Healthcare Professionals' Perspectives on Improving Family-Centred Pain Care in a Tertiary Pediatric Centre

BACKGROUND

Despite being a core component of family-centered and compassionate care, children's pain is often undertreated in Canadian hospitals. Nurses' and other healthcare professionals' (HCPs) ability to understand and respond to a child and their family's pain care needs is integral to improving this care in a family-centered manner.

PURPOSE

To understand nurses' and other HCPs' perceptions of child and family needs to make care more collaborative and patient- and family-centered.

METHODS

Eighteen participants were recruited and represented the specialties of nursing (n = 8), psychology (n = 1), child life services (n = 2), medicine/surgery (n = 3), and administration/leadership (n = 4); 3 of the administrators had a nursing background. Transcripts were analysed using a semantic, inductive approach with two coders using a codebook to ensure reliability.

RESULTS

Participants felt that pain care was important, but that it needs to take greater priority in the hospital. In our analysis, we identified four core needs that nurses and other HCPs have to provide better pain care: 1. Better acknowledgement of child and family experiences; 2. Better visual and written knowledge translation tools for patients and families; 3. Better provision of verbal pain education to children and families by nurses and other HCPs; and 4. Help for patients and families to advocate for better pain care when they feel their needs are not being met.

CONCLUSIONS

Nurses and other HCPs value patient- and family-centered pain care, and wish to empower families to advocate for it when it is sub-optimal.

ICU Care Team's Perception of Clinical Research in the ICU: A Cross-Sectional Study

OBJECTIVES

Adequate recruitment is essential for successful clinical research. ICU nurses play a crucial role in identifying eligible patients, introducing research teams, facilitating informed consent, and caring for enrolled patients. However, a larger group of multidisciplinary healthcare professionals (the ICU care team) is equally important in promoting clinical research participation.To describe the ICU care team's experiences in ongoing clinical research, identifying perceived barriers and enablers to their participation, and apply a behavior framework to enhance research engagement.

DESIGN

Cross-sectional survey study.

SETTING

Four adult ICUs and one PICU between June 2021 and March 2023.

SUBJECTS

We recruited nurses, physicians, nurse practitioners, allied health professionals, and unit clerks.

MEASUREMENT AND MAIN RESULTS

We developed and validated a cross-sectional survey based on the Capability, Opportunity, Motivation, Behavior model. This survey included: 1) demographic questions (n = 7); 2) research experience questions (n = 6), 3) capability questions (n = 8); 4) opportunity questions (n = 11); 5) and motivation questions (n = 13).A total of 172 ICU care team members completed the survey. Results showed differences in capabilities, opportunities, and motivations among ICU care team members. For example, fellow/attending physicians and nurse practitioners reported higher confidence in discussing research with patients/families, while registered nurses and allied health professionals expressed less confidence.

CONCLUSIONS

ICU care team members face multiple barriers that impact their involvement with the conduct of ICU research. To effectively engage healthcare professionals in this process, it is essential to address their capabilities (research knowledge and skills to communicate research with patients/families), create opportunities (collaboration/communication with research team, discuss research during multidisciplinary rounds), and motivate them (recognize their help and share the results of the research being conducted at their site) to improve ICU care team engagement in the conduct of ICU research.

How and why might interprofessional patient- and family-centered rounds improve outcomes among healthcare teams and hospitalized patients? A conceptual framework informed by scoping and narrative literature review methods

Poor communication within healthcare contributes to inefficiencies, medical errors, conflict, and other adverse outcomes. A promising model to improve outcomes resulting from poor communication in the inpatient hospital setting is Interprofessional Patient- and Family-Centered rounds (IPFCR). IPFCR brings two or more health professions together with hospitalized patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. A growing body of literature focuses on implementation and outcomes of IPFCR to improve healthcare quality and team and patient outcomes. Most studies report positive changes following IPFCR implementation. However, conceptual frameworks and theoretical models are lacking in the IPFCR literature and represent a major gap that needs to be addressed to move this field forward. The purpose of this two-part review is to propose a conceptual framework of how IPFCR works. The goal is to articulate a framework that can be tested in subsequent research studies. Published IPFCR literature and relevant theories and frameworks were examined and synthesized to explore how IPFCR works, to situate IPFCR in relation to existing models and frameworks, and to postulate core components and underlying causal mechanisms. A preliminary, context-specific, conceptual framework is proposed illustrating interrelationships between four core components of IPFCR (interprofessional approach, intentional patient and family engagement, rounding structure, shared development of a daily care plan), improvements in communication, and better outcomes.

