Abstract
Most critically ill neonates require constant monitoring, continuous care, and supervision. However, distance created by admission and prolonged stay in a neonatal intensive care unit (NICU) may contribute to a delay in parent-infant bonding. This review aimed to determine how family-centered care (FCC) in the NICU affects parental bonding with critically ill infants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to perform a systematic search of the literature within the following four electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, and Web of Science. The search was conducted through July/August 2020. Research quality was evaluated using the Johns Hopkins Nursing Evidence-Based Practice Grading Scale. Out of 816 articles identified through literature search, 16 of the studies met our inclusion criteria. The majority of the studies (n = 14) found FCC interventions resulted in a significant increase in parental bonding. Results showed evidence practicing FCC in the NICU setting supports early parent-infant bonding. Nurses should consider implementing evidence-based FCC strategies into practice, such as allowing parents unrestricted access to their infants. More rigorous research with larger samples is recommended. More studies are also needed focusing on father-infant dyads and mother-father-infant triads.
Keywords
Introduction
Approximately 7 out of every 100 births result in an admission to a Neonatal Intensive Care Unit (NICU) in the United States (Harrison et al., 2018). Globally, high numbers of NICU admissions continue to be reported, with annual admissions of 1 in 7 infants reported in the United Kingdom (ONS, 2017) and 2.63 million newborns admitted in China in 2018 (Li et al., 2021). These critically ill newborns require continuous care and supervision to support their immature organs and treat complications (Caner et al., 2015). However, newborns separated while in the NICU complicates parental role development and the natural progression of parents’ physical, psychological, and emotional connection with their infants (Adama et al., 2017; Del Fabbro and Cain, 2016).
Neonatal Intensive Care Units are a complex and sophisticated physical healthcare environment that uses highly technological equipment to provide intensive care by neonatologists and specialized NICU nurses (Williams et al., 2018). Such an environment is in stark contrast to intrauterine existence. In the NICU, loud noises, bright lights, sophisticated equipment, and painful stimuli contribute to stress, leading to short and long-term negative consequences in children (D’Agata et al., 2016). This strange and unpleasant world can frighten newborn infants, as well as parents who may be feeling uncertain about their infants’ health (Hagen et al., 2016). High-risk delivery and NICU admission also contribute to a delay in initial physical contact between parents and newborns (Harrison et al., 2018). In that situation, family members may be partially or entirely deprived of direct interaction with their infants (Adama et al., 2017). Therefore, NICU hospitalization for a prolonged time may cause newborn infants to become isolated from family members, potentially delaying the bonding process (Bialoskurski et al., 1999).
The concept of bonding proposed by Klaus and Kennel (1982) refers to a mental, emotional, and behavioral tie that is experienced by parents through feelings of love towards the infant (Klaus and Kennell, 1982). Bonding starts by establishing a connection while the fetus is developing during pregnancy (Bialoskurski et al., 1999) and continues to grow through touching, smelling, seeing, breastfeeding, and caring for the infant (Klaus et al., 2013). Parental bonding is established through physical presence and parental involvement in caregiving, which can include holding, comforting, bathing, skin-to-skin contact, infant massage, and breastfeeding (Raiskila et al., 2017). The concept of parental sensitivity and responsiveness as defined by Ainsworth and Bell (1970) is also consistent with bonding. Both bonding and parental sensitivity include domains of feelings of love and closeness by parents for their infant.
Although attachment is often used interchangeably with bonding, they represent two distinct concepts. Attachment, as originally proposed by Bowlby (1958), is defined as a deep tie between two people, a reciprocal relationship. According to Bowlby, when infants are born, they are pre-programmed to biologically attach to their mothers. Through attachment, very young infants display smiling, crying, sucking, and rooting behaviors, which help them to survive. Attachment is an infants’ behavioral response to the parents’ feelings (Bicking and Hupcey, 2013).
Bonding provides many positive benefits to both parents and newborns (Heo and Oh, 2019). Parents who have a strong bond with their infants report feeling more confident, making improvements in their parenting process, and having more positive attitudes about childrearing (Kim et al., 2017). In addition, parents who establish an early bond report less anxiety (Ettenberger et al., 2017; Vittner et al., 2018) and stress (Cho et al., 2016; Vittner et al., 2018). Positive outcomes for infants as a result of parental bonding include greater weight gain (Ettenberger et al., 2017; Levy-Shiff et al., 2018), more stability in breathing (Cho et al., 2016), earlier discharge, and less exhibited stress while in the NICU (Vittner et al., 2018).
