Running head: INTEGRATIVE REVIEW 1

Integrative Review

Ashton Birdsong

Bon Secours Memorial College of Nursing

Dr. Arlene Holowaychuk

NUR 4122

April 2, 2019

Honor Code: “I Pledge…”

INTEGRATIVE REVIEW 2

Abstract

The purpose of this integrative review is to examine research literature that evaluates the

correlation between family involvement in neonatal and pediatric critical care settings and

patient outcomes. Previous research indicates that the use of the Family Centered Care (FCC) in

critical care settings leads to favorable outcomes. However, further improvements are still

pursued to improve patient outcomes, parental experiences and decrease length of stay. The

PICO question under consideration is: Does increased family involvement influence length of

stay and patient outcomes in patients placed in PICU/NICU settings? The research design is an

integrative review. The databases used to locate research articles were EBSCO CINAHL and

Pub Med. The results yielded 730 articles and five met the inclusion criteria. The findings and

results of the five reviewed studies indicate a positive effect of implementing family-centered

care practices in NICU/PICU settings and that increased parental involvement has positive

impacts on their child’s well-being. Limitations to the review include lack of experience of the

researcher, limited time to complete the assignment, and limited number of articles for the

review. The implications of these findings suggest there are positive benefits of implementing

increased family-integrated care not only to critically ill children, but their parents as well.

Recommendations for further research include exploring the impact on individual family

members, different gestational age, and level of parents’ active role during their child’s care.
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Integrative Review

The purpose of this integrative review is to examine research literature that evaluates the

correlation between family involvement in neonatal and pediatric critical care settings and

patient outcomes. Family-Centered Care has been previously researched and results indicated

favorable effects on infants, children, and their families, by decreasing anxiety and depression,

increasing parental confidence and competency, and promoting the development of early

interaction (Raiskila, 2014). With recent developments in improved treatment practices, modern

equipment, and more effective clinical practices, mortality and morbidity rates have decreased

immensely in intensive care units across neonatal and pediatric populations. However, further

improvements are still pursued to improve patient outcomes, length of stay, and parental

experiences (Broom, 2017). Parents are vital players in providing sufficient emotional, social,

and physical support for their children to promote proper development during their hospital stay

and past their recovery (Raiskila, 2014). The aim of the review is to examine and discuss

previous research information as it relates to the researcher’s PICO question: Does increased

family involvement influence length of stay and patient outcomes in patients placed in

PICU/NICU settings?

Design and Search Methods

The research design is an integrated review. The articles were researched utilizing two

search engines, EBSCO CINAHL and Pub Med. The search terms included, ‘family

involvement’, ‘PICU’, ‘NICU’, ‘length of stay’, ‘outcomes’, and ‘parental presence’. The results

yielded 541results from EBSCO CINAHL and 189 results from Pub Med. To ensure a current

approach of the issue, the search was limited to peer-reviewed qualitative and quantitative

nursing research journal articles, published in English, and written between 2014-2019. The
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articles had to pertain to the researcher’s PICO question, “Does increased family involvement

influence length of stay and patient outcomes in patients placed in PICU/NICU settings?”

Furthermore, the research articles were selected based on the following inclusion criteria:

pediatric or neonatal intensive care population, patient outcomes, parental involvement, length of

stay, and family-centered care. The research articles that did not include the above criteria, were

excluded. The screening produced a total of five articles, three quantitative and two qualitative.

Findings and Results

The findings and results of the five reviewed studies all indicate a positive effect of

implementing family-centered care practices in NICU/PICU settings and that increased parental

involvement has positive impacts on their child’s well-being. A summary of the research articles

is attached via Appendix 1. The researcher outlined the review according to the following

themes: positive impact family-centered care (FCC) has on patient outcomes and parental

perceptions.