Service Climate and Nurses' Collaboration with Families of Older Patients in the Care Process during Hospitalization

This study focuses on the concrete role of the presence of a ward's service climate in cultivating nurses' collaboration with family members. Accordingly, this study examined the moderating role of the service climate in the link between nurses' attitudes toward the family and their collaboration with family members in the care process. This is the second article of a series of studies we conducted among health staff in Israeli public hospitals. Relying on the patient- and family-centered care approach and using a cross-sectional study of 179 nurses from 13 internal medicine, surgical and geriatric wards at a large public hospital in Israel, we conducted a multiple regression analysis to test the contribution of all relationship variables to predicting nurses' collaborative behavior with the family in the care process during elderly hospitalization. The findings indicate that service climate had a conditional moderating effect on the relationship between nurses' perception of the family as a burden and their collaboration with the family in nursing care. Namely, in the absence of a targeted service climate, nurses form perceptions about the families as a burden, which in turn affects their distinct non-collaboration, and vice versa.

"I don't know how we would have coped without it." Understanding the Importance of a Virtual Hospital Visiting Program During the COVID-19 Pandemic

As the COVID-19 pandemic reached Canada in full strength, the concept of allowing visiting to patients became an impossibility in most healthcare organizations. In March 2020, hospitals across Canada made the decision to close to visitors. This was a complicated decision which left admitted patients with very little option for connecting with family and friends other than through the telephone. In response, North York General Hospital launched a virtual family visiting (VFV) program across all inpatient units. Here we report the findings of a qualitative study of the program informed by an interpretive descriptive approach. Interviews were conducted with families who participated in the VFV program at North York General Hospital in Toronto, Canada during the first wave of the COVID pandemic. A total of 24 family members were interviewed. As anticipated, the family members were all extremely pleased with the opportunity to connect virtually and very satisfied with the VFV program. What was less anticipated was the anxiety and distress that families experienced in being separated from their loved ones. Our data analysis revealed 4 key themes which we have labeled (a) the unforeseen consequences of separation trauma, (b) increased vulnerability of patients and family, (c) a lifeline of human connection, and (d) the role of the facilitator as a connector. This work contributes significantly to a system-level understanding of the impact of imposed separation, increased vulnerability, and the importance of providing an alternative way for families to be present with their loved ones in these unprecedented times.

Nurse Attitudes: A Descriptive Study of Families' Importance in Inpatient Nursing Care

BACKGROUND

Family support and patient outcomes are linked to nurses' attitudes toward families' importance in patient care.

OBJECTIVES

The purpose of this study was to characterize inpatient oncology nurses' attitudes toward families' importance in nursing care and determine characteristics related to these attitudes.

METHODS

A descriptive, cross-sectional design was used with a single set of measurements from inpatient oncology nurses at a comprehensive cancer center in the southeastern United States. Nurse characteristics were summarized using frequency and percentages. Time variables were summarized using median and interquartile range. There were five primary outcomes.

FINDINGS

Nurses considered the role of the family important, but level varied by FINC-NA item. Characteristics related to family importance overall included hospital unit and general approach to care.

A Modified Delphi Process to Prioritize Experiences and Guidance Related to ICU Restricted Visitation Policies During the Coronavirus Disease 2019 Pandemic

To create evidence-based consensus statements for restricted ICU visitation policies to support critically ill patients, families, and healthcare professionals during current and future pandemics.

DESIGN

Three rounds of a remote modified Delphi consensus process.

SETTING

Online survey and virtual polling from February 2, 2021, to April 8, 2021.

SUBJECTS

Stakeholders (patients, families, clinicians, researchers, allied health professionals, decision-makers) admitted to or working in Canadian ICUs during the coronavirus disease 2019 pandemic.

