FiCare

Family Integrated CareTM

This binder belongs to:

learning and caring

Neonatal Intensive Care Unit

Introduction to Family Integrated Care

We welcome you and your new baby to NICU.

Family Integrated Care, or FICare, is a model of care practised in Dunedin NICU, where parents are encouraged to be active members of the team caring for their baby. The team of nurses and doctors understand the unique medical needs of the babies and can support parents and teach them how best to care for their baby.

The goal of the FICare model of care is for parents to form close bonds with their baby and to leave NICU with reduced stress and anxiety, and increased confidence.

7pm: Nursing handover and shift change

6pm: Visiting time ends

3pm: Nursing handover and shift change

While in NICU…

Baby care

Neonatal Intensive Care Unit

24 hours in NICU

11pm: Nursing handover and shift change

Care

social

2pm: Visiting time begins

Quiet time

6am: Blood tests; update of charts

7am: Nursing handover and shift change

8.15am: Medical handover and shift change 8.30am: Ward round begins

10am: Meal vouchers delivered for boarder mums 11am: Tests/procedures requested on ward round

Away from NICU…

Spend time with your family / whānau

eating and sleeping times

Contact with family and friends

breast milk

time from home to hospital

leisure

contact with NICU for

Neonatal Intensive Care Unit

Accommodation for parents in NICU

After delivery, mothers are inpatients in Queen Mary (QM) until obstetrically discharged. Post-discharge there are the following options. This is dependent on where you live and individual circumstances:

Out of town families

Mum stays in hospital as a boarder in a shared room

• In NICU boarder room (room 3 or 4) or

• In QM Room 25

Partner and siblings

• At home, or

• In motel accommodation provided by National Travel Assistance (if eligible).

(Motel accommodation may be limited at times e.g. sporting events and concerts)

Dunedin families

The expectation is that the family will stay in their own home. Transport assistance may be available (check with Social Worker).

Self-care (one–three nights with baby prior to discharge)

Expected for all families prior to discharge

• Mum and baby with a partner or support person in NICU self-care room

Sleeping at cotside

The unit is not designed to accommodate parents sleeping at their baby’s cotside. However, in some circumstances plans can be made in consultation with the NICU team.

Generally there will be only one parent at the cotside sleeping, and a plan recorded on My Care Plan.

Consideration needs to be given to:

• Safety and privacy for baby and parent

• Safety and privacy for other babies and families in NICU, and staff

• Sleep quality (noise, light, disturbance)

• Need for breaks for food and drink, hygiene. (There are no facilities for partners to shower.)

• Clinical needs of the unit (admissions, resuscitation, high occupancy etc.)

In some individual circumstances

Mum and/or partner and/or support person may be accommodated in NICU self-care rooms depending on availability and circumstances. Plans should be made in consultation with NICU team.

Extended Family/Whānau

Refer to Visitor Policy. Parents are asked to take responsibility for managing visitors at the cotside.

Neonatal Intensive Care Unit

Parent and Nursing Responsibilities

Nurses in NICU are expected to continue to provide care in accordance with Southern DHB policies. Their professional responsibility and accountability remains aligned to Nursing Council of New Zealand scope of practice for the Registered Nurse (RN). The focus of FICare is that nurses provide coaching and support so that parents can take on a more active role as caregivers of their baby during their stay in NICU. The FICare model of care requires partnership between the nurse and parents characterised by co-operation and shared responsibilities. To help identify these shared responsibilities a detailed list of tasks and expectations are provided below for guidance.

Task Parent responsibilities Nursing responsibilities

Orientation

to Family Integrated Care

NGT feeds

Receive orientation

Follow infection control precautions including hand hygiene for you and you visitors

Get familiar with the layout of the unit

Learn about NICU equipment

Second person to check milk with RN

Draw up milk

Parent can hold the feed

Provide orientation

Teach infection control precautions

Show layout of the unit

Teach how to use basic equipment

Explain NICU equipment

Double check milk with parent

Double check volume of milk to be administered

Check position of NGT/OGT

Hang feed

Documentation of feeds

Oral feeds:

Breast or bottle and other

As above

• Learn to breastfeed with support

Alternatively learn other feeding techniques e.g. bottle feeding, cup feeding or finger feeding as needed

Medication

Identify the purpose of routine medications

Administration of approved oral medications under nursing supervision

As above

Nurse feeds when parent unavailable

Skin to skin care

As much as possible when baby is stable

Provide teaching on the indication of routine medications

Double check oral medication, dosage, patient, time and route with parent and another RN

