Parents’ Experiences With a Model of Integrated Maternity and Neonatal Care Designed to Empower Parents

Abstract

Objective: To explore the experiences of parents with an integrated maternity and neonatal ward designed to empower parents by providing family-integrated care (FICare) to mother-newborn couplets in single-family rooms. Design: A qualitative analysis with a contextual constructivist approach. Setting: An integrated maternity and neonatal level 2 ward designed to empower parents in a teaching hospital in Amsterdam, the Netherlands. Maternity and neonatal care, up to and including highly complex care, is provided to mother-newborn couplets in single-family rooms according to the principles of FICare. Participants: Twenty-seven mothers and nine fathers of newborns who were hospitalized for at least 7 days. Methods: We held four focus group discussions and eight semistructured interviews 1 to 3 months after discharge of the newborn to explore which experiences (mechanisms) facilitated or impeded aspects of parent empowerment (outcomes) under which specific conditions of the integrated infrastructure (contexts). We used the realist evaluation model to analyze the data. Results: Our analysis revealed five themes of parent empowerment (outcomes): Feeling Respected, Gaining Self-Management Tools, Insights Into the Newborn's Condition, Perceived Control, and Self-Efficacy. For each theme, participants reported facilitating and impeding experiences (mechanisms) that were initiated and influenced by the combination of single-family rooms, couplet care, rooming-in, and FICare (contexts). Unrestricted physical proximity to their newborns, 24 hours per day, in a safe private environment offered parents intensive learning experiences through active participation in care. It helped them to achieve independent parenthood at the time of discharge, but it also generated challenges such as power conflicts with the staff; prioritizing care for themselves, siblings, or the newborn; feelings of isolation; and lack of sleep. Conclusion: Providing FICare to mother-newborn couplets in single-family rooms offers parents an intensive learning context for independent parenthood at the time of discharge. Health care professionals should be aware of the challenges and facilitators experienced by parents in the context of close physical proximity to their newborns 24 hours per day in single-family rooms. This awareness will allow them to better support parents in their empowerment process toward independent parenthood at the time of discharge.

The clinical, humanistic, and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions. A narrative synthesis systematic literature review

“…Forty-eight publications, including six evidence syntheses, reported on privacy (see supplementary table 9). (8,9,19,26,28,30–34,36,38–42,44,47,51,58,59,68,77,86,98,99,101–122) Eighteen were before-and-after studies, 23 were contemporaneous studies, one used mixed designs, and six were evidence syntheses. Nine had low quality scores but 19 had high quality scores.…”

“…Twenty-three studies were found that assessed maternity and neonatal care (see Figure 3 and supplementary Table 4). (10,11,15,(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57) Most (n=14) were before-and after studies and the remainder were contemporaneous studies. Three studies were low quality and only one had a highquality score.…”

“…Fourteen papers reported on outcomes in neonatal care. (10,15,38,(41)(42)(43)46,49,(52)(53)(54)(55)(56)(57) Many of the results for neonates in ICUs showed no differences in outcomes between accommodation types. Significant improvements were seen in breastfeeding outcomes (10,15,55,58) and weight gain (46,58) in favour of single rooms.…”

“…Eleven studies addressed neonatal care in ICUs. (9,19,38,40,44,47,51,98,103,106,107) All but two (38,51) favoured single rooms for privacy.…”

“… (8,9,19,26,28,(30)(31)(32)(33)(34)36,(38)(39)(40)(41)(42)44,47,51,58,59,68,77,86,98,99,. Eighteen were before-and-after studies, 23 were contemporaneous studies, one used mixed designs, and six were evidence syntheses.…”