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Metrics details. We have developed a Family Integrated Care FIC model for use in a neonatal intensive care unit NICU where parents provide most of the care for their infant, while nurses teach and counsel parents. The objective of this pilot Married but looking in Obrien CA cohort analytic study was to explore the feasibility, safety, and potential outcomes of implementing this model in a Canadian NICU.
Families attended daily education sessions and were mentored at the bedside by nurses. The primary outcome was weight gain, as measured by change in z-score for weight 21 days after enrolment. Differences in weight gain between the two groups were analyzed using a linear mixed effects multivariable regression model.
This study included 42 mothers and their infants. Of the enrolled infants, matched control data were available for 31 who completed the study. There was also a ificant increase in the incidence of breastfeeding at discharge Feedback from the parents and nurses indicated that FIC was feasible and appropriately implemented. This study suggests that the FIC model is feasible and safe in a Canadian healthcare setting and in improved weight gain among preterm infants. In addition, Married but looking in Obrien CA innovation has the potential to improve other short and long-term infant and family outcomes.
A multi-centre randomized controlled trial is needed to further evaluate the efficacy of FIC in the Canadian context. In the highly technological environment of the modern neonatal intensive care unit NICUinfants are physically, psychologically, and emotionally separated from their parents. To address this issue, many programs, such as kangaroo care, skin-to-skin care, and family-centred care, encourage greater parent involvement [ 1 — 3 ].
However, most programs still adhere to the common premise that only NICU professionals with special skills can provide care for the infant, and parents are generally relegated to a supportive role. Many feel anxious and unprepared to care for their infants after discharge [ 4 ]. Many of the programs, such as COPE, have focused on a specific aspect of family-centred care, such as a parental education and behavioural interventions, and have shown benefits to infants and parents [ 6 ]. However, the review concluded that despite all these efforts there has been poor dissemination of family-centred care practices into NICUs and few large randomised controlled studies of most family-centred models of care.
In another review of interventions for preterm infants included in this supplement, Benzies et al. Several reports from outside North America have also suggested that parents can play a larger role in providing direct care of infants in the NICU and that there may be many short and long-term benefits of this practice. However, these practices have not ly been adopted in North America [ 1 — 38 ]. In our Family Integrated Care FIC model, which was implemented in this pilot study, we adopted a major paradigm shift by including parents as an integral part of the NICU team so that they could provide active care for their infant, instead of being in a passive support role.
During their participation in the FIC program, parents learned how to provide all care except for intravenous fluid administration and medications for their infants in the NICU, while the nurses became educators and coaches for the parents.
Education of the parents and the nurses to support their role changes was seen as a key component of the program and two curricula were developed for this as part of the program. In addition to education, we also provided additional physical and psychological supports for the FIC parents. Psychological support was provided by veteran parents who had prior experience of having an infant admitted to the NICU. One of three veteran parents was available in the NICU for a half-day a week, where they led or co-led the FIC education session scheduled for that day.
Each veteran parent also facilitated a recreational activity, such as arts and crafts or a coffee hour, in order to develop a sense of community within the FIC program, and was available to FIC parents by phone or. Support for the nurses included the availability of two nurses who were members of the FIC steering committee and a study coordinator to help facilitate and answer caregiver questions at the bedside.
Increased social work support was also available to address any problems that arose, such as issues with communication between parents, veteran parents, and healthcare providers. The purpose of the prospective matched case-control pilot study described here was to: 1 Explore the feasibility and safety of the FIC model in a Canadian NICU, and 2 Identify potential improvements in neonatal and parental outcomes. This pilot study of FIC was a cohort analytic study, in that the cohorts were identified before implementation of the intervention FIC rather than based on outcome, as is the case in a case-control study.
The cohort analytic de is superior to a case-control study as it provides stronger evidence of causality [ 9 ]. As this was a pilot study, we enrolled only 4 patients at a time on a rolling basis. When a bed space was available, and if there were no immediate plans for transfer, we approached the family for written consent to participate in FIC.
The parent who committed to be the primary caregiver ed the consent form and completed a demographic questionnaire. The partners were invited to participate to the best of their ability in the FIC program but specific demographic data were not collected from them. Infants were excluded if they had severe congenital anomalies, were receiving palliative care, were critically ill and deemed unlikely to survive, were scheduled for early Married but looking in Obrien CA, or their parents were unable to participate due to health, social, or language issues that would inhibit their Married but looking in Obrien CA with the medical and nursing team.
The study was approved by our institutional Research Ethics Board.
Parents enrolled in the FIC program were oriented to the program, the supports, the tools provided for their self education, and the charting required by a research nurse. Some sessions included material taught by other members of the multidisciplinary NICU team, such as a pharmacist, dietician, or lactation consultant.
Parents were also expected to provide care for their infant sespecially in the areas of feeding, bathing, dressing, holding, and providing skin-to-skin care, perform basic charting, and maintain a record of their own learning regarding their proficiency in providing care for their infant s in the NICU. Forty nurses who volunteered to participate in the project were provided with additional education on how to deliver the FIC program. These nurses were preferentially ased to take care of FIC families as staffing permitted and provided one-on-one and small group education and coaching to the FIC parents.
