The impact of family-centered care interventions on neonatal and parental outcomes in a Turkish hospital



      This study aimed to improve nurses’ attitudes towards parental engagement and to examine the impact of implementing nursing interventions related to family-centred care on neonatal and parental outcomes in a university hospital in Turkey.


      A quasi-experimental, nonequivalent, and post-test research design was used. Using convenience sampling, the study was completed with 128 preterm infants and their parents, including 64 in the experimental group and 64 in the control group at a neonatal intensive care unit of a university hospital. The control group data were collected from medical records and parents before practising family-centred nursing interventions developed for the experimental group. In addition, nurses were given a four hour training session aimed to improve their attitudes towards parental participation in care, with the nurses’ attitudes measured before, immediately after, and one month after the training. The experimental group data were collected from medical records and parents after 10 nursing interventions based on family-centred care supported by managers began to be implemented by trained nurses in the neonatal intensive care unit. The Parent-Preterm Infant Characteristics Form, Maternal Attachment Inventory, Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N), and Parental Engagement Attitude Scale were used for the data collection.


      While nurses’ scores of attitudes toward parental participation obtained immediately after and one month after the training were higher than those before the training, the scores one month after were lower compared to those immediately after. The results indicated that discharge weight gain of infants in the experimental group were significantly higher than those in the control group and that there was no significant difference between the groups in length of stay at neonatal intensive care unit. The maternal attachment and satisfaction scores of the parents in the experimental group were significantly higher than those in the control group.


      Implementing family-centred nursing care interventions, developed based on unit needs and supported by managers, with trained neonatal intensive care nurses positively impacted parent-infant attachment, parent satisfaction, and infant weight gain.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Aarthun A.
        • Akerjordet K.
        Parent participation in decision-making in health-care services for children: an integrative review.
        Journal of Nursing Management. 2014; 22: 177-191
        • Ahmann E.
        • Dokken D.
        Strategies for encouraging patient/family member partnerships with the health care team.
        Pediatric Nursing. 2012; 38: 235
        • Albayrak S.
        • Büyükgönenç A.L.
        The adaptation of the empowerment of parents in the intensive care-neonatology: Validity and reliability study, Koç Üniversitesi Hemşirelikte Eğitim ve Araştırma Dergisi.
        (in Turkish). 2019; 16 (doi:10.5222): 313-323
        • Al-Motlaq M.
        • Shields L.
        Family-centered care as a western centric model in developing countries.
        Holistic Nursing Practice. 2017; 31: 343-347
        • Aronson P.L.
        • Yau J.
        • Helfaer M.A.
        • Morrison W.
        Impact of family presence during pediatric intensive care unit rounds on the family and medical team.
        Pediatrics. 2009; 124: 1119-1125
        • Austin B.
        • Downing C.
        • Hastings-Tolsma M.
        Experience of neonatal intensive care unit nurses in providing developmentally-supportive care: a qualitative study.
        Nursing & Health Sciences. 2019; 21: 336-344
        • Bera A.
        • Ghosh J.
        • Singh A.K.
        • Hazra A.
        • Mukherjee S.
        • Mukherjee R.
        Effect of kangaroo mother care on growthand development of low birthweight babies up to 12 months of age: a controlled clinical trial.
        Acta Paediatrica. 2014; 103: 643-650
        • Borimnejad L.
        • Mehrnush N.
        • Seyed-Fatemi N.
        • Haghani H.
        The effect of empowerment program on mother-infant interaction and weight gain in preterm infants.
        Zahedan Journal of Research in Medical Sciences. 2012; 14: 19-23
        • Conde-Agudelo A.
        • Belizán J.M.
        • Diaz-Rossello J.
        Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.
        Cochrane Database of Systematic Reviews. 2011; 3CD002771
        • Daneman S.
        • Macaluso J.
        • Guzzetta E.C.
        Healthcare providers’ attitudes toward parent participation in the care of the hospitalized child.
        Journal for Specialist in Pediatric Nursing. 2003; 8: 90-98
        • Davidson J.E.
        • Aslakson R.A.
        • Long A.C.
        • Puntillo K.A.
        • Kross E.K.
        • Hart J.
        • et al.
        Guidelines for family-centered care in the neonatal, pediatric, and adult ICU.
        Critical Care Medicine. 2017; 45: 103-128
      1. Bergman N.J., Westrup B., Kuhn P., Daly M., Bertoncelli N., Caballero S., & König K. EFCNI, . European standards of care for newborn health: Very early and continuous skin-to-skin contact. (2018), Retrieved from: ( (accessed on May 29, 2020)

