In this section, we provide information and tools that help you evaluate your needs, assess the environment, establish planning committees and engage staff and parents.
Getting Started
The first step in implementing FICare is to gain a thorough understanding of what the program aims to achieve, why it may be of benefit and how it can be implemented. By familiarizing yourself with all of the materials and videos on this website, you will learn what FICare is all about. This knowledge may need to be supplemented with a review of additional resources and publications, some of which are referenced on the website.
FICare Steering Committee
Before you begin to implement FICare, you will need to identify the people who will champion the change. In the early planning stages, you should bring people together (a steering committee) who are passionate about FICare to begin working on developing an implementation plan.
The steering committee should include representatives for all stakeholder groups who will be involved in FICare implementation including veteran parents, administrators, physicians, nurses, and other health care providers. Nursing staff play such a fundamental role in supporting this model of care that it is critically important that they be involved at the outset. The committee will establish workgroups who will be responsible for addressing and implementing the various components of FICare.
Planning
In the early stages of steering committee meetings, the group should establish the goals and objectives of the committee. A current assessment of where the NICU is on the continuum of family-centered care practices and philosophy needs to be performed to establish a starting point. Getting buy-in from organisational and clinical leadership is a key component of planning. The team needs to be able to articulate clearly why they believe that the change is necessary and feel supported during the development. Knowledge of the model and its benefits will help the team to gain confidence in getting stakeholder participation.
Guiding concepts
FICare is an actionable model based on the principles of family-centered care by which parents are true partners in their infant’s care, integrated into the health care team and supported to participate to the best of their ability in their infant’s care, even when in the NICU. We believe that the 4 pillars of FICare are the scaffolding that supports the model. The implementation of FICare involves striving to establish those 4 pillars: Staff Education and Support, Parent Education, Supportive NICU Environment and Psychosocial Support. The toolkit provides many valuable resources to implement these guiding concepts in your unit.
Engagement
Getting buy-in from staff is key to successful implementation. There needs to be frequent and clear communication with staff to address their concerns as implementation and sustaining the model may be challenging. Staff may initially feel criticized and concerned about how the change might impact their nursing role. They may also be worried about extra work demands. The sustainability of the model, once implemented, depends on continuous, open, two-way communication between staff and parents and ongoing celebration of the improvements.
Staff
All NICU staff needs to be informed on a regular basis, about the principles of FICare, and have a clear understanding of the benefits of the model for parents, infants, families and staff. There should be opportunities for staff to provide feedback about their needs or concerns when working with the changed model of care and for staff to support each other in their roles. Ongoing education sessions should provide strategies for staff to help them support greater integration of parents and to facilitate parents engagement and participation in their infants care. There needs to be transparency about what parents are being taught in the education sessions and there should be formal opportunities for staff to participate in the parent education curriculum. As the primary ‘on-the-ground’ driving-force that supports parents in the delivery of FICare in the NICU, front line nurses should be acknowledged and appreciated for the important, and often difficult, work they are doing.
Families
In the very early stages of their NICU stay, parents need to be informed about FICare and the ongoing role that they will play in the care of their infant. It is important to be mindful that many parents may feel very overwhelmed and stressed, and information sharing from the outset and inviting them to feel part of the team will help reduce their anxiety. Parents should be encouraged to regularly participate in all aspects of infant care to the best of their abilities. Communication from staff should aim to create empowered parents who know how to fully participate in FICare. Parents need to be taught from ‘where they are at’; parents will experience the NICU differently and will have widely varying knowledge bases and beliefs.
Example from a FICare site
The Steering Committee at Mount Sinai Hospital included:
- Staff Neonatologist
- Coordinator of Family Integrated Care Project
- Parent Resource Nurse
- Two NICU Nurses
- Research Assistant
- Social Worker
- Lactation Consultant
- Three Veteran Parents
During the initial phases of planning, the research and development team met weekly to determine how to implement Family Integrated Care at our site. We soon created 3 sub-committees, and continued to meet bi-weekly as a Steering Committee until the project was well underway. Although it meant a great time commitment from everyone on the team, the many voices representing different disciplines, including veteran parents perspectives, was invaluable.