Staff Perceptions of Family-Centered Care in Italian Neonatal Intensive Care Units: A Multicenter Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Ethics
2.2. Participants
2.3. The Family-Centred Care Questionnaire-Revised (FCCQ-R)
2.4. Data Collection
2.5. Data Analysis
3. Results
3.1. Participants
3.2. Reliability of the FCCQ-R@it-NICU
3.3. Current and Necessary Activities of the FCCQ-R@it-NICU
3.4. Associations between FCCQ-R@it-NICU Scores and Participants’ Characteristics
3.5. Regression Model
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Current | Necessary | |
---|---|---|
FCCQ-R@it-NICU | Mean (SD) | Mean (SD) |
The family as the constant of the child’s life | ||
1. Staff encourage parents and just in case also siblings to come and go any time that meets the family’s needs | 3.30 (1.16) | 4.15 (0.98) |
2. Staff work with families to determine the level of participation in direct care and decision-making that suits the family’s needs best | 3.50 (1.03) | 4.33 (0.77) |
3. The family is the key decision maker in the care of their infant | 2.37 (1.00) | 3.20 (1.16) |
Parent and professional collaboration | ||
4. Staff determine the infant’s needs in consultation with the family and other health professionals | 3.35 (1.06) | 4.18 (0.85) |
5. Parents contribute to the development and review of hospital policies and practices | 2.24 (0.99) | 2.23 (0.98) |
6. Parents and siblings are involved in staff continuing education Programs in various ways. | 1.98 (0.98) | 1.96 (0.96) |
7. Educational programs (for family members) and written material convey the sense that families are the key actors in care. | 2.82 (1.05) | 2.80 (1.05) |
8. The admission process is used, when possible, as an opportunity to begin involving the family as members in the health care team. [if possible] | 3.50 (1.05) | 3.48 (1.05) |
9. Hospital facilities, policies, and procedures foster family choices for participation. | 2.92 (1.10) | 2.90 (1.09) |
10. Interviews with families are conducted in a private location. | 3.12 (1.31) | 4.57 (0.70) |
11. Explanations are presented to the family, using a variety of techniques depending on the individual needs and learning styles of the family | 3.58 (1.08) | 4.52 (0.67) |
12. Staff are aware of and take approaches that address the fact that families take time to develop trust. | 3.77 (0.82) | 4.45 (0.60) |
13. Staff discuss with the family what helps them deal with events during hospitalization | 3.68 (0.85) | 4.40 (0.66) |
14. Staff assess the level of understanding and skills of the family before and after teaching. | 3.78 (0.87) | 4.44 (0.60) |
Sharing information with parents | ||
15. Staff promote, when possible, the infant’s preadmission information program, through which families familiarize with hospital ward staff, routines, and equipment prior to a scheduled admission to the PICU. | 2.40 (1.08) | 3.82 (0.97) |
16. After an emergency admission or unscheduled admission, there is an organized system for helping families understand and adjust to the health care experience. | 2.94 (1.10) | 4.22 (0.70) |
17. Information is routinely communicated to help families understand each aspect of care that their infant will experience such as anticipated sequence of events, reasons for change/treatment/procedure, ways to cope. | 3.50 (0.95) | 4.38 (0.68) |
18. Any family member significantly involved in the infant care is encouraged to discuss or chart information about the care of their infant. | 2.80 (1.04) | 3.79 (0.98) |
