Parents as partners in care: Lessons from the Baby Friendly Initiative in Exeter

doi:10.1016/j.jnn.2017.11.006

Journal of Neonatal Nursing

Volume 24, Issue 1, February 2018, Pages 17-20

https://doi.org/10.1016/j.jnn.2017.11.006 Get rights and content

Abstract

Neonatal care has changed beyond recognition in the past few decades with advances in technology meaning smaller and sicker babies are surviving more than ever before. Families can sometimes feel they are left watching on from the side lines, not knowing what their role is in the situation. Supporting parents to be partners in care can make a difference by supporting parents to be present with their baby, to make and to be involved in decisions regarding the care of their baby and to improve the close and loving relationships that are fractured when a baby is requiring neonatal care.

The Baby Friendly Initiative standards for neonatal units are one way of changing the culture and philosophy of neonatal units in the United Kingdom and can make a real difference to families.

Introduction

Neonatal staff have considered family centred care for decades. Visiting hours were extended to encompass the whole day, chairs were provided next to incubators, and parents were encouraged to be involved in care. So why so many families are still reporting dissatisfaction in care, traumatic responses to their neonatal experiences and for some, and a reduced attachment to their child?

Are parents truly partners in the care of their baby? Have we truly welcomed families to the neonatal unit? Have we, the neonatal team, kept the seat of power and been unwilling to share? Is it just easier to do our job alone and get on with caring for our babies on our neonatal unit?

It could be viewed, that as neonatal staff, we haven't been able to relinquish the power we hold. Neonatal staff are experts in saving the lives of extremely vulnerable infants. Parents are indebted to the neonatal team for saving the life of their precious baby, sometimes many times over. But what happens after survival? How can we try to minimise the unwanted effects of spending time on the neonatal unit? How do we support the baby and family to thrive together?

Section snippets

Parents as partners in care

One of the simplest answers to create a culture where parents are seen as partners in the care of their child may be to truly welcome families to the neonatal unit. Parents are not visitors, they are parents. When families, who come all shapes and sizes, are kept at the centre of care planning, they can feel more welcome, may feel slightly less scared, they stay with their baby for longer periods, they participate in care and decision making and they become part of the team, as equals. Their

Implementation of the Baby Friendly Initiative neonatal standards

The neonatal unit at the Royal Devon and Exeter Hospital is a level 2 neonatal unit with 26 cots with approximately 650 admissions per year. We chose the Baby Friendly Initiative (BFI) neonatal standards as a way to improve the family experience. The BFI standards for neonatal units provide a firm structure on which to base the changes needed to the current neonatal unit culture to truly acknowledge the importance of the family.

The three standards, developing close and loving relationships,

The Exeter experience

The neonatal unit at the Royal Devon and Exeter Hospital was the first neonatal unit to be accredited by the UNICEF Baby Friendly Initiative in the UK.

Initially we looked at how we welcomed families. It was found that a welcoming environment did not just mean lots of smiling nurses. It comes down to how comfortable families are made to feel staying in an unfamiliar environment so that you are not wanting to leave at every opportunity. For example, an upright, hard chair is not going to

Summary

There will be resistance and challenges to any changes that are required to enable parents to be true partners, so strong leadership, individualised staff support, clear visions of what true family centred care is, and using the parents voice are all principles in ensuring these changes in culture are embedded into practice. By keeping the family at the centre of everything, ensures that all families are treated with respect and dignity, every day. The Baby Friendly standards impacts on all

References (3)

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Cited by (7)

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To describe the transition from a traditional hospital design with separate maternity and neonatal departments to a design in which maternity and neonatal health care infrastructures are integrated to empower parents.
A descriptive, qualitative analysis.
A mother and child center in a teaching hospital in Amsterdam.
Six staff members who were involved in the transition.
We analyzed the content of all relevant policy reports and other related documents that were produced during the transition from April 2010 to October 2014. This content was supplemented with in-depth, semistructured interviews with the six participants. We used thematic analysis and Bravo et al.’s model of patient empowerment to analyze the documents and the qualitative interview data.
We identified eight themes. At the health care system level, the four themes were Joint Vision and Goal, Integration of Three Wards Into One With Single-Family Rooms, Reorganization of the Health Care Team, and New Equipment. At the health care provider level, the three themes were Training for Extension of Professional Goals, Intensified Coaching for Parents, and Implementing Patient Centeredness. The single theme at the patient level was Opinions and Experiences of Parents.
We found a good fit between the new design and Bravo et al.’s model of patient empowerment. Challenges that remain include the adaptation of staff training programs and further development of the infrastructure in collaboration with staff and parents. The experiences of parents and staff members will be evaluated in future studies.
Maintaining momentum
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Citation Excerpt :
This person-centred approach can be seen as acknowledging the notion of holistic care that incorporates a person's context and individual preferences and beliefs, not limited to only the patient but to families and caregivers too (Santana et al., 2018). In line with a person-centred philosophy, the FIC model highlights how parents should be regarded as equal members of the neonatal unit multidisciplinary team (Read and Rattenbury, 2018). It follows that parents are a source of valuable information for students and staff working in neonatal care to learn from.
Family integrated care (FIC), where parents are an integral part of their baby's care and decision-making can enhance parental involvement and empowerment, contributing to decreased parental separation and stress. It follows that parents can also be a central part of neonatal education for staff in the neonatal speciality. This paper focuses on what students and staff can learn from parents about what they feel is important to make their experience better. A narrative, interpretive approach was undertaken to collect and analyse parent interview narratives. A specific question was posed to a purposive sample of parents who have had premature babies about what health professionals can learn from them. Thematic analysis revealed five key themes relating to the importance of: communicating; listening; empathising; acknowledging (the parent's role); realising (what matters to parents). These elements were incorporated into a framework named by the mnemonic, ‘CLEAR’. This highlights what parents want staff to be cognisant of when caring for them and their babies. Learning from the parents in our care enables a greater understanding of their experiences at difficult and challenging times. Having a deeper understanding of parents' experiences can contribute to enhanced empathic learning.
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