Action research on relationship centred care (ARRCC)

Developing family-centred care in a neonatal intensive care unit: an action research study

(The ARRCC study – Action Research on Relationship Centred Care)

There is convincing evidence of the benefits of parental involvement in the care of their infants in the Neonatal Intensive Care Unit (NICU) with a direct link demonstrated between increased parental involvement and reduced length of stay, reduced need for re-hospitalisation, and improved long-term morbidity (Ortenstrand et al 2010, O’Brien et al 2013). Several reports highlight that although parents are generally satisfied with the standard of clinical care provided to their infant, a more family-centred approach to neonatal care is needed (Poppy Steering Group 2009, Bliss 2011, Picker Institute 2012). Parents report that they wish to receive more information, stay longer in the neonatal unit, be more involved in decisions about their baby’s care and work more in partnership with healthcare professionals. Although research evidence identifies the benefits of individual interventions to promote family-centred care, there is a lack of knowledge about how these interventions might be implemented into everyday practice on a NICU. This pilot study will provide valuable insights into this process of change.

The aim of the proposed study is to develop, implement and evaluate an evidence-based family-centred intervention to promote greater parental involvement in the care of their infant in NICU. A participatory action research approach will be used in which the lead researcher (CS) will work with nurses, the MDT and parents to co-develop the intervention and support the change in practice. The study comprises the following phases of the action research process (Meyer 2010).

The Exploration phase will provide insight into the context in which the intervention will be introduced, together with staff and parent perceptions of parental involvement in care.  Baseline measures of staff and parental satisfaction with care, and parental stress will be obtained using validated survey instruments. Baseline data for infants will include breastfeeding rates and parent/infant skin-to-skin contact. Focus groups and interviews with staff will provide insight into the current context of parental involvement in care together with perceived barriers and enablers to introducing the proposed change. Focus groups with parents and parent-completed diaries will provide insight into factors influencing parental involvement in care. Data collected from this stage will inform the development of the evidence-based intervention.

The Intervention phase will involve three action research cycles during which the intervention will be tested and further refined. Each cycle will involve a period of planning, acting observing and re-planning. On-going data collection from parents and staff will be used to inform the further development of the intervention and change process.

The Evaluation phase will signal the end of active facilitation by the lead researcher, as the intervention will be sufficiently refined to allow evaluation of its impact. Baseline measures on staff, parents and infants taken in the exploration phase will be repeated in order to identify any changes. Focus groups and interviews with staff and parents will provide insight into their perceptions of the success of the initiative in promoting family-centred care.

The proposed study will contribute new knowledge about how nurses can contribute alongside other members of the MDT to a family-centred model of care in which parents are actively involved in the care of their infant on NICU. Greater understanding of the impact of family-centred care on staff and parents will be gained. It is anticipated that the findings from this study will inform future research in this field and have the potential to inform future policy and practice on NICUs in the UK.