A model of family-centered care at the paediatric and neonatal intensive care setting in Ghana

Abstract

Family-Centered Care (FCC) is an innovative approach of promoting quality healthcare. However, its main concepts remain unclear in different settings, especially in intensive care units. FCC is widely documented and researched globally, yet its implementation in the Ghanaian context has been challenging due to inadequate context specific models.

Purpose: To study FCC in the intensive care setting, develop and evaluate a model of FCC for neonatal and paediatric intensive care units (NICU/PICUs).

Methodology: An exploratory mixed methods triangulation design was conducted in three phases using the Family Systems Theory as a theoretical foundation. Phase one was a scoping review of relevant data followed by a qualitative study (N=84) based on constructivist grounded theory (CGT) and then a descriptive quantitative study (N=446) involving families, clinicians, and health managers at the intensive care units (ICUs). Phase two was a Modified Delphi study (N=24) in order to develop the model of Family-Centered Care which was then evaluated subsequently in phase three by experts (N=25). The scoping data was content analysed, data of the qualitative study was examined using CGT analysis whiles Principal Component Analysis was used to study the quantitative data (with orthogonal Varimax rotations and parallel analysis). Estimation of descriptive statistics, content validity index (CVI), Cronbach’s alpha, and Intra-Class Correlation Coefficient (ICC) were performed to evaluate the model.

Results: The main concepts of FCC practiced in Ghanaian NICU/PICUs were respect/dignity, participation, and effective communication in a well-designed NICU/PICU environment through family acceptance (λ=19.793, factor score of -0.814, & 95th λ=1.751), maintaining privacy/confidentiality (λ=2.243, factor score of -0.827, & 95th λ=1.657), psychosocial needs (λ=1.930, factor score of -0.599, & 95th λ=1.597), and respectful communication (λ =1.554, factor score of -0.729, & 95th λ=1.546). The FCC practice in Ghana were challenged with lack of funding (factor score of 0.804), inadequate space (factor score of -0.650), abandoned babies (factor score of 0.780) and inadequate logistics/personnel (factor score of 0.770). These concepts were used to develop the NICU/PICUs FCC model, viii which showed sound psychometric properties (Cronbach’s alpha=0.953, model content validity index (M-CVI/Ave) =0.924 and average measure of Intra-Class CorrelationICC=0.951) on evaluation. The model theorizes a Trilogic Multidisciplinary Partnership (TMP) between families, clinicians, and health managers in a well-designed NICU/PICU environment to promote respect/dignity, effective communication, and family participation to facilitate the integration and implementation of FCC in the Ghanaian ICUs for critically ill children and their families.

Conclusion: This study triangulated data from clinicians, families, and health managers in order to develop a model of Family-Centered Care for NICU/PICUs in the Ghanaian context. The model will support clinical practice and training in neonatal, paediatrics, and intensive and critical care as well as instigate further research in the field. Future research should, however, test the model and its recommendations with a large sample in Randomized Control Trial (RCT) and cohort studies for its full-scale implementations as well as conduct 5-year periodic reviews for validation and possible revision.