During December 2017, the Journal of Neonatal Nursing published a series of articles on the partnership of care between staff and parents on neonatal units. This discussion goes far beyond what is discussed in relation to normal maternal and newborn health.
These articles do not address gender issues relating to support for parents – how mothers and fathers have different needs arising from different social expectations on them. This is a weakness, given other research we have published on Family Included that shows the gender awareness is important in achieving the highest standard of neonatal care. But the articles do set out a vision that provides a strong foundation for gender sensitive care.
A partnership between professionals and parents means enabling the parents to be active carers of the baby, supporting them to bond with the baby and engaging them in decision-making.
The idea of a partnership between professionals and parents matured in Estonia where there was a shortage of healthcare professionals. This meant mothers were brought in to help with the care and this resulted in improved health outcomes. 
The philosophy and benefits of this approach are well recognised, yet there are still barriers to implementing it in all countries of the world. Many families still report dissatisfaction with the care.
A question of power
At the heart of the issue, according to Karen Read and Louise Rattenbury, who work for the Royal Devon and Exeter NHS Foundation Trust in UK, is the power balance between neonatal staff and parents. The health system positions staff as experts in an emergency situation, with parents heavily indebted to them. Parents can easily find themselves in the position of visitors and are unable to assert any authority over the care of the baby. But “parents are the best people to care for their baby.” 
A first step is simply to create a welcoming environment. In Exeter, “a welcoming environment did not just mean lots of smiling nurses; it comes down to how comfortable families are made to feel staying in unfamiliar environment.” This includes things like comfortable chairs, enough chairs for two parents, keeping restrictions to further visitors to a minimum, not communicating subtly that it is time for parents to leave at the end of the day, providing space for parents to eat, drink and have time to themselves, and involving parents in ward rounds and other medical procedures. Overnight staying is a priority in Exeter, with folding beds and special rooms for when the mother is also ill and in a hospital bed herself. Parents typically crave to be near their babies and there have been examples in Exeter with parents staying with their baby every night for over 80 nights. 
Another important process on the neonatal unit is to encourage parent-baby skin-to-skin care. This requires well trained staff able to reassure anxious parents, particularly when the baby has an extremely low birth weight. Education for the parents is important, as well as privacy and comfort. 
Models of professional-parent partnership
In UK, three models of professional-parent partnership are current:
- Baby Friendly accreditation
- Bliss accreditation
- Family integrated care
Baby Friendly Initiative
The Baby Friendly Initiative (BFI) neonatal standards developed by UNICEF focus on three aspects of baby care: (1) developing close and loving baby/parent relationships, (2) promoting breastfeeding and (3) working with parents as partners in care. The BFI has an accreditation process, which starts with a signed commitment from service managers and the development of a breastfeeding policy and training programme. Assessors then evaluate the current level of staff knowledge, providing the basis for a staff training programme. Finally, parental experience is explored. 
Bliss is a UK charity for babies born premature or sick babies. Its aim is to improve the survival and quality of life of these babies and partnership with parents is at the heart of its strategy. Bliss is promoting family-centred care in three ways. 
- The Bliss Baby Charter, created in 2009. This is a self-assessment and self-improvement tool for neonatal units. The Charter defines what needs to be in place to support parents to bond with and actively care for their baby. A key issue in UK is the lack of accommodation and kitchen facilities in many units, and also the high cost for parents to travel every day to the neonatal unit.
- The Family and Infant Neurodevelopmental Education (FINE) training programme, which includes a focus on parent-infant and family-professional relationships and how to organise family participation.
More recently, Bliss has been promoting the family Integrated Care model in UK – see below.
Family Integrated Care
Family Integrated Care (or Family Delivered Care) is an advanced form of partnership with parents, which evolved originally in Estonia and has been pioneered in Canada. The process was designed in collaboration with parents.
Staff are trained to be coaches, mentors and counsellors for parents.
- Parents receive a competency assessment and then training, co-delivered by staff and veteran parents.
- Parents are specifically encouraged to be present at least 6 hours a day. Facilities are in place to support this – kitchen, family room and accommodation for every parent.
- Parents are encouraged to be involved in daily and enhanced care for their baby with a level of autonomy following competency based training.
- Parents are encouraged to be active members of the ward round and they present their babies to the health professionals. They are encouraged to tell their stories, so that staff can see things from their point of view.
- Parents are told the purpose of routine medication and, under supervision of nursing staff, administer oral medication.
- Psychosocial support and peer support from trained veteran parents.
Using communication technologies to engage with parents
At the Neonatal Care Unit at Imperial College Healthcare NHS Trust in London, they have developed an “Integrated Family Delivered Care” mobile app, in consultation with parents. This provides a single channel of information to parents, which greatly helps consistency of communication across members of the neonatal team. Parents can download the app and register when their baby admitted to the neonatal unit. The app caters for multiple babies. The app has a non-interactive section which provides parental education in fifteen chapters and links to other trusted external information sources. This part of the app also has a ‘developmental timeline’ that follows the development of the baby from 23 to 42 weeks. The other section is more interactive, which has a diary section enabling parents to record words and photos along their journey, and easily share these with friends and family. The diary section allows parents to chart their skin-to-skin cuddles, milk expression and feeding episodes. 
Also at the Imperial neonatal unit, they provide parents with sound blocking headphones so that parents can remain peacefully with their infants during ward rounds, when medical staff move round the unit discussing each baby in turn. These rounds can continue for several hours in a busy unit. 
The Royal Hospital for Children in Glasgow has launched a video messaging system, VCreate. This allows healthcare professionals to send parents short video messages about their babies. These are available to parents via secure log-in. This tool is valuable for parents who cannot be in the unit as much as they would like, such as sick mothers. 
- Banerjee J, Aloysius A, Platonos K & Deierl A (2017), Family centred care and family delivered care – what are we talking about?, Journal of Neonatal Nursing
- Read K & Rattenbury L (2017), Parents as partners in care: lessons from the Baby Friendly Initiative in Exeter, Journal of Neonatal Nursing
- Lim S (2017), Neonatal nurses’ perceptions of supportive factors and barriers to the implementation of skin-to-sking care in extremely low birth weight (ELBX) infants – a qualitative study, Journal of Neonatal Nursing
- Kelly H (2017), Putting families at the heart of their baby’s care, Journal of Neonatal Nursing
- Banerjee J, Alysius A, Platonos K & Deierl (2017), Innovations: supporting family integrated care, Journal of Neonatal Nursing
Photo: Army Medicine. Creative Commons.