Effect of Family Integrated Care on the Discharge of Parents With Premature Babies in the Neonatal Intensive Care Unit
Effect of Family Integrated Care on the Discharge of Parents With Premature Babies in the Neonatal Intensive Care Unit
Physiological and structural features of premature infants differ from mature newborns.
 Families worry about touching their very sensitive and fragile babies, which are quite
 different from their expectations, and they seriously concern about how they will take care
 of their babies who are cared for by the specialist staff at the hospital when they are
 discharged to home. Different approaches and models are applied in the Neonatal Intensive
 Care Units (NICU) to prepare families, especially mothers, for the discharge process and to
 overcome these fears of the parents. However, most of the time, investigators observe in both
 researches and units that these approaches are not efficient. In this study, which
 investigators started with the questions as "What can investigators do better in this issue?"
 and "How can investigators help families more in this process?", investigator have seen that
 Family Integrated Care (FICare) model is applied in some clinics abroad and successful
 results have been obtained. However, investigators did not come across a study that applied
 this model and examined the effect of it on parents on being ready for discharge. Since this
 study will be a first in terms of both this aspect and the application of this model in our
 country, in this unique study, investigators aim to draw attention to this approach in our
 country, also contribute to keeping the premature babies healthy.

 Research Hypotheses:

 H0: Family Integrated Care Model is not an effective method for parents to be ready for
 discharge.

 H1: Family Integrated Care Model can be applied in NICU. H2: Family Integrated Care Model
 positively affects parents' readiness for discharge.
Background: The Family Integrated Care (FICare) model is a modern approach that supports the
 participation of parents (excluding ventilation, monitor adjustments, vascular fluid and drug
 administration) developed in collaboration between parents and healthcare professionals,
 which is carried out gradually in the NICU (1). Parents are informed about the general
 development of the baby, brain and sensory development, motor and behavior development, care
 of the premature. In addition, parents are informed about what they can do about general body
 cleaning and care, especially in touch, attachment, skin-to-skin contact, breastfeeding and
 increased breast milk and diaper change (2).FICare; It is a care model with a 25% increase in
 the weight gain of premature babies, a 80% increase in breastfeeding rate, a 25% decrease in
 parental stress, a significant decrease in critical incident reports such as hospital
 infection and sudden infant death (3). The care that these babies receive in their first
 hours, days, weeks and months is vital to determine their future health and long-term
 outcomes. Evidence suggests that if parents are supported and encouraged to take care of
 their babies while in hospital, this will have better outcomes for both the baby and their
 family. FICare support not only reduces the length of hospital stay of parents, but also
 reduces the rate of re-hospitalization, and strengthens the bond between parents and babies.
 It helps parents feel safer when taking care of their babies, both in the hospital and at
 home (4).

 A standard care model for discharge preparation is not applied to parents who have a
 premature baby in their NICU. Institutions make the decision to discharge with the opinions
 of the doctor and nurse working in the unit. With the FICare model, it is thought that
 parents will be prepared for discharge, bonding between parents and babies, fulfilling their
 parental roles, supporting babies' breastfeeding, reducing hospital stay, enhancing
 parental-employee communication, and increasing the quality of care services..

 Method: This research is a randomized controlled experimental study. The data of the research
 will be carried out between 01.08.2020-01.05.2021 with the parents of the premature babies in
 accordance with the inclusion criteria in the Neonatal Intensive Care Unit of the Ministry of
 Health University Education and Research Hospital. The sample of the study was calculated in
 accordance with the intervention group selection criteria and by performing power analysis.
 Power analysis was performed using G * Power (v3.1.7) program in order to determine sample
 size. The effect range value was taken as 0.70 as the method used in cases where it is
 unknown how many units difference is significant between the groups. In cases where Type 1
 error probability (α) was 0.05 (at a confidence level of 95%), at a power level of 80% and
 the effect range was 0.70, the study was planned with a total of 68 mothers, including 34
 mothers women for each group. It will be ensured that the mothers to be assigned to the study
 and control groups show similarity in terms of two factors (age, education level). People
 will be assigned to groups with simple random sampling. The sample of the study will randomly
 allocated into two groups: the FICare model will be applied to the intervention group, and
 the other group, which was the control group, will be followed in the routine maintenance of
 the service. Since the Family Integrated Care model will be given by researchers and baby
 nurses trained in this subject, single blind (researchers are not blind) randomization will
 be provided. The statistician was also blinded for the data analysis purpose. In the data
 collection tools, investigators would use the "Parental Identification Information Form"
 containing the sociodemographic characteristics of the family, the "Newborn Identification
 Information Form containing the characteristic features of the babies" and the
 readiness-ready scales prepared for mother and father, with validity and reliability studies.

 FICare trainings will be given to the parents in the study group, and the parents will
 experience their care (sub-care, skin care, bath etc.) applications on the model and then on
 their babies.

 There will be no intervention to the control group and the routine care and discharge process
 of the clinic will be applied. The questionnaire will be applied to both groups in the first
 24 hours of the baby's hospitalization, and the same questionnaire will be applied 24 hours
 before the discharge plan. The results of the two surveys will be compared.

 Statistical Analysis in Data Evaluation will be done using Statistical Package for the Social
 Sciences (SPSS) software. For normality, the Kolmogorov-Smirnov (K-S) test will be used. In
 order to determine whether there are differences in dependent variables according to
 independent variables, independent group t-test will be used if the distribution is normal,
 and if the distribution is not in normal percentages, Mann Whitney-U test will be used.
 Results will be evaluated at 95% confidence interval and significance at p <0.05 level
Inclusion Criteria:

 -  Newborn to be premature (between 28 and 34 weeks of gestation)

 -  The baby is admitted to the neonatal intensive care unit and sleeps for at least 7
 days

 -  The absence of congenital anomaly in the newborn (craniofacial anomaly such as cleft
 palate, cleft lip, paralysis of facial muscles)

 -  Any screened newborn gastrointestinal, neurological, and Genetic the absence of
 disease

 -  The absence of congenital heart disease requiring surgical treatment in newborns

 -  The mother and father do not have a diagnosed psychiatric illness

 -  Mother and father being open to communication and cooperation

 -  Mother and father volunteering to participate in the research

 -  Being a literate mother and father

 -  The mother has primiparous and first maternity experience,

 -  Having the first parenting experience in participant father

 -  Participant mom and dad being 19 and over

 -  Participation of parents in the initiative group in training and practices for the
 FICare model

 -  Participation in routine care in parents in the NICU to the parents in the control
 group

 -  Baby nurses in charge of a 4-hour training on the Family Integrated Care model

 -  Mothers and fathers in the venture group stay at least 6-8 hours a day in hospital

 -  Mothers and fathers in the intervention group to perform at least 3 treatments a day
 with a nurse

 Exclusion Criteria:

 -  One of the parents does not want to join

 -  Congenital anomaly of premature baby

 -  Premature baby undergoing surgical intervention