The articles in this In Focus series highlight neonatal research pertaining to family-centered developmental care. Although family-centered developmental care is considered an essential aspect of the care provided in the neonatal intensive care unit (NICU), in reality, providers are still trying to achieve this standard. Care in the NICU is evolving, resulting in a more supportive environment for high-risk infants and families, but providers still have much to learn about how to best support optimal outcomes. In each of the three articles in this section, the authors examine developmentally supportive care from different perspectives.
First, Cone and colleagues describe how the use of four-handed care during endotracheal suctioning of ventilated high-risk infants supports the infant and the care providers. The concept of four-handed care is borrowed from dentistry wherein the dentist works intuitively in tandem with the assistant to provide care to the patient. The synchrony within the team is so smooth that often little or no visible communication occurs. These researchers are the first to further explore and understand how this phenomenon might be useful in supporting the implementation of family-centered developmental care interventions in the NICU. This pilot study raises our awareness of the multiplicity of outcomes associated with an intervention that is supportive of infants, families, and providers.
This series also includes two articles related to a very important aspect of provision of family-centered developmental care: parent experiences and satisfaction with care in the NICU. Butt and colleagues address the meaning and impact of parent satisfaction. It is important to understand what researchers have previously studied so that we may prioritize future actions, increase parent satisfaction, and more effectively study this phenomenon. The use of evidence to guide developmentally supportive practices in the NICU is becoming increasingly evident in the clinical setting. Next steps for making family-centered developmental care the standard include more explicit, comparative effectiveness research. The purpose of such research is to determine which interventions make the most difference, with the least risk, and for the greatest good for infants, families, and care providers. Understanding whether the evidence is strong enough to change clinical practice will help practitioners to best support infants and families, increase parent satisfaction, and improve long-term outcomes.
In the final article, Uhl and colleagues explore parents’ experience of care during their children's hospitalization in a mixed-methods design. They found that parents might indicate satisfaction with provision of information on a questionnaire or survey, but when asked for more details about their experiences, their accounts differed. This important finding is easily addressed by improving nursing care philosophies so they are more representative of partnerships with families. These philosophies should include an effort to engage families and their beliefs with caregiving practices. The authors emphasize the importance of continued evaluation of NICU care, so that the intent of care is actually what is perceived and received.
The science pertaining to family-centered developmental care is still evolving and promises to improve the care and outcomes for some of our most vulnerable patients: neonates. This series serves as a stepping stone to reaching this goal.