- Robin Bisgaard RN MSN CN IV, Benioff Children’s Hospital, Intensive Care Nursery
- Linda Franck RN PHD FAAN, UCSF School of Nursing
UCSF will be the first US hospital to implement an innovative approach to Family Centered Care in the Intensive Care Nursery (ICN).
Our Canadian colleagues conducted a major clinical trial across every ICN in Canada studying Family Integrated Care (FiCare; O’Brien, 2013). Results are very promising and show improved breast feeding, earlier hospital discharge and reduced parents stress scores. “Research suggests that infants admitted to the Neonatal Intensive Care Unit (NICU) and cared for under the FICare model grow faster and have less stress, spend fewer days in the NICU, and are less likely to be readmitted to hospital after discharge, compared to infants cared for primarily by staff. These infants are also more likely to be breastfed and for a longer time, which provides a host of long-term health benefits. The improved confidence and skills of parents in FICare increases parental readiness for the transition from hospital to home, improves management abilities at home, and lowers parental anxiety. Finally, parental involvement helps staff feel more confident in the abilities of the parent, which will help facilitate getting everyone home as soon as possible” (www.familyintegratedcare.com). The model is based on parent engagement, education and support. Parent stress during and after having a child in the ICN is quite significant; PTSD symptoms are present in a large percentage of parents after an ICN stay. Long-term stress of this nature interferes with bonding, growth and development in the child, significant health related illness in parents and the highest divorce rate in couples after such experiences. Patient and family engagement improves many aspects of hospital performance, which includes safety, quality, financial performance, patient/parent reports on experience of care, patient outcomes, and employee satisfaction (AHRQ, n.d.). Our Canadian colleagues have challenged our team to bring this success and model/philosophy to the US. In bringing this to the UCSF BCH ICN, there are four major novel components of care to our ICN:
- A new peer parent mentor program. This involves recruitment and training mentor parents to support current parents in the ICN as well as ongoing support for mentor parents.
- Daily group parent education sessions related to the care and diagnosis of their child will be a new component. This will not only provide daily education for parents but potential peer group benefits.
- Specialized Nursing training regarding Ficare philosophy and components of care.
- We have developed a mobile app for parents that aims to support parent engagement, education and peer support. (We have very fortunate support from Wills Way Foundation, Intuit, PTBI)
After more than 2 years of planning, engagement with our alumni parents and innovation of the mobile app, we have started enrollment (baseline data collection) Nov 1, 2016. There are 4 other nurseries preparing to join the study (UCLA 2 campuses, UCSF Benioff Children’s Hospital Oakland, Community Regional Medical Center in Fresno, Kaiser Santa Clara). UCSF will be the pilot institution and our program and training information will be shared. It is critical that we assess the effectiveness and impact on parents, volunteers and staff well before our larger study results are available. There is no qualitative component to the study to date with potential for rich information unavailable through larger study aims.
Explore the challenges and successes in program implementation of Family Integrated Care (including mobile enhanced FiCare via app) for parents. Specifically:
- What are the needs of parents who have infants in the Neonatal Intensive Care Unit?
- What do parents perceive as supportive to their parenting role
- What behaviors and programs support parents with an infant in the neonatal intensive care unit.
Potential Impact to UCSF Medical Center:
The UCSF Benioff Children’s Hospital Intensive Care Nursery is a 58 bed Regional Tertiary level 3 nursery with 950 infants seen each year. There are over 200 nurses. With our facility being the first training institute for a US study, we must be prepared for immediate evaluation of our training, tools and implementation plan.
Approach and Sample
Research design: Ethnographic qualitative approach primarily based on symbolic interaction
Data collection: In person (recorded) interviews, focus groups, observation and field notes.
Data analysis/interpretation: Semi structured interviews with parents will be analyzed after transcription for thematic interpretation. Observations will include parent education sessions, bedside education. Focus groups on program will be conducted with parents, in their education session. Ten parent interviews (including maternal and paternal interviews) and 2 focus groups will be conducted. Analysis will include assessment of the needs parents and perceived support and will include standard care and education in the ICN, mobile family integration care (MFICare) materials, observations and interviews with parents. Analysis will be based on a symbolic interaction framework (Blumer, 1969). This includes the assumptions that meaning arises from a social and self-reflective process, that informants and investigators jointly create knowledge and findings, and that investigators must enter into the world of the people being studied (Rehm, 2005).