Family-Centered Care Outcomes

Two of the five research articles utilized quantitative studies to determine the correlation

between FCC and positive outcomes in NICU/PICU patients (Raiskila, Axelin, Rapeli, Vasko &

Lehtonen, 2014). & O’Brien et al.,2018). In a study conducted by Axelin et al. (2014), the

authors researched the development of care practices that enable parental closeness and parental

participation in the NICU setting. This retrospective study reviewed 295 charts of very preterm

infants born at less than 32 weeks gestation or born with a weight less than 1500 grams in Turku

University Hospital over an 11-year span. The methods of research for this study included a

retrospective review of infant’s medical charts, using their gestational age, birth weight, and

gender as means of guidance. Major variables studied were thermoregulation management,

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which included incubator time, enteral and oral feeding practices, which focused on

breastfeeding practices, and lastly parent-infant skin-to-skin care practices. After the data was

collected, analysis of covariance was used to further study associations between outcome

variables. Results indicated that hospital care practices of very preterm infants that supported

and enabled better parental involvement showed a positive correlation to increased preterm

improvements in their weight gain. These findings served as indicators of progressive trends in

FCC, highlighting the notable discoveries regarding skin-to-skin care and breast-feeding.

The second quantitative study completed by Kariel O’Brien et al. (2018), studied the

effect of integrating NICU parents into their child’s health-care team and aimed to analyze the

effect FCC had on infant and parent outcomes, safety, and resource use. This multicentered-

cluster, randomized control trial was comprised of 26 NICUs from Canada, Australia, and New

Zealand. The NICUs were randomly selected to either provide Family Integrated Care (FICare)

or to provide standard NICU care. 895 infants were placed in the FICare group and 891 were

placed in the standard NICU care group. Infants were considered eligible if they were born at 33

weeks gestation or less, and no or low-level respiratory support. Parents were required to commit

to being physically present for at least six hours a day while also attending education sessions

and actively caring for their infant. The primary outcome measured was the infants weight at day

21 after enrollment. Secondary outcomes measured were weight gain velocity, high frequency

breastfeeding, parental stress and anxiety at enrollment and day 21, NICU mortality and

morbidity, safety, and resource use. Data was analyzed using linear regression for continuous

variable and logistic regression for categorical variables. The researchers found that the use of

FICare is a vital advancement in neonatal care as evidenced by improved infant weight gain,

decreased parental stress and anxiety, and increased breastfeeding exclusivity at discharge.
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Parental Perceptions

Three of the five research articles studied the effect parental perceptions and participation

have on family-centered care (Aija, Toome, Axelin, Raiskila & Lehtonen, 2019; Broom, Parsons,

Carlisle & Kecskes, 2017; & Hill, Knafl, Docherty & Santacroce, 2018). The quantitative multi-

centered prospective study conducted by Aija et al. (2019) evaluated the degree of parental

participation in medical rounding as well as aiming to identify family and hospital characteristics

that may facilitate or hinder parental integration into medical rounds. The study was comprised

of a total of 241 NICU families from 11 European countries. Parents were considered eligible if

their infant was born preterm before 35 weeks gestation. Questionnaires were given to parents at

discharge to measure parent and infant characteristics and unit characteristics. Data was collected

via a series of randomized text messages sent out every evening that asked parents a series of

questions that covered aspects of FCC like active listening, parental participation, individualized

guidance and participation, shared decision-making, emotional support. The data was analyzed

using descriptive statistics that characterized infants and families using a seven point Likert

Scale rating their participation. The results indicate that parental involvement in medical rounds

is variable depending on location globally. The factors increasing parental presence during

medical rounding differed based on unit policies, an overall invitation to parents into rounding

discussions, higher gestational age of the infant, and higher education of the father.

Margaret Broom et al. (2017) completed a qualitative focus group study evaluating the

impact of FCC models have on encouraging active parental participation in their infant’s care

and the model’s influence on decreasing parental stress and increasing parental competence. The

sample was comprised of 16 families who had participated in Family-Integrated Care (FICare)

during their first six months along with 80 staff members in an Australian level 3 NICU. The
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data was retrieved from two focus groups: one for parents and one for staff. Audio recordings

were taken during the focus groups then transcribed afterwards. Each transcript was reviewed

using thematic content analysis following a qualitative descriptive approach. Transcripts were

then read by two members of the study team who determined themes repeated throughout the

context, which were highlighted and created into a detailed outline. The findings indicated that

both parents and staff found the FICare to be very beneficial. They found the program to have a

positive impact on parental confidence and role attainment, while also improving communication

between both parent-to-parent and parent-to-staff. Staff spent more time educating and

supporting NICU parents, which led them to perform less hands- on care.

