Healthcare Professional's Sense of Coherence of Parental Involvement in Neonatal Intensive Care Units: A Framework Synthesis

Abstract

Background: Family-centred card (FCC) is recognised as the gold-standard in paediatric healthcare practices. Its foundation centres around active parental participation in their infant’s care and decision-making. However, FCC’s vague definition and lack of standardised practice has confused what FCC entails. Despite healthcare professionals’ (HCP) acknowledgement of the benefits and importance of FCC, inconsistent and questionable implementation persists in neonatal intensive care units (NICUs). Parental experiences have been the main focal points of FCC, but comprehensive understanding of NICU HCP’s experiences is lacking. Aims: This review aims to synthesise the experience of healthcare professionals regarding parental involvement in infant care and decision-making in NICUs. Design: A qualitative systematic review was conducted. Methods: Seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, Web of Science and ProQuest) were searched from their respective dates of inception until December 2020. Selected studies were appraised using the Critical Appraisal Skills Programme checklist. A framework synthesis was conducted to analyse data using Antonovsky’s Sense of Coherence (SOC) theory. Results: A total of 28 studies were included in this review. Three overarching themes guided by Antonovsky’s SOC theory: (1) Comprehensibility of parental involvement in FCC, (2) Manageability of parental involvement in care and decision-making, and (3) Meaningfulness of parental involvement in shared decision-making in neonatal care, and nine sub-themes were identified. HCPs had mixed views of parental involvement, seeing meaning for benefits attributed to infants and parents, but were hindered by organisational, environmental, and personal obstacles that weakened their sense of coherence of the situation, making them unprepared to involve parents into care. Conclusions: HCPs require integrated formalised support to cope with parental involvement in NICUs. The implementation of organisational changes and psychological support were strategies that helped enhance HCPs’ sense of coherence.