Challenges and Solutions to Building Family-Staff Relationships in the NICU: A Qualitative Study

OBJECTIVE The objective of this study was to understand factors that impact family-staff relationships in the neonatal intensive care unit (NICU) from the perspective of staff. Staff shared: (1) general challenges that impact family-staff relationships, (2) role-specific challenges (by discipline), and (3) solutions that could help improve family-staff relationships. METHODS We conducted this study at an urban hospital level IV NICU. In this qualitative study, we conducted 5 focus groups with a convenience sample of NICU healthcare staff (N = 22, 100% women, white/non-Hispanic; age: M = 45 ± 12 [29 − 65]). Focus groups included physicians and a nurse practitioner, unit leadership, nurses, social workers, and occupational therapists. We used a hybrid, inductive-deductive thematic approach to examine qualitative data. RESULTS Staff shared general and role-specific challenges that impact their interactions with parents. They reported that parental anxiety, parental decision-making, trust, and staff assumptions can strain relationship dynamics. Each discipline also shared specific challenges they face—some were universal (eg, limited time) and others were unique to their role (eg, stigma for social work). Staff offered potential solutions that can improve family-staff dynamics in the NICU (eg, interprofessional teamwork). CONCLUSIONS Findings highlight the structural, cultural, and clinical changes needed to promote team-based care. Interprofessional communication skills trainings, training in trauma-informed care, primary intensivist models, and structured team and family meetings show promise for improving family-staff dynamics. More work is needed to improve family-centered communication, teamwork, and psychosocial resources. Focusing on these areas would help improve the family-staff interactions and enhance outcomes for families.