Lastly, in the qualitative descriptive study by Hill et al., (2018), researchers studied the

parental perception on impact of physical and cultural environments in the PICU have on the

successful delivery of FCC in pediatric critical care settings. The sample was comprised of a

total of 61 interviews with mothers and fathers of infants with complex congenital heart defects

treated in the PICU. The data was retrieved from secondary analysis based on previous interview

data on a longitudinal study that examined parental experiences with core concepts of FCC and

how the physical and cultural environment influenced their overall PICU experience. Those core

concepts included information sharing, participation, respect and dignity, were all implemented

by their care team. Careful review of interview transcripts for each case was done to collect the

above data. The data was then analyzed by direct content analysis that coded the data which was

followed by a review to identify parental experiences and their relationship to physical and

cultural environments. Results indicated that both physical and cultural environments impacted

their perceptions on how core concepts were implemented by their care team.
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Discussion and Implications

The studies reviewed provide insight and awareness into the question,does increased

familial involvement influence length and stay and patient outcomes in NICU and PICU

patients? Practices that supported parental involvement in their infant’s care significantly

improved very preterm infant weight gain (Raiskila et al., 2014 & O’Brien et al., 2018). Findings

also suggest that increased parental involvement and inclusion benefits many psychosocial

aspects parents may feel, like increased confidence and competence (Broom et al. 2017 & Aija et

al., 2018). Parental perceptions of their child’s critical care environment was also studied and

found that the physical and cultural environment of the intensive care unit was shown to both

contribute to and alleviate parental distress (Hill et al., 2018). The implications of these findings

suggest there are positive benefits of implementing. Recommendations for further research

include exploring the impact on individual family members, different gestational age, and level

of parents’ active role during their child’s care.

Limitations

This integrative review has limitations present that should be noted. Given that only five

articles were used for this class assignment, it cannot be considered an exhaustive review. The

articles used in this review were written within the last five years, so they cannot be generalized

due to the limited time frame.

Broom et al. (2017) determined that a small focus group size elicited a broad range of

opinions on the benefits of FICare program. Because of the secondary analysis method used in

C. Hill et al. (2018), researchers were unable to control the course of the interviews and research

further into more data that related to the study’s specific aims. The study design of Raiskila et

al.,(2014) was retrospective, which is considered to be a limitation. Additionally, another

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limitation was the charts that were reviewed were handwritten, microfilmed, and scanned,

making the documentation of care practices inconsistent. Regarding the study that implemented

the use of text messages, researchers Aija et al., (2019) encountered some technological

difficulties sending text messages in certain countries, which resulted in missing data. Data was

also missing in research by O’Brien et al., (2018) due to increased rates of transfers to level 2

NICU’s in the FICare sites.

Conclusion

The relationship between parental involvement in the PICU/NICU setting and patient

outcomes is discussed throughout this integrative review. Results indicated a positive correlation

with increased parental involvement and their child’s physical well-being, as well as improving

many psychosocial aspects of parents’ perceptions and experiences in the critical-care setting.

Despite substantial evidence on the correlation on length of stay and parental presence, evidence

supporting improved weight gain can lead to the assumption that length of stay is affected. The

findings in this integrative review implicate the importance of parental involvement and

integration of family-centered care by staff in critical care settings of young loved ones.
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References

Aija, A.,Toome, L., Axelin, A., Raiskila, S.,& Lehtonen, L. (2019). Parents’ presence and

participation in medical rounds in 11 European neonatal units. Early Human

Development, 130 10-16. doi:10.1016/j.earlhumdev.2019.01.003

Broom, M., Parsons, G., Carlisle, H., & Kecskes, Z. (2017). Exploring parental and staff

perceptions of the family-integrated care model: a qualitative focus study. National