Although a prolonged NICU stay limits parental interaction with the infant, bonding may be improved through Family-centered Care (FCC) practices (Institute for Patient- and Family-Centered Care, 2020). Griffin (2006) conceptually described NICU FCC as unrestricted parental presence, parental involvement in caregiving, and open communication between parents and the healthcare team. Parental presence is exemplified by parents interactively engaging with their newborns, such as talking with their infants, reading books, telling stories, and singing lullabies (Griffin, 2006). Parental involvement in caregiving is demonstrated through direct physical care such as skin-to-skin contact, touching, holding, breastfeeding, infant massage, and changing a diaper. Finally, parents should be actively involved in decision-making related to the care of their infant through open communication with their healthcare team. Family-centered Care encourages parents to take a central role in infant care, focusing on their status as “caregivers” instead of “visitors” (Griffin, 2006). Despite parental bonding having many benefits, it is not clear how FCC practices involving parental presence and involvement affect this important outcome in the NICU environment during the crucial post-natal period.
Aim
The purpose of this systematic review was to answer the following search question:
Among parents of premature infants admitted more than one week to the NICU, does FCC, specifically parental presence and/or involvement, affect bonding?
Methods
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used in execution of this review (Moher et al., 2009).
Eligibility criteria
Eligible studies in this systematic review included quantitative research examining the effect of FCC practice interventions, specifically involving physical contact or interactive presence, on parental bonding. Only quantitative portions of mixed methods studies were included. Study population had to include mothers and/or fathers with premature (24 w–37 w) newborns or sick infants who were admitted for at least one week in the NICU. Studies that operationalized attachment as defined by this review were excluded, regardless of what term was used by the study. Studies that measured parental sensitivity and responsiveness were included, as these instruments operationalized dimensions of bonding, such as parents’ feelings of closeness and love toward their infants. The search was also limited to English but was not restricted by year published or country of origin.
Database search
During July–August 2020, a systematic search of literature was conducted of all inclusive years within four electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, and Web of Science. The following MeSH headings and keywords were used (see online supplemental material for specific database search language):
((MH “Intensive Care, Neonatal”) OR (MH “Intensive Care Units, Neonatal”) OR “neonatal intensive” OR “NICU” AND “family centered” OR “physical contact” OR presence OR interact* OR touch OR “kangaroo care” OR “rooming-in” AND Bond* OR attach* OR “parent-infant”).
An ancestry search of reference lists of included studies was also conducted for further sources that were not identified through database searches.
Screening process and data extraction
Zotero reference management software was used to screen references and facilitate the removal of duplicates. Search execution was conducted by first author ([redacted initials]) with items initially screened based on their titles and abstracts. Subsequently, full-text articles were assessed for eligibility and reasons for exclusion recorded. Final list of included studies was confirmed by second author ([redacted initials]) with any disagreement resolved by discussion. Then, both authors independently extracted data from reports. Data extraction for qualitative synthesis was performed based on the Matrix Method (Garrard, 2017). Data included purpose, study design, number of subjects, subject characteristics, infant characteristics, dependent variable, independent variables, instruments, FCC (type/frequency/time), data collection, and findings. A meta-analysis could not be conducted due to heterogeneity of included interventions and outcome measures.
Quality assessment
Strength and quality of each included study were evaluated using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Rating Scale (Dang and Dearholt, 2018). First, a numeric rating was assigned based on strength of the overall study design: (I) experimental, (II) quasi-experimental, or (III) non-experimental. An alphabetic grade was then given based on an assessment of study quality (A-high, B-good, and C-low quality). Quality assessment focused on the following characteristics: consistency in generalizability of results, sufficiency of sample size, adequacy of control, consistency in recommendations based on results and existing literature, and definitive conclusions. Two researchers independently evaluated study quality and any disagreement was resolved by discussion.
Results
Study characteristics
A flow diagram of detailed search results is provided in Figure 1. A combined total of 914 articles was retrieved from four electronic databases with an additional two articles identified from an ancestral search. After duplicates were removed, titles and abstracts of 816 articles were then screened based on the inclusion and exclusion criteria. Full texts of the remaining 72 articles were scrutinized, resulting in 16 studies eligible for inclusion in the systematic review. Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagram of search strategy.
Literature review summary on the impact of family-centered care (FCC) on bonding.