        • Feeg V.D.
        • Paraszczuk A.M.
        • Çavusoglu H.
        • Shields L.
        • Pars H.
        • Al Mamun A
        How is family centered care perceived by healthcare providers from different countries? An international comparison study.
        Journal of Pediatric Nursing. 2016; 31: 267-276
        • Fernandes J.D.
        • Machado M.C.
        • Oliveira Z.N.P.
        Children and newborn skin care and prevention.
        Anais Brasileiros de Dermatologia. 2011; 86 (Retrieved from:): 102-110
        • Franck L.S.
        • O'Brien K
        The evolution of family-centered care: From supporting parent-delivered interventions to a model of family integrated care.
        Birth Defects Research. 2019; 111: 1044-1059
        • Gilbert C.
        • Darlow B.
        • Zin A.
        • Sivasubramaniam S.
        • Shah S.
        • Gianini N.
        • et al.
        Educating neonatal nurses in Brazil: a before-and-after study with interrupted time series analysis.
        Neonatology. 2014; 106: 201-208
        • Gill K.M.
        Health professionals' attitudes toward parent participation in hospitalized children's care.
        Children's Health Care. 1993; 22: 257-271
        • Grol R.
        • Wensing M.
        • Eccles M.
        • Davis D.
        Improving patient care the implementation of change in health care.
        John Wiley & Sons, 2013
      2. Health Statistics Yearbook (2018). Health Statistics. Retrieved from:,siy2018en2pdf.pdf?0 (accessed on June 11, 2020)

