Parental satisfaction with hospital care for children with non-syndromic craniosynostosis: A mixed-method study.

PURPOSE: The study aims to investigate factors influencing parents' satisfaction with hospital care for children with craniosynostosis during hospitalization for surgery. DESIGN AND METHODS: A mixed-methods study with a convergent, parallel design was used. Ninety-five parents responded to the Swedish Pyramid Questionnaire for Treatment, a 25-item questionnaire with six quality domains. In addition, 20 parents were interviewed about their experiences. Frequencies were calculated, and content analysis was used to analyze free-text comments and transcribed interviews. RESULTS: Parents' assessment of the overall quality of care was high (mean 87%, range 10-100%). They were most satisfied in the domain staff attitudes and less satisfied with information routines and participation. Content analysis of the interviews gave two overarching themes: Factors that parents experienced as facilitating good quality of care and Factors that parents experienced as impeding good quality of care. CONCLUSIONS: Parents were generally satisfied with the care provided, and interviews captured parents´ views on important factors. Staff attitudes affected parents' perception of quality of care. PRACTICAL IMPLICATIONS: Clear information and dialogue as well as making parents feel they are part of their child's team can result in higher satisfaction, and allowing families to stay together in the hospital can ease the hospitalization experience. Using a theoretical model can help in suggesting relevant caring actions based on parents' reported care experiences.

Parents' experiences of sham feeding their child with esophageal atresia at home while awaiting reconstructive surgery. A qualitative interview study.

PURPOSE: This study aimed to explore parents' experience of sham feeding their baby born with esophageal atresia at home, waiting for reconstructive surgery. METHOD: Semi-structured interviews were conducted with parents of six children born with esophageal atresia waiting for delayed reconstruction. The interviews were analyzed using qualitative content analysis. RESULTS: Parents experienced that sham feed reinforced the healthy abilities in their baby. They had faith in their own ability as parents to care for their child as well as to see to their baby's strength to cope with difficulties. Parents expressed that the health care system can hinder as well as be a major support on their way to a more normal life at home while waiting for reconstructive surgery. CONCLUSION: The experience of sham feeding at home while waiting for reconstructive surgery is characterized by positive aspects both for children born with esophageal atresia and their parents.

The experience of parents in Ronald McDonald houses in France.

BACKGROUND: Ronald McDonald houses are located close to children's hospitals. They enable the hospitalized child to benefit from their family's presence, while helping the family to cope better with their child's hospital stay. This study aimed to describe the experience of parents staying in Ronald McDonald houses in France, identify their needs, and study the psychological impact of their child being in hospital. METHOD: This cross-sectional observational epidemiological study was conducted in 2016, using anonymous self-administered questionnaires offered to parents staying in one of the nine Ronald McDonald houses in France. The questionnaire had two sections: a general section about the hospitalized child, and a 62 questions section to be completed by each parent, including a Hospital Anxiety and Depression Scale (HADS). RESULTS: The participation rate was 62.9%: 71% of mothers completed the questionnaire (n = 320), and 54.7% of fathers did so (n = 246). They were the parents of 333 children (53.9% boys, 46.1% girls), under 1 year old (44.1%), hospitalized in the following three departments: intensive care (24%), pediatric oncology (23.1%), and neonatal care (20.1%). The mothers on average spent 11 h a day at their child's bedside, while the fathers spent 8 h 47 min. The parents tended to be employees or manual workers, and mostly lived together, with an average 2-h journey to hospital. They reported financial problems in 42.1% of cases, significant sleep deprivation (>90 min) in 73.2% of cases, and anxiety and depressive disorders: anxiety (59%) and depression (26%). There were some significant differences between the experiences of mothers and fathers: mothers lost out on their sleep and lost more appetite, and spent more time at their child's bedside, while the fathers encountered twice as many work-related difficulties (p<0.01). Additionally, their perception of the Ronald McDonald House was similar, as over 90% of them stated that this family accommodation allowed them to feel closer to their child and supported them in their role as parents. CONCLUSION: The parents of children in hospital were 6-8 times more anxious than the general population, while clinical symptoms of depression were twice as common as in the overall population. Despite this suffering linked to their child's illness, the parents rated highly the support provided by the Ronald McDonald House in helping them cope with their child's time in hospital.

