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PEDIATRICS Vol. 111 No. 4 April 2003, pp. e450-e460

ELECTRONIC ARTICLE

Implementing Potentially Better Practices for Improving Family-Centered Care in Neonatal Intensive Care Units: Successes and Challenges

Kimberly A. Cisneros Moore, RNC, BSN*, Kara Coker, RN, MSN{ddagger}, Allison B. DuBuisson, MS§, Betsy Swett, RNC|| and William H. Edwards, MD

* Children’s Hospital at Providence Alaska Medical Center, Anchorage, Alaska
{ddagger} DeVos Children’s Hospital, Grand Rapids, Michigan
§ Women’s Hospital of Greensboro, Greensboro, North Carolina
|| Woman’s Hospital, Baton Rouge, Louisiana
Children’s Hospital at Dartmouth, Lebanon, New Hampshire

--> Objective. Multidisciplinary teams from 11 medical center neonatal intensive care units collaborated in a quality improvement project with a focus on family-centered care.

Methods. Through a process of self-analysis, literature review, benchmarking site visits, and expert consultation, 10 potentially better practice (PBP) areas were defined. Improvement activities in 4 of the 10 areas are given as examples of successes and challenges that individual centers encountered. The 4 areas are vision and philosophy, unit culture, family participation in care, and families as advisors.

Results. Centers were at different places for all of the PBPs at the beginning and throughout the collaboration. Seven centers developed or revised their vision or philosophy of care statements about family-centered care. Incorporating the vision and philosophy of care into performance appraisals, hiring of new personnel, and changing unit culture to a more family-centered practice were more challenging than developing the statements. Full parent participation in care requires unrestricted access to the neonatal intensive care unit. The shift from considering parents to be "visitors" to being partners in caring for their child was more difficult for centers with restricted visitation policies. All centers developed, expanded, or started plans for establishing family advisory councils. The experience of 2 centers is described.

Conclusions. Family-centered care is more of a journey than a destination. Collaborating centers in this project found themselves at different places in that journey. Through perseverance in implementing the PBPs, all have moved further along the path.

Key Words: family-centered care • parental involvement • parent advisory council • collaborative quality improvement • multidisciplinary • neonatal intensive care • NIC/Q 2000

Abbreviations: NICU, neonatal intensive care unit • NIC/Q 2000, Neonatal Intensive Care Unit Quality Improvement Collaborative Year 2000 • PBPs, potentially better practices

Received for publication Aug 13, 2002; Accepted Oct 24, 2002.




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