Challenges of Family-Centered Care in a Neonatal Intensive Care Unit during the Visitation Restrictions After COVID-19 Pandemic Peak: A Qualitative Study of Parents’ and Nurses’ Perspectives

Authors

DOI:

https://doi.org/10.60099/prijnr.2024.268511

Keywords:

COVID-19, family-centered care, neonatal intensive care, nurses’ perspective, parents’ perspectives, Descriptive qualitative research, visiting restrictions

Abstract

Family-centered care is crucial for parent-infant bonding and collaborative healthcare in neonatal intensive care units. COVID-19 visitation restrictions have hindered this care’s effectiveness and posed challenges in Thai units. This study, conducted in a southern Thailand hospital, explored nurses’ and parents’ perspectives on implementing family-centered care during restricted visitation policies, providing globally applicable insights. An exploratory-descriptive qualitative approach was used, involving semi-structured
interviews with ten nurses and ten parents to explore their nuanced perspectives from June to August 2023. The interviews were conducted face-to-face, individually, using a semi-structured interview guide, and the transcripts were analyzed using thematic
analysis to identify significant themes. Findings from this study comprised five themes: 1) Having a mindset to involve parents in care, 2) Parents receiving psychological support, 3) Challenges of communication, 4) Negative impact of restricted visiting times, and 5) Accommodating flexible visiting hours in exceptional circumstances. Providing the best possible care for infants requires an adaptable and flexible approach to meet each family’s unique needs. Additionally, healthcare providers need to explore how they can implement
family-centered care effectively during visiting restrictions in the NICU in different contexts. Further research is necessary to investigate the practical implementation of this by nurses and how hospital administrators can support it in Thai neonatal intensive care units under policies restricting family visits.

References

Garfield H, Westgate B, Chaudhary R, King M, O’Curry S, Archibald SJ. Parental and staff experiences of restricted parental presence on a neonatal intensive care unit during COVID‐19. Acta Paediatr. 2021;110(12):3308-14. doi: 10.1111/apa.16085. DOI: https://doi.org/10.1111/apa.16085

Broom M, Cochrane T, Cruickshank D, Carlisle H. Parental perceptions on the impact of visiting restrictions during COVID-19 in a tertiary neonatal intensive care unit. J Paediatr Child Health. 2022;58(10):1747-52. doi: 10.1111/jpc.16079. DOI: https://doi.org/10.1111/jpc.16079

Campbell-Yeo M, Dol J, McCulloch H, Hughes B, Hundert A, Bacchini F, et al. The impact of parental presence restrictions on Canadian parents in the NICU during COVID-19: a national survey. J Fam Nurs. 2023;29(1):18-27. doi: 10.1177/10748407221114326. DOI: https://doi.org/10.1177/10748407221114326

Bainter J, Fry M, Miller B, Miller T, Nyberg A, O’Dell A, et al. Family presence in the NICU: constraints and opportunities in the COVID-19 era. Pediatr Nurs. 2020;46(5):256-9. Available from: https://www.proquest.com/docview/2459473524?sourcetype=Scholarly%20Journals

Murray PD, Swanson JR. Visitation restrictions: is it right and how do we support families in the NICU during COVID-19? J Perinatol. 2020;40(10):1576-81. doi: 10.1038/s41372-020-00781-1. DOI: https://doi.org/10.1038/s41372-020-00781-1

Institute for Patient- and Family-Centered Care. Patient-and family- centered care defined [Internet]. 2020. Available from: https://www.ipfcc.org/bestpractices/sustainable-partnerships/background/pfcc-defined.html

Duff J, Curnen K, Reed A, Kranz C. Engaging parents of hospitalized neonates during a pandemic. J Neonatal Nurs. 2021;27(3):185–7. doi: 10.1016/j.jnn.2020.11.013. DOI: https://doi.org/10.1016/j.jnn.2020.11.013

Yu X, Zhang J. Family-centred care for hospitalized preterm infants: a systematic review and meta-analysis. Int J Nur Pract. 2019;25(3):e12705. doi: 10.1111/ijn.12705. DOI: https://doi.org/10.1111/ijn.12705

Ding X, Zhu L, Zhang R, Wang L, Wang TT, Latour JM. Effects of family-centred care interventions on preterm infants and parents in neonatal intensive care units: a systematic review and meta-analysis of randomised controlled trials. Aust Crit Care. 2019;32(1):63-75. doi: 10.1016/j.aucc.2018.10.007. DOI: https://doi.org/10.1016/j.aucc.2018.10.007