Parents' experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic pediatric early warning system (the DETECT study): A qualitative interview study.

Background: Failure to recognize and respond to clinical deterioration in a timely and effective manner is an urgent safety concern, driving the need for early identification systems to be embedded in the care of children in hospital. Pediatric early warning systems (PEWS) or PEW scores alert health professionals (HPs) to signs of deterioration, trigger a review and escalate care as needed. PEW scoring allows HPs to record a child's vital signs and other key data including parent concern. Aim: This study aimed to explore the experiences and perceptions of parents about the acceptability of a newly implemented electronic surveillance system (the DETECT surveillance system), and factors that influenced acceptability and their awareness around signs of clinical deterioration and raising concern. Methods: Descriptive, qualitative semi-structured telephone interviews were undertaken with parents of children who had experienced a critical deterioration event (CDE) (n = 19) and parents of those who had not experienced a CDE (non-CDE parents) (n = 17). Data were collected between February 2020 and February 2021. Results: Qualitative data were analyzed using generic thematic analysis. Analysis revealed an overarching theme of trust as a key factor that underpinned all aspects of children's vital signs being recorded and monitored. The main themes reflect three domains of parents' trust: trust in themselves, trust in the HPs, and trust in the technology. Conclusion: Parents' experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic pediatric early warning system (The DETECT system) were positive; they found it acceptable and welcomed the use of new technology to support the care of their child.

Experiences and attitudes of parents of children with cow's milk and other food-allergy.

INTRODUCTION AND OBJECTIVE: The attitude and behaviors of parents are important in the management of children with food allergy (FA). The aim of this study is to evaluate the experiences and attitudes of parents of children with allergy to cow's milk and other FA. MATERIALS AND METHODS: The parents of children with FA were asked to complete an 18-item questionnaire to evaluate the FA history and experiences during diagnosis, treatment, and follow up. RESULTS: The data from 558 (91.2%) survey questionnaire that were filled completely were analyzed. The mean age of the parents was 33.4+4.9. It was found that most common food allergen was cow's milk (85.3%). The mean time to diagnosis from the onset of symptoms was 10.9±18.4 months. Around 229 parents (41.6%) admitted to at least four different physicians and 68 (12.3%) parents admitted to at least five different physicians before diagnosis. The median time to diagnosis from the onset of symptoms was five (1-108) months in the patients admitted to four or more physicians, but it was one (1-48) month in the patients that admitted to less physicians (p˂0.001). The most common symptoms were dermatitis and mucus-bloody stool, the least common ones were cardiovascular symptoms. Only 21.1% of the patients were able to use hypoallergenic formulas (HAF) in accordance with the recommendation of the physician. CONCLUSIONS: Delayed diagnosis of FA is a major concern, and during this period the patients admit many physicians. A majority of the patients with CMPA experience difficulties while using HAFs, and only one-fifth of them is able to use formula regularly.

Experiences and attitudes of parents of children with cow’s milk and other food-allergy

Introduction and objective: The attitude and behaviors of parents are important in the man-agement of children with food allergy (FA). The aim of this study is to evaluate th e experi-ences and attitudes of parents of children with allergy to cow’s milk and other FA.Materials and methods: The parents of children with FA were asked to complete an 18-item questionnaire to evaluate the FA history and experiences during diagnosis, treatment, and follow up.Results:Th e dat a fro m 55 8 (91.2%) surve y questionnaire tha t wer e fille d completely wer e ana-lyzed. The mean age of the parents was 33.4+4.9. It was found that most common food aller-gen was cow’s milk (85.3%). The mean time to diagnosis from the onset of symptoms was 10.9±18.4 months. Around 22 9 parents (41.6%) admitted to at leas t fou r different physicians and 68 (12.3%) parents admitted to at leas t fiv e different physicians before diagnosis. Th e median time to d iagnosis from the o nset of s ymptoms was five ( 1-108) months in t he p atients admitted to four or more physicians, but it was one (1-48) month in the patients that admitted to less physicians (p<0.001). The most common symptoms were dermatitis and mucus-bloody stool, the least common ones were cardiovascular symptoms. Only 21.1% of the patients were able to use hypoallergenic formulas (HAF) in accordance with the recommendation of the physician.Conclusions: Delayed diagnosis of FA is a major concern, and during this period the patients admi t man y physicians. A majority of th e patients wit h CMP A experience difficulties while using HAFs, and only one-fifth of them is able to use formula regularly (AU)

Experiences of parents with children with congenital disorders of glycosylation: What can we learn from them?

