Following their NNA NI Neonatal Team of the Year win, we had the chance to visit SWAH in Northern Ireland to find out more about their approach to FICare. Karen Weir, NI Neonatal Nurse of the Year and NNA FICare SIG national representative for Northern Ireland, has kindly put together a blog post to delve deeper into how the unit’s FICare journey unfolded.
The Neonatal unit in the South West Hospital (SWAH) began its journey with FICARE (Family Integrated Care) in February 2023.
We are a small level 3 unit, based in a rural part of Northern Ireland, one of 2 hospitals serving the Western part of the province. We work in partnership with our colleagues in the NI Neonatal Network, who deliver neonatal services in a total of 7 units. We have 6 commissioned spaces for babies born after 34 weeks gestation.
Our decision to choose the FICARE model of care was precipitated by difficulties securing Senior Medical and Nursing staff. We had an options appraisal meeting involving Neonatal and Critical Friends from within and outside the Neonatal Network, and opted for the FICARE model as the most sustainable and achievable model.
We tend to call this FICARE model of care ‘Next to me’, as something the families immediately understand and can identify with. It promotes an equal partnership between families and staff, so that parents are enabled to care for their own babies, and be recognised as primary care givers. The role of the nurse is to facilitate instead of ‘do’.
In choosing a new model of care, we recognised that this might create anxiety within the MDT about any potential change of role or perceived loss of control. Fortunately our decision to move to this model of care coincided with the appointment of a new, dynamic ward manager, who was able to show us how we were in a unique position to lead and set an example to other neonatal units in how we could implement and develop the FICARE model and showcase excellence.
Any reservations the team had about FICARE were mitigated when it became apparent how much the babies and their parents were benefiting from this new model of care. We had underestimated how much they wanted to do, and how much satisfaction they would get from being fully involved.
We redesigned our admission booklet so that parents were aware from their first introduction to the team of how we valued their role alongside us.
We rewrote our parent information leaflet on tube feeding, inviting all of our families to participate, something we had only previously introduced to those who were taking their baby home with a feeding tube. Very quickly it became the norm for parents to be tube feeding, even if it was only required for a matter of days.
Parents were included in ward rounds and had their voices heard, so decision making was shared.
We changed our protocols for weighing babies and measuring head circumferences, so it was something we did with parents.
We moved babies from incubators to cots when parents were with us, so they had the opportunity to dress their baby for the first time.
Similarly, we always tried to let the family offer the first bottle feed if the baby was feeding this way.
We found it easier to initiate and establish breastfeeding, especially in those mothers who had previously not intended to choose this method of feeding.
Parents told us they felt more confident, less anxious, and better prepared for discharge.
The financial savings made from being able to stay in the unit were also significant, especially for our families from rural communities.
Our MDT team became more cohesive and told us they felt more satisfaction in their role. Team morale was boosted by being at the forefront of a new initiative. We developed better relationships with our obstetric colleagues, had a renewed sense of purpose and could demonstrate that we were helping to secure the future of our unit.
No new project is without its challenges. We are unable to accept babies who are still undergoing ROP treatment as we have no current ROP services available. We have no funding for psychological support. Delayed capital works to redesign the unit have restricted our opportunity to offer dedicated FICARE to only 5 families. Opportunities for training are difficult due to ongoing staffing issues. We have identified we need to update our policies, and this will take time to put in place.
However, we now have dedicated funding and have recently appointed a project manager to lead FICARE in our unit, so the future is really exciting for the team and we anticipate we will be able to make significant progress in implementation.
We conclude with a video we recorded with Conor and Michelle, who have generously shared the story of their baby Darragh born at 34 weeks. They tell us about his antenatal and postnatal care, and shared experiences of receiving FICARE in our unit, and how they felt it benefited them as first time parents. We hope you will find it as encouraging as we do.