        • Jeihooni A.K.
        • Kashfi S.H.
        • Bahmandost M.
        • Harsini P.A.
        Promoting preventive behaviors of nosocomial infections in nurses: the effect of an educational program based on health belief model.
        Investigación y Educación en Enfermería. 2018; 36: e09
        • Jolley J.
        • Shields L.
        The evolution of family-centered care.
        Journal of Pediatric Nursing. 2009; 24: 164-170
        • Kavlak O
        • Şirin A.
        The Turkish version of maternal attachment inventory.
        Uluslararası İnsan Bilimleri Dergisi (in Turkish). 2009; 6 (Retrieved from): 189-202
        • Kaya A.
        • Güven S.T.
        • Dalgıç A.I.
        The significance and effectiveness of kangaroo care for premature infants.
        New Trends and Issues Proceedings on Advances in Pure and Applied Sciences. 2017; 08 (Retrieved from: 92-97
        • Kurt F.Y.
        • Küçükoğlu S.
        • Özdemir A.A.
        • Özcan Z.
        The effect of kangaroo care on maternal attachment in preterm infants.
        Nigerian Journal of Clinical Practice. 2020; 23: 26-32
        • Kurtuluş N.
        • Yıldız K.
        • Korucu E.
        • Özyazıcıoğlu N.
        Determination of pediatric nurses’ attitudes on family-centered care.
        International Journal of Caring Sciences. 2018; 11 (Retrieved from:): 1066-1072
        • Lake E.T.
        • Staiger D.
        • Edwards E.M.
        • Smith J.G.
        • Rogowski J.A.
        Nursing care disparities in neonatal intensive care units.
        Health Services Research. 2018; 53: 3007-3026
        • Latour J.M.
        • Duivenvoorden H.J.
        • Hazelzet J.A.
        • van Goudoever J.B.
        Development and validation of a neonatal intensive care parent satisfaction instrument.
        Pediatric Critical Care Medicine. 2012; 13: 554-559
        • Maree C.
        • Downes F.
        Trends in family-centered care in neonatal intensive care.
        The Journal of Perinatal & Neonatal Nursing. 2016; 30: 265-269
        • Medina I.M.F.
        • Granero-Molina J.
        • Fernández-Sola C.
        • Hernández-Padilla J.M.
        • Ávila M.C.
        • Rodríguez M.D.M.L.
        Bonding in neonatal intensive care units: Experiences of extremely preterm infants’ mothers.
        Women and Birth. 2018; 31: 325-330
        • Mirlashari J.
        • Brown H.
        • Fomani F.K.
        • de Salaberry J.
        • Zadeh T.K.
        • Khoshkhou F.
        The challenges of implementing family-centered care in NICU from the perspectives of physicians and nurses.
        Journal of Pediatric Nursing. 2020; 50: 91-98
        • Musafili A.
        • Essén B.
        • Baribwira C.
        • Rukundo A.
        • Persson L.Å.
        Evaluating Helping Babies Breathe: Training for healthcare workers at hospitals in Rwanda.
        Acta Paediatrica. 2013; 102: e34-e38
        • Müller M.E.
        Prenatal and postnatal attachment: A modest correlation.
        Journal of Obstetric, Gynecologic, and Neonatal Nursing. 1996; 25: 161-166
        • Power N.
        • Franck L.
        Parent participation in the care of hospitalized children: a systematic review.
        Journal of Advanced Nursing. 2008; 62: 622-641
        • O’Brien K.
        • Robson K.
        • Bracht M.
        • Cruz M.
        • Lui K.
        • Alvaro R.
        • et al.
        Effectiveness of family integrated care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial.
        The Lancet Child & Adolescent Health. 2018; 2: 245-254
        • Oude Maatman S.M.
        • Bohlin K.
        • Lilliesköld S.
        • Garberg H.T.
        • Uitewaal-Poslawky I.
        • Kars M.C.
        • van den Hoogen A.
        Factors influencing implementation of family-centered care in a neonatal intensive care unit.
        Frontiers in Pediatrics. 2020; 8: 222
        • Örtenstrand A.
        • Westrup B.
        • Broström E.B.
        • Sarman I.
        • Åkerström S.
        • Brune T.
        • et al.
        The stockholm neonatal family centered care study: Effects on length of stay and infant morbidity.
        Pediatrics. 2010; 125: e278-e285
        • Segers E.
        • Ockhuijsen H.
        • Baarendse P.
        • Eerden I.
        • Hoogen A.
        The impact of family centred care interventions in a neonatal or paediatric intensive care unit on parents’ satisfaction and length of stay: A systematic review.
        Intensive & Critical Care Nursing. 2019; 50: 63-70
        • Skidmore M.B.
        • Urquhart H.
        Retention of skills in neonatal resuscitation.
        Paediatrics & Child Health. 2001; 6: 31-35
        • Trajkovski S.
        • Schmied V.
        • Vickers M.
        • Jackson D.
        Neonatal nurses’ perspectives of family-centred care: a qualitative study.
        Journal of Clinical Nursing. 2012; 21: 2477-2487
      3. World Health Organization. WHO recommendations on postnatal care of the mother and newborn (2013). WHO Library Cataloguing-in-Publication Data. 2014. ISBN 978 92 4 150664 9 (NLM classification: WQ 500). Retrieved from (accessed on June 15, 2020)

        • Yıldırım Özbodur S.
        A validity and reliability study of parent participation attitude scale in Turkey. (Unpublished master’s thesis).
        Dokuz Eylül University, 2008
        • Yu Y.T.
        • Hsieh W.S.
        • Hsu C.H.
        • Lin C.H.
        • Lin Y.J.
        • Hsieh S.
        • et al.
        Family-centered care improved neonatal medical and neurobehavioral outcomes in preterm infants: Randomized controlled trial.
        Physical Therapy. 2017; 97: 1158-1168
        • Yu X.
        • Zhang J.
        Family-centred care for hospitalized preterm infants: a systematic review and meta-analysis.
        The International Journal of Nursing Practice. 2019; 25: e12705
        • Zengin Akkuş P.
        • Ilter Bahadur E.
        • Coşkun A.
        • Koken G.
        • Karahan S.
        • Özmert E.N.
        Family-centred service: perspectives of paediatric residents from a non-Western country.
        Child: Care, Health and Development. 2020; 46: 275-282