BACKGROUND: Congenital disorders of glycosylation are a group of rare metabolic, genetic diseases that cause severe cognitive and physical impairments. Owing to the rarity of this condition, the experiences of these parents are poorly understood. OBJECTIVE: This study aimed to explore parents' experiences of caring for a child or young adult with congenital disorders of glycosylation. METHODS: Semi-structured interviews were conducted with 33 parents from 11 countries by teleconference to assess their experience of parenting children with the stated condition. Through thematic analysis, combining deductive and inductive strategies, we identified common themes across the interviews regarding the initial stage of diagnosis and the current experience. RESULTS: Parents reported many difficulties in managing the disease and its consequences, mainly related to the condition's management and the child's well-being, focusing less on their own burden and distress. Receiving and adapting to the diagnosis was described as a strenuous and highly emotional process, with parents facing a lack of medical knowledge and difficulty in accessing competent health providers. Regarding the experience of parenting a child with congenital disorders of glycosylation, participants' concerns focused on the child and were related to promoting the child's development and autonomy and finding adequate health and educational support. Participants identified several support strategies. Relevant patient associations provided critical informational, instrumental, and social support. CONCLUSIONS: Results point to parents' need to receive support from informed healthcare and educational providers that recognize their unique challenges and multiple needs.

Patients and Parents' Experience of Multi-Family Therapy for Anorexia Nervosa: A Pilot Study.

BACKGROUND: Family therapy is considered as the gold standard in treatment of adolescents with anorexia nervosa (AN). Among the different types of family therapy, multi-family therapy (MFT) is increasingly used for treating AN, and shows promising results. In this article, our focus relied on the patients' and their parents' perceptions of the effectiveness and the underlying mechanisms of the MFT. METHODS: The present pilot exploratory qualitative study included two focus groups conducted using a semi-structured approach: one with the adolescents (n = 3), and another with one or two of their parents (n = 4 mothers; n = 2 fathers). The subjects discussed were the changes observed in both AN symptoms and family interactions following therapy, and the mechanisms underlying these changes. We crossed the perspectives of the adolescents and of the parents on these two points. RESULTS: Qualitative analysis revealed that while both adolescents and parents had difficulties relating the changes they observed in the last year to MFT, they were able to say that the group cohesion had several positive effects and that their family dynamics had improved. In the light of analysis the adolescents perceived more improvements related eating disorders symptoms than their parents did, while parents were concerned about a negative effect of MFT on their children. DISCUSSION: While both patients and parents perceived improvements in both AN symptoms and family interactions in the past year, it was not clear if they considered MFT to have led to these improvements. FG also explored the MFT mechanisms underlying changes. Both adolescents and their parents stressed the beneficial effects of identification to others members of the group and shared experience to overcome social isolation. Parents also mentioned the sympathy they felt for each other. The idea that they give a central place to families in the therapy was also described by the families.

Parents' Attitudes Toward and Experience of Non-Suicidal Self-Injury in Adolescents: A Qualitative Study.

BACKGROUND: Non-suicidal self-injury (NSSI) is prevalent in adolescents and brings a series of serious consequences to their well-being. However, little is known about parents' attitude toward NSSI in Chinese adolescents. The study aims to investigate the parents' attitudes toward and perceptions of adolescents who have engaged in NSSI behaviors, and the impact of NSSI on their parents. METHODS: Purposive sampling was used in the study. The biological parents of adolescents with NSSI were recruited from the psychiatric ward of a tertiary hospital in China. Semi-structured interviews were conducted which contained three aspects, that is the history of NSSI, the process of seeking or maintaining help and the impacts on the family. Each interview typically lasted 40-50 min. All of the interviews were audio-recorded. Their responses were analyzed by the thematic analysis. RESULTS: Twenty participants completed the interview, consisting of 16 mothers and 4 fathers. Three themes and eight sub-themes were extracted: (1) the attitudes to children's NSSI behaviors (ignorance, shame, and stereotype); (2) coping strategies of parents (the initial response to adolescents' NSSI, and the way of help-seeking); (3) the impacts on family (altered parenting and communication styles, limited personal lives, and increased psychological pressure). CONCLUSION: The results showed that parents lack the knowledge about NSSI and its treatment and are suffering great emotional stress. It is recommended to expand the popularization of knowledge of NSSI in adolescents and more interventions adapted to China's sociocultural climate are required for the well-being of parents and NSSI in adolescents.