MEASUREMENTS AND MAIN RESULTS

During Round 1, key stakeholders used a 9-point Likert scale to rate experiences (1-not significant, 9-significant impact on patients, families, healthcare professionals, or patient- and family-centered care) and strategies (1-not essential, 9-essential recommendation for inclusion in the development of restricted visitation policies) and used a free-text box to capture experiences/strategies we may have missed. Consensus was achieved if the median score was 7-9 or 1-3. During Round 2, participants used a 9-point Likert scale to re-rate experiences/strategies that did not meet consensus during Round 1 (median score of 4-6) and rate new items identified in Round 1. During Rounds 2 and 3, participants ranked items that reached consensus by order of importance (relative to other related items and experiences) using a weighted ranking system (0-100 points). Participants prioritized 11 experiences (e.g., variability of family's comfort with technology, healthcare professional moral distress) and developed 21 consensus statements (e.g., communicate policy changes to the hospital staff before the public, permit visitors at end-of-life regardless of coronavirus disease 2019 status, creating a clear definition for end-of-life) regarding restricted visitation policies.

CONCLUSIONS

We have formulated evidence-informed consensus statements regarding restricted visitation policies informed by diverse stakeholders, which could enhance patient- and family-centered care during a pandemic.

Characteristics of Hospices Providing High-Quality Care

Background: The hospice market has changed substantially, shifting from predominately not-for-profit independent entities to for-profit national chains. Little is known about how hospice organizational characteristics are associated with quality of hospice care. Objective: To examine the association between hospice characteristics and care processes and performance on measures of hospice care quality. Design: Logistic regression models assessed the association between hospice characteristics and processes and hospices being in the top quartile of quality measure performance. Setting/Subjects: U.S. hospices with publicly reported measure scores in 2015-2017. Measurements: Summaries of hospice-level performance on Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey measures (including communication, timely care, symptom management, emotional and spiritual support, respect, training families, overall rating, and willingness to recommend) and Hospice Item Set (HIS) measures (including pain screening and assessment, dyspnea screening and treatment, bowel regimen for patients on opioids, discussion of treatment preferences, and beliefs/values addressed). Results: Of the 2746 hospices that met public reporting requirements, 5.6% were in the top quartile of both CAHPS and HIS performance. Characteristics associated with being in the top quartile for CAHPS included being a nonprofit and nonchain or government hospice, smaller size (<200 patients per year), and serving a rural area. Characteristics associated with being in the top quartile for HIS included being in a for-profit chain, larger size (91+ patients per year), and having <40% of patients in a nursing home. Providing professional staff visits in the last two days of life to a higher proportion of patients was associated with hospices being in the top quartile of HIS and in the top quartile of CAHPS. Conclusions: Hospice characteristics associated with strong performance on HIS measures differ from those associated with strong performance on CAHPS measures. Providing professional staff visits in the last two days of life is associated with high performance on both quality domains.

The LOTUS: A Journey to Value-Based, Patient-Centered Care

In response to the merger of our 248-bed community hospital with a new health system, a multidisciplinary team began a journey of holistic transformation via the evolution of a new rounding process called Leadership, Ownership, Transformation, Unity, and Sustainability (LOTUS) in the 20-bed ICU. Morphing from a hierarchical practice structure with limited engagement of multidisciplinary members, the LOTUS initiative (named for the blossom whose petals surround its core, the patient) afforded each discipline (petal) an equal voice and allowed a once-fragmented team to work cohesively, collaboratively, and at the highest level of the scope of practice for each discipline, thus affording expert guidance during care planning while providing a method to collect quality metrics. LOTUS allows us to view our patients in a new way as we refocused goal determination on patients and their families. The restructuring and evolution into a high-functioning team was targeted with the goal of enhancing quality critical care for patients, which, in the literature, has correlated with improved patient safety and decreased mortality and ICU length of stay.

The Effects of Anesthesia on the Pediatric Developing Brain: Strategies to Reduce Anesthesia Use in Pediatric MRI and Nursing's Role in Driving Patient Safety

PURPOSE

To describe the physiological and biological principles of anesthesia for children; nonanesthesia practices; the state of the evidence of patient- and family-centered care strategies to reduce anesthesia use; and role of nursing in ensuring patient safety through reducing anesthesia use for pediatric magnetic resonance imaging (MRI).

