The Effect of Family-Integrated Care Based on Swanson's Theory of Caring on Premature Infants
Phase: NA
Conditions: Premature Infants
Sponsor: Yongkang Maternal and Child Health Hospital

Study protocol on the Application of Family-Integrated Care
Guided by Swanson's Caring Theory in the Care of Preterm
Infants
Version number: 20230701，V1.0
Release date: 2023.07.01
Background and significance
Premature infants are defined as those born before 37 weeks of gestation. Their
growth and development require more meticulous attention and specialized care. Due
to underdeveloped organs and weakened immune systems, family members often lack
a comprehensive understanding of the unique needs of preterm infants within
traditional medical care settings, which may lead to gaps or deficiencies in the
caregiving process. The involvement and supportive role of the family are often
insufficient, making it difficult to meet the complex care requirements of premature
infants in the neonatal intensive care unit (NICU). Currently, the family-centered care
model is widely implemented in clinical practice and has demonstrated positive
outcomes in improving care quality and patient outcomes.
The care of premature infants necessitates collaborative efforts between
healthcare
professionals
and
family
members.
This
study
introduces
a
family-participatory care model grounded in Swanson’s theory of caring. By fostering
greater family
involvement
and
initiative, caregivers
can
develop
a deeper
understanding of the infants’ specific care requirements and design individualized
care plans accordingly. This approach holds significant value in supporting the
physical development of premature infants and preserving the psychological
well-being of their families.
The comprehensive implementation of this project can deliver tailored services
to premature infants and their families, more effectively addressing their specific care
requirements. By adopting a more professional and individualized care approach,

premature infants can experience a greater sense of security, while the psychological
stress on their families can be alleviated. The family-centered care model encourages
active involvement of family members in the caregiving process. Through hands-on
experience and guided practice, family members can acquire essential skills for caring
for premature infants. Close collaboration between family members and healthcare
professionals significantly enhances the overall effectiveness of care. Furthermore,
this collaborative environment fosters stronger trust and mutual support among family
members, enabling premature infants to achieve faster and more stable recovery under
scientifically guided care.
Furthermore, the promotion of a family-integrated care model can enhance the
professional competence and communication abilities of healthcare personnel, foster
close collaboration between families and medical institutions, and encourage
innovative thinking among medical staff in the care of premature infants, thereby
promoting mutual development and improved outcomes. Therefore, this project not
only effectively improves the health outcomes of premature infants and enhances the
well-being of their families, but also contributes to the innovation of care models in
nursing practices and provides a theoretical foundation for the advancement of
premature infant care services.
The current research status and development trends
Akturk U (2018) proposed
[1] the establishment of a multidisciplinary care
intervention team comprising nurses, physicians, and psychological counselors. Prior
to the implementation of the intervention, the psychological counselor should conduct
comprehensive training for the entire team. During this phase, the team would
collaboratively review and clarify the theoretical foundations of Swanson's theory,
essential caregiving skills, and the psychological characteristics of patients. Based on
this foundational work, an effective care framework and operational mechanism can
be developed, ultimately enhancing the overall quality of patient care.
Health literacy serves as a critical foundation for delivering high-quality
healthcare. Improving the health literacy of patients and caregivers can enhance the

efficiency and effectiveness of care delivery. According to the World Health
Organization, individual health literacy encompasses the knowledge, motivation, and
skills that enable individuals to access, understand, and apply health information and
services in order to promote and sustain their health [2]。
Swanson's theory was developed by the distinguished British professor Swanson.
The theoretical framework is primarily inspired by three phenomenological studies [3].
First, it explores which types of caregiving behaviors are most beneficial for pregnant
women who have experienced unsuccessful childbirth. Second, it investigates the care
requirements of new parents and the corresponding caregiving behaviors exhibited by
caregivers. Finally, the theory establishes a caregiving model tailored for high-risk
pregnant women—such as first-time mothers, single parents, and individuals with low
educational attainment or socioeconomic status. Following the implementation of the
intervention, these women demonstrated a significant improvement in their ability to
care for their newborns.
Professor Swanson proposed that, with regard to care behaviors, caregivers
should actively acquire an understanding of the identities of the service recipients, the
methods of providing effective care, and the rationale behind their ongoing service
provision. Furthermore, caregivers are expected to integrate multidisciplinary
knowledge, including aspects of caregiving and humanistic concern [4]
Currently,
the
Swanson
theory
has
gained
widespread
popularity
and
demonstrated favorable outcomes in practical applications. Studies indicate that
international scholars have extensively applied this theory across various domains,
including maternal care for pregnant and postpartum women, rehabilitation for
individuals with limb dysfunction, mental health support for those experiencing
post-traumatic stress disorder, and management of patients with hypertension
[5].
However, its implementation within China remains in the early stages.
Most NICU operate in a closed format without accommodating parental presence
or active involvement [6]. Nevertheless, in such settings, nursing staff typically assume
primary caregiving responsibilities, while parents remain largely excluded from the
care process. Consequently, caregivers often experience heightened anxiety and