Demographic and treatment characteristics were collected from the infants enrolled in the study, including gestational age, birth weight, small for gestational age, singleton status, Apgar score at 1 min and 5 min, score of neonatal acute physiology version II SNAPIIdays on oxygen, days on CPAP, days on ventilation, surfactant administration, and caffeine administration. All factors were given equal weight and the controls were selected from the first match made for each enrolled infant.
The same variables in the control group were extracted from the NICU clinical database. The primary outcome of the study, which was selected a prioriwas change in weight at 21 days following enrolment in the FIC program as measured by the z-score [ 10 ]. The z-score refers to the exact of standard deviations greater or smaller than the median, and is used to monitor the growth of an infant relative to the expected intrauterine growth rate [ 10 ]. The score is standardized to population growth standards and more appropriate than percentiles for infants whose size lies outside the normal range of a growth chart Married but looking in Obrien CA 10 ].
Demographic data were collected from the FIC parent in the caregiving role including their age, relationship status, of other children, income, education level, distance travelled to the NICU, and ethnic background. We also measured the level of parental stress by asking the parent in the caregiving role to complete a PSS-NICU questionnaire [ 16 ] in the first week following admission and when their infant reached 35 weeks corrected age if still present in the unit. Each subscale consists of a series of examples of potentially stressful aspects of the NICU environment, e.
All FIC parents were interviewed prior to discharge or transfer and at neurodevelopmental follow-up 4 months post-discharge by a research coordinator who knew the families. A total of Married but looking in Obrien CA out of the 40 nurses who participated in the FIC program were interviewed on a one-to-one basis by a research assistant who did not work in the NICU 6 months following implementation of the program. The nurse interviews also examined their experiences with the program and its implementation. Analysis of the differences in clinical outcomes was performed on an intention-to-treat basis using SAS software v9.
For the multivariable analyses, we examined the weight change after 21 days of enrolment WtWt1 by testing the interaction FIC x Time using mixed-effect models to for the repeated measurement of weight and correlated data due to the matched controls. A total of 56 families were approached regarding enrolment in the FIC pilot study. The total of infants Married but looking in Obrien CA was 46 there were 4 sets of twins but of these 4 infants were then excluded, 3 because of unanticipated transfer within the first week of enrolment 1 of those was a set of twins and 1 because the infant became medically unstable with pulmonary hypertension.
We were unable to find matched controls for 11 FIC infants based on the criteria, so the final study population was 31 infants with 62 matched controls. At enrolment the mean age after birth of the infants in the FIC group was There were no differences in the characteristics of infants who were involved in the FIC program and the infants in the control group Table 1.
The FIC infants for whom a matched control could not be found had a median gestational age of 27 weeks range, 23—34 weeksa median birth weight of g range, — ga median age at enrolment of 22 days range, 7—90 daysand a median corrected gestational age at enrolment of With the exception of corrected gestational age, these figures are similar to those of the FIC infants with matched controls see Table 1suggesting that the older corrected age of the unmatched infants at enrolment was the reason matched controls could not be found.
These infants would have been outliers in comparison with the general population of NICU infants. There was a However, the use of a linear mixed effects multivariable regression model, adjusted for Apgar score at 5 min, SNAPII, maternal age, and birth weight showed that the rate of change in weight gain was ificantly higher for the FIC group The secondary outcomes of the study are also included in Table 2.
When compared with the control group, there was a decrease in the incidence of nosocomial infection 0 vs. The families lived at variable distances from the hospital, from 15 minutes by subway to 2 hours by car. Only 22 of the mothers were Canadian born, although 11 had been resident in Canada for more than 10 years. The ethnic background of the mothers was varied, with 22 identifying themselves as Caucasian.
The mothers varied in age from 23 to 45 years old, with a mean SD age of 34 5. However, by discharge the mean parental stress score had fallen to 2. In contrast, no ificant change was noted in the control group 3. The data collected during semi-structured interviews with parents and nurses indicated that the FIC program was acceptable as a model of care to both groups. Specific parent and nurse feedback on the implementation of the program was incorporated into program improvements made during the pilot study.
For example, the parent curriculum was updated and improvements were Married but looking in Obrien CA to the parent room. A complete qualitative evaluation of the FIC educational program for parents and nurses and the parent-to-parent support provided by the veteran parents will be published elsewhere, but a brief overview is provided here.
Another important theme that was identified by the parents was the change in their relationship with the medical care team and with other parents. All of the 19 nurses who were interviewed described the benefits of the program both for themselves and families. They are there all the time and you rely on their information much more, mostly because of your bond and you know their knowledge and their confidence.
It is a model of care that addresses the need to facilitate a care partnership with parents of NICU infants and promote maternal development in the NICU [ 2021 ]. Unlike other cultural settings where FIC has been adopted, our discussions with families and NICU staff indicated that to make such a model feasible in Canada, in addition to physical and Married but looking in Obrien CA supports, we needed to add other dimensions to our program, specifically parent education, parent-to-parent support, and nursing education.
reports in the literature on the topic of family-centred care interventions in the NICU appear to be grouped into 2 major fields, those focusing on the provision of parent education and those more focused on the care-by-parent model, whereas our FIC program combined the two. The literature on the benefits of providing educational interventions alone to parents of preterm infants is mixed.Married but looking in Obrien CA
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A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit