Health care providers' perspectives of providing culturally competent care in the NICU.

OBJECTIVE: To examine the experiences and perceptions of health care providers caring for new immigrant families in the neonatal intensive care unit (NICU). DESIGN: Qualitative design using grounded theory methodology. SETTING: Two tertiary-level NICUs of two large metropolitan hospitals in western Canada. PARTICIPANTS: Fifty eight (58) health care providers from multiple disciplines. METHODS: Health care providers were interviewed during seven focus groups. We recorded and transcribed focus group data. We analyzed transcripts via line-by-line coding, categorization of codes, concept saturation, and theme generation assisted through NVIVO software. RESULTS: Health care providers identified the nuanced construct of fragile interactions that is embedded within care of the new immigrant family in the NICU. During crisis, decision making, differing norms and beliefs, and language and communication are barriers that affected the fragile nature of interactions. During transition home, fragile interactions were affected by unintentional stereotyping, limited time for intangible activities, and lack of intuitive perceptions of the needs of new immigrant families. Health care providers employed caring and culturally competent strategies to overcome the fragile nature of interactions. CONCLUSION: Within the premise of providing family-centered care is the concept of honoring cultural, ethnic, and socioeconomic diversity; it is imperative that culturally competent care be considered and implemented as a separate stand-alone aspect when caring for new immigrant families.

Connection versus disconnection: examining culturally competent care in the neonatal intensive care unit.

Culturally competent health care is of critical importance; however, it is presented as a frequent challenge in health care settings. This study explored cross-cultural care from the health care provider perspective within two tertiary level Neonatal Intensive Care Units (NICUs). Fifty eight inter-professional health care providers (HCP) participated in focus groups. Participants identified perceived care-related experiences of newly immigrated parents whose infant received care in the NICU as well as health care provider perspectives on delivering that care. Results identified core processes of "connection" and "disconnection," which appeared to have a substantial bearing on NICU experience and interaction. Connection comprised congruity, synergy, and "fit," and resulted in an enhanced relationship between the family and HCP. Disconnection, in contrast, entailed a lack of "fit" and in some cases, misunderstanding and/or conflict between the family and a member or members of the health care team. Connection and disconnection occurred at various junctures of NICU care. These junctures reflected interaction between the family and HCP at the bedside and/or at the level of the unit, hospital, or community at large. Implications for practice, policy, and research are discussed.

Developing nurse/parent relationships in the NICU through negotiated partnership.

OBJECTIVE: To explore parents' experience and satisfaction with care in the Neonatal Intensive Care Unit (NICU). DESIGN: Qualitative design using an interpretive description method. SETTING: A tertiary-level care 69-bed NICU. PARTICIPANTS: Ten parents (nine mothers and one father) were interviewed. METHOD: Parents were interviewed in person or via telephone, either following or close to discharge. Interviews were recorded, transcribed, and then analyzed using an evolving coding guide. RESULTS: All parents indicated that the relationship they developed with the bedside nurse was the most significant factor affecting their satisfaction with their NICU experience. All parents described nursing actions of perceptive engagement, cautious guidance, and subtle presence, which facilitated the development of this relationship. Further analysis of the data revealed that parents portrayed nurses in ideal nurse/parent interactions as fulfilling the roles of teacher, guardian, and facilitator. CONCLUSION: Developing a collaborative and effective nurse/parent relationship is the most significant factor affecting parents' satisfaction with their NICU experience. Providing nursing care in a manner that optimizes consistency and continuity of care facilitates the ability of both parties to develop this relationship.

Including parents in the evaluation of clinical microsystems in the neonatal intensive care unit.

Neonatal intensive care is an area of healthcare that has experienced significant growth in recent years. As a result, "megaunits" of more than 60 beds are not uncommon. Delivering care in units of this size that incorporates the principles of family-centered care and that is satisfying to both staff and parents is challenging. One proposed method to enhance delivery of care in the megaunit NICU has been to implement a clinical microsystem approach. Up to now, research to evaluate the efficacy of a clinical microsystem has focused primarily on staff satisfaction and perception. However, implementing the clinical microsystem within the NICU requires that careful attention be paid to the parents and their experience and perception of their infant's care in the NICU. This article reviews the basic principles of family-centered care, identifies components of care that affect parents' satisfaction with NICU care, reviews the theoretical underpinnings of the clinical microsystem, and discusses areas for future research.