Families in Transition: The Lived Experience of Parenting a Transgender Child.

Research exploring the parents' experience of their child undergoing gender transition is almost nonexistent. However, as the number of individuals who identify as transgender increases, gender identity will continue to evolve; therefore, supporting families of these individuals is paramount. Parents of transgender children were interviewed and yielded five themes: (a) It Rocks Your World; (b) Dancing Around in a Way that Doesn't Distance; (c) Your Child Is Still Your Child; (d) Worrying About the Future; and (e) Transformational: Finally an Answer. These themes begin to identify the complex nature and struggles parents face as they encounter the emotional and physical aspects of their child's gender transition. The findings raise awareness of the parents' perspective, provide a better understanding of the complex family issues that occur, and provide nursing suggestions on how to continue to work to facilitate "healthy families" and promote cultural sensitivity.

Parental Groups During Pregnancy and the Child's First Year: Swedish Parents' Experiences.

The aim of the study was to assess parents' experience of parental support given before and after childbirth in a mid-Sweden region. A coherent education program implemented in a mid-Sweden region was evaluated. Data from two different samples of parents was collected through questionnaires. From the antenatal classes 563 women and men took part in the study. The other sample consisted of 176 parents from the child health care classes. The vast majority of parents from both groups were content with the sessions and their overall view was very positive. Both men and women felt strengthened before birth and in their parental role. New knowledge about breastfeeding and children's needs were gained. New thoughts about equal parenting and children's needs and development were achieved to a limited extent.

Unsung heroes, flying blind-A metasynthesis of parents' experiences of caring for children with special health-care needs at home.

AIMS AND OBJECTIVES: To aggregate, synthesise and interpret qualitative research studies of parents' experiences of caring for a child with special health-care needs at home. BACKGROUND: Advances in the field of medical and nursing science have ensured better survival rates for children with chronic illnesses. Many of these children have significant special health-care needs. Today parents assume a caregiver role, undertaking tasks previously provided by nurses in hospitals. As the complexity of care delivered by parents continues to develop, synthesised knowledge can provide an evidence base that will support and guide nurses when caring for these families. DESIGN: Metasynthesis. METHODS: Based upon a systematic search protocol, a structured literature search, covering the years 2003-2016, was conducted in five electronic databases. Ten studies were included and appraised using the Critical Appraisal Skills Program assessment tool. A metasummary and a metasynthesis were undertaken guided by the metasynthesis methodology as described by Sandelowski and Barroso (Handbook for synthesizing qualitative research. New York, NY: Springer, 2007). RESULTS: The results were interpreted and integrated under the overarching theme "unsung heroes, flying blind," supported by eight elucidating categories that illustrate aspects of the parents' life world. CONCLUSIONS: The enormous burden of care can weaken the parents' will to carry on and result in a decreased ability to provide care. This can have an impact on the parents' health, family functioning and the sick child's potential health outcomes. Nurses are in a unique position to help these families and should be better prepared for the role. RELEVANCE TO CLINICAL PRACTICE: Knowledge of how parents of children with special health-care needs experience their daily lives can promote trust in nurses and guide them in their efforts to support families with children living with chronic illness.

Collaborative child home injury prevention in Thailand: An action research study.

Child home accidental injury is a global health issue, and promoting child safety is a pediatric nursing challenge worldwide. Planning child home accidental injury prevention requires understanding of factors influencing parents' behavior. Evidence suggests that participatory health promotion positively influences behavior; however, research on Thai parents is limited. This qualitative, action research study aimed to understand Thai parents' experiences of participating in a collaborative child home accidental injury prevention program and its influence on their behavior. Eight parental mother/father couples from one Thai province consented to participate, providing a wide range of data via in-depth individual interviews and self-assessment questionnaires. Thematic analysis of interview transcripts yielded three themes: collaborative learning, parental behavior change, and reflective learning extends beyond families. Participants reported that workshop participation improved their child home accidental injury-prevention behavior. The present study can inform pediatric nursing, child health-care practice, and child health policy in Thailand and beyond.

