How do neonatal nurses involve parents in decision-making regarding kangaroo care in neonatal intensive care: a mixed methods study.

Abstract

Background: Being confronted with a premature birth and a neonatal intensive care unit (NICU) can be distressing for parents and influences their sense of parental identity negatively. Involving parents in decisions can strengthen parents’ sense of control and empowerment. One way to participate in care is kangaroo care (KC), which has shown positive results, for both parents and infants. NICU-nurses play a crucial role in stimulating the performance of KC. However, little is known about how NICU-nurses involve parents in decisions regarding KC. Research question: How do neonatal nurses involve parents in decision-making regarding kangaroo care in neonatal intensive care units? Method: To gain insight in how NICU-nurses involve parents in this decision-making process, a mixed-methods explanatory sequential study was used. A quantitative phase using a questionnaire was followed by a qualitative phase, consisting of semi-structured interviews. Results: NICU-nurses are not fully aware of the meaning of shared decision-making regarding the principles of family centred care. Once they do, they feel reluctant to work according to these principles, but they do see possibilities of involving parents in decisions regarding KC later during admission. Building a good relationship with parents, involving them in the care and stability of the infant are preconditions for shared decision-making. There is not always consensus about when to apply KC and different forms of advice are given to parents. NICU-nurses want to be in control in terms of making the final decision because of their experience and knowledge, and because they feel responsible for their professional conduct. Conclusion and implications of key findings: Although sharing decisions with parents is one of the principles of family centred care, NICU-nurses are ambivalent about doing this. This study indicates an improvement in knowledge of shared decision-making, the usage of a model and imbedding shared decision-making in hospital policy.