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Directly involving parents in ICU care benefits infant wellbeing and nurse job satisfaction

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Involving parents in the care of premature babies in hospital not only improves their wellbeing but may also reduce conflict with staff and boost nurses’ job satisfaction, according to a new study.

Mothers and fathers whose newborn babies are being looked after in intensive care are often seen as peripheral and regarded simply as visitors, noted researchers.

“Parents are too often perceived as visitors to the intensive care unit. Our findings challenge this approach”

Karel O’Brien

Yet their study suggests there are multiple benefits to involving them in delivering direct care to their children from participating in ward rounds to giving medicine.

The research, carried out in Canada, Australia and New Zealand, set out to explore the impact of a specific programme that sees both parents and nursing staff get training on how mothers and fathers can play an active role in caring for premature babies.

In all, 26 neonatal units were randomly assigned to either deliver the Family Integrated Care (FICare) programme or provide standard care. There were around 890 pre-term babies in each of the two groups – all born at 33 weeks or earlier.

Under the FICare programme, parents attend education sessions that give them the skills to provide many aspects of care to their newborn child including bathing, feeding, changing nappies, administering oral medication and taking a baby’s temperature.

In addition, they are actively encouraged to take part in ward rounds, chart their infant’s growth and progress and participate in making decisions about their baby’s care with clinicians.

“FICare can help maximise the effect of family-integrated care on the health of the whole family and on staff”

Study authors

Parents are also informed about the tasks they cannot do such as adjusting oxygen levels, which was the responsibility of nurses.

As well as being encouraged to be hands on, parents are also provided with emotional support to help reduce stress and are linked up with others who are going through or have been through similar experiences.

Researchers found this approach had a positive impact, leading to improved weight gain among premature babies, better breastfeeding rates and reduced parental stress and anxiety, compared to those receiving standard care.

These outcomes could translate into lasting benefits for children, they suggest in the journal Lancet Child and Adolescent Health.

“How care is provided to the family, not just the infant, has a positive effect on the wellbeing of both infant and family,” said lead author Dr Karel O’Brien, from the paediatrics department at the Sinai Health System in Toronto.

“Weight gain, breastfeeding and reduced parental stress and anxiety are all associated with positive neurodevelopmental outcomes, suggesting that integrating parents into the care of infants at this early stage could potentially have longer-term benefits,” she said.

“We investigated the attitudes of nurses and parents, and received mostly positive feedback”

Study authors

However, the paper stressed the need to educate and support both families and nursing staff as part of a culture shift in neonatal intensive care.

Educating parents on how to look after pre-term babies without then supporting them to put that knowledge into practice would “lessen the impact”, warned the study authors.

“Similarly, encouraging parents to care for their infants without providing nurses with the knowledge and skillset to support parents as partners could create conflict at the bedside,” they said.

“By implementing and supporting a culture change within the entire neonatal ICU, FICare can help maximise the effect of family-integrated care on the health of the whole family and on staff, who might experience less conflict with parents and greater job satisfaction as a result,” they added.

One issue identified is that the programme involves a considerable time commitment on the part of parents who must agree to spend at least six hours per day, five days a week at their baby’s bedside and attend education sessions for at least three weeks.

This may have introduced a certain amount of bias when it came to who was and was not included in the trial, which may in turn have influenced the results.

Expanding the FICare model to other types of units will require input from both parents and staff “particularly nurses”, stressed the paper’s authors.

“In our pilot study, we investigated the attitudes of nurses and parents towards FICare as well as their acceptance of the FICare model, and received mostly positive feedback, although there were also suggestions for improvement,” they noted.

Sinai Health System in Toronto

Involving parents in intensive care helps infants and nurses

Dr Karel O’Brien

“The attitudes of staff and parents will need to be assessed on a larger scale to determine how to effectively promote the expansion of FICare to other types of units,” they added.

Overall, the researchers said their findings challenged practice where parents were left very much on the sidelines.

“Parents are too often perceived as visitors to the intensive care unit, said Dr O’Brien.

“Our findings challenge this approach and show the benefits to both infants and their families of incorporating parents as key members of the infant’s healthcare team, and helping parents to assume the role of primary caregiver as soon as possible,” she said.


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Readers' comments (1)

  • After many years caring for neonates I am convinced that parental involvement in care is beneficial to parents and helps form a close bond with the neonate. However one point not mentioned in this study is the extra nursing time required for every aspect of parental involvement and is why there is sometimes a lack of eagerness by nursing staff. Neonatal care is difficult and stressful and most nurses will tell you if honest that much of the stress comes from dealing with desperately worried parents..Neonatal units are rarely overstaffed and nurses often skip breaks to deliver vital services. Perhaps now is the time for researchers to add that into their studies and offer suggestions for how parents can help create a pleasant and optimum atmosphere for the essential expert care required for the babies.

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