As barreiras e as estratégias para a implementação do cuidado integrado na família no contexto da unidade de terapia intensiva neonatal: uma revisão de literatura

Abstract

Family Integrated Care (FIC) is an initiative implemented for the first time in a Canadian Neonatal Intensive Care Unit (NICU). The FIC has four well-maintained pillars: environment; education and support to the team; parent education/psychological support and active participation/partnership. The objective of this study was to review the available literature between May 2017 and May 2022, about the FIC model in the NICU, in order to identify the barriers and strategies necessary for its implementation. A search was carried out for scientific articles indexed in the following databases: PubMed and Cochrane, using the following keywords: intensive care units, neonatal; family integrated care; family-integrated care; FiCare. Were found 115 articles in PubMed and 39 articles in Cochrane, totaling 154 articles. Only 9 studies were selected after analysis of eligibility criteria. All studies used qualitative methodology, involving semi-structured interviews, triangles or focus groups with parents, health professionals and/or hospital administrators, and were carried out in different NICU with care levels II, III or IV, according to the 2012 American Academy of Pediatrics (AAP) classification, and a level IIIC NICU, according to the 2004 AAP classification. Among the selected studies, four of them addressed the context of the FIC in the NICU during the period of the COVID-19 pandemic. The main barriers identified for implementing the FIC were: staff resistance to changes, lack of staff training, learning difficulties, and active parental participation. It can be facilitated by: changes implemented gradually, active listening to the team and parents, implementation protocols periodically reviewed by the team, support for the team's doubts after training, individualized training for parents, face-to-face training of at least two caregivers, parent certification of care, educational sessions, and parent support materials. Additional barriers are imposed by sanitary barriers as a result of the COVID-19 pandemic. The FIC model promotes true cultural change at all hospital levels. It is a viable strategy and well received by parents. More studies are needed on the impact of the pandemic on family care for high-risk neonates in the NICU.