insufficient preparedness following the discharge of preterm infants, which may result
in significant caregiving challenges.
FI Care [7] emphasizes that parents should assume the primary responsibility for
caring for premature infants in the NICU and asserts that they should serve as the
principal caregivers and decision-makers. Research indicates that a family-centered
care approach can significantly alleviate parental stress and anxiety. The United States
has developed a data collection platform to support research on family-participatory
care models [8], offering a valuable resource for parents who are unable to visit
hospitals to understand the care requirements of premature infants. This indicates that
international research on family-participatory care models began earlier and was
conducted on a larger scale, thereby providing both theoretical foundations and
practical guidance for enhancing parental caregiving capabilities.
Research Topics and Technological Approaches
3.1 Main topic
The care of premature infants represents a multifaceted challenge that involves
not only physical and mental health aspects but also broader socio-economic
considerations. Swanson's Caring Theory is a well-established nursing framework that
emphasizes the provision of comprehensive and systematic care, centered on
principles such as understanding, companionship, support, empowerment, and the
preservation of hope. This study seeks to investigate the application and impact of
Swanson's Caring Theory within the context of family-participatory care for
premature infants.
The care process is guided by the five core principles of Swanson's Theory of
Caring. 1. Knowing: Provide the family with a comprehensive explanation of the
preterm
infant's
development,
potential
complications,
and
essential
care
considerations to ensure they have a thorough understanding of neonatal care
requirements. 2. Being with: Offer consistent emotional presence and companionship
to the family within the NICU setting, aiming to alleviate feelings of anxiety and
helplessness while fostering a relationship of trust. 3. Doing for: Support and guide
family members in actively participating in the infant's daily care routines, including

feeding, diaper changing, and basic physical assessments. 4. Enabling: Acknowledge
and validate the emotional challenges experienced by the family, provide appropriate
psychological support, and assist them in accessing relevant social and professional
resources. 5. Maintaining belief: Foster a sense of hope and resilience by maintaining
open, positive communication and encouraging the family to remain optimistic about
the infant's progress and their own capacity to cope with challenges.
The impact of family-involved care on premature infants was assessed through
various indicators, including infant health outcomes such as growth and development
metrics (e.g., weight, height, and head circumference), the psychological well-being
of family members, objective evaluations of caregiving quality (such as accuracy and
timeliness of care delivery), and family satisfaction surveys.
3.2 Technological Approaches
1. Family participation
Family participation constitutes a central principle in family-centered care. It is
essential to appropriately evaluate the extent of family members' involvement in daily
caregiving practices, in order to ensure their rightful role and accountability in the
care process and to facilitate their comprehensive understanding of the unique needs
of preterm infants. This evaluation can be systematically conducted through
family-administered
questionnaires,
observational
metrics,
and
assessments
performed by healthcare professionals.
2. Communication skills
A comprehensive understanding and continued adherence to Swanson's Caring
Theory highlight the critical role of effective communication in the caregiving process.
Enhancing the communication abilities of both healthcare professionals and family
members, as well as engaging in thorough communication regarding the infant’s
needs and care procedures, contributes to the establishment of genuine trust and
minimizes communication barriers throughout the care delivery.
3. Emotional Empowerment
This serves as a critical technical indicator for assessing the suitability of family
members for participation in patient care, particularly in cases involving emotional

disturbances or mental health conditions within the family. It necessitates that
healthcare professionals possess specialized emotional support capabilities and the
ability to provide appropriate guidance. Through open and empathetic communication,
medical staff should progressively adapt to the evolving needs of the patient’s family.
4. The correctness of care operations
The care of premature infants requires a high level of professional expertise.
Errors in care procedures can easily cause serious harm to the infants. Therefore, it is
very necessary to assess and record the correctness of care procedures, as well as the
improvement of skills of family members during the process of learning and
familiarizing themselves with the care procedures.
5. The timeliness of care
As premature infants are a high-risk group, their health conditions may change
dramatically. It is very important to assess the timeliness of care, which can help
detect and solve problems in the early stage. The missed visit count method can be
used to statistically record the timeliness of care.
Research Plan, Technical Approach, Organizational Structure
4.1 Research Plan
1. Inclusion and exclusion criteria
The inclusion criteria were as follows: gestational age ranging from 28 to 36
weeks, stable vital signs for at least 24 hours, and parental accompaniment of preterm
infants during hospitalization. The exclusion criteria included: preterm infants with
severe congenital or genetic disorders, dysfunction of vital organs, or requiring
mechanical life support; preterm infants requiring surgical intervention; and preterm
infants with a birth weight below 500 grams.
2. Intervention and Control
FICare nursing method guided by Swanson's caring theory encompasses the
following five dimensions:
Understanding: A neonatologist provided a comprehensive explanation regarding
the developmental progress of premature infants, potential complications, and
essential aspects of nursing care to ensure the family gained a thorough understanding

