Overview
The Close Collaboration with Parents training is an educational program for healthcare staff to improve family-centered care in neonatal units including NICUs. In the training, the staff learn about the relationship (communication) ｗith parents and the importance of parents through learning theory, bedside training, and reflections. The family-centered care culture of the neonatal unit will change and improve outcomes for babies and their families after the change in mindset happens with as many staff members.
The implementation of the training at the NICU level has two steps. First, mentors (3-4 people per unit in general) implement the training. The mentors, then, mentor the other healthcare staff (mentees). It usually take about half a year for the mentor training and about a year for the healthcare staff training. Thus, it takes about 1.5 years for a NICU to complete the implementation of the Close Collaboration with Parents.
Contents of training
The training for each healthcare staff consists of four phases. In each training phase, a mentee, who receives the training, learns the theory through e-learning, carries out the bedside training and reflects on it with the mentor. It takes about 36 hours (5 working days) for a mentee to complete the training.
In the training, the healthcare staff will experience different relationships with parents than usual and notice the significance of support for parents using communication. More focus is on learning from “different experiences than usual” although they can also learn specific communication skills.
The training consists of four training phases
Phase I: Observation of baby behavior
Observation of the baby’s behavior is a prerequisite for individual care and support for the baby according to their developmental stage. This will also serve as the basis of Phase II training onward where we conduct joint observation of the baby’s behavior with the parents. Systematic behavioral observations in the Close Collaboration with Parents training are based on the Neonatal Behavioral Assessment Scale (NBAS), Assessment of Preterm Infant Behavior (APIB), and the Neonatal Network Neurobehavioral Scale (NNNS). Observation includes five levels of baby behavior: physiological signs, muscle tone and motor control, states of alertness, interactive behavior, signs of stress and self-soothing.
In the bedside training, the mentee together with the mentor observes the baby’s behavior and its changes, mainly before, during, and after baby care. In the reflection, they discuss the implications of the observed behaviors and the proposals for better care for the baby.
Phase II: Joint observation with parents
Phase II training provides an opportunity to observe baby behaviors with the parents. Parents are said to be able to observe baby behaviors and intuitively understand them. However, NICU healthcare staff should build appropriate relationships with parents and create a supportive environment to maximize their potential skills. The mentee may realize the parents’ potential and the importance of bringing it out through the training.
In the bedside training, the mentee and the mentor carry out joint observation with the parents to observe the baby’s behavior and its changes, mainly before, during, and after baby care. The mentee may realize that the parents could already observe the behaviors well, or that their observation was promoted by his/her appropriate communication. In the reflection, they talk about how such communication different from usual was experienced by the parents, baby, and the NICU healthcare staff.
Phase III: Understanding of parents’ background
While Phase I and II focus on a baby, Phase III training offers us an opportunity to think about the family as a whole. In neonatal medicine, consideration of family background and feelings may not always be considered important. The neonatal health care staff may not understand how to apply the information to clinical practices. Phase III training aims to listen to the parents about their family background to further develop neonatal care along with their feelings and offer better family support. In the bedside training, the mentees and mentor listen to the parents talking about their story from the beginning of the pregnancy (or even before if necessary) to now. A semi-structured interview, namely CLIP-I, is used. In the reflection, they think about the impact of family background and staff-parent interaction on the current family situation and discuss better parent support.
PhaseIV：Collaborative decision-making (parents’ participation in medical rounds and collaborative discharge planning)
Parents’ preparation for discharge in the NICU is important in that they will be responsible for decision-making regarding their baby after discharge. Shared decision-making, parents’ participation in decision-making, in the NICU is meaningful in many ways. In Phase IV training, the mentee and the mentor think about how to carry out shared decision-making, how they can promote it, and its effectiveness when medical rounds or discharge preparation.
Bedside training is classified into two. In training in medical rounds, the mentee and the mentor participate in and observe the rounds, as a third party if possible, thinking of to what degree the parents participate in the round and what promoters and barriers of their participation are. They also interview the parents to get tips on how to make better medical rounds.
The other training is about parents’ preparation for discharge. A baby’s discharge from the NICU requires not only the baby’s physiological stability but also the parents’ readiness for their care skills and feelings and a better home environment. The mentee and the mentor discuss in the reflection how they can proceed with the discharge preparation together with the parents.
Implementation process in Japan
We plan to start providing the implementation of the training by healthcare staff in Japan after Nagano Children’s Hospital completes the implementation. We will inform you of the details via this web page or any social media.
The implementation of the training is NICU-wide in general.
The first step of the implementation is education for local mentors, who receive the training first and train the other NICU staff. Education for local mentors begins with a five-day training at Nagano Children’s Hospital. The local mentors understand the overview of the Close Collaboration with Parents training through the lectures and experiences of each training phase. They can also see how each staff member and the NICU as a whole may change after the implementation. After that, they learn each training phase: learning the theory using the e-learning module, experiencing bedside training, and their experiences being reflected using remote reflective sessions with the training team in Nagano. Education for local mentors is completed after a five-day training in a NICU that implements the training, including the review of each training phase. The local mentors together with the managers of the NICU and the training team in Nagano also discuss the plan of staff training in the NICU. It usually takes about 4 to 6 months for education for local mentors.
Then, the local mentors will start staff training, targeting the other healthcare staff in the NICU. The staff training takes about 6 to 18 months, depending on the number of local mentors and staff and the frequency of the training sessions. Staff training is one of the biggest challenges of the Close Collaboration with Parents. The local mentors need to get used to mentoring and there will be possible inhibitors and unexpected troubles that arise in the course of training. Regular follow-up sessions take place to cope with these problems together with the local mentors, to understand their progress in training, and to encourage the local mentors. The frequency and the duration of the follow-up sessions depend on their individual needs. The training team in Nagano will be responsible for the training of local mentors and other healthcare staff until the staff training is completed. We keep in close contact with the training team in Finland and may provide specific consultation if necessary.