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Indian Pediatr 2017;54: 788 |
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Family-Centered Care: Beginning of a New Era
in India
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Jogender Kumar and *Amitabh
Singh
Departments of Pediatrics; PGIMER, Chandigarh, and * VMMC
and Safdarjung Hospital, New Delhi, India.
Email:
[email protected]
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The concept of family-centered care (FCC) is entirely a new concept in
neonatal care in India. We read the article by Verma, et al. [1],
and would like to commend authors for their work. In many neonatal units
in India, parents are not allowed to enter in neonatal intensive care
unit (NICU), and others have fixed visiting hours. FCC is a partnership
approach in which family and health care worker collaborate in
decision-making and information sharing, and respect and honor
differences. Partnership and collaboration, negotiation, and care in the
context of family and community are key principles of FCC [2]. In
countries like India where the health care professional to patient ratio
is very poor, FCC can be a yardstick to improve care. FCC increases
professional satisfaction and decreases litigation charges besides
decreasing costs and effective utilization of resources [3].
We would like to highlight certain issues in present
study [1]:
1. In index study, mean gestation was near term
(36.4 weeks); however, in real life scenario, the majority of
infants in NICU are preterms who need more dedicated care. Quite
often, parents and/or health professionals are not confident in
handling these babies. So, there is need to empower parents by more
training.
2. In present study, mean time spent bedside by
attendant was 14.7 hours/day. This long stay will lead to fatigue in
attendants. So, we must objectively assess fatigue score as well as
satisfaction level in attendants, and should collect feedback from
them to make it more convenient for them.
3. The author stated that actual time spent
bedside by an attendant in previous 24 hours was noted weekly by
direct inquiry. This is prone to recall bias, and prospective
documentation in parent contact sheet would have been better.
4. Exclusion of twins and triplets from the study
does not seem to be rational, and it compromises generalizability of
the study. In real life, we face feeding difficulties in most of
these babies. There are ongoing studies with some evidence that
group- caring and cot-sharing for twins/triplets improve behavioral
and developmental outcomes. These are the families and babies who
will be most benefitted with FCC.
Evidence shows that high-quality, family-centered
care during the hospital stay is associated with a significant reduction
in nonurgent emergency visits in these children [4]. We are hoping same
for these neonates, and expect further studies with large sample size,
including preterm neonates and twins.
References
1. Verma A, Maria A, Pandey RM, Hans C, Verma A,
Sherwani F. Family-centered care to complement care of sick newborns: A
randomized controlled trial. Indian Pediatr. 2017;54:455-9.
2. Kuo DZ, Houtrow AJ, Arango P, Kuhlthau KA, Simmons
JM, Neff JM. Family-centered care: current applications and future
directions in pediatric health care. Matern Child Health J.
2012;16:297-305.
3. Committee on Hospital Care and Institute for
Patient- and Family-Centered Care. Patient- and family-centered care and
the pediatrician’s role. Pediatrics. 2012;129:394–404.
4. Brousseau DC, Hoffmann RG, Nattinger AB, Flores G, Zhang Y,
Gorelick M. Quality of primary care and subsequent pediatric emergency
department utilization. Pediatrics. 2007;119:1131–8.
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