Supervise administration of medication

Record on medication chart

Double check with another RN as per SDHB policy and chart accordingly

• Assess readiness/condition of baby

Assistance with preparation and learning of technique

Monitor baby

Support parent

Adjustment of oxygen as required

Task Parent responsibilities

Bathing/ hygiene

Safe practices around bathing and nappy changes

Provide developmentally

Neonatal Intensive Care Unit

Dressing

and bradycardia events

Monitors

Safe practices

Education to recognise and respond to

and bradycardia

Call for assistance

Basic understanding and education of vital signs and alarm limits

No manipulation of alarm limits

No silencing of alarms without nursing

Nursing responsibilities

Teaching/coaching and assisting

Documentation

Oxygen

Adjust prongs on the face and inform nurse

No manipulation of oxygen flow or concentration

Phototherapy

Reposition eye shades

Turn on/off biliblanket, lights

Assistance

Responds to parents call

Assesses the situation and provides

assistance to baby

Document

Record vital signs on obs chart

Ensure proper position of leads and sat

Check tracing on monitor

Manipulate oxygen flow and concentration as indicated

Record oxygen flow and concentration

Education & maintenance of optimal phototherapy

Monitoring SBRs

Guide thermoregulation

Neonatal Intensive Care Unit

Parent Knowledge and Skills Checklist

Here is an outline of skills and knowledge you will gain in the NICU as you care for your baby. You can use this as a checklist as you learn. Please be sure to ask your nurse if you have any questions or need more information.

Knowledge/Skill

I understand the importance of appropriate hand washing using soap and water and/or alcohol rub including removing jewellery

I understand the importance of a clean bedside area and know where to store breast pumps

I have been orientated to the resources for parents in the NICU

Developmental Care

I understand the principles of developmental care

I can provide skin-to-skin care for my baby

I understand signs of stress as well as signs of discomfort or pain

I can position my baby properly and make his/her bed

I understand behavioural cues: e.g. alert, awake, sleepy or feeding cues

Date I was taught I feel comfortable with this Comments

Neonatal Intensive Care Unit

Knowledge/Skill

Babycares

I can change my baby’s nappy, provide skin care, mouth care and know when to provide eye care

I can take my baby’s temperature and feel my baby’s warmth and understand temperature instability

I can dress my baby

I can bath my baby with special attention to water temperature, positioning and safety

I feel comfortable taking my baby in and out of the incubator/cot

Specific skills

I can recognise jaundice, adjust eye shields, and have received education on phototherapy

I know the difference between apnoeas, bradycardias and desaturations

I know when to call for help

I can give routine oral medications Double check (2 RNs)

Date I was taught I feel comfortable with this Comments

Knowledge/Skill

Expressing Milk

I label, store and transport my milk properly

I can wash my expressing equipment properly using detergent and warm water to rinse Change milton solution daily

Tube Feeding

I can draw up feeds, EBM, HMF, formula, label them correctly and double check with my nurse

I can warm my milk and check it with my nurse

I know how to position/ reposition my baby for feeding and watch for signs of stress and feeding intolerance

Breastfeeding/Non-Nutritive Sucking

I have worked with my nurse and/or a lactation consultant to develop a feeding plan

I know how to position my baby at the breast for non-nutritive sucking or breastfeeding and watch for signs of stress

I know how to latch my baby on the breast and assess when my baby is sucking, swallowing and breathing

Neonatal Intensive Care Unit

Date I was

feel

with this

Knowledge/Skill

Bottle Feeding

I have worked with my nurse to develop a feeding plan

I can warm my breast milk/ formula and check it with my nurse

I know how to position/ reposition my baby for feeding, pacing of feed and monitor for signs of stress

I can wash my bottles and teats properly using detergent and warm water to rinse. Change milton solution daily

Documentation

I understand how to document appropriately and ask for clarification when necessary e.g. My Care Plan, Baby steps to discharge, self care chart

Communication

I use My Care Plan to communicate with the nursing staff and update this regularly

I am comfortable participating on ward rounds and have an active role in discussing a plan of care for my baby

Getting Ready for home

I am actively working on completing Baby Steps to Discharge

I have discussed the contents of the Homeward Bound package with my nurse

Neonatal Intensive Care Unit

Date I was taught I feel comfortable with this Comments

My notes

Neonatal Intensive Care Unit

NICU Ward Round and Presentation

The ward round takes place between approximately 8.30am and 10.30am each day. This is the time your baby will be examined by medical staff. They will discuss your baby’s progress with the NICU team and make a plan for treatment and care for the next 24 hours. We would encourage you to be present at this time to meet the team and be involved in the discussion and ask any questions you may have.

