Experiences of the Iranian Neonatal Intensive Care Unit Nurses in Implementing Family-Centered Care: Walking on an Insecure Foundation

Authors

1 Department of Pediatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

2 Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

4 Clinical Research Fellow, Coventry University, Coventry, England

Abstract

Background: Most of the nurses have accepted family-centered care (FCC) as a standard model of care; however, they meet difficulties using this model. The aim of this study was to explore the perception of Neonatal Intensive Care Unit (NICU) nurses about the implementation of FCC.
Methods: This qualitative study was carried out on 11 in-service NICU nurses with at least three years of work experience using an interpretative phenomenological approach. The study setting was three separate NICUs of three teaching hospitals affiliated with Tabriz University of Medical Sciences, Tabriz, Iran. Data collection was performed through semi-structured interviews and field notes. The data were analyzed using the seven-stage Diekelmann, Allen, and Tanner approach.
Results: One of the important themes emerging in this study was “Walking on an insecure foundation” that included three subthemes of “Inappropriate base”, “A pathway with no lines” and “Unequal encounter”. The nurses described a lack of facilities, inadequate space, and staff’s specific instruction in encouraging parents’ engagement, as well as high work pressure due to short staffing as factors that affected their ability to provide an ideal FCC.
Conclusion: As the findings indicated, the lack of essential substructures and absence of a systematic program to engage parents in the care process of their infants have resulted in different operations by the nurses and discontinuous FCC implementation in NICUs. Officials and policy-makers should consider basic requirements, adequate workforce, and explicit guidelines to contextualize and guarantee the continuity of FCC.

Keywords


1. Girgin BA, Sivri BB. The importance of family centered care and assessment. Global J Adv Pure Appl Sci. 2015; 7:29-33.

 2. Mikkelsen G, Frederiksen K. Family‐centred care of children in hospital–a concept analysis. J Adv Nurs. 2011; 67(5):1152-62.

 3. Asai H. Predictors of nurses’ family‐centered care practises in the neonatal intensive care unit. Jpn J Nurs Sci. 2011; 8(1):57-65.

4. Flacking R, Lehtonen L, Thomson G, Axelin A, Ahlqvist S, Moran VH, et al. Closeness and separation in neonatal intensive care. Acta Paediatr. 2012; 101(10):1032-7.

5. Altimier L, Phillips R. The neonatal integrative developmental care model: advanced clinical applications of the seven core measures for neuroprotective family-centered developmental care. Newborn Infant Nurs Rev. 2016; 16(4):230-44.

6. Gooding JS, Cooper LG, Blaine AI, Franck LS, Howse JL, Berns SD. Family support and family-centered care in the neonatal intensive care unit: origins, advances, impact. Semin Perinatol. 2011; 35(1): 20-8.

7. Ramezani T, Hadian Shirazi Z, Sabet Sarvestani R, Moattari M. Family-centered care in neonatal intensive care unit: a concept analysis. Int J Community Based Nurs Midwifery. 2014; 2(4): 268-78.

8. Axelin A, Ahlqvist-Björkroth S, Kauppila W, Boukydis Z, Lehtonen L. Nurses' perspectives on the close collaboration with parents training program in the NICU. MCN Am J Matern Child Nurs. 2014; 39(4):260-8.

 9. Corrêa AR, Andrade AC, Manzo BF, Couto DL, Duarte ED. The family-centered care practices in newborn unit nursing perspective. Escola Anna Nery. 2015; 19(4):629-34.

10. Feeg VD, Paraszczuk AM, Çavuşoğlu H, Shields L, Pars H, Al Mamun A. How is family centered care perceived by healthcare providers from different countries? An international comparison study. J Pediatr Nurs. 2016; 31(3):267-76.

