Translating family systems care into neonatology practice: A mixed method study of practitioners' attitudes, practice skills and implementation experience.

BACKGROUND Family-centered care interventions are a recommended part of high-quality neonatal intensive care. Evidence suggests that engaging and supporting families improves parental and infant health outcomes. Enabling practitioners to work with families in a relational, strength-oriented way is thus vital to ensure quality care. However, implementing family-centered care remains a challenge, and its uptake is often slow and inconsistent. OBJECTIVES To examine the impact of family systems care implementation activities on neonatal nurses' and physicians' attitudes and skills in working with families, and to explore their implementation experience. DESIGN Mixed method design. SETTING AND PARTICIPANTS Two neonatal intensive and one intermediate care unit in a Swiss, university-affiliated hospital. A total of 65 practitioners participated in the pre-post study, and 17 in focus group interviews. METHODS Quantitative data was obtained before, mid-, and post-implementation through an online questionnaire. Attitudes were measured with the Families' Importance in Nursing Care - Nurses' Attitudes Scale. Skills and reciprocity in working with families was assessed with the Family Nursing Practice Scale. Four focus group interviews were conducted post-implementation. Data analysis included descriptive statistics, group comparison, and qualitative content analysis. RESULTS A statistically significant increase in practice skills and reciprocity, but not in attitudes was found mid- and post-implementation. Practitioners reported new ways of working with families, which included enhanced awareness of the extended family, intentional relationship-building, augmented family involvement, and systemic interventions, such as therapeutic listening. They experienced implementation as a wheel that moved forward or stood still, depending on the challenges faced and the predominance of enabling versus limiting organizational factors. Practitioners felt not only challenged regarding the meaning of being-acting in family-centered ways, but also in delivering family systems care consistently and collaboratively. While practitioners experienced the educational workshop as helpful, they felt left alone during consolidation. CONCLUSIONS Findings demonstrate that the inter-professional implementation of family systems care is highly relevant for practitioners' clinical practice. Implementation strategies yielded an increase in practice skills/reciprocity and new ways of working with families, but no quantifiable impact on attitudes. Adoption fluctuated and was ongoing, hindered by organizational constraints and lack of consolidation support. Nonetheless, practitioners gave numerous examples of family-centered practices. A combination of implementation strategies offered over time and supported by organizational structures are the most likely means to enable teams to work in partnership with families, and to promote infant and family well-being in neonatal care