National Evaluation of the Close Collaboration With Parents Training. Enhancing Parents' Presence and Participation During Neonatal Intensive Care.

The aim of this study was to evaluate the effects of an educational intervention for neonatal staff on parent-infant physical closeness during their infant's stay in the Neonatal Intensive Care Unit (NICU) and parents' and staff perception on family centered care (FCC) in the unit. We hypothesized that parents spend more time in the unit and have more skin-to skin contact with their infant after the intervention compared to the time before the intervention. We also hypothesized that care culture becomes more family centered after the intervention both from parent and staff perspectives.

Study NICUs and participants This study was an intervention study, comparing the situation before and after the intervention. It was carried out in nine NICUs in Finland, including two level III hospitals and seven level II hospitals. The study progressed stepwise between May 2012 and September 2018; two or three hospitals participated in the study simultaneously. The study permission was granted by the Hospital District of Southwest Finland (T57/2012) and separately by each study site.

The study participants were recruited during three-month periods before and after the Close Collaboration with Parents training program, which lasted for 18 months. Every parent of an infant estimated to stay in the NICU longer than three days was approached. Other inclusion criteria were: 1) the infant had no major congenital anomalies or syndromes, 2) the parents spoke Finnish or Swedish, 3) the family lived in the catchment area of the hospital. A log including infant's gestational age, birth weight, the length of hospital period and the distance to home was kept for all admissions of infants with a length of stay longer than 3 days to identify eligible parents and evaluate drop-out rate.

The staff introduced the study protocol to parents and gave them at least one day to consider their participation. After the parents signed the informed consent form, they were given instructions for use of the closeness diaries and text messages. The parents provided infant characteristics (including gestational age, birthweight, birth head circumference, sex, mode of delivery, and whether the infant was a singleton/multiple or had siblings) and family characteristics (including parents' age, education, socio-economic status and the distance from the hospital to home).

Closeness diary The duration of parents' presence in the NICU and skin-to-skin contact (SSC) was reported with closeness diaries. Presence in the unit was defined by being inside the unit, not necessarily all the time in the room of the baby. SSC was defined as the baby lying on the parent's bare chest dressed only in a diaper and a cap if necessary. On the diary, there were four different timelines where parents filled in the time spent in NICU and SSC with their infant: mother present, mother SSC, father present, and father SSC. Parents were asked to fill in the diaries from the time of recruitment until discharge. During data collection, the diaries were stored in a folder at the bedside so that other families or nurses did not see the diaries.