Using appreciative inquiry to enhance family centred care in the neonatal intensive care unit

Abstract

A preterm or complicated birth and the subsequent hospitalisation of the neonate can be a traumatic and stressful experience for both parents and neonates. Parents often encounter challenges to the development of their parenting roles while in the neonatal intensive care unit (NICU), potentially resulting in immediate and long-term impacts on the neonate and overall family functioning. To support and meet the needs of parents experiencing a NICU admission, family centred care (FCC) has been developed and acknowledged as the 'best way' of caring for hospitalised children. The philosophy of FCC focuses on the health and wellbeing of the newborn and their family, through the development of respectful partnerships between health care professionals and parents. A general consensus exists in the literature regarding the value and importance of FCC. However, published research identifies major barriers in the implementation of this philosophy into clinical practice. An appreciative inquiry (AI) approach was used in this study to bring neonatal nurses and parents together to examine their perceptions and experiences of FCC and to collaboratively develop innovative strategies to improve care for the neonate and family. AI is a theoretical research perspective, an emerging research methodology and a world-view that builds on action research, organisational learning and organisational change. AI offers a unique, positive participatory strength-based approach to promoting organisational learning, facilitating change and building effective partnerships. AI consists of four phases known as the 4D cycle (discovery, dream, design and destiny). The discovery phase of the study set out to explore neonatal nurses' and parents' perceptions of FCC. This phase consisted of four focus groups and five face-to-face interviews with 33 neonatal nurses and one focus group with six parents (total n=39). Data were analysed using inductive thematic analysis and four dominant themes emerged 'Getting to know parents and their wishes', 'Involving family in the day to day care', 'Finding a happy medium' and 'transitioning across the continuum'. The dream and design phases consisted of one full day workshop that brought neonatal nurses and parents together to collectively explore FCC in the neonatal intensive care unit (NICU). The workshop consisted of nine neonatal nurses and six graduate NICU parents (total n=15). During this phase parents and nurses developed collaborative insights about optimal FCC that could be built upon to support neonates and families. Data were analysed using inductive thematic analysis. One overarching theme emerged 'sharing experiences and stories' that comprised four sub themes: 'discovering what works well'; 'dreaming of the ideal'; 'fixing things'; and, 'destiny, projections for the future'. As a result of the workshop a FCC working party was formed where parents and nurses agreed to meet on a monthly basis to develop and implement strategies to enhance FCC in the NICU. Researcher reflective field notes were thematically analysed and the following themes emerged 'great expectations'; 'negotiations around role boundaries'; 'progressing the agenda'; and 'ongoing challenges for nurse led initiatives'. The destiny phase of the study reports on the progress and experiences of the FCC working party two years from when the working party was formed. Two focus groups and four individual face-to-face interviews were held (n=12 participants). Data were analysed using thematic analysis. Four dominant themes emerged 'creating a physical and mental space'; 'building and maintaining momentum'; 'ongoing organisational support'; and, 'continuing collaborations'. This is the first known study that has used an AI approach to bring neonatal nurses and parents together to collaboratively develop strategies to strengthen FCC in the NICU. This original research aimed to improve neonatal outcomes and contribute to a body of knowledge surrounding FCC in the NICU. The findings of this study revealed that while neonatal nurses report a commitment to FCC, there continues to be incomplete or inconsistent applications of FCC principles in neonatal care. While nurses report the need to deliver FCC, the study revealed that successful implementation of FCC in the NICU is difficult and requires time, education, resources and ongoing organisational commitment and support. This study highlighted the importance of developing social networks and the need for interdisciplinary collaborations that includes both health professionals and families. AI provided a useful framework for this study and created opportunities for the exchange of information, networking and developing partnerships and collaborations.

Date of Award	2016
Original language	English