DESIGN

Integrative literature review.

METHODS

Review and synthesis of experimental and nonexperimental literature.

FINDINGS

Anesthesia use in pediatric MRI: 20 studies met inclusion criteria. Physiological and biological side effects of anesthesia in children are substantial. Of significance is the developing research on the extent to which anesthesia affects the developing brain of children. Nonanesthesia in pediatric MRI: 16 studies met inclusion criteria. Common themes were noted between patient- and family-centered care strategies and reducing anesthesia use in children requiring MRI.

CONCLUSIONS

There are significant risks associated with anesthesia on the developing brain. Nurses play an important role in using patient-centered strategies to reduce pediatric anesthesia use and advocate for patient safety.

A Toolkit to Improve Diversity in Patient and Family Advisory Councils: A New Method to Advance Health Equity

The Institute of Medicine (2001) identifies equity as one of six essential components of health-care quality. However, many health-care organizations lack a formal method to deeply understand and evaluate diverse patient and family experiences. Understanding care experiences of patients and families from minority racial and ethnic groups is essential to improving pervasive health disparities and to making health care more equitable. This article describes the creation of a toolkit aimed at strengthening health-care organizations' abilities to advance health equity through patient and family advisory councils (PFACs). This resource, cocreated with representatives from diverse PFACs, identifies and promotes strategies to recruit and retain diverse representation in advisory councils.

Partnering with Patients, Families, and Caregivers in Nephrology Nursing Research

Nurses value patient- and family-centered care as one of the most important elements of nursing, and as such, these foundations are embedded into nursing practice and theory. Patient engagement in health research, as an evolution of patient- and family-centered care, has emerged as a critical new way of doing research over the last several years. However, the benefit, value, and exploration of ways in which patient partnerships can be built within the context of nephrology nursing research are still relatively new. This article describes patient-centered outcomes research, discusses how patients can be involved throughout the research process, and provides examples for effective partnerships in nephrology nursing research.

Engineering a Foundation for Partnership to Improve Medication Safety during Care Transitions

There are major gaps and barriers for patients and caregivers after hospital discharge to achieve safe medication use. Patients and caregivers are often not ready to take on the responsibility for medication management when transitioned from inpatient care. Current approaches tend to focus on adding isolated strategies. A system thinking can enable a fundamental transformation to redesign professionals' interactions with patients and caregivers with an explicit goal to develop patients and caregivers into true partners, with targeted roles, skills, attitude, knowledge, and tool support. We must recognize the fact that medication safety during care transition and, more so, at patient homes is the property of a "work system", in which the patient and caregivers are at the center, with collaboration with health professionals. Innovative ideas are needed to engineer work system components by systematically examining professionals' interactions with patients and caregivers, such as those during hospital stays and transitions (e.g., follow-up phone calls, community pharmacist consults, and home visits). Based on human factors principles, we describe a set of recommendations on engineering partnership with patients and their caregivers at different stages of a care episode, to enable productive interactions among work systems that are distributed and are often limited in their ability to exchange information and co-align their interests.

Evolving Motivations: Patients' and Caregivers' Perceptions About Seeking Myotonic Dystrophy (DM1) and Huntington's Disease Care

Patient-centered care provision is challenging under ideal circumstances; myotonic dystrophy (DM1) and Huntington's disease (HD) are examples of chronic, progressive health conditions that may challenge its limits. If we can understand how care unfolds in these conditions, health care providers may be better equipped to address patients' needs. Constructivist grounded theory informed data collection and analysis. Fourteen patients with DM1 or HD, and 10 caregivers participated in semistructured interviews. Constant comparative analysis was used to identify themes. Participants attended clinic to seek expert information and social support. Medical management, altruism, and support provided the motivation. However, motivations evolved, with clinic becoming more important for caregivers as patients deteriorated. Clinic was conceptualized as a "safe space" to actively participate in health care and research. In the absence of disease-halting or curative treatments, participants perceived that they derived a therapeutic benefit from seeking care and from engaging in education and advocacy.

