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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Volume 1, Issue 2

Susannah LabbeThe Evolution of Family-Centered Care in the NICU

By Susannah Labbe, BSN, RNC-NIC

Family-centered care is the standard for best practice in pediatric nursing. Children’s Hospital Central California embraces these principles. The evolution of family-centered practices has had a dramatic effect on the care delivery model being implemented in our Neonatal Intensive Care Unit (NICU).  

The theoretical framework outlined by Patricia Benner in “From Novice to Expert” (1984) applies the “Dreyfus Model of Skill Acquisition” (Dreyfus & Dreyfus, 1980) to nursing proficiency. Benner identified five levels of nursing proficiency: novice, advanced beginner, competent, proficient and expert. The same “skills acquisition” model can be applied to the development and integration of family-centered care practices in the NICU.  Nursing Excellence

As novices we identified areas, relative to family-centered care, that would require practice change. Parent surveys and application of the Vermont Oxford Network (VON) Neonatal Intensive Care Quality Improvement Collaborative’s “Potentially Better Practices” (2000) were used as tools to guide our actions. The “Partners in Care” Committee was formed to address the importance of early and consistent parent participation as caregivers and decision makers. The Committee consists of a multidisciplinary group of Hospital and NICU staff as well as parent representatives. It is important that staff embrace the family as a primary source of strength and support throughout their child’s hospitalization (Cooper et al., 2007). 

Consistent with the Dreyfus model of skill acquisition, it is crucial to be aware of the importance of experiential input. As identified in Benner’s model, the “advanced beginner” incorporates concepts learned through actual experiences. For example, our neonatal transport team recognized the importance of family bonding and the stress caused by maternal separation. This experience prompted the use of digital photography to minimize that stress by providing mothers with a digital picture of their baby prior to transporting them to Children’s Hospital. The use of pictures to enhance bonding during times of separation is supported in research (Franklin, 2006).

Private NICU roomTo facilitate family participation throughout hospitalization, visitation policies have been enhanced. It is recognized that the first visit to the NICU can be emotionally overwhelming. To reduce parental stress at this time, bedside nurses are encouraged to greet parents at the NICU entrance and to escort them to their child’s bedside. Families have responded positively to this simple practice. With the NICU expansion, principles of family-centered care have guided the architecture and construction in the development of additional beds. The expansion includes 21 private and two semi-private rooms. These rooms promote privacy and allow parents to be present with their child 24 hours a day. Family members are welcomed at the bedside and staff reports a more effective teaching environment with the private-room layout.

Parents are encouraged to participate in care. Educational materials outlining suggested interventions for infants, based on gestational age, are available through the Hospital website. Families are able to personalize their infant’s beds with signs, pictures, prayer cards and linens. A communication board is located at each bedside and may be used for communication between parents and healthcare providers. In accordance with current research, skin-to-skin holding – or kangaroo care – has many benefits for both mother and infant (Dodd, 2005; Johnson, 2007). With this in mind, the unit acquired several reclining chairs to facilitate kangaroo care. 

As noted by Griffin & Abraham (2006), “by increasing parental involvement in care given throughout hospitalization and working with families to facilitate the discharge process, parents may emerge from the NICU experience with increased competence and confidence in infant care giving.” To reduce the stress and anxiety that can often accompany discharge to home, families are offered several educational classes and networking opportunities. These classes are provided by staff from nursing, occupational therapy, lactation and speech therapy. Less formal opportunities are also available in the form of a parent-mentor welcome class and a meet-the-doctor open forum with one of the unit’s neonatologists. 

Throughout each change, our NICU has progressed integrating the concepts of family-centered care into clinical practice. Recently this transition was recognized with the development of the “Family Centered Care Award.” This award is given to clinicians whose actions exemplify the holistic application of family-centered care in their job performance. These individuals serve as mentors for others at various levels of skill acquisition.

Our journey through the application of family-centered care continues to evolve. Future plans include a remodel of the NICU waiting room that incorporates parent suggestions. Strategies are also being conceptualized for staff education regarding family-centered care. In accordance with the American Academy of Pediatrics’ recommendations, we also hope to implement family-centered rounding to promote ongoing family-physician interaction. Through this journey of excellence, our goal is to improve the quality of care provided for patients and families. 

As a unit we have increased our knowledge and developed systems and guidelines in support of family-centered care. We must progress to an increasingly higher phase evolving towards “proficient” and “expert” levels of family-centered care. This is the vision for the NICU.

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing
practice. Menlo Park, CA: Addison-Wesley.

Cooper, L.G., Gooding, J.S., Gallagher, J., Sternesky, L., Ledsky, R. & Berns, S.D.
(2007). Impact of a family-centered care initiative on NICU care, staff and
families. Journal of Perinatology, 27, S32-S37.

Dodd, V.L. (2005). Implications of kangaroo care for growth and development in preterm
infants. JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34, 218-232.

Dreyfus, S.E. & Dreyfus, H.L. (1980). A Five Stage model of the mental activities
involved in direct skill acquisition. Report supported by the Air Force Office of
Scientific Research (AFSC), USAF Contract F4962079C0063, University of
California at Berkeley, A155480.

Franklin, C. (2006). The neonatal nurse’s role in parental attachment in the NICU.
Critical Care Nursing Quarterly, 29, 81-85.

Griffin, T. & Abraham, M. (2006). Transition to home from the newborn intensive care
unit: Applying the principles of family-centered care to the discharge process. Journal of Perinatal & Neonatal Nursing, 20(3)243-249.

Johnson, A. N. (2007). The maternal experience of kangaroo holding premature infants. JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing, 36, 568-573.

Vermont Oxford Network, Vermont oxford network tools for improvement series:
Enhancing family-centered care. Burlington, VT: Vermont Oxford Network; 2000


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