19. Staff coordinate the flow and sequence of information given to families, ensuring that the infant’s needs are apriority. | 3.57 (0.94) | 4.29 (0.69) |
Parent-to-parent support | ||
20. Staff encourage parents to discuss concerns with other parents with similar experiences informally or in formal parent groups. | 3.16 (1.09) | 4.11 (0.88) |
21. Staff provide programs and support for parents, siblings and members of the extended family to assist families in managing needs | 2.94 (1.09) | 4.19 (0.78) |
22. Staff assess the needs and concerns of siblings. | 2.44 (1.09) | 3.78 (0.98) |
23. There is a designated comfortable area for parents to gather. | 2.97 (1.35) | 4.29 (0.78) |
Developmental needs | ||
24. Staff help family to establish/stay in touch with their family and significant others | 2.68 (1.04) | 3.71 (0.92) |
25. Direct care managers have an adequate knowledge in infant development to support hospital staff in the practice of family-centred care. | 3.44 (1.12) | 4.29 (0.72) |
26. Hospital brochures accurately describe the health care experience for infant and their families. | 3.08 (1.12) | 4.27 (0.75) |
27. Staff maintain familiar routines for each infant and family. | 2.56 (1.01) | 3.71 (0.94) |
28. Staff assess the infant interaction with staff and family. | 3.56 (0.91) | 4.15 (0.75) |
Emotional and financial support for families | ||
29. When possible, the same staff are assigned to care for the infant and family. | 3.05 (1.19) | 3.93 (1.00) |
30. Information and support are provided to help families understand the illness process and the impact on the infant and family, choices and risks, services, and roles of various health professionals | 3.61 (0.91) | 4.36 (0.69) |
31. Staff recognize the financial strain on families and assist them in obtaining help | 3.40 (1.00) | 4.06 (0.80) |
32. During procedures, a staff member is designated to explain to the family exactly what is happening. | 2.64 (1.06) | 3.98 (0.84) |
Design of health care system | ||
33. Outpatient services are available daily and in the evening hours. | 2.10 (1.04) | 3.62 (1.03) |
34. All written material for families is available in Italian or in the mostly commonly spoken languages | 3.33 (1.11) | 4.19 (0.76) |
35. A written summary of relevant information about the infant is available in the primary official language of the family. | 2.40 (1.12) | 4.08 (0.82) |
36. The physical layout of the unit is designed to meet the developmental and psychosocial needs of infant and family | 2.32 (1.12) | 4.24 (0.86) |
37. Resources exist to help provide families with the appropriate support that they need at varying times | 2.86 (1.04) | 4.13 (0.78) |
38. Parent evaluations are considered reliable sources of information about how well the hospital meets their needs. | 3.29 (0.93) | 3.99 (0.80) |
39. Staffing patterns are planned according to the developmental and psychosocial needs of infant. | 2.98 (1.10) | 4.08 (0.84) |
Emotional support for staff | ||
40. There are guidelines to assist staff in providing care during painful procedures such as: implementing pain-relieving techniques and ways to keep the child calm during and after the procedure | 4.11 (0.92) | 4.56 (0.65) |
41. Job descriptions and performance appraisal systems incorporate expectations of family-centred care such as: knowledge of family dynamics and skills in collaboration, problem solving and interventions that address family’s needs | 2.90 (0.97) | 3.96 (0.76) |