Note: BO, birth order of infant; BW, birthweight; GA, infants’ gestational age at delivery; LOS, length of hospitalization; PA, age of parent(s); M, mean; y, years; g, grams; w, weeks; d, days; Unk, unknown; F/I, Father-infant; M/I, Mother-infant; P/I, Parent-infant; M/F/I, Mother-father-infant; KC, Kangaroo Care; TC; Traditional Care; MT, Music Therapy; TS, Tactile Stimulation; OT, oxytocin level; RCT, Randomized control trial.
aConfidence Intervals and effect sizes reported if available.
bBased on Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines Third Edition (Dang and Dearholt, 2018).
Fifteen research studies included in this review were conducted in Canada (1), Colombia (2), India (1), Iran (2), South Korea (3), Sweden (1), Turkey (1), United Kingdom (1), and United States (3), while the systematic review contained studies from Sweden, UK, India, Israel, and South Korea. Three studies were conducted among parent-infant dyads (Barlow et al., 2016; Ettenberger et al., 2017; Lariviere and Rennick, 2011), nine studies among mother-infant dyads (Cho et al., 2016; Kleberg et al., 2007; Kurt et al., 2020; McGregor and Casey; 2012; Metgud and Honap, 2015; Pour and Raghibi, 2016; Tessier et al., 1998; Vahdati et al., 2017; Whipple, 2000), only one study among father-infant dyads (Kim et al., 2017), and three studies among mother-father-infant triads (Heo and Oh, 2019; Vittner et al., 2018, 2019). Sample sizes ranged from 20 (Kleberg et al., 2007; Whipple, 2000) to 488 (Tessier et al., 1998). Parents’ ages ranged from 16 to 39 years and average gestational age of infants varied from 24.0 to 37.3 weeks. Infants’ prematurity level varied among studies. Twelve studies included moderate to late preterm newborns (32w–37w) (Cho et al., 2016; Heo and Oh, 2019; Lariviere and Rennick, 2011; Kim et al., 2017; Kurt et al., 2020; McGregor and Casey; 2012; Metgud and Honap, 2015; Pour and Raghibi, 2016; Tessier et al., 1998; Vahdati et al., 2017; Vittner et al., 2018, 2019). One study each included very preterm infants (28w–32w) (Barlow et al., 2016) and extremely preterm infants (less than 28 w) (Kleberg et al., 2007). Two studies included both very preterm and late preterm infants (Ettenberger et al., 2017; Whipple, 2000). All included studies received ethical approval from appropriate institutional review boards and informed consent was obtained from participants.
Definition of bonding
Each study identified the NICU as a potential contributor towards difficulties in parental bonding due to its high stress environment and limited parent-infant contact. The actual definition of bonding varied slightly among studies. Conceptually, eleven studies defined bonding as parents’ feelings of emotional closeness, love, and intense connectedness to their newborns (Cho et al., 2016; Ettenberger et al., 2017; Heo and Oh, 2019; Kim et al., 2017; Kleberg et al., 2007; Kurt et al., 2020; Lariviere and Rennick, 2011; McGregor and Casey; 2012; Pour and Raghibi, 2016; Tessier et al., 1998; Vahdati et al., 2017), while another four also included being sensitive in response to infants’ needs (Barlow et al., 2016; Vittner et al., 2018, 2019; Whipple, 2000). Finally, one study did not define bonding (Metgud and Honap, 2015).
Bonding was measured using a variety of different instruments. Eight studies used established instruments to measure bonding (Cho et al., 2016; Ettenberger et al., 2017; Heo and Oh, 2019; Kim et al., 2017; Kurt et al., 2020; McGregor and Casey; 2012; Metgud and Honap, 2015; Pour and Raghibi, 2016). Among them, researchers in three studies translated instruments into their native language (Ettenberger et al., 2017; Heo and Oh, 2019; Pour and Raghibi, 2016). Reported Cronbach alpha results ranged between 0.78 (Pour and Raghibi, 2016) to 0.96 (Cho et al., 2016). However, two studies did not report Cronbach’s alpha results (Ettenberger et al., 2017; Metgud and Honap, 2015). Three studies used instruments developed by researchers to measure bonding (Kleberg et al., 2007; Lariviere and Rennick, 2011; Whipple, 2000) and among them, only one reported its internal consistency (Cronbach’s alpha = 0.87; Kleberg et al., 2007).
Seven studies measured bonding by evaluating parent engagement with their neonate (Barlow et al., 2016; Lariviere and Rennick, 2011; Tessier et al., 1998; Vahdati et al., 2017; Vittner et al., 2018, 2019; Whipple, 2000). Among them, researchers in four studies analyzed video recorded interactions of parents with their infants to measure bonding (Barlow et al., 2016; Lariviere and Rennick, 2011; Tessier et al., 1998; Vittner et al., 2018). These recordings varied in duration from 3-min (Barlow et al., 2016) to 15-min (Tessier et al., 1998; Lariviere and Rennick, 2011). Additionally, in studies by Vittner and colleagues (2018, 2019), bonding was determined by measuring salivary oxytocin level as the oxytocinergic system plays key role in bonding formation.