Association of Neonatal Nurse. doi:10.1097/ANC.0000000000000443

Hill, C., Knafl, K., Docherty, S., & Santacroce, S. (2018). Parent perceptions of the impact of

the pediatric intensive care environment on delivery of family-centered care. Intensive &

Critical Care Nursing (50) 88-94. doi:10.1016/j.iccn.2018.07.007

O’Brien, K., Bracht, M., Cruz, M., Lui, K., Alvaro, R., da Silva, O., Monterrosa, L., Narvey, M.,

Ng, E., Soraisham, A., Ye, X., & Mirea, L. (2018). Effectiveness of family integrated

care in neonatal intensive care units on infant and parent outcomes: a multicenter,

multinational, cluster-randomized controlled trial. Lancet Child Adolescent Health (2):

245-254. doi: 10.1016/S2352-4642(18)30039-7

Raiskila, S., Axelin, A., Rapeli,S., Vasko, I., Lehtonen, L. (2014). Trends in care practices

reflecting parental involvement in neonatal care. Early Human Development (90) 863-

867. doi: 10.1016/j.earlhumdev.2014.08.010

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Appendix

Article Reference Aija, A.,Toome, L., Axelin, A., Raiskila, S.,& Lehtonen, L.
(2019). Parents’ presence and participation in medical rounds in 11
European neonatal units. Early Human Development, 130 10-16.
Doi:
Background/Problem Background: Care practices that encourage parent-preterm infant
Statement closeness have been proven to improve overall development of
preterm infants. Many positive outcomes have been found to be
resulted from increased parental involvement in NICU’s, yet there
has been little research assessing parent’s perspectives on their role
in decision making in the NICU setting.

Problem Statement: The purpose of this study was to evaluate

parents’ presence and the degree their participation in discussions
during medical rounds in 11 European NICUs, as well as
identifying family and hospital characteristics that may facilitate or
hinder parental integrations in medical rounds. The aim of this
study was to study parental presence, the degree of their
participation during medical rounds, and to identify underlying
factors for participation.
Conceptual/theoretical None
Framework

Design/ Design: Quantitative – multi-centered prospective study

Method/Philosophical
Underpinnings Methods: The International Closeness Survey – carried out by the
Separation and Closeness Experiences in Neonatal Environment
(SCENE) study group.
- SCENE: multi-disciplinary group of international professionals
who carry out research to identify, construct, implement, and
evaluate best practices for parent-infant closeness
Sample/ Setting/Ethical Sample: Parents of preterm infants born before 35 weeks gestation;
Considerations 30 families for every participating NICU – 262 families total in
participation

Setting: 11 NICUs in six European countries

Ethical Considerations: Study was approved by the boards of

ethics of all participating hospitals or countries
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Major Variables Studied Questions covered different aspects of FCC Care:

(and their definition), if
appropriate
- Active listening
- Parental participation
- Individualized guidance
- Shared decision-making
- Mutual trust
- Individualized information
- Emotional support

Measurement Tool/Data Measurement Tools: The International Closeness Survey – carried

Collection Method out by the Separation and Closeness Experiences in Neonatal
Environment (SCENE) study group, questionnaires at discharge to
measure parent and infant characteristics and unit characteristics

Data Collection Method: Every evening during infant’s stay, in

randomized order, 1 out of 9 text messages were sent to both
parents via mobile device. Parents used the 7 point Likert scale,
where higher values were more positive and lower numbers were
more negative. .
Data Analysis  Descriptive statistics were used to characterize infants and
families in the participating hospitals.
 Parents mean scores for participation were calculated on a
7-point Likert scale.
 Impact on parental presence and participation on
family/hospital characteristics (gestational age, time to first
massage, time to hospital from home, home living siblings,
parent’s education and employment, parent’s age, foreign
language, units’ admissions, first skin-to-skin contact,
opportunity to stay overnight, invitation to all rounds) were
all assessed using uni- and multi-variate mixed generalized
linear models with hospital as a random factor.
Findings/Discussion Findings: It was found that parental involvement in medical rounds
is significantly variable in different NICUs globally. The factors
increasing parental presence during medical rounding differed
based on unit policies regarding parents invitation to medical
rounds, higher gestational age of the infant, and higher education
of the father.