'Now she has become my daughter': parents' early experiences of skin-to-skin contact with extremely preterm infants.

BACKGROUND: Based on the Family-Centred Care philosophy, skin-to-skin contact is a key activity in neonatal care, and use of this practice is increasing also with extremely preterm infants. Little is known about parents' immediate experiences of and readiness for skin-to-skin contact, while their fragile infant may still not be 'on safe ground'. Knowledge about parents' experiences might reduce doubt and reluctance among healthcare professionals to use skin-to-skin contact with extremely preterm infants and thus increase its dissemination in practice. AIMS AND OBJECTIVES: To explore parents' immediate experiences of skin-to-skin contact with extremely preterm infants <28-week postmenstrual age. METHODOLOGICAL DESIGN: A qualitative study using thematic analysis. RESEARCH METHODS: Thirteen semi-structured interviews conducted in 2008 with 16 parents after skin-to-skin contact with their extremely preterm infants analysed using inductive thematic analysis. FINDINGS: Parents' experiences were related to the process before, during and after skin-to-skin contact and moved from ambivalence to appreciating skin-to-skin contact as beneficial for both parents and infant. The process comprised three stages: (i) overcoming ambivalence through professional support and personal experience; (ii) proximity creating parental feelings and an inner need to provide care; (iii) feeling useful as a parent and realising the importance of skin-to-skin contact. Having repeatedly gone through stages 2 and 3, parents developed an overall confidence in the value of bonding, independent of the infant's survival. CONCLUSIONS: Parents progressed from ambivalence to a feeling of fundamental mutual needs for skin-to-skin contact. Parents found the bonding facilitated by skin-to-skin contact to be valuable, regardless of the infant's survival.

Parents experiences of discharge readiness from a Swedish neonatal intensive care unit.

AIM: The aim of this study was to describe how parents experienced the support at, and preparation for discharge from, the NICU and how they experienced the first time at home. DESIGN: A qualitative design with quantitative elements was applied. METHODS: A questionnaire study. Data were analysed using qualitative content analysis with quantitative elements. RESULTS: The majority of included parents felt adequately prepared for going home and sufficiently supported during the first period home. Negative experiences were related to lack of time for preparation, lack of support and information, especially about the infant's food intake, breastfeeding, and tube feeding, and lack of follow-up counselling post discharge. This study supports that parents who are closely involved in their infant's care at the NICU, and who stay with the infant at the NICU around the clock, are well prepared for the transition to home.

Differences and similarities between mothers and fathers of premature children: a qualitative study of parents' coping experiences in a neonatal intensive care unit.

BACKGROUND: The aim of this study was to explore and describe the coping experiences of parents to children admitted to a neonatal unit. METHODS: A qualitative research approach was chosen, using in-depth interviews with eight fathers and eight mothers. RESULTS: The main findings were that parents with previous complicated births had more difficulties in coping compared to those parents with no experience with complications. Coping seemed easier where parents' opinions were heard regarding their baby's care and when both parents were present in the neonatal intensive care unit (NICU). The main similarities between mothers and fathers were the reluctance to speak their opinions on childcare, and both experienced a sense of alienation and problems in bonding with the baby. They also needed a limitation on the number of visitors in the NICU. Differences between mothers and fathers were that fathers tried hard to be the strong partner in the relationship, and were more concerned with the mother if she was seriously ill postpartum, while mothers were more concerned for their baby. Mothers' postpartum period was felt as more stressful if the father was not present, but mothers were also better at welcoming support from the health personnel. CONCLUSION: This study highlights the parent's coping experiences in NICUs. Coping seemed easier where parents' opinions were heard. Nurses in the NICU should take the former experiences of the parents into consideration when nursing in the NICU and planning for discharge.

Systematic review of qualitative studies exploring parental experiences in the Neonatal Intensive Care Unit.