Meesters N, van Dijk M, Sampaio de Carvalho F, Haverman L, Reiss IKM, Simons SHP, van den Bosch GE. COVID-19 lockdown impacts the wellbeing of parents with infants on a Dutch neonatal intensive care unit. J Pediatr Nurs. 2022;62:106-12. doi: 10.1016/j.pedn.2021.09.024. DOI: https://doi.org/10.1016/j.pedn.2021.09.024

Ncube S, van der Linde J, du Toit M, Graham MA, Eccles R. Nurses’ perspectives on the impact of the COVID-19 pandemic on parental involvement in NICUs. Int J Afr Nurs Sci. 2024;20:100699. doi: 10.1016/j.ijans.2024. 100699. DOI: https://doi.org/10.1016/j.ijans.2024.100699

Hendrawati S, Fatimah S, Fitri SYR, Mardhiyah A, Nurhidayah I. Needs of parents in critically ill infants care in the neonatal intensive care unit (NICU). J Keperawatan. 2018;9(1): 43-57. doi: 10.22219/jk.v9i1.4651 (in Indonesian).

Vetcho S, Cooke M, Petsky H, Saito A, Ullman AJ. Family-centered care across Thai neonatal intensive care units: a national, cross-sectional survey. J Perinat Neonatal Nurs. 2023 Dec 15. doi: 10.1097/JPN.0000000000000763. DOI: https://doi.org/10.1097/JPN.0000000000000763

Hunter D, McCallum J, Howes D. Defining exploratory-descriptive qualitative (EDQ) research and considering its application to healthcare. J Nurs Health Care. 2019;4(1). Available from: https://eprints.gla.ac.uk/180272/

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-57. doi: 10.1093/intqhc/mzm042. DOI: https://doi.org/10.1093/intqhc/mzm042

Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):533-44. doi: 10.1007/s10488-013-0528-y. DOI: https://doi.org/10.1007/s10488-013-0528-y

Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.

Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. London: SAGE; 2006.

Stuckey HL. The first step in data analysis: transcribing and managing qualitative research data. J Soc Health Diabetes. 2014;2(1):6-8. doi: 10.4103/2321-0656.120254. DOI: https://doi.org/10.4103/2321-0656.120254

Institute for Patient- and Family-Centered Care. Interview methodology and questions [Internet]. 2023. Available from: http://www.ipfcc.org/bestpractices/interview-method.pdf

Morgan DL, Guevara H. Interview guide. In: Given L, editor. The SAGE encyclopedia of qualitative research methods. Thousand Oaks: Sage; 2012.

Creswell JW, Creswell JD. Research design: qualitative, quantitative, and mixed methods approaches. 5th ed. Thousand Oaks: Sage; 2018.

Braun V, Clarke V, Hayfield N, Terry G. Thematic analysis. In: Liamputtong P, editor. Handbook of research methods in health social sciences. Singapore: Springer Nature; 2019. pp. 843-60. DOI: https://doi.org/10.1007/978-981-10-5251-4_103

Chowdhury MF. Coding, sorting and sifting of qualitative data analysis: debates and discussion. Qual Quant. 2015; 49(3):1135-43. doi: 10.1007/s11135-014-0039-2. DOI: https://doi.org/10.1007/s11135-014-0039-2

Palomaa AK, Korhonen A, Pölkki T. Factors influencing parental participation in neonatal pain alleviation. J Pediatr Nurs. 2016;31(5):519-27. doi:10.1016/j.pedn. 2016.05.004. DOI: https://doi.org/10.1016/j.pedn.2016.05.004

Heo YJ, Oh WO. The effectiveness of a parent participation improvement program for parents on partnership, attachment infant growth in a neonatal intensive care unit: a randomized controlled trial. Int J Nurs Stud. 2019;95:19- 27. doi: 10.1016/j.ijnurstu.2019.03.018. DOI: https://doi.org/10.1016/j.ijnurstu.2019.03.018

Brelsford GM, Doheny KK, Stoner J. A systematic review of psycho-spiritual interventions in the NICU: supporting parents› mental health and psychological well-being. Adv Neonatal Care. 2024;24(2):141-50. doi: 10.1097/ ANC.0000000000001160. DOI: https://doi.org/10.1097/ANC.0000000000001160

Hall SL, Cross J, Selix NW, Patterson C, Segre L, Chuffo- Siewert R, Geller PA, Martin ML. Recommendations for enhancing psychosocial support of NICU parents through staff education and support. J Perinatol.2015;35(Suppl 1):S29-36. doi: 10.1038/jp.2015.147. DOI: https://doi.org/10.1038/jp.2015.147

