The effectiveness of a parent participation improvement program for parents on partnership, attachment infant growth in a neonatal intensive care unit: A randomized controlled trial

Background: Parent participation based on collaboration with nurses is recognized as an important concept in neonatal care. However, there is a lack of research providing specific strategies to promote parent participation in clinical activities, and there are few studies including both mothers and fathers. Objectives: The purpose of this study was to develop a Parent Participation Improvement Program for parents in neonatal intensive care units, and to evaluate its effects on parents' partnerships with nurses, attachment to infants, and infants' body weight. Design: The study consisted of two phases. The first phase involved development of the Parent Participation Improvement Program. The second phase, a parallel two-group randomized controlled trial to evaluate the effectiveness of this program, was conducted from February to August 2017 in the neonatal intensive care unit of a hospital in Seoul, South Korea. A total of 66 infants born at <37 weeks gestation, receiving high-flow nasal cannula or less respiratory support, and their 132 parents (66 mothers and 66 fathers) were approached for enrollment in the study. Sixty-six preterm infants were randomly assigned to the intervention group (n=33 infants/66 parents) or the control group (n=33 infants/66 parents). Methods King's theory of goal attainment was used as the theoretical framework for this program. A literature review and in-depth interviews were conducted to organize and determine the contents of the program. To evaluate its effectiveness, in the second phase, the intervention group participated in a parent participation program comprised of an individualized interaction stage, a pre-participation stage, and an active-participation stage for two weeks. The control group was allowed routine visits. The Pediatric Nurse Parent Partnership Scale and the Maternal Attachment Inventory scale were employed, and infants were weighed on the same calibrated scale by a researcher. Results: In the final analysis, compared with the control group, both the mothers and fathers in the intervention group reported significantly higher scores in partnership (Mann Whitney U=99.50, p<.001) and attachment (t=8.47, p<.001), as well as significantly higher scores within all partnership subscales except "communication." There was no difference in infants' weight between the intervention and control groups. Conclusions: The Parent Participation Improvement Program was proven effective in improving parents' partnerships with nurses and attachment to their infants. The results are expected to more effectively facilitate parent participation in neonatal care. (C) 2019 Published by Elsevier Ltd.