of the care requirements for premature infants.
Accompaniment: Two nursing guides provided essential support to parents of
newborns in the NICU, helping to alleviate the anxiety and sense of helplessness
among family members and fostering a relationship of trust between the medical staff
and the families.
Help: A neonatal nurse played a guiding role in facilitating parental involvement
in the daily care of premature infants, which encompassed feeding guidance,
introduction of complementary foods, skin care, and related aspects.
Empowerment: A psychological counselor was assigned to provide psychological
counseling and guidance to new parents, offering appropriate emotional support and
assisting them in accessing necessary social and professional resources.
Maintaining Confidence: A neonatologist and a nurse monitored neonatal
development through outpatient visits and telephone follow-ups to encourage families
to sustain their confidence in improving infant health outcomes and to support them in
maintaining a positive outlook when facing challenges in caregiving.
The control group will continue to receive the traditional model of hospital care,
encompassing standard medical services such as physical health monitoring and
nutritional support.
3. Outcome
The primary outcomes included the corrected head circumference, weight, and
height of the newborns at 1 month, 3 months, and 6 months of age. Additionally,
parental anxiety and depression status was assessed using the Trait Anxiety Inventory
(T-AI), which measures long-term and stable anxiety tendencies, and the State
Anxiety Inventory (S-AI), which evaluates current or recent anxiety states. Parental
self-efficacy and satisfaction with their parenting role were assessed using the
Child-Parental Self-Competence Scale (C-PSOC).
Secondary outcomes included the length of hospital stay, discharge weight, and
the number of unplanned hospitalizations.
Confounding factors included fetal gender, gestational age, birth weight, duration
of oxygen therapy, duration of total enteral feeding, and the duration required to

transition from full enteral feeding to full oral feeding, defined as the time from the
initiation of oral feeding (when preterm infants begin to suck voluntarily and consume
the first milk volume exceeding 5 mL) to the complete establishment of full oral
feeding.
4. Sample Size Calculation
With
the
assistance
of
Select
Statistical
Services
(https://select-statistics.co.uk/calculators/sample-size-calculator-two-means/),
the
sample size was determined. This calculation utilizes the following formula to
compute the sample size n:
n=
2×(Zα 2+Zβ)2×σ2
d2
Among them, "Zα/2" denotes the critical value of the standard normal distribution
at α/2 (for a 95% confidence level, α = 0.05, and the corresponding critical value is
1.96); "Zβ" denotes the critical value of the standard normal distribution at β (for a
statistical power of 80%, β = 0.2, and the corresponding critical value is 0.84); "σ²"
represents the population variance, which is set at 2.5; and "d" refers to the minimum
detectable difference, which is set at 1.5 for the primary outcome analysis. Based on
these parameters, the required minimum sample size per group is calculated to be 18
participants.
5. Statistical Analysis
Measurement data that conformed to a normal distribution were expressed as
mean ± standard deviation (SD). Independent sample t-tests and paired sample t-tests
were employed to assess intergroup statistical differences. For measurement data that
did not conform to a normal distribution, results were summarized as median
(interquartile range), and the Mann-Whitney U test was applied to evaluate statistical
differences between groups. Categorical data were presented as frequency and
percentage [n (%)] and analyzed using the chi-square test. Repeated measurement
data were examined using repeated measures analysis of variance (ANOVA). All
statistical analyses were conducted using SPSS version 25.0.

4.2 Technical Approach
The Application of Family-Participatory Care Based on Swanson's Caring
Theory in Premature Infants
Formulate
a
specific
research plan.
Carry out professional training
Collect and record the data of premature infants'
care, and compare and analyze the effectiveness
under the intervention of Swanson's caring
theory.
Statistical analysis, output results
4.3 Organizational mode
The project leader assumes responsibility for the planning, coordination, and
supervision of the entire research process, including decision-making, resource
allocation, and risk management. The research focuses on preterm infants, and the
project leader is tasked with applying for research sites and securing necessary
equipment support. Additionally, the leader collaborates with relevant departments
and institutions to promote the implementation of family-participatory care based on
Swanson's Caring Theory in the context of preterm infant care. Other project
members are assigned specific responsibilities, such as data collection, care

intervention, and outcome analysis. Furthermore, the project's progress and outcomes
are regularly evaluated and monitored. Based on these evaluations, the research plan
and intervention strategies are adjusted in a timely manner to ensure the study's
effectiveness and feasibility.

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