Are we family centered? Families don’t think so!

Finlayson K, et al. Mothers’ perceptions of family centred care in neonatal intensive care units. Sex Reprod Healthc. 2014;5(3):119-24.

This qualitative study interviewed mothers who had babies in one of three NICUs in the UK which claim to practice family-centered care. As usual in qualitative research, the sample size was tiny (12 mothers) and you can’t be sure how generalizable the results are from this very limited data set.

Nevertheless, I think the results should make us all stop and consider, and I wouldn’t be at all surprised to find parallels among mothers in Canada, or anywhere else in the world.

The mothers felt dis-empowered, with an overall theme that the authors called “Finding my Place”. The various aspects of this lack of ability to feel like a mother were referred to under these descriptions: Mothering in Limbo; Deference to the Experts; Anxious Surveillance; Muted Relations, Power Struggles and Consistently Inconsistent. Its worth a read if you can get access:

All of the mothers highlighted staff inconsistencies as being one of the most upsetting aspects of the care they received. Criticism from nurses about the way they were mothering or being given conflicting pieces of advice or information made them feel incompetent, naive and disrespected.

As the authors state

Despite the rhetoric about the practice of family centered care as the principle model of care in these neonatal units, there was little in the mothers’ narratives to support this.

Some of what they show is probably an inevitable result of the power and experience imbalance between parents and neonatal staff. Parents (mothers in this study) are suddenly thrust into an environment which is foreign, where the staff have enormously more knowledge than they do. On the other hand, there are clearly huge areas for improvement: one mother reports being told by a nurse that “you don’t need to concern yourself with” tube feeding, “we need to concern ourselves with that”. I can imagine a nurse saying that in a kindly manner, trying to relieve stress for a mother, and it doesn’t sound so bad in my head, but its easy to see how it could be interpreted by a mother as being pushed aside.

Making sure that all the staff in the NICU know what parents are expected and allowed to do, and that they have a consistent approach, will really help parents. Helping parents develop the skills they need to participate in the care of their infants, ensuring that they can safely collaborate, will start to make us more truly “family centered”.


About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research and tagged , . Bookmark the permalink.

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