Abstract
Background
Family integrated care (FICare) is a model of care which shifts the role of parents from ‘observers’ of their infant’s care to being their infant’s ‘primary caregiver’ in Neonatal Intensive Care Units (NICU). One NICU in the South Island of New Zealand (SI-NZ) implemented FICare after being involved in an international randomised controlled trial (RCT) comparing FICare with standard NICU care. FICare’s model comprises four pillars previously identified as necessary for implementation: 1) Staff education and support, 2) Parent education, 3) NICU environment and resources, and 4) Psychosocial support. The RCT found FICare improved infant weight gain and breastfeeding rates and decreased hospital acquired infections and parental stress. However, alongside trial findings there is a need for qualitative research to inform the effective implementation of FICare – and specifically in New Zealand (NZ).
Aim
To qualitatively understand the experience of providing and receiving care via the FICare model from the perspectives of NICU staff, parents and whānau.
Methods
Group and individual interviews were used to collect data about staff experiences delivering FICare; serial interviews were used for parents’/whānau experiences. Two interviews were undertaken with parents/whānau: 1) during their NICU admission, and 2) six to twelve weeks post-NICU discharge. Interviews were audio-recorded, transcribed verbatim and analysed thematically.
Results
Thirteen multidisciplinary NICU staff were interviewed; there were six parent/whānau first interviews in NICU, and five post-discharge. Staff identified that differences in staff FICare education affected FICare delivery with some receiving more robust education than others. Although providing culturally responsive care is not specified within the FICare model, many staff reported that FICare’s principles aligned well with those of the Treaty of Waitangi. Parent/whānau interviewees reported inconsistencies in care between participants who were able to stay in NICU with their infants and those who could not. Participants who stayed in NICU described experiences of receiving care closely aligned with FICare, such as actions guided by the pillars of Parent education, NICU environment and resources, and Psychosocial support. Parents unable to stay in NICU (e.g. due to work, other child commitments or availability of parent beds), were less likely to report care aligned with the FICare model. Participants staying in NICU reported culturally responsive care and greater satisfaction with parent-staff relationships, parent-infant engagement and trust with staff, compared to those who did not.
Conclusion
Findings led to development of an adapted FICare model – potentially more appropriate for NZ. Future testing of this adapted model (named ‘FICare-NZ’) by other researchers is welcomed. Key aspects of FICare-NZ include the importance of culturally responsive care. Additionally, for successful FICare implementation it is recommended that all staff receive consistent FICare education. Therefore, FICare-NZ can be depicted with ‘Staff education’ becoming a foundational step supporting the other three pillars; with a second, and equally critical, foundational step being added for ‘Culturally responsive care’. FICare-NZ therefore comprises these two steps leading up to three (original FICare) pillars: 1) ‘Parent education’, 2) ‘NICU environment and resources’, and 3) ‘Psychosocial support’. Finally, FICare-NZ proposes a canopy layer on top of the pillars to represent the importance of ‘Parents’ experiences of NICU admission’.