​Family-centred intensive care

The Close Collaboration Training Program has been developed in our unit to facilitate family-centred care practices in neonatal intensive care. The training program is based on the assumption that parental care and an emerging relationship with the parents are crucial for the development of the newborn infant. The early parent-infant relationship is a unique developmental stage. Therefore, the parents can support the development of their preterm or sick newborn already during hospitalization by being present and by providing them with love and care.

Often a parent of a newborn infant has an intuitive need to stay close to his/her infant to protect and get to know her/him. Therefore, a separation from the newborn may cause stress and anxiety for the parents. Parents' unlimited possibility to participate in the care of their infant during intensive care also supports their own well-being and thereby, the relationship with their infant.

Parents' presence in the unit and participation in the infant care is influenced by care culture e.g. how they are welcomed to the unit, how opportunities to participate in infant care are provided, and how their opinions are heard in decision making. The Close Collaboration with Parents Training Program aims to increase staff capacity to support early parent-infant relationship and to create a partnership with parents in the care of their infant.

The entire Turku University Hospital neonatal intensive care unit staff has participated in the training program. Our unit is also a training centre for units in other hospitals.

The Close Collaboration with Parents training program is an educational program for  multiprofessional NICU healthcare teams. The goal of the training program is to increase staff members’ skills to collaborate with parents during the infants hospital stay and, thereby, facilitate family centred care culture unit-wide. One motivation to implement the program is the need to update care culture and to prepare the staff for a single family room based unit. Another motivation is the need to support parents’ presence and parent-infant skin-to-skin contact in the current unit context and, thereby, increase the quality of the care.

We developed and carried out the Close Collaboration with Parents Training Program in the neonatal intensive care unit of Turku University Hospital during the years 2009 to 2012. Now, the program has been implemented in several Finnish units as well as in other countries. The corner stones of the training program are the joint observation of infant's individual behaviour with parents and planning the infant care with parents based on this joint observations. The training supports the staff in their capacity to listen to parents regarding decision-making and thereby integrates parents in the care team. This increases parents' presence and participation in the care of the infant. The long-term goal is to support infant development and the development of an attachment relationship between parents and the infant to produce parental psychosocial well-being.

The training program is based on clinical research evidence and theories of developmental psychology. It consists of bedside learning with a mentor, reflective practices, and theoretical teaching supported by a manual and e-learning platform (password protected). We train local mentors to facilitate the learning process of other staff members in their unit. The mentors, together with the medical director and head nurse of the unit, will form a local training team. The team participates actively in the education provided by the trainers and is responsible for the practical organization of the training in their unit. 

We provide contact teaching, consulting, and supervision for the mentors, the medical director, and the head nurse for one and a half years. The mentors receive five weeks of contact teaching by our trainer mentors. The contact teaching includes lectures for the whole staff and mentoring for the local mentors-to-be. The contact teaching can be organized both in Turku and in the target unit according to the needs of a unit.

The training team of the Close Collaboration with Parents program:

Sari Ahlqvist-Björkroth, PhD, psychotherapist, Coordinator of the CC training program

Liisa Lehtonen, MD, Head of Neonatology, Turku University Hospital, Professor in Paediatrics

Sanna Pick, RN

Helena Lindberg, RN

Pirjo Tahvanainen, RN

Hannele Haapala, RN

Siw Hellsten, RN

Jussi Sundgren, Midwife

Anu Yrttiaho, RN

Nina Urmas, RN

Mariia Aro-Panula, RN

Training materials:

Link to the training manual (password protected)

Link to online learning program (password protected)

Please do not hesitate to contact us for future information:

close-collaboration(a)utu.fi

The Units that have been trained so far:

