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. 2020 Oct 1;17(19):7197. doi: 10.3390/ijerph17197197

Table 2.

Overview of included studies showing active parental involvement in neonatal intensive care unit (NICU) care delivery.

Quantitative Studies
Author(s), Year and Country Study Design Study Purpose Sample Characteristics Main Variables Methodological Quality Level Results Limitations
Hedberg et al. (2009)
Sweden		 Quantitative
dichotomous responses		 Explore parents’ views on parental performance of care in the NICU. N = 29 parents:
  • -

    N = 18 women

  • -

    N = 11 men

  • -

    N = 21 PNs

(19 N-III parents
10 parents N-II)		 Parents:
  • -

    Gender

  • -

    No of children

  • -

    Gestational age (GA) PNs

  • -

    Postnatal age in the study

 80% Parents can take care of the PN.
Support the role of parents as caregivers.
Nurse educators.		 The sample should be bigger
Martinez et al. (2010)
Mexico		 Quantitative
descriptive		 Understand the healthcare environment and the administration of parental care.
Parent participation in NICU, at different levels.		 N = 9 H:
  • -

    N = 4 private.

  • -

    Level I

  • -

    N = 2 public.

  • -

    Level III

  • -

    N = 3 mixed.

1 Level III
2 Level II
  • -

    Level of care.

  • -

    Hospital birth rate.

  • -

    NICU characteristics.

  • -

    Human resources.

  • -

    Parental involvement

  • -

    Post-discharge follow-up

 60% Encourage parent participation.
Implementation of the FCC philosophy.
Healthcare training and parent care training.		 Enlarge sample size.
Evaluate infrastructure, equipment, organization.
O’Brien et al. (2013)
Canada		 Quantitative cohort analysis Explore the feasibility of implementing the FCC care model.
IN NICU promote maternal development: attention to PN.		 N = 42 PNs
4 twin PNs were excluded
(N =14 PN G. Control)
N = 42 mothers
(N = 14 mothers
G. Control)		 Rn:
  • -

    GA PN

  • -

    Birth weight

  • -

    Apgar 1’ and 5’

  • -

    Oxygen days

  • -

    Administration of vasoactive agents and caffeine

Mothers:
  • -

    Marital Status

  • -

    Age

  • -

    No of children 2–15 years

  • -

    Distance from the hospital

  • -

    Educational level

 60% FCC model is feasible and safe.
It improves maternal care and PN results.		 Use critical incidence reports only to monitor security.
Non-representative, non-generalizable parents
Sannino et al. (2016)
Italy		 Quantitative non-randomized control single center Evaluate NIDCAP effectiveness mother care participation PN. N = 43 PN (32 GE):
  • -

    N = 21

G. Intervention
  • -

    N = 22 G. Control

N = 33 mothers.
  • -

    N = 17

G. Intervention
  • -

    N = 16

G. Control		 PN:
  • -

    GA PN

  • -

    Birth weight

Mothers:
  • -

    Maternal age

  • -

    Educational level

Questionnaire:
  • -

    Parent Support

  • -

    Quality care

 60% NIDCAP effective participation of mother in care of PN improves neurofunctional development.
Mothers in
NIDCAP group more involved.		 Small sample size.
No group randomization.
Bias of the population studied, only one center
Simphronio et al. (2016)
Brazil		 Quantitative
quasi-experimental		 To evaluate the effects of FCC implementation on perception and parental stress on caring capacity. N = 132 parents of PN
(N = 66 phase prior to intervention,
N = 66 after intervention).		 Parents:
  • -

    Sociodemographic profile

  • -

    Distance from the hospital

  • -

    Hospitalization experiences

  • -

    Social Support

Neonates:
  • -

    Length of stay

  • -

    Age

  • -

    Diagnosis

 100% Improved parental perception in FCC in terms of respect, collaboration and support in the post-intervention phase.
Greater satisfaction, increased capacity to care for children.
Less parental stress and anxiety after intervention		 The study investigated two measures (perception and stress).
Short-term evaluation.
By Bernardo et al. (2017)
Italy		 Quantitative prospective non-randomized cohort Compare levels of satisfaction and stress, participation and care:
- Parents group FCC.
- Non-FCC parents.		 G. FCC:
  • -

    N = 24 parents

  • -

    N = 24 mothers

  • -

    N = 24 PN

G. NO FCC:
  • -

    N = 24 parents

  • -

    N = 24 mothers

  • -

    N = 24 PN

 Parents:
  • -

    Nationality

  • -

    Age

  • -

    Educational level

Rn:
  • -

    GA PN

  • -

    Apgar 1’-5

  • -

    Length of stay

 60% FCC Group: higher satisfaction, lower stress level when participating in care.
Family integration model advantages, future need for trials.		 Small sample size.
Selected population of PN disease Qx.
Non-randomization.
Do not distinguish between procedures that are a source of stress for parents.
Ottosson et al. (2017)
Sweden		 Quantitative multiple regression analysis Identify process of care components.
Vision parents participation care.		 N = 141 parents of NICU children.
  • -

    N = 60 men

  • -

    N = 81 women

 Characteristics of parents:
  • -

    University Education

  • -

    Previous parental experience

Questionnaire
EMPATHIC-N):
  • -

    Information for parents, treatment and care.

