Family integrated care in practice: A Singapore special care nursery experience

Title: Family integrated care in practice: A Singapore special care nursery experience

Abstract:

Family Integrated Care (FIC) is a collaborative model of neonatal care that actively engages parents as partners in the care of their hospitalised infants. While FIC has demonstrated improved infant and parental outcomes in Western neonatal intensive care units (NICUs), its implementation in Singapore, particularly in level II Special Care Nurseries (SCNs) remains under-evaluated. This study aimed to examine the feasibility, acceptability, and preliminary infant outcomes of a parent-led FIC programme tailored to the local context, where parents were encouraged to participate for 1–2 hours daily at their own pace. A mixed methods design was used. Thirteen families of infants expected to stay at least two weeks were enrolled. The intervention group received structured, nurse-supported FIC education throughout hospitalisation, while a contemporaneous control group received standard care. Quantitative measures included pre- and post-intervention parental self-efficacy scores using the Perceived Maternal Parenting Self-Efficacy (PMP S-E) scale, as well as infant outcomes (weight gain, breastfeeding initiation, kangaroo care, and length of stay). Nurse surveys and semi-structured interviews with both parents and nurses captured qualitative perspectives. Findings revealed a statistically significant improvement in maternal self-efficacy post-intervention (p < .01). Compared to controls, infants in the FIC group demonstrated higher rates of kangaroo care, parental visits, and breastfeeding, with a positive trend toward greater weight gain. Nurse surveys reflected generally positive perceptions of FIC’s value in enhancing family engagement and discharge readiness. However, nurses also reported increased workload and stress associated with programme delivery. Thematic analysis of interviews with nurses and mothers identified five key themes: 

1. Building Confidence
2. FIC as a Bridge for Bonding and Discharge
3. Central Role of Nurses and Family
4. Structural and Logistical Barriers
5. Need for Interdisciplinary Integration. 

These themes highlight both the perceived impact and the operational challenges of embedding FIC sustainably within routine practice. This study demonstrates that a modified, parent-led FIC programme is feasible and acceptable within a level II SCN. While promising in enhancing parent confidence and infant outcomes, structured workflows, dedicated staff time, and multidisciplinary alignment are essential for long-term integration and scalability. Nurses play a pivotal role in shaping successful FIC implementation, underscoring the importance of nursing leadership in advancing family-centred neonatal care.

Biography:

Shu Hui is a in the Neonatal Intensive Care Unit (NICU) with a strong interest in Family Integrated Care (FIC) and neurodevelopmental support for preterm infants. She holds a Bachelor’s degree with Honours from the National University of Singapore, where her thesis focused on FIC. Since then, she has contributed to two research studies in this area and presented on neurodevelopmental care at the 2024 Perinatal Congress. With experience in both the Special Care Nursery and NICU, she is committed to improving the care experience for families and advancing nursing practices that support infant development and parental involvement.