Challenges and Solutions to Building Family-Staff Relationships in the NICU: A Qualitative Study.

Abstract

Objective: The objective of this study was to understand factors that impact family-staff relationships in the neonatal intensive care unit (NICU) from the perspective of staff. Staff shared: (1) general challenges that impact family-staff relationships, (2) role-specific challenges (by discipline), and (3) solutions that could help improve family-staff relationships.

Methods: We conducted this study at an urban hospital level IV NICU. In this qualitative study, we conducted 5 focus groups with a convenience sample of NICU healthcare staff (N = 22, 100% women, white/non-Hispanic; age: M = 45 ± 12 [29 - 65]). Focus groups included physicians and a nurse practitioner, unit leadership, nurses, social workers, and occupational therapists. We used a hybrid, inductive-deductive thematic approach to examine qualitative data.

Results: Staff shared general and role-specific challenges that impact their interactions with parents. They reported that parental anxiety, parental decision-making, trust, and staff assumptions can strain relationship dynamics. Each discipline also shared specific challenges they face-some were universal (eg, limited time) and others were unique to their role (eg, stigma for social work). Staff offered potential solutions that can improve family-staff dynamics in the NICU (eg, interprofessional teamwork).

Conclusions: Findings highlight the structural, cultural, and clinical changes needed to promote team-based care. Interprofessional communication skills trainings, training in trauma-informed care, primary intensivist models, and structured team and family meetings show promise for improving family-staff dynamics. More work is needed to improve family-centered communication, teamwork, and psychosocial resources. Focusing on these areas would help improve the family-staff interactions and enhance outcomes for families.