Discussion: Few background characteristics explained differences

between the units, concluding that unit culture plays an important
role in parental participation.
Appraisal/Worth to Unit culture varies between NICUs globally and this study shows
practice the importance of creating and supporting a lasting partnership
between NICU parents and health-care team members.

This study does not particularly address the PICO question well
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due to the focus being primarily on the parental outcomes versus

the patient (infant) outcomes.
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Article Reference Broom, M., Parsons, G., Carlisle, H., & Kecskes, Z. (2017).
Exploring parental and staff perceptions of the family-integrated
care model: a qualitative focus study. National Association of
Neonatal Nurse. Doi:
Background/Problem Background: Throughout recent decades, NICU’s worldwide have
Statement utilized forms of Family-Centered Care (FCC) models, where
healthcare professionals encourage and support families to be more
involved in their infant’s care. This has been proven to make
parents/family members feel more confident and empowered in
treating and caring for their infants.
Problem Statement: The purpose of this study was to evaluate the
impact of FCC models developed by NICUs in encouraging active
parental participation in their infants care and the FCC models’
influence on decreasing parental stress and increasing parental
competence.
Conceptual/theoretical None
Framework
Design/ Design: Qualitative
Method/Philosophical
Underpinnings Methods: Focus Group (open-ended questions)

Sample/ Setting/Ethical Sample: Focus group of 16 families who had participated in the
Considerations FICare program during the first 6 months; 80 staff members were
asked to participate

Setting: Australian level 3 NICU who provide care for up to 750

neonates per year born between 23-44 weeks gestation

Ethical Considerations: Project was approved by local health

human research ethics committee. Written consent was obtained
from all participants who voluntarily participated in the study.

Major Variables Studied  Bedside education and participation in care

(and their definition), if  Group education sessions
appropriate  Family Centered Ward Rounds
 Miracle Babies Psychosocial Support

Measurement Tool/Data Measurement Tools: 2 focus groups – one for parents and one for
Collection Method staff members

Data Collection Method: Audio recordings were taken during the

focus groups then transcribed afterward.
Data Analysis  Transcripts were reviewed using thematic content analysis
following a qualitative descriptive approach.
 Each transcript was read by 2 members of the study team
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who determined themes repeated throughout the context.

The findings were considered by the team with key themes
highlighted, which created a detailed outline of the findings.
Findings/Discussion Findings: Both parents and staff found the FICare program to be
very beneficial. They agreed that it had a positive impact on
parental confidence and role attainment, while also improving
communication between parent-to-parent and parent-to-staff. Staff
reported they spent more time educating and supporting NICU
parents while performing less hands-on care.

Discussion: This study found each component of the program

beneficial to parents by improving experience in the NICU while
increasing parental confidence and role attainment.
Appraisal/Worth to This study highlights the importance of integrating and accepting
practice parents as active members of their infant’s care team. Additionally,
nurse’s roles may transition from primarily bed side to educating,
caring, and supporting parents during their NICU experience.

This study does not particularly address the PICO question well due
to the focus being primarily on the parental outcomes versus the
patient (infant) outcomes.
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Article Reference Hill, C., Knafl, K., Docherty, S., & Santacroce, S. (2018). Parent
perceptions of the impact of the pediatric intensive care environment
on delivery of family-centered care. Intensive & Critical Care
Nursing (50) 88-94. DOI:
Background/Problem Background: The Institute for Patient and Family-Centered Care
Statement (IPFCC) states that parents are vital members of the partnership
that is needed to ensure the successful delivery of FCC in
pediatric critical care settings. With an increased push for
pediatric care to be more family-centered, parent perceptions on
the delivery of FCC care is critical to the advancement of care.