Bry A, Wigert H, Bry K. Need and benefit of communication training for NICU nurses. PEC Innov. 2023;2:100137. doi: 10.1016/j.pecinn.2023.100137. DOI: https://doi.org/10.1016/j.pecinn.2023.100137

Larocque C, Peterson WE, Squires JE, Mason-Ward M, Mayhew K, Harrison D. Family-centred care in the neonatal intensive care unit: a concept analysis and literature review. J Neonatal Nurs. 2021;27(6):402-11. doi:10.1016/j. jnn.2021.06.014. DOI: https://doi.org/10.1016/j.jnn.2021.06.014

Epstein EG, Arechiga J, Dancy M, Simon J, Wilson D, Alhusen JL. Integrative review of technology to support communication with parents of infants in the NICU. J Obstet Gynecol Neonatal Nurs. 2017;46(3):357-66. doi: 10.1016/j.jogn.2016.11.019. DOI: https://doi.org/10.1016/j.jogn.2016.11.019

Wreesmann WW, Lorié ES, van Veenendaal NR, van Kempen AAMW, Ket JCF, Labrie NHM. The functions of adequate communication in the neonatal care unit: a systematic review and meta-synthesis of qualitative research. Patient Educ Couns. 2021;104(7):1505-17. doi: 10.1016/j.pec.2020.11.029. DOI: https://doi.org/10.1016/j.pec.2020.11.029

Jones L, Taylor T, Watson B, Fenwick J, Dordic T. Negotiating care in the special care nursery: parents’ and nurses’ perceptions of nurse–parent communication. J Pediatr Nurs. 2015;30(6):e71-80. doi: 10.1016/j. pedn.2015.03.006. DOI: https://doi.org/10.1016/j.pedn.2015.03.006

Labrie NHM, van Veenendaal NR, Ludolph RA, Ket JCF, van der Schoor SRD, van Kempen A. Effects of parent-provider communication during infant hospitalization in the NICU on parents: a systematic review with meta-synthesis and narrative synthesis. Patient Educ Couns. 2021;104(7): 1526-52. doi: 10.1016/j.pec.2021.04.023. DOI: https://doi.org/10.1016/j.pec.2021.04.023

Yance B, Do K, Heath J, Fucile S. Parental perceptions of the impact of NICU visitation policies and restrictions due to the COVID-19 pandemic: a qualitative study. Adv Neonatal Care. 2023;23(4): 311-9. doi: 10.1097/ ANC.0000000000001077. DOI: https://doi.org/10.1097/ANC.0000000000001077

Greene MM, Rossman B, Patra K, Kratovil A, Khan S, Meier PP. Maternal psychological distress and visitation to the neonatal intensive care unit. Acta Paediatr. 2015;104(7):e306-13. doi: 10.1111/apa.12975. DOI: https://doi.org/10.1111/apa.12975

Carter BS, Willis T, Knackstedt A. Neonatal family-centered care in a pandemic. J Perinatol. 2021;41(5):1177–9. doi: 10.1038/s41372-021-00976-0. DOI: https://doi.org/10.1038/s41372-021-00976-0

Vetcho S, Ullman AJ, Petsky H, Wiroonpanich W, Cooke M. Parent and interdisciplinary professional perceptions of family-centered care in Thai NICU: a qualitative study. Nurs Crit Care. 2023;28(1):47-55. doi: 10.1111/nicc.12711. DOI: https://doi.org/10.1111/nicc.12711

Ghorbani F. Open visitation in the NICU: nurses’ perspectives on barriers and facilitators. Front Nurs. 2023;10(2):183-91. doi: 10.2478/FON-2023-0019. DOI: https://doi.org/10.2478/fon-2023-0019

Jannes C, Miedaner F, Langhammer K, Enke C, Göpel W, Kribs A, Nitzsche A, Riedel R. Woopen C, Kuntz L, Roth B. Increased parental satisfaction by unrestricted visiting hours and developmentally supportive care in NICUs– results of a German multicenter study. J Maternl Fetal Neonatal Med. 2020;33(11);1874-80. doi: 10.1080/ 14767058.2018.1532499. DOI: https://doi.org/10.1080/14767058.2018.1532499

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Published

2024-06-12

How to Cite

1.
Vetcho S, Phumdoung S, Kain V, Chaisri P. Challenges of Family-Centered Care in a Neonatal Intensive Care Unit during the Visitation Restrictions After COVID-19 Pandemic Peak: A Qualitative Study of Parents’ and Nurses’ Perspectives. PRIJNR [Internet]. 2024 Jun. 12 [cited 2024 Nov. 22];28(3):632-44. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/268511