Assessment of feasibility and acceptability of family-centered care implemented at a neonatal intensive care unit in India

Abstract

Background A family-centered care (FCC) parent participation program that ensures an infant is not separated from parents against their will was developed for the caring of their small or sick newborn at a neonatal intensive care unit (NICU) in Delhi, India. Healthcare provider sensitization training directed at psychosocial and tangible support and an audio-visual training tool for parent-attendants were developed that included: 1) handwashing, infection prevention, protocol for entry; 2) developmentally supportive care, breastfeeding, expression of breastmilk and assisted feeding; 3) kangaroo mother care; and 4) preparation for discharge and care at home. The study aimed to examine the feasibility and acceptability of the FCC model in a NICU in India. Methods A prospective cohort design collected quantitative data on each parent-attendant/infant dyad at enrollment, during the NICU stay, and at discharge. Feasibility of the FCC program was measured by assessing the participation of parent-attendants and healthcare providers, and whether training components were implemented as intended. Acceptability was measured by the proportion of parent-attendants who participated in the trainings and their ability to accurately complete program activities. Results Of 395 NICU admissions during the study period, eligible participants included 333 parent-attendant/infant dyads, 24 doctors, and 21 nurses. Of the 1242 planned parent-attendant training sessions, 939 (75.6%) were held, indicating that program fidelity was high, and the majority of trainings were implemented as intended. While 50% of parent-attendants completed all 4 FCC training sessions, 95% completed sessions 1 and 2; 60% of the total participating parent-attendants completed session 3, and 75% completed session 4. Compliance rates were over 96% for 5 of 10 FCC parent-attendant activities, and 60 to 78% for the remaining 5 activities. Conclusions FCC was feasible to implement in this setting and was acceptable to participating parent-attendants and healthcare providers. Parents participated in trainings conducted by NICU providers and engaged in essential care to their infants in the NICU. A standard care approach and behavior norms for healthcare providers directed psychosocial and tangible support to parent-attendants so that a child is not separated from his or her parents against their will while receiving advanced care in the NICU.

Family engagement in paediatric acute care settings: A realist review

“…A philosophy of family engagement is reflected in policies and practices that are visible in the infrastructure, the culture and the behaviours of direct care providers. Maria et al (2021) recognized the importance of hospital philosophy, strategic priorities and healthcare provider buy-in to the acceptability and feasibility of implementing a model of care that focuses on participatory collaboration between direct care providers and families in the care of newborns. Provider and newborn outcomes of providers' sensitization training sessions were presented to hospital leadership in order to create a paradigm shift in the organizational approach to the care of newborns.…”

At-Risk Newborns: Overlooked in Expansion From Essential Newborn Care to Small and Sick Newborn Care in Low- and Middle-Income Countries

“…Besides the necessary infrastructure, human resources, and supplies, the family-centered care approach would be an ideal overarching requirement for all options. 27 Postnatal/postpartum units may exist as wards or single rooms, the latter being more common in HICs and in some private facilities in LMICs. Where these units are used for at-risk newborns, a special demarcated area or room, preferably located near the nursing station, would permit easy identification for providing the extra required nursing care and additional visits by the physicians, as well as ensure that such mother-baby dyads are not inadvertently discharged too early.…”

“…Besides the necessary infrastructure, human resources, and supplies, the family-centered care approach would be an ideal overarching requirement for all options. 27 …”

“…There is now evidence to suggest that the ideal option for all categories of care may be the mother-baby unit with no separation, using kangaroo mother care and family-centered care wherever feasible for low birthweight infants, beginning at birth. 27 , 31 However, this requires careful planning, appropriate infrastructure, beds, equipment, supplies, and suitably trained, motivated administrative staff and health care providers, as well as, most importantly, a shift in the culture of care.…”

Parents’ Views on Prolonged Maternal Hospital Stay With Sick Newborn Infants in a Tertiary Neonatal Unit in Sri Lanka

“…8 In keeping with current global trends NICUs in India are also now moving toward FICare. 9 The mother-infant unit, established in 1979, in Tallinn Children's Hospital, Estonia, had mothers in the hospital 24 hours a day providing care to their infants, which made adherence to the Baby Friendly Hospital Initiative feasible for this group of infants. 10 This is similar to the policy in Sri Lanka, but the infants studied in Estonia were more than 1500 g at birth, compared with the preterm population in Sri Lankan NICUs, where about 40% would have a birth weight of less than 1500 g (unpublished data [Rodrigo, 2018]).…”