  • -

    Parent participation.

  • -

    Professional attitude.

 80% Strong points of PN: better interaction with breastfeeding and caring.
Professional hands-on involvement: facilitates parent participation.
Important contact nurse continuity.		 No random sample: generalization of results questioned.
Palma et al. (2017)
Chile		 Quantitative cross-sectional description Knowing stress levels and parental perceptions of participating PN in NICU care. N = 100 parents
(N = 43 men,
N = 57 women)
N = 59 RN.		 Parents:
  • -

    Average age

  • -

    Level of studies

  • -

    Place of residence

Mother:
  • -

    Parity.

  • -

    Multiple pregnancy.

  • -

    Pregnancy complications.

  • -

    Previous abortions.

  • -

    Type of delivery

 100% Support and parent education, allows them to cope with stress.
Encourage care and practices that promote parent–PN bonding.		 Not analyze other factors that can influence stress, such as mental health, social network, personality.
Verma et al. (2017)
India		 Quantitative randomized controlled trial Evaluate impact of parent involvement in care of PN. N = 295 PN NICU:
G.Control=147
G.Interven=148
Family:
  • -

    37% parents

  • -

    43% mothers

  • -

    20% grandparents
  • -

    Average weight

  • -

    GA PN

  • -

    Gender

  • -

    Type of delivery

  • -

    Interventions made by parents

 80% G. Intervention, better preparation good home transition. Decreases hospital stay.
Parent empowerment: cornerstone of the continuum of care		 Study low power to detect differences.
No evaluation of long-term results.
Govindaswamy et al. (2020)
Australia		 Quantitative
prospective cohort		 Identify needs for parental involvement in NICU care N = 48 parents of PN
(N = 23 G. Intervention
N = 25 G. Control)
N = 48 PN.		 Characteristics of parents:
  • -

    Age group:

or 18–36 (30)
or 36–40 (11)
or 40 (7)
  • -

    First child:

or Yes (28)
o No (20)
  • -

    Previous NICU experience:

or Yes (2)
o No (46)
Characteristics PN:
  • -

    Gender:

  • ○

    Male (28)

or Female (20)
  • -

    Gestational age:

or 28–34 (2)
or 34–37 (13)
or 37(33)
  • -

    Birth weight:

or 1500 (1)
or 1501–2500 (10)
or 2501 (37)		 60% Parents G. Intervention need to actively participate in PN care, recognize caregiving role.
FCC Model meeting parent needs. 		Difficult to evaluate sample representativeness and generalization of results.
Includes only parents who can read and write in English.
Limited sampling method.
Qualitative Studies
Campo et al. (2018)
Argentina		 Qualitative phenomenological paradigm Identify parenting needs.
Pick up parental care granted to PN upon discharge.		 N = 8 parents children admitted to NICU.
  • -

    Emotional support

  • -

    Coordination and integration of care.

  • -

    Information, education, family participation.

  • -

    Physical comfort, support for daily activities.

 100% Parents argue nursing: teaches care, family empowerment
Communication improves bonding.
Open NICU guides and trains parents in care.		 Data are collected until they provide information relevant to the study.
Stelwagen et al. (2019)
Holland		 Qualitative descriptive Describes transition from traditional NICU design to new infrastructure that enables parent empowerment N = 53 families Room design:
  • -

    Patient type.

  • -

    Sanitary equipment.

  • -

    Hospitalization/High

  • -

    Joint accommodation

  • -

    No of meters

 60% Implementation of infrastructure for neonatal care, facilitates parent empowerment.
Requires willingness to change.		 Minimum description of the implementation mechanism and its cost.
Mixed Studies
Hernandez et al. (2016)
Colombia		 Quantitative descriptive and qualitative analysis Evaluate strategies for developing PN and FCC in NICU N = 7 mothers
  • -

    Current problems in care, barriers to FCC implementation.

  • -

    FCC knowledge and perceptions.

  • -

    Unity environment, parent involvement, interaction with staff.

  • -

    Changes in neonatal practice

 80% Healthcare workers: Encourages humanized care in NICUs.
Educates the family in PN care, with mutual communication and training.
Parents need more communication, participation, and increased visiting hours.
The changes to promote FCC obtained positive results in the short term.		 Personal change during study, obstacle to continuous reflection.
Changes in care practice occurred over a short period of time.