AIMS AND OBJECTIVES: To determine the feasibility and utility of a thematic analysis approach to synthesising qualitative evidence about parental experiences in the neonatal intensive care unit. BACKGROUND: Admission of infants to the neonatal intensive care unit is usually an unexpected event for parents who can cause them to experience psychosocial difficulties. A qualitative systematic review is the best method for exploring these parents' experiences regarding this type of admission. DESIGN: Systematic review. METHODS: Qualitative studies in peer-reviewed journals aimed at understanding parental experiences regarding infant neonatal intensive care unit admission were identified in six electronic databases. Three reviewers selected relevant articles and assessed the quality of the methodological studies using the Critical Appraisal Skills Programme. A thematic analysis approach was used to identify the most common themes in the studies describing parental experiences in the neonatal intensive care unit. RESULTS: A total of eighty articles were identified; nine studies were included in this review. Four studies used semistructured interviews, three used interviews, one used self-reporting and one used both focus group and interview methodologies. Common themes across parents' experiences were the stress of hospitalisation, alteration in parenting roles and the impact of infant hospitalisation on psychological health. CONCLUSION: Having an infant hospitalised in the neonatal intensive care unit is a stressful experience for parents. This experience is the result of exposure to different stressors related to the infant's condition, an alteration in parenting roles or the neonatal intensive care unit environment and staffing. These parents suffered negative psychological effects, experienced an interrupted development of a healthy parent-infant attachment and/or felt parental role alteration. RELEVANCE TO CLINICAL PRACTICE: The study's findings are crucial for neonatal intensive care unit nurses to develop intervention strategies and programmes that help parents to decrease the stress of their experience and to support them in facing this stressful situation.

Measuring parents' perspective on continuity of care in children with special health care needs.

INTRODUCTION: Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1) to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q) designed to measure parents' perspective on continuity of care for children with special health care needs and (2) to evaluate the continuity of care based on parental experiences in this population. METHODS: SpeNK-Q was derived from a previous qualitative study and was based on Haggerty's constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child's hospital discharge. Principal component analysis was used to examine the structure of the instrument. RESULTS: Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family-paediatrician relationship; family support; information on care plan. CONCLUSIONS AND DISCUSSION: SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services.

Parents' experiences of healthcare provider actions when their child dies: an integrative review of the literature.

PURPOSE: To review, critique and synthesise current research studies that examine parental perceptions of healthcare provider actions during and after the death of a child. CONCLUSIONS: Five main themes were synthesised from the literature: staff attitudes and affect; follow-up care and ongoing contact; communication; attending to the parents; and continuity of care. PRACTICE IMPLICATIONS: This review helps to identify important aspects of paediatric end-of-life care as recognised by parents, with the intention of placing the family at the centre of any future end-of-life care education or policy/protocol development.

The neonatal nurses' view of their role in emotional support of parents and its complexities.

AIMS AND OBJECTIVES: To explore the nurses' views of their role both in the neonatal intensive care unit and in the provision of interacting with, and emotionally supporting, families. BACKGROUND: The neonatal intensive care nurse has a large and complex clinical role and also a role of emotional supporter for parents in the neonatal intensive care unit. Identifying components of their role and recognising the elements within the nursery that obstruct or encourage this role can allow for modification of nurse education and peer support. DESIGN: Qualitative study based on semistructured interviews. METHODS: Nine neonatal nurses from a single neonatal intensive care unit were interviewed and the data analysed thematically using NVIVO version 10. RESULTS: Participants viewed their role as an enjoyable yet difficult one, requiring seniority, training and experience. They provided support to parents by communicating, listening, providing individualised support and by encouraging parental involvement with their baby. Constructive elements that contributed to the provision of support included a positive neonatal intensive care unit environment and providing a parent support group. More obstructive elements were a lack of physical neonatal intensive care unit space, little time available for nurse-to-parent conversation and language and cultural barriers between nurses and parents. CONCLUSION: The role of the neonatal nurse in providing emotional support is complex and requires a high level of ongoing support and education for staff, and minimisation of physical and staff-related obstructions. RELEVANCE TO CLINICAL PRACTICE: The modern neonatal intensive care unit offers complex medical and nursing services and with this care comes higher needs from both babies and their parents. Neonatal intensive care unit nurses should be supported in their roles by having peer support available in the neonatal intensive care unit and education and training in emotional support and counselling skills. The nursing staff also require a comfortable and practical physical working space in which to assist parents to be with their baby.