Family-Centered Care for the Newborn

Many regulatory and professional agencies countenance the idea of patient-and family-centered care, yet lack an infrastructure able to support such care or employ health care professionals who lack the necessary education, experience, or skills. This book is a comprehensive guide to family-centered care for healthy, ill, or preterm newborns. It guides health care professionals in creating, supporting, and advancing a culture that values partnerships with families. The book is replete with practical suggestions, strategies for effectively communicating with families, and best practices for health professionals who wish to develop partnerships with families before and after childbirth.

At the core of family-centered care is the belief that family-centered care and the ability to convey its particular language is as important to newborn and family wellbeing as clinical care. The book is based on four guiding principles that include treating people with dignity and respect, providing information in ways that are useful and affirming, welcoming family participation in care and decision-making at a level chosen by the family, and collaborating with families at the bedside and beyond. The book offers strategies to promote implementation of a family-centered environment in the delivery room or NICU, practical approaches to communicating with families before and after delivery, and tips on policy review to facilitate a culture of family-centered care. It also discusses how to welcome families during interdisciplinary rounds and nurse hand-offs, and ways to support families during procedures and resuscitation.

Key Features:

• Provides a comprehensive guide to implementing family-centered care for healthy, ill, and preterm newborns
• Guides health care professionals in creating, supporting, and advancing a culture that values partnerships with families
• Offers strategies for effectively communicating with families to foster family-centered care
• Reflects on the power of language used with and about families
• Includes tips on policy review to foster and support a culture of family-centered care

Foreword xi

Preface xv

Introduction xvii

Part I: Basic Conc epts of Pati ent- and

Family-Centered Care 1

1. Designing Family-Centered Care 3

Partnering in Family-Centered Newborn Care 4

System- and Provider-Centered Approaches

to Health Care 15

Family-Focused Approach to Health Care 17

Changing the Organizational Culture to Support

Family-Centered Care 18

Key Points 23

References 24

2. Creating the Family-Centered Environment 25

Environmental Considerations 26

The Language of Partnership 31

The "Visitation" Policy 32

How Families Can Improve Systems of Care 38

Family Advisors' Role in Enhancing the Family-Centered

Environment 41

Key Points 43

References 44

viii Contents

Part II: Appl ying Conc epts in Mat ernity Care 45

3. Supporting the Mother and Family With

a High-Risk Pregnancy 47

Antenatal Counseling of the High-Risk Mother 47

Support of Mothers During High-Risk Pregnancy

Hospitalization 50

Preparation for Possible NICU Admission 52

Key Points 53

References 54

4. The Birth Plan 55

Partnering With Families Through a Birth Plan 55

Strategies for Supporting and Improving the Birth Plan 56

When a Birth Plan Must be Abandoned 59

Key Points 63

References 63

5. Supporting the Infant, Mother, and Family in the

Birthing Room and Beyond 65

Keeping the Family Together in the Birthing Room 66

Supporting Partnerships in Emergency Situations 71

Mother-Baby Care 72

Key Points 76

References 76

6. Supporting the Mother and Family During

Admission, Procedures, and Resuscitation in the NICU 79

Welcoming Parents During NICU Admission 79

Welcoming Parents During Procedures 85

Welcoming Parents During Resuscitation 88

Key Points 90

References 91

Part III: Appl ying Conc epts in the NICU

Environment 93

7. Supporting the Role of the Mother and

Family in the NICU 95

Defining and Supporting the Family's Role in the NICU 95

Challenges to the Family's Role in Care 97

Contents ix

The Nurses' Role as Coach 107

Supporting Nursing Staff to Empower the Family in

the Baby's Care 108

Key Points 111

References 111

8. Welcoming Parents During Interdisciplinary

Rounds and Nurse Hand-Offs 113

Challenges to Welcoming Parents During Rounds or

Nurse Hand-Offs 114

Benefits of Family-Centered Rounds and Hand-Offs 118

Parents as Educators 119

Staff Education and Support 121

Key Points 122

References 122

9. Planning for the Journey Home 125

Physical Examinations as a Partnership Opportunity 126

Making the Transition From the NICU to Home 127

From Discharge Planning to Partnership in Care 128

Monthly Care Meetings 134

Key Points 135

Reference 135

10. Family Support 137

Virtual Connections 137

In-Person Connections 138

Key Points 139

References 140

Part IV: Family-Centered Care du ring

Chall enging Situati ons 141

11. Communicating With and Supporting Parents in

Palliative Care, Withdrawal of Support, and Bereavement 143

Antenatal Planning for Palliative Care 143

Strategies for Communicating Bad News to Parents 145

Supporting Families During and After the Baby's Death 146

Key Points 150

References 150

x Contents

12. Challenging Situations 153

Parents Who Never Come 156

Parents Who Are "Overinvolved" 159

Angry Parents 160

Parents in Denial 162

Parents Who Overstimulate the Baby 163

Mothers With Substance Abuse 165

Key Points 167

References 167

13. Resources and Tools to Advance Patient- and Family-

Centered Care 169

Websites 170

Index 171