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Mapping family integrated care practices in the neonatal units across the UK
  1. Katie Dharmarajah1,
  2. Emilie Seager2,
  3. Aniko Deierl2,
  4. Jayanta Banerjee2,3
  5. On behalf of the Integrated Family Delivered Care core group
  1. 1 Paediatrics, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Neonatology, Imperial College Healthcare NHS Trust, London, UK
  3. 3 Department of Neonatal medicine, Imperial College London Institute of Clinical Sciences, London, UK
  1. Correspondence to Dr Jayanta Banerjee, Neonatology, Imperial College Healthcare NHS Trust, London W12 0HS, UK; jayanta.banerjee{at}nhs.net

https://doi.org/10.1136/archdischild-2019-317671

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    Family integrated care (FIC), where parents are empowered through structured training to form an important component of the caregiving team, is fast becoming the standard of care across neonatal units in the UK. The Parents of Preterm Infants (POPPY) survey in 20101 found variability of practice and inadequate facilities to support even family centred care (FCC). To explore the change in the parental participatory model in the neonatal unit over the last 8 years, we designed and conducted an online questionnaire survey. The aim was to explore current practice, understanding and strategy for FIC using the Qualtrics web assessment toolkit (Qualtrics, Provo, Utah, USA).

    Of the 195 UK neonatal units, 78 responses were received. Practice of FIC in neonatal units across the UK remains varied, and often refers to FCC. Among the respondents, 86% reported delivering some elements of FIC, the breadth of activities delivered are detailed in table 1. The perceived advantages of FIC included: reduced parental stress (72%), improved breast feeding (65%), improved neurodevelopmental outcomes (59%) and reduced hospital stay (54%); these were reflected in the multicentre cluster-randomised trial led by Mount Sinai Hospital in Toronto, Canada,2 and the outcomes of the Integrated Family Delivered Care project at Imperial neonatal units in the UK.3 Implementation of FIC focused on educational and environmental aspects. Education included staff training (50%), 1:1 parent training (39%) and parent competency assessments (43%). Environmental adaptations included 24-hour access (98%), kitchen facilities (96%) and free or subsidised parking (94%) for parents. Attitudes to parental involvement were varied but only 46% of respondents allowed parents deemed competent to have autonomy in caring for their babies. However, 74% responded that they perceive parents as equal partners in the neonatal team. Less than half (43%) had adequate support from the medical team in providing FIC, in contrast to 72% receiving adequate support from the nursing teams in a neonatal unit.

    View this table:
    Table 1

    The activities that parents were allowed to participate in as part of FIC (n=52 responses to this question)

    This survey demonstrates that progress has been made in embedding FCC and the principles of the Bliss Baby Charter4 into the culture of UK neonatal units since the POPPY survey in 2008,1 but there is still a long way to go to implement all the principles of an FIC model in creating a parent supportive and collaborative environment. A larger national survey funded and supported through a national programme would be useful to understand the practices and cultures of all UK neonatal units, as would greater understanding of parental perceptions of FIC. We would advocate for a structured FIC programme in all neonatal units across the UK, which would require an educational programme for neonatal nurses, junior and senior doctors and parents and allied health professionals. Both this and the environmental support required for FIC require funding. But the mandate is clear, FIC improves infant and parental health outcomes2 3 and is the future direction of travel in neonatology.

    References

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      2. O'Brien K ,
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      . Effectiveness of family integrated care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. The Lancet Child & Adolescent Health 2018;2:245–54.doi:10.1016/S2352-4642(18)30039-7
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      2. Banerjee J ,
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    Footnotes

    • Collaborators Integrated Family Delivered Care group. Neonatal Unit, Imperial College Healthcare NHS Trust, London W12 0HS, UK

    • Contributors JB and AD conceptualised the survey. KD, ES, AD and JB developed the study design. KD wrote the first draft and reviewed and revised the manuscript. ES, AD and JB reviewed and revised the manuscript. All authors approved the final manuscript and agree to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.