A Narrative Review of Patient and Family Engagement: The "Foundation" of the Medical "Home"

BACKGROUND

Patient and family engagement (PFE) is vital to the spirit of the medical home. This article reflects the efforts of an expert consensus panel, the Patient and Family Engagement Workgroup, as part of the Society of General Internal Medicine's 2013 Research Conference.

OBJECTIVE

To review extant literature on PFE in pediatric and adult medicine and quality improvement, highlight emerging best practices and models, suggest questions for future research, and provide references to tools and resources to facilitate implementation of PFE strategies.

METHODS

We conducted a narrative review of relevant articles published from 2000 to 2015. Additional information was retrieved from personal contact with experts and recommended sources from workgroup members.

RESULTS

Despite the theoretical importance of PFE and policy recommendations that PFE occurs at all levels across the health care system, evidence of effectiveness is limited, particularly for quality improvement. There is some evidence that PFE is effective, mostly related to engagement in the care of individual patients, but the evidence is mixed and few studies have assessed the effect of PFE on health outcomes. Measurement issues and the lack of a single comprehensive conceptual model pose challenges to progress in this field. Recommendations for future research and a list of practical tools and resources to facilitate PFE are provided.

CONCLUSIONS

Although PFE appeals to patients, families, providers, and policy-makers, research is needed to assess outcomes beyond satisfaction, address implementation barriers, and support engagement in practice redesign and quality improvement. Partnering with patients and families has great potential to support high-quality health care and optimize outcomes.

A Narrative Synthesis of the Components of and Evidence for Patient- and Family-Centered Care

A narrative synthesis was conducted to determine typical patient- and family-centered care (PFCC) components and their link to outcomes in pediatric populations. 68 studies with PFCC interventions and experimental designs were included. Study features were synthesized based on 5 core PFCC components (i.e., education from the provider to the patient and/or family, information sharing from the family to the provider, social-emotional support, adapting care to match family background, and/or s decision-making) and 4 outcome categories (health status; the experience, knowledge, and attitudes of the patient/family; patient/family behavior; or provider behavior). The most common PFCC component was education; the least common was adapting care to family background. The presence of social-emotional support alone, as well as educational interventions augmented with shared decision-making, social-emotional support, or adaptations of care based on family background, predicted improvements in families' knowledge, attitudes, and experience. Interventions that targeted the family were associated with positive outcomes.

Proportional Distribution of Patient Satisfaction Scores by Clinical Service: The PRIME Model

The Proportional Responsibility for Integrated Metrics by Encounter (PRIME) model is a novel means of allocating patient experience scores based on the proportion of each physician's involvement in care. Secondary analysis was performed on Hospital Consumer Assessment of Healthcare Providers and Systems surveys from a tertiary care academic institution. The PRIME model was used to calculate specialty-level scores based on encounters during a hospitalization. Standard and PRIME scores for services with the most inpatient encounters were calculated. Hospital medicine had the most discharges and encounters. The standard model generated a score of 74.6, while the PRIME model yielded a score of 74.9. The standard model could not generate a score for anesthesiology due to the lack of returned surveys, but the PRIME model yielded a score of 84.2. The PRIME model provides a more equitable method for distributing satisfaction scores and can generate scores for specialties that the standard model cannot.

Patient, family, and provider complex care situations in pediatric acute medical care: Creation of the Red Flags Situation Assessment Tool

PURPOSE

To develop and test a questionnaire to identify situations among patients, families, and providers that lead to complex pediatric medical care in a tertiary hospital setting.

DESIGN

A mixed methods approach was used. Qualitative content analysis of hospital documents was conducted to develop questionnaire items. Psychometric analyses were used to measure reliability, and factor analysis was used to reduce instrument length.

RESULTS

A 54-item questionnaire with 11 categories was distributed to 205 nurses and medical staff. Psychometric analysis of responses identified a final refined tool with 31 items comprised of six factors.

PRACTICE IMPLICATIONS

The Red Flags Situation Assessment Tool can be used to identify complex care situations and address them earlier in a hospital course to avoid challenges to providing patient- and family-centered care.

