Increasing Parental Involvement/Satisfaction

Personally, I check our teaching checklist to see what the parents are done before. Sometimes, the RNs don't record if the parents changed the diaper, etc, so if it's blank, I ask if they've done it. If not, I show them how or walk them through it if they are reluctant/scared. I always ask if they have any questions and update them on the changes made since they were in last.

Many of our parents feel the same way, left out of the loop so to speak. One mom expressed that she felt we were keeping her at a distance so we could do things "our way". We have since began to have the NNPs or residents calling parents with daily updates, especially with med changes or new procedures or testing. This has helped. Nursing instituted a bedside journal for our chronic babies and parent feedback has been very positive. Another thing we are doing is a scrapbooking night every Tues for interested parents, this is led by a volunteer who had a baby in our unit a couple years ago. It's great to see the parents leave with huge smiles on their faces!

Dear BittyBabyRN,

What a great thread! I have spent the last year researching on customer service satisfaction and hope to write an article on the topic soon. I can share with you some tidbits that you may find helpful.

First, the Institute of Family Centered Care has standards as to what this should look like in NICU's. If you google the topic there are a wealth of sites with more info. One of the best articles is recent and in Pediatrics 2003;111 access this online, full text: www.pediatrics.org/cgi/content/full/111/4/SEI/e437 Title is: Evaluation and Development of Potentially Better Practices for Improving Family-Centered Care in NICU's. I would begin with this and also another web site which gives the NICU nurse an idea of how the experience is for parents. That site with numerous parent stories is www.premature-infant.com/imagine-parentmain.html. The stories may move you to tears, so have kleenex handy! First, we need a vision of how we think FCC should look in our units.

Second, we need to survey famililes before discharge and aks them what we could have done better. Some units have parent advisory boards to get info and direction from, also.

Once you have that info you could develop a staff committee to select care practice goals and plan the training to accomplish them. Some examples I've implemented or seen done are these:

1. A kangaroo care calendar at each infant's bedside (private rooms) so parent could put a cute sticker on the days that they KC'd. I wouldn't use this in open bay units, because you wouldn't want parents to compare.

2. Developmental care emphasizes that often when procedures are done the baby requires 4 hands; two to contain the baby, eg hold paci, and two hands-the nurses- to do the procedure. I've begun involving my parents as my helpers and they feel so needed. (Let's face it, we often don't have a helpful nurse available.)

3. Children's Medical Ventures has a terrific laminated flip chart on sale for $29.00 that details the development of 26 week to discharge babies and how parents can be involved. Each unit could have some for parents to view at scrub in.

4. Near the scrub sink where parents scrub in we have a white child-sized bookcase and a sign encouraging parents to read through the portholes to their babies, because they need to hear their familiar voices. We provide numerous donated books they can use and return to the unit secretaries' desk, where they are virexed and then returned to the book case. It gives them something to do besides sit there and now many parents bring their own favorites and read every visit.

5. My home unit has recording equipment that we can wheel on a small desk into a conference room. Parents sing/pray/talk to their infant into a mic and with the push of a button this is then recorded onto a CD that can be played with feedings for the infant. The parents love the idea that their voice stays in the NICU with their infant when they can't be there and research showed better language development at age 6-8yrs when this was done.

6, In the book , Influencer, by Patterson, Grenny, etc, page 37 details how a hospital of 4,000 employees dramatically improved their customer service scores by focusing on 5 vital behaviors. I have adapted these in my NICU practice with slight modification with the result that I have numerous families wanting me to primary their infants!! These behaviors are: smile, make eye contact, identify yourself, (I want them to feel I'm fully present for them and try to treat them as though we are best friends. This is our moment together and I want it to be a great one.)

#4 is tell them the plan for while they are there . . . what you will do for their baby, including them, while they are there. #5 Ask, is there anything else I can do for you while you're here? I include two other things: I praise and support any of their efforts to mastering care of their baby and I always ask if they know the plan of care to getting their baby home and when they have last spoken to a doctor. I remind them they can always request to speak to a doctor rather than a nurse and many aren't aware of that.

7. Get them Kangarooing ASAP! It empowers them and increases milk production.

8. With RT assistance I have parents of even VLBW intubated infants lift for linen changes.

9. A couple times a week they should first do mini sponge baths in the isolette and then swaddled baths, many times before discharge at whatever time/day suits them best.

10. All parents want continuity of care and we would want it for our babies if we were in their shoes, so primary or team nursing should be the norm, not the rare exception.

Hope to see many more great ideas on your thread.

Friends:

I made two errors on the web sites I listed (worked too many nights, I guess and had too little sleep) Here are the corrections:

www.pediatrics.org/cgi/content/full/111/4/SE1/e437

and www.premature-infant.com/imagines-parentmain.html

So sorry.