Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses

Abstract

Background: Family-Centered Care (FCC) is considered to be the gold standard ofNICU patient care. Some of the benefits of FCC practice include greater neurobehavioral development and shorter hospital stay for infants and improvement in staff satisfaction and feelings of reward for nurses. However, barriers to FCC exist in its implementation. Current research has yet to examine how organizational and nursing factors, such as nurse empowerment and compassion fatigue (CF), may be associated with FCC practice in the unique NICU environment. Therefore, the overall purpose of this mixed methods study was to investigate implementation barriers and facilitators of FCC among neonatal nurses. Specific Aims: This mixed-methods study aimed to: a) determine the relationships between nurse empowerment, compassion fatigue, and FCC practices among NICU nurses, while controlling for individual and institutional characteristics; and b) generate a grounded theory that identifies the process by which neonatal nurses engage in FCC practices in the context of the NICU setting. Method: A sequential, convergent mixed-method (quan>QUAL) design was used to address the study aims. The quantitative portion of the study used a cross-sectional, descriptive correlational design. The qualitative component of the study used a grounded theory approach to give a more comprehensive context and explanation of the delivery of FCC. The study was funded by National Association of Neonatal Nurses (NANN) and Sigma Theta Tau International Epsilon Zeta Chapter. Subjects were recruited from social media and NANN membership. A total of 176 bedside NICU nurses with at least 6- month experience were recruited to complete an anonymous, online survey. The following established instruments were included in the survey: The Family-Centered Care Questionnaire-Revised, The Psychological Empowerment Instrument, and the compassion fatigue subscale of Professional Quality of Life Scale. A purposive sample of survey participants was selected from the respondents who agreed to volunteer for an interview. These unstructured, 60 minutes interviews were conducted virtually using web conference software. A total of 20 neonatal nurses were interviewed. Quantitative data analysis consisted of bivariate and multivariate statistical procedures. Hierarchical linear regression analysis was conducted to identify the variables that explain the most variance in FCC. Grounded theory strategies guided the analysis of the qualitative data. Integration of qualitative and quantitative data occurred through a sampling plan, analysis, and discussion. Conclusion: This study contributed to our understanding of the facilitators and barriers to NICU nurses’ FCC practices and the role of CF and nurse empowerment. Findings arising from this study were disseminated in several scholarly conferences and the two prepared manuscripts will be disseminated in neonatal science journals. Future studies should examine facilitators and barriers of FCC practices in the NICU from other healthcare providers’ perspectives and evaluate interventions.