Perceived barriers of family‐centred care in neonatal intensive care units: A qualitative study

Abstract

BackgroundFamily‐centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana.AimTo describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers.DesignThe study employed a descriptive qualitative design.MethodsThe researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist.ResultsPerceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes.ConclusionThe findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice.Relevance to Clinical PracticeHealth facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.

Implementation of Family Centered Care for Neonates Admitted in a Special Care Baby Unit in Sierra Leone

“…Barriers to successful FCC implementation were highlighted in a study conducted in Ghana where overworked staff who perceived caregivers to be “in their way” were reluctant to provide essential education to mothers and showed such disrespect to caregivers that some caregivers reported that they considered removing their sick infants from the unit. 30 These negative attitudes discourage rapport between caregivers and nursing staff as they are unwilling to initiate discussions with them. This was corroborated by our study as caregivers in the control group expressed concerns regarding the accessibility of the nursing staff who they felt were too busy to address their concerns.…”