Including Parents in the Evaluation of Clinical Microsystems in the Neonatal Intensive Care Unit

Abstract

Neonatal intensive care is an area of healthcare that has experienced significant growth in recent years. As a result, "megaunits" of more than 60 beds are not uncommon. Delivering care in units of this size that incorporates the principles of family-centered care and that is satisfying to both staff and parents is challenging. One proposed method to enhance delivery of care in the megaunit NICU has been to implement a clinical microsystem approach. Up to now, research to evaluate the efficacy of a clinical microsystem has focused primarily on staff satisfaction and perception. However, implementing the clinical microsystem within the NICU requires that careful attention be paid to the parents and their experience and perception of their infant's care in the NICU. This article reviews the basic principles of family-centered care, identifies components of care that affect parents' satisfaction with NICU care, reviews the theoretical underpinnings of the clinical microsystem, and discusses areas for future research.

Parental Satisfaction of Traditional System of Neonatal Intensive Care Unit Services in a Public Sector Hospital in North India

“…Constraints on staff limit the time available for extensive parent counselling by physicians, leaving parents to depend on nurses to help explain their infant's status. [8] Reis et al [11] report that interaction with nurses and verbal and written information regarding the condition of infants were essential, and of course the method of communication was also of significance. It has also been observed that excessive information can lead to parental confusion, which therefore can decrease confidence in healthcare systems, increase anxiety and eventually decrease parental satisfaction.…”

Introduction of microsystems in a level 3 neonatal intensive care unit—an interprofessional approach

“…This study is the first study of its kind, which prospectively planned the neonatal microsystem model of care in a large NICU to assess its potential risks and benefits in wide variety of aspects of health care. The prospective design of this trial helped us to address the identified characteristics of a high functioning microsystem through scheduled weekly meeting, inquiring feedback, providing information and continuing education so that essential elements of clinical microsystem could be maintained and positive culture could be fostered [4, 6]. …”

“…Advancement in neonatal care along with enhancement of life-saving technologies has resulted in the growth of neonatal intensive care units (NICU) in number and size [1, 2]. Development of large neonatal intensive units with over 40 beds, referred to as mega-units, has raised questions regarding their ability to maintain continuity and quality of care of these fragile patients [3, 4]. Increased rate of adverse events, provider burnout, strained infrastructure and impaired health system’s operation are among the potential risks associated with development of large NICUs.…”

“…The reconstruction of mega-units of intensive care into smaller care units within a single operational service defined by specific patient population, clinical team providers and determined process and purpose might help with provision of safe and effective care [4–6]. …”

Effect of Family-centered Care on Improving Parental Satisfaction and Reducing Readmission among Premature Infants: A Randomized Controlled Trial

“…In a study by Reis et al, the parents stated that interaction with nurses and verbal and written information regarding the conditions of their infants were essential; of course, the method of communication was also of significance [17]. In some studies, it has been also revealed that information can lead to parental confusion; therefore, it can decrease confidence in health care systems, increase anxiety, and eventually decrease parental satisfaction [7,18]; these results are not consistent with the findings of the present study.…”