The Effect of Family Integrated Care on Preparing Parents With Premature Infants Hospitalized in the Neonatal Intensive Care Unit for Discharge
Condition: Neonatal Intensive Care Unit; Parents
Study type: Interventional

Summary: 
      Physiological and structural features of premature infants differ from mature newborns.
      Families worry about touching their very sensitive and fragile babies, which are quite
      different from their expectations, and they seriously concern about how they will take care
      of their babies who are cared for by the specialist staff at the hospital when they are
      discharged to home. Different approaches and models are applied in the Neonatal Intensive
      Care Units (NICU) to prepare families, especially mothers, for the discharge process and to
      overcome these fears of the parents. However, most of the time, investigators observe in both
      researches and units that these approaches are not efficient. In this study, which
      investigators started with the questions as "What can investigators do better in this issue?"
      and "How can investigators help families more in this process?", investigator have seen that
      Family Integrated Care (FICare) model is applied in some clinics abroad and successful
      results have been obtained. However, investigators did not come across a study that applied
      this model and examined the effect of it on parents on being ready for discharge. Since this
      study will be a first in terms of both this aspect and the application of this model in our
      country, in this unique study, investigators aim to draw attention to this approach in our
      country, also contribute to keeping the premature babies healthy.

      Research Hypotheses:

      H0 There is no difference between the readiness for discharge of mothers and fathers included
      in the FICare model compared to the control group.

      H1 The hypothesis of this study is that the mothers included in the FICare model have higher
      levels of discharge readiness than the control group.

      H2 The hypothesis of this study is that the fathers included in the FICare model have higher
      levels of discharge readiness than the control group.
    

Detailed description: 
      Background: The Family Integrated Care (FICare) model is a modern approach that supports the
      participation of parents (excluding ventilation, monitor adjustments, vascular fluid and drug
      administration) developed in collaboration between parents and healthcare professionals,
      which is carried out gradually in the NICU (1). Parents are informed about the general
      development of the baby, brain and sensory development, motor and behavior development, care
      of the premature. In addition, parents are informed about what they can do about general body
      cleaning and care, especially in touch, attachment, skin-to-skin contact, breastfeeding and
      increased breast milk and diaper change (2).FICare; It is a care model with a 25% increase in
      the weight gain of premature babies, a 80% increase in breastfeeding rate, a 25% decrease in
      parental stress, a significant decrease in critical incident reports such as hospital
      infection and sudden infant death (3). The care that these babies receive in their first
      hours, days, weeks and months is vital to determine their future health and long-term
      outcomes. Evidence suggests that if parents are supported and encouraged to take care of
      their babies while in hospital, this will have better outcomes for both the baby and their
      family. FICare support not only reduces the length of hospital stay of parents, but also
      reduces the rate of re-hospitalization, and strengthens the bond between parents and babies.
      It helps parents feel safer when taking care of their babies, both in the hospital and at
      home (4).

      A standard care model for discharge preparation is not applied to parents who have a
      premature baby in their NICU. Institutions make the decision to discharge with the opinions
      of the doctor and nurse working in the unit. With the FICare model, it is thought that
      parents will be prepared for discharge, bonding between parents and babies, fulfilling their
      parental roles, supporting babies' breastfeeding, reducing hospital stay, enhancing
      parental-employee communication, and increasing the quality of care services..

      Premature infants who were hospitalized for at least seven days between February 6, 2020, and
      August 15, 2021, in the NICU of a training and research hospital formed the population of the
      study. In the study, the total number of parents was determined as 68 when the margin of
      error was 5%, the power level was 81.17%, and the effect size value was 0.70. At the end of
      the study, a post hoc power analysis was conducted to determine the adequacy of the sample
      size. As a result of the power analysis, for the details of the difference between the groups
      in terms of the scale score of fathers with premature babies in the neonatal intensive care
      unit, type 1 error: 0.05, n: 68 people, effect size = 1.990, and the power level according to
      the structure was determined as 1.000. To determine the difference in terms of the scale
      score of mothers with premature babies in the neonatal intensive care unit, type 1 error:
      0.05, n: 68 people, effect size = 2.586 and power level according to temperature was
      determined as 1.000. These values show that the sample size is sufficient.
    

Intervention name(s): Supporting parents who have premature babies to be ready for discharge with the training given within the scope of FICare model.
Intervention type(s): Other
Intervention description(s): At least 1 week of FICare training for parents At least 4 hours of training on FICare for health professionals Trainings will be held between 13:30 and 15:30 in a training room with heat, light and seating arrangement (for parents who are not able to participate in the training during the week, trainings will be held at the appropriate time interval on the weekend .) Premature baby dummy on oral care, eye care, nose care, ear care, skin care, bath, attired in clothes,/removal, safe sleeping baby, safe transport, kangaroo care (physical contact), non-invasive drug application will be shown and the parents also will be asked to implement,
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized Controlled Trial
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: premature; Family Integrated Care; discharge; readiness; parents