Problem Statement: The purpose of this study was to examine

parental perception on how both the physical and cultural
environment of the PICU impacted the implementation of family-
centered care. By understanding the joint experiences of both parent
and child in the PICU setting, and by evaluating their perception of
family-centered care, more effective implementation practices may
be more attainable in the near future.
Conceptual/theoretical None
Framework
Design/ Design: Qualitative descriptive
Method/Philosophical
Underpinnings Methods: Secondary analysis based on previous interview data on a
longitudinal study used to examine parents’ experience with core
concepts of FCC and how the physical/cultural environment of the
PICU influenced those experiences.
Sample/ Setting/Ethical Sample:
Considerations - Sixty one interviews with 3 mothers and 3 fathers (31
interviews with mothers, 30 interviews with fathers) of
infants with complex congenital heart defects treated in the
PICU

Setting: PICU setting in the Southeastern United States with few

private rooms

Ethical Considerations: IRB approval was obtained from the first

authors academic institution as well as from the IRB responsible for
the oversight of the primary study.

Major Variables Studied  Quantity and depth of information related to FCC contained
(and their definition), if in parent interview data
appropriate  Informational variability based upon time of diagnosis
 Length of PICU stay
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Measurement Tool/Data Measurement Tools: 3 cases were examined

Collection Method
Data Collection Method: careful reading of interview transcripts for
each case and development of codes that were applied to the entire
data set.
Data Analysis  Direct content analysis was used to code the data using FCC
care concepts which was followed by a review to identify the
nature of parents’ experiences related to each of the core
concepts and the PICU physical and cultural environment
Findings/Discussion Findings: Parents indicated that the physical and cultural
environment of the PICU impacted their perceptions on how core
concepts such as information sharing, participation, respect and
dignity, were all implemented by their care team.

Discussion: The parents involved in the study indicated that physical

and cultural environments of the PICU does influence the delivery of
care. Evidence was found that supports collaboration between
parents and clinicians related to care coordination, treatment plans,
and delivery of care.
Appraisal/Worth to This study highlights the importance of understanding the stress
practice parents endure when their child is in a PICU setting. Both physical
and cultural environment of the PICU should always be considered
by health-care professionals to ensure care that is both patient and
family centered.

This study does not particularly address the PICO question well due
to the focus being primarily on the parental outcomes versus the
patient (infant) outcomes.
INTEGRATIVE REVIEW 18

Article Reference O’Brien, K., Bracht, M., Cruz, M., Lui, K., Alvaro, R., da Silva, O.,
Monterrosa, L., Narvey, M., Ng, E., Soraisham, A., Ye, X., & Mirea,
L. (2018). Effectiveness of family integrated care in neonatal
intensive care units on infant and parent outcomes: a multicenter,
multinational, cluster-randomized controlled trial. Lancet Child
Adolescent Health (2): 245-254 DOI:
Background/Problem Background:
Statement Problem Statement: The purpose of this study is to assess the effect
of integrating NICU parents into their child’s health-care team. By
doing so, there are positive correlations of parental-infant interaction
on infant weight gain, breastfeeding rates, and parental stress levels.
Conceptual/theoretical None
Framework

Design/ Design: Quantitative – Multicentre cluster - Randomized Control

Method/Philosophical Trial
Underpinnings
Methods: 26 NICU’s were randomly assigned to either provide
FICare or standard NICU care

Philosophical Underpinnings: not clearly defined

Sample/ Setting/Ethical Sample: 895 infants in the FICare group and 891 in the standard
Considerations NICU care group. Eligible infants were born at 33 weeks gestation or
less, and had no or low-level respiratory support. Parents needed to
commit to being present for at least 6 hours a day, while also
attending educational sessions and actively caring for their infant.

Setting: NICU’s in Canada (18), Australia (6), and New Zealand (1)

Ethical Considerations: Approval was obtained from all participating

sites. Parents gave written informed consent for enrollment. A safety
monitoring committee, who reviewed the rate of neonatal mortality
and morbidities on a biannual basis, was created.