42. Continuing education programs provide opportunities for staff to learn to approach families effectively | 3.06 (1.0) | 4.23 (0.75) |
43. The hospital recognizes and rewards staff’s specific knowledge and skills that are needed to care for infants and families | 2.17 (1.04) | 4.21 (0.87) |
44. Staff are encouraged to identify, plan and evaluate new programs, policies and procedures to improve the quality of infant and family care. | 3.11 (1.11) | 4.32 (0.70) |
45. Staff are able to express confidentially to those responsible for assuring quality care, their concerns related to those demands of providing care for their infants and families | 3.40 (1.06) | 4.26 (0.67) |
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Variables | Sample | Number | Percentage (%) |
---|---|---|---|
Sex (n = 921) | |||
Female | 821 | (88.3) | |
Male | 100 | (10.9) | |
Staff (n = 890) | |||
Fixed-term | 810 | (91.01) | |
Temporary | 80 | (8.99) | |
Health Professionals (n = 916) | |||
Nurse | 546 | (59.61) | |
Pediatric Nurse | 151 | (16.48) | |
Medical Doctor | 176 | (19.21) | |
Others | 26 | (2.84) | |
HC Professional | 17 | (1.86) | |
Job Position (n = 828) | |||
Head/Coordinator | 46 | (5.56) | |
Non coordinator | 782 | (94.44) | |
Education (n = 870) | |||
Regional Diploma | 212 | (24.5) | |
Bachelor of Science | 330 | (37.9) | |
Master of Science | 66 | (7.5) | |
PhD or MD | 152 | (17.5) | |
Other | 110 | (12.6) | |
Clinical Setting (n = 914) | |||
NICU | 48 | (5.25) | |
Intermediate Care | 22 | (2.41) | |
Both | 844 | (92.34) | |
Family information (n = 906) | |||
Staff with children | 565 | (62.36) | |
Staff without children | 341 | (37.64) | |
Age (n = 914) | |||
>51 | 150 | (16.41) | |
41–50 | 333 | (36.43) | |
31–40 | 304 | (33.26) | |
20–30 | 127 | (13.89) | |
Years of experiences (n = 437) | |||
>10 | 162 | (37.1) | |
≤10 | 275 | (62.9) |
Subscales | Current | Necessary |
---|---|---|
The family as the constant of the child’s life | 0.66 | 0.65 |
Collaboration between parents and health professionals | 0.76 | 0.70 |
Recognize family individuality | 0.70 | 0.80 |
Share complete information | 0.72 | 0.76 |
Understand the developmental needs of the child | 0.65 | 0.75 |
Encourage parent-to-parent support | 0.66 | 0.78 |
Provide emotional and financial support | 0.57 | 0.61 |
Assuring that the healthcare delivery system responds to family needs | 0.73 | 0.82 |
Provide emotional support to staff | 0.74 | 0.85 |
Total index | 0.91 | 0.92 |
Sub-Scales for Current Domains | 1. | 2. | 3. | 4. | 5. | 6. | 7. | 8. | 9. |
1. The family as the constant of the child’s life | 1 | ||||||||
2. Collaboration between parents and health professionals | 0.639 ** | 1 | |||||||
3. Recognize family individuality | 0.426 ** | 0.558 ** | 1 | ||||||
4. Share complete information | 0.434 ** | 0.553 ** | 0.739 ** | 1 | |||||
5. Understand the developmental needs of the child | 0.431 ** | 0.489 ** | 0.508 ** | 0.572 ** | 1 | ||||
6. Encourage parent-to-parent support | 0.477 ** | 0.575 ** | 0.598 ** | 0.622 ** | 0.590 ** | 1 | |||
7. Provide emotional and financial support | 0.394 ** | 0.459 ** | 0.559 ** | 0.591 ** | 0.545 ** | 0.614 ** | 1 | ||
8. Assuring that the healthcare delivery system responds to family needs | 0.396 ** | 0.514 ** | 0.477 ** | 0.518 ** | 0.526 ** | 0.599 ** | 0.539 ** | 1 | |
