Elsevier

Seminars in Perinatology

Volume 35, Issue 1, February 2011, Pages 20-28
Seminars in Perinatology

Family Support and Family-Centered Care in the Neonatal Intensive Care Unit: Origins, Advances, Impact

https://doi.org/10.1053/j.semperi.2010.10.004Get rights and content

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.

Section snippets

Origins of Neonatal FCC

Through the 1800s, the birth and care of infants born in the United States encompassed FCC naturally although the term had not yet been coined. Most infants were born at home with little involvement of physicians, and care was provided almost exclusively by the mother and extended—usually female—family members. During the course of the 19th century, infant deaths were accepted as a normal part of life, a “reflection of the natural order in which the strong outlived the weak.”4

From the later

NICU Staff

Staff members in all roles—even those not directly involved in patient care—can contribute to FCC. Formal training for physicians and nurses in how to explain medical concepts to families fully and compassionately has been shown to be important.8 Other examples of integration of FCC into the culture and functioning of the NICU include participation by families who have been through the NICU experience in teaching FCC to medical students through home visits, discussion groups, role playing, and

Parent Education

Educating parents about the NICU environment, their infant's condition, and relevant procedures helps facilitate their active participation in family-physician discussions.2, 11 Parent education sessions and materials on topics such as infant development, NICU conditions, the emotional strain associated with a NICU experience, transition to home, and supporting siblings are rated highly by parents as helping to reduce their stress and increase parental confidence.20 Best practice standards for

Supporting Families' Psychological Wellbeing

Various FCC initiatives have shown promising results in relation to improved parental mental health. Mothers who participated in the Creating Opportunities for Family Empowerment (ie, COPE) program, an audiotaped educational-behavioral program about how to engage with and care for their hospitalized infant, were less stressed than mothers who did not participate in the program.60 Mothers who had contact with a March of Dimes NICU Family Support Specialist reported less stress and higher

Conclusion and Recommendations for Further Study

Despite the significant need to support families with infants in intensive care and the clear benefits of such support, significant progress is needed in both uptake of FCC and family support and in building the base of evidence for discrete practices and for comprehensive FCC programs.

Numerous individual components of FCC have been demonstrated to be successful and several comprehensive program models have seen strong success in establishing FCC practices. Models and approaches noted for

Acknowledgments

The authors would like to acknowledge the assistance and dedication of Sarah Rand, March of Dimes volunteer research assistant, and Kelli Signorelli of the March of Dimes Chapter Program Support Department.

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