Family at the Core: Mapping Challenges and Opportunities in Implementing Family-Centered Care in NICUs

Abstract

Background:
Family-Centered Care (FCC) is widely recognized as a gold standard approach to quality neonatal healthcare, particularly in Neonatal Intensive Care Units (NICUs). FCC is built on the principles of dignity and respect, information sharing, participation, and collaboration. FCC supports shared decision-making and active parental involvement in neonatal care.

Objective:
To synthesize existing evidence on the benefits and the barriers nurses faced in implementing FCC practices in the NICUs.

Method:
This scoping review was conducted following the Arksey and O’Malley framework and reported in accordance with the PRISMA 2020 guidelines. A comprehensive search was performed across PubMed, CINAHL, Scopus, Web of Science, and Google Scholar databases. Peer-reviewed full text studies published in English between 2015 and 2024 were included based on predefined inclusion criteria.

Results:
A total, there were 828 articles that were obtained from the search of databases. After screening these studies in terms of their publication year, study features, geography, and context, 250 articles were excluded. The remaining literature was assessed in full text articles based on the inclusion criteria, which led to the selection of 25 articles for the scoping review. In addition, the review of literature revealed three major themes extracted namely concept of Family-Centered Care (FCC); FCC facilitators and FCC barriers in the NICUs.

Discussion:
Globally, Several facilitators to FCC among nurses and parents in NICUs were commonly found as factors facilitating the application of FCC among nurses and parents in NICUs include good nurse-parent communication; nurse and parent education; health policy support; and family-oriented NICU environment. On the other hand, staff shortage; workload, infrastructural constraints; restricted visiting policies; communication problems; cultural beliefs; and lack of institutional support were all barriers. The above findings are significant since FCC is known to increase the degree of parental involvement, strengthen the parent-child relationship, enhance parental satisfaction, and improve neonatal outcomes. Successful FCC involves both adequate provision of resources and therapeutic communication between nurses and parents.

Conclusion:
FCC implementation in NICUs is shaped by organizational, cultural, and communication factors, with training, resources, and leadership acting as key facilitators. However, persistent systemic barriers and limited context-specific evidence, particularly from Pakistan, highlight the need for future research.