11. Foster MJ, Whitehead L, Maybee P, Cullens V. The parents’, hospitalized child’s, and health care providers’ perceptions and experiences of family centered care within a pediatric critical care setting: A metasynthesis of qualitative research. J Fam Nurs. 2013; 19(4):431-68. 12. Meskarpour-Amiri M, Mehdizadeh P, Barouni M, Dopeykar N, Ramezanian M. Assessment the trend of inequality in the distribution of intensive care beds in Iran: using GINI index. Global J Health Sci. 2014; 6(6):28-36. 13. Dalvand H, Rassafiani M, Bagheri H. Family centered approach: a literature the review. J Modern Rehabil. 2014; 8(1):1-9 .

 14. Speziale HS, Streubert HJ, Carpenter DR. Qualitative research in nursing: advancing the humanistic imperative. Philadelphia: Lippincott Williams & Wilkins; 2011.

15. Van Manen M. Researching lived experience: human science for an action sensitive pedagogy. Abingdon, UK: Routledge; 2016.

 16. Holloway I, Galvin K. Qualitative research in nursing and healthcare. New Jersey: John Wiley & Sons; 2016.

 17. Alligood MR. Nursing theorists and their work. New York: Elsevier Health Sciences; 2014.

 18. Diekelmann N, Allen D, Tanner CA. The NLN criteria for appraisal of baccalaureate programs: a critical hermeneutic analysis. New York: National League for Nursing; 1989.

19. Polit DF, Beck CT. Nursing research: principles and methods. Philadelphia: Lippincott Williams & Wilkins; 2004.

 20. Holloway I, Wheeler S. Qualitative research in nursing and healthcare. New Jersey: John Wiley & Sons; 2013.

 21. Shahheidari M, Homer C. Impact of the design of neonatal intensive care units on neonates, staff, and families: a systematic literature review. J Perinat Neonatal Nurs. 2012; 26(3):260-6.

 22. Örtenstrand A. The role of single‐patient neonatal intensive care unit rooms for preterm infants. Acta Paediatr. 2014; 103(5):462-3.

23. Mirlashari J, Sadeghi T, Sagheb S, Khanmohammadzadeh T. Nurses’ and physicians’ perspective about barriers to implement family centered care in neonatal intensive care units. Iran J Nurs. 2015; 28(93):140-50.

 24. Hadian SZ, Sharif F, Rakhshan M, Pishva N, Jahanpour F. The obstacles against nurse-family communication in family-centered care in neonatal intensive care unit: a qualitative study. J Caring Sci. 2015; 4(3):207-16.

25. Gomes da Silva TR, Figueiredo Manzo B, Custodia de Faria Fioreti FC, Morais Silva P. Family-centered care from the perspective of nurses in the Neonatal Intensive Care Unit. Rev Rede Enferm Nord. 2016; 17(5):643-50.

 26. Griffin T. A family-centered “visitation” policy in the neonatal intensive care unit that welcomes parents as partners. J Perinat Neonatal Nurs. 2013; 27(2):160-5.

 27. Trajkovski S, Schmied V, Vickers M, Jackson D. Neonatal nurses’ perspectives of family‐centred care: a qualitative study. J Clin Nurs. 2012; 21(17‐18):2477-87.

28. Craig J, Glick C, Phillips R, Hall S, Smith J, Browne J. Recommendations for involving the family in developmental care of the NICU baby. J Perinatol. 2015; 35(Suppl 1):S5-8.

 29. Dashti E, Rassouli M, Khanali Mojen L, Puorhoseingholi A, Shirinabady Farahani A. Patientto-nurse staffing ratios and its outcomes on nurses and premature infants in NICUs. Quart J Nurs Manag. 2015; 4(2):39-48.

30. Vasli P, Salsali M, Tatarpoor P. Perspectives of nurses on barriers of parental participation in pediatric care: A qualitative study. J Hayat. 2012; 18(3):22-32.

 31. Hall EO, Kronborg H, Aagaard H, Ammentorp J. Walking the line between the possible and the ideal: Lived experiences of neonatal nurses. Intensive Crit Care Nurs. 2010; 26(6):307-13.