9. Provide emotional support to staff | 0.384 ** | 0.516 ** | 0.551 ** | 0.566 ** | 0.470 ** | 0.600 ** | 0.548 ** | 0.587 ** | 1 |
Sub-Scales for Necessary Domains | 1. | 2. | 3. | 4. | 5. | 6. | 7. | 8. | 9. |
1. The family as the constant of the child’s life | 1 | ||||||||
2. Collaboration between parents and health professionals | 0.623 ** | 1 | |||||||
3. Recognize family individuality | 0.450 ** | 0.605 ** | 1 | ||||||
4. Share complete information | 0.424 ** | 0.585 ** | 0.791 ** | 1 | |||||
5. Understand the developmental needs of the child | 0.464 ** | 0.565 ** | 0.648 ** | 0.658 ** | 1 | ||||
6. Encourage parent-to-parent support | 0.516 ** | 0.642 ** | 0.678 ** | 0.698 ** | 0.717 ** | 1 | |||
7. Provide emotional and financial support | 0.432 ** | 0.544 ** | 0.629 ** | 0.635 ** | 0.643 ** | 0.728 ** | 1 | ||
8. Assuring that the healthcare delivery system responds to family needs | 0.448 ** | 0.570 ** | 0.653 ** | 0.653 ** | 0.647 ** | 0.726 ** | 0.729 ** | 1 | |
9. Provide emotional support to staff | 0.422 ** | 0.542 ** | 0.659 ** | 0.683 ** | 0.631 ** | 0.701 ** | 0.698 ** | 0.778 ** | 1 |
FCCQ-R@it-NICU | Current Mean (SD) | Necessary Mean (SD) | Gap Mean (SD) | p-Value |
---|---|---|---|---|
The family as the constant of the child’s life | 30.05 (0.84) | 30.90 (0.76) | 0.86 (0.87) | <0.01 |
Collaboration between parents and health professionals | 2.79 (0.72) | 3.75 (0.67) | 0.97 (0.83) | <0.01 |
Recognize family individuality | 3.39 (0.66) | 4.37 (0.51) | 0.98 (0.72) | <0.01 |
Share complete information | 3.03 (0.72) | 4.10 (0.59) | 1.08 (0.83) | <0.01 |
Understand the developmental needs of the child | 2.86 (0.82) | 4.09 (0.67) | 1.23 (0.93) | <0.01 |
Encourage parent-to-parent support | 3.06 (0.70) | 4.03 (0.61) | 0.98 (0.79) | <0.01 |
Provide emotional and financial support | 3.16 (0.70) | 4.08 (0.62) | 0.92 (0.76) | <0.01 |
Assuring that the healthcare delivery system responds to family needs | 2.75 (0.67) | 4.05 (0.59) | 1.31 (0.85) | <0.01 |
Provide emotional support to staff | 3.13 (0.70) | 4.26 (0.56) | 1.15 (0.83) | <0.01 |
Total index | 3.02 (0.20) | 4.07 (0.18) | 1.05 (0.02) | <0.01 |
Current Mean (SD) | p-Value | Necessary Mean (SD) | p-Value | Gap Mean (SD) | p-Value | |
---|---|---|---|---|---|---|
Sex | ||||||
Female | 2.99 (0.01) | 0.34 | 4.08 (0.48) | 0.42 | 1.12 (0.84) | 0.07 |
Male | 3.05 (0.45) | 4.04 (0.39) | 0.97 (0.64) | |||
Age | ||||||
20–30 | 3.01 (0.52) | 0.30 | 4.13 (0.41) | 0.06 | 1.12 (0.83) | 0.07 |
31–40 | 2.99 (0.5) | 4.13 (0.51) | 1.19 (0.89) | |||
41–50 | 3.00 (0.53) | 4.06 (0.48) | 1.11 (0.82) | |||
>51 | 3.04 (0.51) | 4.02 (0.46) | 0.97 (0.70) | |||
Parental Status | ||||||
With children | 2.99 (0.53) | 0.48 | 4.05 (0.48) | 0.01 * | 1.09 (0.85) | 0.37 |
Without children | 3.01 (0.53) | 4.13 (0.45) | 1.14 (0.77) | |||
Professions | ||||||
Pediatric Nurse | 2.93 (0.55) | <0.01 ** | 4.07 (0.49) | 0.02 * | 1.22 (0.89) | <0.01 ** |
General Nurse | 3.03 (0.47) | 4.01 (0.52) | 0.94 (0.75) | |||
Physician | 3.13 (0.60) | 4.16 (0.41) | 0.97 (0.65) | |||
Other Allied Healthcare Professionals | 3.31 (0.60) | 4.19 (0.45) | 0.69 (0.63) | |||
Others | 3.22 (0.62) | 4.26 (0.39) | 1.12 (0.72) | |||
Job Position | ||||||
Head/Coordinator | 3.20 (0.45) | <0.01 ** | 4.27 (0.43) | <0.01 ** | 1.14 (0.64) | 0.89 |
Non coordinator | 2.99 (0.53) | 4.08 (0.46) | 1.12 (0.80) | |||
Education | ||||||