When you feel comfortable you are invited to present information about your baby on the ward round. Below are some suggestions of background information and current progress about your baby that you may wish to share with the medical and nursing staff during the round. You are welcome to share different information in a different style should you prefer.

My baby, (name), is a boy/girl now X days old. My baby was born at X weeks gestation by (type of delivery).

My baby’s birth weight was X grams and he/she now weighs X gram.

My baby’s history:

My baby’s current leave “problems”:

Today my baby seems: Well/unwell.

Comfortable/uncomfortable. My baby seems stable/unstable on current breathing support. My baby is tolerating/not tolerating feeds.

My concerns/questions today are:

Neonatal Intensive Care Unit

Record of Education Sessions Attended

Education Session Date Attended Comments/Reflections

Introduction to FICare

Parenting in NICU

Current medications

Home medications

Iron, Vitamin C, Panadol/ Ibuprofen, antihistamines, nappy creams, bonjella, rhugar, probiotics, gaviscon

The Journey to Suck Feeding Baby Steps to Discharge

Getting ready for home

Developmental Care

Understanding your baby’s behaviour

How to support my baby’s development

Hot Topic in NICU care

Neonatal Intensive Care Unit

Useful Websites & Apps

The internet and social media is full of information that may or may not all be reliable or applicable to your baby’s age and stage. Below are some sites we would recommend.

Neonatal Trust: www.neonataltrust.org.nz

• Support for NICU families

• Provide the booklet “What to expect when it wasn’t what you expect”

• Includes weight conversion chart and a great glossary of commonly used terms in NICU

Babble by MidCentral DHB app:

• Developed from NICU in Palmerston North Hospital for parents who have a baby in NICU

• Full of reliable information of what to expect when your baby is admitted to NICU

• Also provides an opportunity to write and store journals and photos of your baby and share with your family and friends

IFDC app:

• Made by the Imperial College Healthcare NHS Trust in England

• Integrated Family Delivered Neonatal Care. A very useful and empowering app

• Offers up-to-date and comprehensive educatioal material, developmental timelines and different diary functions to document the neonatal journey and memories

Mama Aroha: www.mamaaroha.co.nz

• Breastfeeding tools and videos

FiCare website: www.familyintegratedcare.com

• Canadian Mount Sinai Hospital

• Comprehensive and informative

• Short videos

Hands on expressing: Hands on pumping Internet search and YouTube videos.

• Learn techniques to maximise milk production

Paced bottle feeding: Internet search and YouTube videos.

• A technique to learn how to bottle feed in a way that is more responsive to baby’s cues so the baby has more control over intake

Breast feeding: www.burpapp.co.nz

• An app to direct you to nearest breastfeeding friendly venue

Bellyful: www.bellyful.org.nz

• Provides some free meals to Dunedin families with new-born babies

Miracle Babies: www.miracle babies.org.au

• Australian sipport for Nicu families. They also have a Facebook page

Feel free to share sites you found informative and supportive

Neonatal Intensive Care Unit

Acknowledgements of resources

Thank you to:

• Parents and families from Dunedin NICU who were involved in the original research trial. Their enthusiasm for this model of care was inspirational and motivating.

• NICU team involved in the original research trial who dreamed big and showed us this model of care was possible.

• The Neonatal Trust of NZ.

• NIDCAP: The Children’s Hospital of Westmead Sydney

• Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial Lancet Child Adolesc Health 2018; 2: 245–54 Published Online February 7, 2018 http://dx.doi.org/10.1016/S2352-4642(18)30039-7 Karel O’Brien, Kate Robson, Marianne Bracht, Melinda Cruz, Kei Lui, Ruben Alvaro, Orlando da Silva, Luis Monterrosa, Michael Narvey,Eugene Ng, Amuchou Soraisham, Xiang Y Ye, Lucia Mirea, William Tarnow-Mordi, Shoo K Lee, for the FICare Study Group and FICare Parent Advisory Board

• Gala Hesson and Sean Flaherty from the SDHB communication team.

• Juliet Manning CNM, Jo Dobson ACN and Frances McCaffrey RN: Dunedin NICU FiCare Leadership team.

• Canadian FICare Research and Development team, Mount Sinai Hospital, Toronto, Canada.

We appreciate the assistance and support to launch this model of care into our NICU and embed it in practice.

Ngā mihi Juliet, Jo and Frances