Major Variables Studied  Primary outcome – infant weight at 21 days after enrollment
(and their definition), if  Secondary outcomes – weight gain velocity (data collected a
appropriate beginning of enrollment, day 7, day 14, and day 21); high
frequency breast feeding at hospital discharge (6 or more
feeds/day); parent stress/anxiety at day 21; NICU mortality
and major morbidities; safety and resource use (oxygen
therapy and duration of hospital stay)
Measurement Tool/Data Measurement Tools: Parent stress/anxiety were measured using the
Collection Method Parental Stress Scale questionnaire (PSS: NICU) and the State Trait
Anxiety Index (STAI)
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Data Collection Method: 2 day FICare training workshop focused on

4 pillars of FICare:
 Parent education program with small group educational
sessions, parent bedside coaching, and parental involvement
during medical rounds
 A staff training program with education focusing on the
importance of familial involvement in infant care along with
tools to assist staff in supporting parents
 Policies, procedures, and environmental resources to
operationalize parenteral involvement in caregiving and
support prolonged NICU stays
 Program of psychological support that included peer-to-peer
and professional support from families in the NICU
Data Analysis Descriptive statistics – linear regression for continuous variables and
logistic regression for categorical variables
Findings/Discussion Findings: FICare significantly improves infant weight gain and
parental stress and anxiety, with both are huge variables associated
with positive neurodevelopmental outcomes. It was also found that
FICare improved high-frequency exclusive breastmilk. There were
no significant differences in the secondary outcomes of mortality,
major morbidity, duration of oxygen therapy, and duration of hospital
stay.

Discussion: FICare resulted in improved infant weight gain and

improved parental psychological well-being, which are likely to have
long-term benefits in for infant health. By improving parental
psychological wellbeing, it is likely that improved parent-infant
bonding and enhanced infant outcomes are likely for the future.
Appraisal/Worth to This study found that is safe to involve parents in the care of their
practice infant and quantify the positive effects of parental-infant interactions
on infant weight gain, breastfeeding rates, and parental stress levels.
Both infants and parents were found to have improved outcomes by
the conclusion of this study. This PICO question is applicable to this
study because of the focus on increased infant outcomes as well as
addressing a negative correlation with length of stay and increased
familial interactions.
INTEGRATIVE REVIEW 20

Article Reference Raiskila, S., Axelin, A., Rapeli,S., Vasko, I., Lehtonen, L. (2014). Trends
in care practices reflecting parental involvement in neonatal care.
Early Human Development (90) 863-867. DOI:

Background/Problem Background: Everyday care practices can facilitate or hinder parental

Statement participation and involvement in the NICU setting.

Problem Statement: The purpose of this study is to follow the

development of care practices the enable parent closeness and
participation in the NICU setting.
Conceptual/theoretical Identified
Framework
Design/ Design: Quantitative Non-experimental, Retrospective
Method/Philosophical
Underpinnings Research methods: Data collected and reviewed via patient’s charts

Sample/ Setting/Ethical Sample: 295 of very preterm infants born at less than 32 weeks
Considerations gestation or had birth weight less than 1500 g

Setting: Turku University Hospital 11 year study

Ethical Considerations: Approval was obtained from the Ethical

Committee of the Hospital District of Southwest Finland

Major Variables Studied  Thermoregulation management – including duration of

(and their definition), if incubator time and warmer bed care
appropriate  Enteral and oral feeding practices – focus on breast feeding
 Parent-infant skin-to-skin care practices

Measurement Tool/Data Measurement Tools: Descriptive Statistics

Collection Method
Data Collection Tool: patient data was retrospectively reviewed from
infant’s charts with background data of:
- Gestational age at birth
- Birth weight
- Gender
Data Analysis  Analysis of covariance was used to further study associations
between outcome variables along with gestational age subgroup
analyses were used when there was a significant difference
between cohorts.
Findings/Discussion Findings: Hospital care practices of preterm infants support and enable
better parental involvement, with a positive correlation to increased
preterm improvements in infant’s weight gain. These results are
consistent with other studies
INTEGRATIVE REVIEW 21

Discussion: The practices studied in this article serve as indicators of

progressive trends in family centered care, with notable findings
regarding skin-to-skin care and breastfeeding.
Appraisal/Worth to This study found that significant changes were found that supported
practice and enabled better parental involvement and infant growth. This study
is applicable to the PICO question because of the correlation between
increased familial involvement and patient outcomes, being the
increased infant growth.