Empowerment of parents in neonatal level 2 care

Chapter 1 explains the importance of parent empowerment in neonatal care and how several intervention strategies are used to address barriers to empower parents toward autonomous parenting during hospital admission. To address these barriers, some intervention strategies aim at proximity between parents and newborns such as single-family rooms and couplet care. Other strategies aim at involving parents as primary caregivers, as described in the concept of family-integrated care (FICare). Little is known about the experiences of parents and health professionals with a combination of multiple intervention strategies aimed to empower parents in neonatal Level 2 care. This thesis investigated what we can learn from empowering parents in a neonatal Level 2 setting with FICare in combination with couplet-care, single-family rooms and rooming-in facilities. Chapter 2 describes the changes made to implement an integrated infrastructure of maternity and neonatal Level 2 care to empower parents. A case study was conducted in which we analyzed 38 documents and interviewed 6 stakeholders about the design of a ward that includes FICare, single-family rooms, couplet-care, and rooming-in facilities. The changes primarily served the prerequisite for parental empowerment, namely 24/7 proximity between parents and newborns. Chapter 3 describes the outcomes of a focus group and interview study on the experiences of 26 parents with empowerment within the integrated infrastructure described in chapter 2. Above all, parents felt ‘respected’ as a whole family by being able to stay close to each other 24/7 in their own single-family room. It provided parents with a safe and private learning context in preparation of autonomous parenting. In addition, parents learned from observation of health professionals and from participating in daily medical rounds. We noted that the parents felt like going through an intensive learning process. However, parents also faced challenges with FICare in combination with couplet-care, single-family rooms and rooming-in facilities. In Chapter 4, we appraised 45 health professionals’ self-reported practices in educating parents within this setting from the perspective of competency-based education (CBE) to identify areas for improvement. We found that the education of parents in this setting depended mainly on role modeling and coaching in a safe and private learning environment. We concluded that parent education programs could benefit from designing adult learning programs based on the principles of CBE. The greatest benefit of CBE for parent empowerment in hospital settings is that CBE urges health professionals to empower parents to be active learners and to take part in the improvement of the education program. Chapter 5 describes the experienced changes in professional identity of health professionals when practice transitioned from a ‘paternalistic’ model to a shared or ‘consumerist’ model with increased parent autonomy. We analyzed transcripts of focus groups and interviews with 60 health professionals on their experiences with empowering parents and described factors associated with themes of professional identity. The parents’ constant proximity to their newborns and the single-family room design were found to be major changes in work that influenced the following three themes of professional identity: (1) connectedness and relationships (2) communication, and (3) competencies. A fourth theme, (4) values, beliefs and ethics, affected how the participants coped with the changes described in the first three themes. Values, norms, and beliefs associated with family-integrated care helped health professionals to embrace new roles, but other values, norms and beliefs could act as barriers. The last chapter, chapter 6, summarizes the main findings of our studies as well as the answers to the main research questions of this thesis, followed by a general discussion of three imbalances that might emerge by a combination of empowerment interventions within neonatal care and when parent empowerment is pursued.