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      Close Collaboration with Parents intervention improves family-centered care in different neonatal unit contexts: a pre–post study

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          Abstract

          Background

          The quality of family-centered care and parental participation in care in neonatal units differ widely across the world. Appropriate education might be an effective way to support medical staff in neonatal units to collaborate with parents and implement family-centered care. The aim of this study was to evaluate the effects of the educational intervention on the quality of family-centered care in eight Finnish neonatal intensive care units from both the staff and parent perspectives.

          Methods

          A mixed-method pre–post intervention study was conducted in eight neonatal intensive care units in Finland. Data were collected from staff and parents using the Bliss Baby Charter audit tool and semi-structured interviews.

          Results

          The quality of family-centered care, as assessed by staff and parents, increased significantly after the intervention in all eight units. The intervention was able to help staff define and apply elements of family-centered care, such as shared decision making and collaboration between parents and staff. In interviews, staff described that they learned to support and trust the parents’ ability to take care of their infant.

          Conclusions

          The educational intervention increased the quality of family-centered care and enabled mutual partnership between parents and staff.

          Impact

          • This study shows that the educational intervention for the whole multi-professional staff of the neonatal unit improved the quality of family-centered care.

          • The Close Collaboration with Parents intervention enabled mutual partnership between parents and staff.

          • It also provides evidence that during The Close Collaboration with Parents intervention staff learned to trust the parents’ ability to take care of their infant.

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          Most cited references 28

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          Reducing premature infants' length of stay and improving parents' mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial.

          Although low birth weight premature infants and parents are at high risk for adverse health outcomes, there is a paucity of studies that test early NICU interventions with parents to prevent the development of negative parent-infant interaction trajectories and to reduce hospital length of stay. Our objective was to evaluate the efficacy of an educational-behavioral intervention program (ie, Creating Opportunities for Parent Empowerment) that was designed to enhance parent-infant interactions and parent mental health outcomes for the ultimate purpose of improving child developmental and behavior outcomes. A randomized, controlled trial was conducted with 260 families with preterm infants from 2001 to 2004 in 2 NICUs in the northeast United States. Parents completed self-administered instruments during hospitalization, within 7 days after infant discharge, and at 2 months' corrected age. Blinded observers rated parent-infant interactions in the NICU. All participants received 4 intervention sessions of audiotaped and written materials. Parents in the Creating Opportunities for Parent Empowerment program received information and behavioral activities about the appearance and behavioral characteristics of preterm infants and how best to parent them. The comparison intervention contained information regarding hospital services and policies. Parental stress, depression, anxiety, and beliefs; parent-infant interaction during the NICU stay; NICU length of stay; and total hospitalization were measured. Mothers in the Creating Opportunities for Parent Empowerment program reported significantly less stress in the NICU and less depression and anxiety at 2 months' corrected infant age than did comparison mothers. Blinded observers rated mothers and fathers in the Creating Opportunities for Parent Empowerment program as more positive in interactions with their infants. Mothers and fathers also reported stronger beliefs about their parental role and what behaviors and characteristics to expect of their infants during hospitalization. Infants in the Creating Opportunities for Parent Empowerment program had a 3.8-day shorter NICU length of stay (mean: 31.86 vs 35.63 days) and 3.9-day shorter total hospital length of stay (mean: 35.29 vs 39.19 days) than did comparison infants. A reproducible educational-behavioral intervention program for parents that commences early in the NICU can improve parent mental health outcomes, enhance parent-infant interaction, and reduce hospital length of stay.
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            Family support and family-centered care in the neonatal intensive care unit: origins, advances, impact.

            Family-centered care (FCC) has been increasingly emphasized as an important and necessary element of neonatal intensive care. FCC is conceptualized as a philosophy with a set of guiding principles, as well as a cohort of programs, services, and practices that many hospitals have embraced. Several factors drive the pressing need for family-centered care and support of families of infants in NICUs, including the increase in the number of infants in NICUs; growth in diversity of the population and their concurrent needs; identification of parental and familial stress and lack of parenting confidence; and gaps in support for families, as identified by parents and NICU staff. We explore the origins of and advances in FCC in the NICU and identify various delivery methods and aspects of FCC and family support in the NICU. We examine the research and available evidence supporting FCC in the NICU and offer recommendations for increased dissemination and for future study. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Closeness and separation in neonatal intensive care

              In this paper, we highlight the need for acknowledging the importance and impact of both physical and emotional closeness between the preterm infant and parent in the neonatal intensive care unit. Physical closeness refers to being spatially close and emotional closeness to parental feelings of being emotionally connected to the infant (experiencing feelings of love, warmth and affection). Through consideration of the literature in this area, we outline some of the reasons why physical closeness and emotional closeness are crucial to the physical, emotional and social well-being of both the infant and the parent. These include positive effects on infant brain development, parent psychological well-being and on the parent–infant relationship. The influence of the neonatal unit environment and culture on physical and emotional closeness is also discussed. Conclusions Culturally sensitive care practices, procedures and the physical environment need to be considered to facilitate parent–infant closeness, such as through early and prolonged skin-to-skin contact, family-centred care, increased visiting hours, family rooms and optimization of the space on the units. Further research is required to explore factors that facilitate both physical and emotional closeness to ensure that parent–infant closeness is a priority within neonatal care.
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                Author and article information

                Contributors
                mijotoi@utu.fi
                Journal
                Pediatr Res
                Pediatr. Res
                Pediatric Research
                Nature Publishing Group US (New York )
                0031-3998
                1530-0447
                7 May 2020
                7 May 2020
                2020
                : 88
                : 3
                : 421-428
                Affiliations
                [1 ]GRID grid.1374.1, ISNI 0000 0001 2097 1371, Department of Nursing Science, , University of Turku, ; Turku, Finland
                [2 ]GRID grid.436211.3, ISNI 0000 0004 0400 1203, Laurea University of Applied Sciences, ; Espoo, Finland
                [3 ]GRID grid.1374.1, ISNI 0000 0001 2097 1371, Faculty of Medicine, , University of Turku, ; Turku, Finland
                [4 ]GRID grid.410552.7, ISNI 0000 0004 0628 215X, Hospital District of Southwest Finland, Department of Pediatrics, , Turku University Hospital, ; Turku, Finland
                [5 ]GRID grid.1374.1, ISNI 0000 0001 2097 1371, Department of Biostatistics, , University of Turku, ; Turku, Finland
                [6 ]GRID grid.1374.1, ISNI 0000 0001 2097 1371, Department of Psychology and Speech-Language Pathology, , University of Turku, ; Turku, Finland
                Article
                934
                10.1038/s41390-020-0934-2
                7478938
                32380505
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                Categories
                Clinical Research Article
                Custom metadata
                © International Pediatric Research Foundation, Inc 2020

                Pediatrics

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