Finding a Middle Ground: Exploring the Impact of Patient- and Family-Centered Design on Nurse-Family Interactions in the Neuro ICU

OBJECTIVE

This comparative study of two adult neuro critical care units examined the impact of patient- and family-centered design on nurse-family interactions in a unit designed to increase family involvement.

BACKGROUND

A growing evidence base suggests that the built environment can facilitate the delivery of patient- and family-centered care (PFCC). However, few studies examine how the PFCC model impacts the delivery of care, specifically the role of design in nurse-family interactions in the adult intensive care unit (ICU) from the perspective of the bedside nurse.

METHODS

Two neuro ICUs with the same patient population and staff, but with different layouts, were compared. Structured observations were conducted to assess changes in the frequency, location, and content of interactions between the two units. Discussions with staff provided additional insights into nurse attitudes, perceptions, and experiences caring for families.

RESULTS

Nurses reported challenges balancing the needs of many stakeholders in a complex clinical environment, regardless of unit layout. However, differences in communication patterns between the clinician- and family-centered units were observed. More interactions were observed in nurse workstations in the PFCC unit, with most initiated by family. While the new unit was seen as more conducive to the delivery of PFCC, some nurses reported a loss of workspace control.

CONCLUSIONS

Patient- and family-centered design created new spatial and temporal opportunities for nurse-family interactions in the adult ICU, thus supporting PFCC goals. However, greater exposure to unplanned family encounters may increase nurse stress without adequate spatial and organizational support.

Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction

Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR) on an acute care for the elderly (ACE) unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer patient care. These results point to the interconnectedness and dual benefit to both job satisfaction and patient quality of care that can come from enhancements to team communication.

Committee on Hospital Care and Child Life Council. Child life services

Child life programs are an important component of pediatric hospital-based care to address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life specialists focus on the optimal development and well-being of infants, children, adolescents, and young adults while promoting coping skills and minimizing the adverse effects of hospitalization, health care, and/or other potentially stressful experiences. Using therapeutic play, expressive modalities, and psychological preparation as primary tools, in collaboration with the entire health care team and family, child life interventions facilitate coping and adjustment at times and under circumstances that might otherwise prove overwhelming for the child. Play and developmentally appropriate communication are used to: (1) promote optimal development; (2) educate children and families about health conditions; (3) prepare children and families for medical events or procedures; (4) plan and rehearse useful coping and pain management strategies; (5) help children work through feelings about past or impending experiences; and (6) establish therapeutic relationships with patients, siblings, and parents to support family involvement in each child's care.

A daughter's frustration with the dearth of patient- and family-centered care

Patient involvement in decision-making is an increasingly recognized ethical imperative, one that requires attention to health literacy. Health care that is truly patient- and family-centered, however, is the exception rather than the rule. This first person account of a hospitalization describes the lack of patient and family inclusion in decision-making, failure to use plain language and other health literacy strategies, and disregard for patient and family preferences. The author concludes that if the health care system is going to shift from paternalistic to patient- and family-centered, providers must be trained how to communicate and partner with patients and families. Even the most skilled health professionals, however, will not be able to deliver patient- and family-centered care if the system they work in is not designed to foster or support such care. Committed hospitals will integrate patient- and family-centered care throughout their organizations. This includes their mission statements, quality improvement activities, personnel policies, decision and self-management support, and patient portals. Payment policies can encourage, but are a blunt instrument to drive, health care toward patient and family-centered care. The author references resources to help hospitals make systematic changes to hard wire health literate and patient- and family-centered care.

NICU parent-to-parent partnerships: a comprehensive approach

Parents of newborns in the neonatal intensive care unit (NICU) find themselves in a world of unknown medical terminology, advanced technology, and the realization that their dream of a healthy baby has been shattered. The unique partnership with trained parent-to-parent volunteers, who have had previous NICU experiences, enhances professional support and helps new NICU parents adjust to these unexpected challenges. This practice-based article describes the Helen DeVos Children's Hospital NICU Parent-to-Parent Partnership's (PPP) 40-year commitment to the parent-to-parent philosophy and its comprehensive approach to delivering trained volunteer PPP services to NICU families. A historical review of the literature, including this hospital's original research, current programming, recruiting, training, supervision, and survey feedback, is outlined.