randomized to provide Alberta FICare™ (n = 5) or standard care (n = 5). Alberta FICare™ is a psychoeducational intervention with 3 components: Relational Communication, Parent Education, and Parent Support. We enrolled mothers and their singleton or twin infants born between 32 0/7 and 34 6/7 weeks gestation. The primary outcome was infant hospital LOS. We used a linear regression model to conduct weighted site-level analysis comparing adjusted mean LOS between groups, accounting for site geographic area (urban/regional) and infant risk factors. Secondary outcomes included proportions of infants with readmissions and emergency department visits to 2 months corrected age, type of feeding at discharge, and maternal psychosocial distress and parenting self-efficacy at discharge. Results We enrolled 654 mothers and 765 infants (543 singletons/111 twin cases). Intention to treat analysis included 353 infants/308 mothers in the Alberta FICare™ group and 365 infants/306 mothers in the standard care group. The unadjusted difference between groups in infant hospital LOS (1.96 days) was not statistically significant. Accounting for site geographic area and infant risk factors, infant hospital LOS was 2.55 days shorter (95% CI, − 4.44 to − 0.66) in the Alberta FICare™ group than standard care group, P = .02. Secondary outcomes were not significantly different between groups. Conclusions Alberta FICare™ is effective in reducing preterm infant LOS in level II NICUs, without concomitant increases in readmissions or emergency department visits. A small number of sites in a single jurisdiction and select group infants limit generalizability of findings. Trial registration ClinicalTrials.gov Identifier NCT02879799, retrospectively registered August 26, 2016.
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Affiliation(s)
- Karen M Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, T2N 1N4, Canada. .,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Khalid Aziz
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Northern Alberta Neonatal Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Vibhuti Shah
- Faculty of Medicine, University of Toronto, and Mount Sinai Hospital, Toronto, ON, Canada
| | - Peter Faris
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Analytics, Data Integration, Measurement & Reporting, Alberta Health Services, Calgary, AB, Canada
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jeanne Scotland
- Neonatal Intensive Care Unit, Rockyview General Hospital, Alberta Health Services, Calgary, AB, Canada
| | - Jill Larocque
- Northern Alberta Neonatal Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Kelly J Mrklas
- Strategic Clinical Networks™, System Innovation and Programs, Alberta Health Services, Calgary, AB, Canada
| | | | - H Thomas Stelfox
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Radha Chari
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | | | - Ernest Phillipos
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Northern Alberta Neonatal Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Harish Amin
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeffrey S Hoch
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA.,Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA, USA
| | - Pilar Zanoni
- Faculty of Nursing, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Jana Kurilova
- Faculty of Nursing, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Abhay Lodha
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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