Regional School | 2.95 (0.54) | <0.01 ** | 3.99 (0.52) | 0.002 ** | 1.06 (0.88) | <0.01 ** |
BSc | 3.02 (0.53) | 4.11 (0.48) | 1.15 (0.84) | |||
MSc | 2.91 (0.56) | 4.17 (0.40) | 1.27 (0.84) | |||
PhD or MD | 3.17 (0.50) | 4.18 (0.44) | 1.05 (0.66) | |||
Other | 2.90 (0.52) | 4.07 (0.45) | 1.26 (0.87) | |||
Work Experience | ||||||
Up to 10 years | 3.00 (0.56) | 0.92 | 4.13 (0.44) | <0.01 ** | 1.14 (0.86) | 0.39 |
>10 years | 3.00 (0.50) | 4.04 (0.49) | 1.09 (0.80) | |||
Hospital employed | ||||||
Yes | 3.00 (0.53) | 0.99 | 4.08 (0.47) | 0.87 | 1.11 (0.82) | 0.62 |
No | 3.00 (0.63) | 4.09 (0.54) | 1.06 (0.88) | |||
Work Setting | ||||||
NICU | 2.99 (0.55) | 0.39 | 4.05 (0.49) | 0.78 | 1.10 (0.89) | 0.62 |
Intermediate Care | 3.16 (0.66) | 4.04 (0.42) | 0.95 (0.80) | |||
Both | 3.00 (0.53) | 4.09 (0.48) | 1.12 (0.83) |
Current | Necessary | Gap | |||||||
---|---|---|---|---|---|---|---|---|---|
Coeff. | CI | p | Coeff. | CI | p | Coeff. | CI | p | |
Sex | |||||||||
Male [Ref] | |||||||||
Female | - | - | - | - | - | - | 0.92 | −0.39–2.23 | 0.16 |
Job Profession | |||||||||
Nurse [Ref] | |||||||||
Pediatric Nurse | 0.73 | −0.27–0.17 | 0.15 | −0.43 | −0.13–0.05 | 0.48 | −0.13 | −0.24–−0.23 | 0.02 |
MD | 0.15 | −0.66–0.37 | 0.17 | −0.09 | −0.30–0.11 | 0.11 | −0.28 | −0.53–−0.37 | 0.03 |
HC Professionals | 0.37 | 0.10–0.64 | 0.01 | 0-13 | −0.11–0.37 | 0.38 | −0.34 | −0.59–−0.11 | 0.04 |
Others | 0.21 | −0.22–0.44 | 0.07 | 0.16 | −0.05–0.37 | 0.37 | −0.69 | −0.32–0.19 | 0.59 |
Job Position | |||||||||
Staff [Ref] | |||||||||
Management | 0.20 | 0.38–0.36 | 0.015 | −0.01 | −0.89–0.08 | 0.90 | - | - | - |
Education | |||||||||
Other [Ref] | |||||||||
PhD/MD | 0.15 | −0.88–0.40 | 0.21 | 0.19 | −0.03–0.42 | 0.08 | 0.10 | −0.17–0.37 | 0.46 |
MSc | −0.01 | −0.20–0.18 | 0.92 | 0.09 | −0.07–0.27 | 0.26 | 0.16 | −0.40–0.36 | 0.12 |
BSc | 0.18 | 0.59–0.30 | 0.01 | −0.01 | −0.13–0.09 | 0.79 | −0.13 | −0.27–0.01 | 0.05 |
Regional Diploma | 0.98 | −0.03–0.22 | 0.12 | −0.84 | −0.20–0.03 | 0.14 | −0.12 | −0.26–0.19 | 0.09 |
Age | |||||||||
>51 [Ref] | |||||||||
20–30 | - | - | - | 0.11 | −0.51–0.27 | 0.18 | - | - | - |
31–40 | - | - | - | 0.12 | −0.01–0.23 | 0.05 | - | - | - |
41–50 | - | - | - | 0.05 | −0.46–0.15 | 0.29 | - | - | - |
Work Experience | |||||||||
Rif ≤ 10 | |||||||||
>10 years | - | - | - | −0.01 | −0.90–0.79 | 0.79 | - | - | - |
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Dall’Oglio, I.; Mascolo, R.; Portanova, A.; Ragni, A.; Amadio, P.; Fiori, M.; Tofani, M.; Gawronski, O.; Piga, S.; Rocco, G.; et al. Staff Perceptions of Family-Centered Care in Italian Neonatal Intensive Care Units: A Multicenter Cross-Sectional Study. Children 2022, 9, 1401. https://doi.org/10.3390/children9091401
Dall’Oglio I, Mascolo R, Portanova A, Ragni A, Amadio P, Fiori M, Tofani M, Gawronski O, Piga S, Rocco G, et al. Staff Perceptions of Family-Centered Care in Italian Neonatal Intensive Care Units: A Multicenter Cross-Sectional Study. Children. 2022; 9(9):1401. https://doi.org/10.3390/children9091401
Chicago/Turabian StyleDall’Oglio, Immacolata, Rachele Mascolo, Anna Portanova, Angela Ragni, Patrizia Amadio, Martina Fiori, Marco Tofani, Orsola Gawronski, Simone Piga, Gennaro Rocco, and et al. 2022. "Staff Perceptions of Family-Centered Care in Italian Neonatal Intensive Care Units: A Multicenter Cross-Sectional Study" Children 9, no. 9: 1401. https://doi.org/10.3390/children9091401