The neonatal intensive care unit in Pori

The neonatal intensive care unit in Lahti

The neonatal intensive care unit in Vaasa

The neonatal intensive care unit in Oulu

The neonatal intensive care unit in Hämeenlinna

The neonatal intensive care unit in Kuopio

The neonatal intensive care unit in Lappeenranta

The neonatal intensive care unit in Hyvinkää

The neonatal intensive care unit in Seinäjoki

The neonatal intensive care unit in Trondheim, Norway

The neonatal intensive care unit in Jyväskylä

The neonatal intensive care unit in Kokkola

The first eleven units that participated in the training were included in the evaluation study. The research evaluates both immediate and long-term effects of the Close Collaboration with Parents training program from the perspectives of children, parents, and staff. The first results show a substantial change in care culture toward more family centred care. The follow-up data shows a decrease in maternal depression rates, even up to two years of childs’ age. In addition, the training increases the time that parents are present and holding the infant skin-to-skin.

Research:

The picture above:

Simo Raiskila, MD, PhD
Anna Axelin, RN, Associate Professor
Mirka Toivonen, RN, PhD student
Sari Ahlqvist-Björkroth, PhD, Psychologist
Liisa Lehtonen, MD, Professor in Paediatrics

Current research team:

Liisa Lehtonen, Head of the Division of Neonatalogy at Turku University Hospital. Professor in Pediatrics, University of Turku, Paediatrics and Adolescent Medicine

Anna Axelin, Ph.D., Associate Professor, University of Turku, Nursing Science

Sari Ahlqvist-Björkroth, Ph.D., University of Turku, Paediatrics and Adolescent Medicine

Mirka Toivonen, Ph.D., University of Turku, Nursing Science

Ryo Itoshima, Doctoral Student, University of Turku, Paediatrics and Adolescent Medicine

References:

1. Axelin A, Ahlqvist-Björkroth S, Kauppila W, Boukydis Z & Lehtonen L: Nurses’ Perspectives on the Close Collaboration with Parents training program in the NICU. American Journal of Maternal and Child Nursing, 2014; 39(4): 260-8. Available online: http://dx.doi.org/10.1097/NMC.0000000000000061

2. Raiskila S, Axelin A, Rapeli S, Vasko I & Lehtonen L. Trends in care practices reflecting parental involvement in neonatal care. Early Human Development 2014; 90:863-67

3. Ahlqvist-Björkroth S, Boukydis Z, Axelin A, Liisa Lehtonen. Close Collaboration with Parents intervention to improve parents’ psychological well-being and child development: Description of the intervention and study protocol. Behavioral Brain Research. 2017: available online: https://doi.org/10.1016/j.bbr.2016.10.020

4. Ahlqvist-Björkroth S. Challenges for transition into early parenthood : Prenatal depressive symptoms, marital distress, and premature birth of an infant. Annales Universitatis Turkunesis 2017; B 438 Humaniora http://urn.fi/URN:ISBN:978-951-29-6906-7

5. Alhqvist-Björkroth S, Axelin A, Korja R, Lehtonen L: An educational intervention for NICU staff decreased maternal postpartum depression. Pediatric Research 2019; 85(7): 982-986. Available online: https://doi.org/10.1038/s41390-019-0306-y

6. Toivonen M, Lehtonen L, Ahlqvist-Björkroth S, Axelin A: Key factors supporting implementation of a training program for neonatal family-centered care - a qualitative study. BMC Health Services Research 2019; 19(1):394. Available online: https://doi.org/10.1186/s12913-019-4256-1

7. Toivonen M, Lehtonen L, Löyttyniemi E, Ahlqvist-Björkroth S, Axelin A: Close Collaboration with Parents intervention improves family-centered care in different neonatal unit contexts: a pre-post study. Pediatric Research 2020; 88(3): 421-428. Available online: https://doi.org/10.1038/s41390-020-0934-2

8. He F, Axelin A, Ahlqvist-Björkroth S, Raiskila S, Löyttyniemi E, Lehtonen L: Effectiveness of the Close Collaboration with Parents intervention on parent-infant closeness in NICU. BMC Pediatrics 2021; 28. Available online: https://doi.org/10.1186/s12887-020-02474-2