99: “Family Integrated Care” in Level II NICUs: Perspectives of Administrators, Healthcare Personnel, and Parents Regarding Implementation

Abstract

BACKGROUND: In the Family Integrated Care (FICare) model of level III NICU care, parents are the primary caregivers for their infants. Components of this model include parent education, nursing staff education, and provision of physical and psychosocial support, which enable parents to be active partners in the care team. What is unknown is how best to translate this model to level II NICUs. OBJECTIVES: Capture the perspectives of administrators, healthcare personnel, and parents in four level II NICUs in Ontario regarding FICare implementation. DESIGN/METHODS: Focus groups were conducted separately for administrators and allied healthcare personnel, nurses, and parents (veteran and current) at each site using a semi-structured interview guide. Each focus group had 6-8 members; lasted for 1-1.5 hours; and was audiorecorded, transcribed, and analyzed using thematic content analysis. RESULTS: Perceptions of facilitators and barriers varied among the three participant groups. The overall perception of administrators and healthcare personnel was that elements of family-centered care were already being practiced including engaging parents in the care of their infant, providing written educational materials with some verbal reinforcement, and promoting discharge planning early in the clinical course. The administrators were interested in expanding on what was currently in place. Lack of physical space and amenities for families, different medical and nursing staffing models, and the wide variation in socio-cultural context of families were perceived as challenges to the FICare model. Nurses expressed concern around loss of control, safety, and legal consequences if parents were to take a more active role in infant care. In contrast, although parents were appreciative of the care provided, responses regarding education, communication, and support ranged from very satisfied to dissatisfied. CONCLUSION: Even though all three groups recognize the importance of engaging families in the care of their infant, there are unique challenges to the implementation of FICare in the level II NICU environment. To ensure the parent experience is incorporated, veteran parents should be actively involved with the healthcare team during translation (design and implementation) of the model.