Developing a Neonatal Family-Centered Care Adaptation Framework for NICUs

Thesis Abstract

The transition of neonatal care toward family-centered models has highlighted gaps in the consistent integration of families as core partners in care within NICUs, contributing to suboptimal parent–infant bonding, caregiver stress, and variability in care processes. This study aims to develop an adaptation framework for implementing family-centered care (FCC) in NICUs that is responsive to diverse clinical settings, workflows, and cultural contexts. Specific objectives are to (1) identify determinants of effective FCC adoption from stakeholders’ perspectives; (2) synthesize existing FCC concepts with organizational change theories to articulate an actionable framework; (3) delineate a schema for training, policy, and workflow redesign; (4) assess the feasibility and potential impact of the framework in pilot NICUs; and (5) propose measurable indicators for monitoring and evaluating FCC adaptation over time. The research employs a mixed-methods, instrumental-constructive design anchored in the Diffusion of Innovations theory and the Normalization Process Theory to guide integration into routine practice. The population comprises neonatal care teams, parents of hospitalized infants, and nurse managers across five tertiary NICUs. A purposive sampling strategy targets 60 clinicians (nurses, physicians, allied health professionals), 40 parents, and 10 administrators, with proportional representation to ensure cultural and linguistic diversity. Data collection comprises (a) semi-structured interviews and focus groups (n = 60 clinicians, n = 40 parents) to explore perceived barriers, facilitators, and contextual factors, (b) surveys using the Family-Centered Care Assessment Scale and the Practice Change Agent Instrument to quantify readiness and organizational capability (n = 100 clinicians), (c) direct observations of clinical rounds and parental involvement using a structured FCC fidelity checklist (n = 150 hours of observation), and (d) document analysis of policies, care plans, and training materials. Validity and reliability are addressed through triangulation, pilot-testing of instruments, and inter-rater reliability checks for observational coding (Cohen’s kappa ? 0.80). Data analysis combines thematic analysis for qualitative data, regression analysis to identify predictors of FCC readiness and fidelity, and structural equation modeling to test the relationships among organizational determinants, provider attitudes, and parental engagement outcomes. A synthesized framework will be derived through a multiphase synthesis process, integrating qualitative insights with quantitative evidence, and mapped into a practical FCC Adaptation Framework comprising governance, training, process redesign, family engagement mechanisms, and evaluation metrics. Expected findings include (i) core determinants enabling or inhibiting FCC adoption in NICUs, such as leadership support, staffing models, and cultural alignment; (ii) a theoretically informed model illustrating how diffusion, normalization, and parental involvement influence implementation success; (iii) a set of context-sensitive guidelines for policy, workflow integration, and caregiver education; and (iv) a pilot assessment indicating improvements in family presence during rounds, parental stress reduction, and infant developmental outcomes, with feasibility indicators (fidelity scores > 0.75, parental satisfaction scores increasing by at least 15%). The study’s contribution to knowledge lies in providing a robust, generalizable FCC Adaptation Framework grounded in established implementation science theories, tailored for neonatal care contexts, and accompanied by practical tools for measurement and sustainability. The conclusions are expected to support scalable strategies for embedding FCC as a standard of care in NICUs, with recommendations for national guideline alignment, targeted training curricula, and ongoing monitoring. Policy implications include the need for dedicated resources for staff training, parental support programs, and standardized documentation that captures family involvement as a core clinical activity. Suggestions for further research include longitudinal evaluation across additional sites, refinement of fidelity metrics, and exploration of FCC outcomes across diverse sociocultural populations.