Family-centered Care interventions
Study interventions’ type, composition, frequency, duration, and length varied between studies. Skin-to-skin contact, also known as kangaroo care (KC), was the most commonly investigated FCC intervention. The practice was implemented in 13 studies (Cho et al., 2016; Ettenberger et al., 2017; Heo and Oh, 2019; Kleberg et al., 2007; Kurt et al., 2020; McGregor and Casey, 2012; Metgud and Honap, 2015; Pour and Raghibi, 2016; Tessier et al., 1998; Vahdati et al., 2017; Vittner et al., 2018, 2019; Whipple, 2000) with all except Pour and Raghibi (2016) giving details regarding specific KC procedures. Infants typically wore only a hat and a diaper when being placed on mother’s breast or father’s chest during KC (Cho et al., 2016; Kurt et al., 2020; Metgud and Honap, 2015; Vahdati et al., 2017). Frequency and duration of this intervention varied between studies ranging from twice a week for 19 min sessions (Ettenberger et al., 2017) to 24 h/day continuously until discharge (Tessier et al., 1998). Similar variations in execution were noted in the six KC studies included from McGregor and Casey’s systematic review (2012).
Several studies combined music stimulation with KC interventions (Ettenberger et al., 2017; Vahdati et al., 2017; Whipple, 2000). Frequency, duration, and type of music stimulation varied. In Ettenberger and colleagues (2017), music stimulation was practiced twice a week from beginning of the investigation until hospital discharge. Parents provided KC and sang to infants while a music therapist played guitar. The average session length was 19 min. Alternatively, in Vahdati et al. (2017), parents listened 20 min to slow rhythms and uniform melodies using headphones while providing KC. Finally, in studies by Whipple (2000) and Heo and Oh (2019), parents picked a song and quietly hummed or sang to their infants during KC.
The second most frequently examined FCC intervention was tactile-kinesthetic stimulation (TKS). This practice was implemented in three studies (Kim et al., 2017; Metgud and Honap, 2015; Whipple, 2000). TKS consisted of gentle stroking with moderate pressure on various parts of the infant’s body, such as head, neck, shoulders, back, buttocks, legs, and feet by using the palm and bottom of the fingers (Kim et al., 2017). In studies by Whipple (2000) and Metgud and Honap (2015), researchers used a combination of TKS and other FCC interventions. Kim and colleagues (2017) analyzed only the effects of TKS on parent-infant bonding. Frequency and duration of the intervention varied between studies ranging from 10-min periods per day for five consecutive days (Kim et al., 2017) to 15-min periods three times a day for five consecutive days (Metgud and Honap, 2015).
Several studies conducted interventions in which parents were provided instruction on caring behaviors (Heo and Oh, 2019; Kleberg et al., 2007; Whipple, 2000). Parental training included basic care (e.g., holding, feeding, clothing, bathing, and changing a diaper) and parents were subsequently encouraged to engage in this behavior (Heo and Oh, 2019; Kleberg et al., 2007; Whipple, 2000).
Lariviere and Rennick (2011) used reading a book as a NICU FCC intervention. Every day, parents read a book aloud a few minutes while holding the infant or while placed in an incubator. Finally, Barlow and colleagues (2016) used video interaction guidance (VIG) as an intervention. They recorded parents for three-minutes while they were interacting with their newborns in the NICU. Investigators then discussed the film with parents, encouraging them to recognize moments of attunement such as when infant makes touches or makes eye contact.
Methodological quality
According to the JHNEBP Rating Scale (Dang and Dearholt, 2018), level of evidence for seven studies was graded as “I” (Barlow et al., 2016; Heo and Oh, 2019; Kleberg et al., 2007; Tessier et al., 1998; Vahdati et al., 2017; Vittner et al., 2018, 2019) because they were either randomized control trials or randomized crossover studies. Eight studies were graded as “II” (Cho et al., 2016; Ettenberger et al., 2017; Kim et al., 2017; Kurt et al., 2020; Lariviere and Rennick, 2011; Metgud and Honap, 2015; Pour and Raghibi, 2016; Whipple, 2000), because they were all quasi-experimental studies. Only one study, a systematic review, was graded as “III” (McGregor and Casey, 2012), because it included a mixture of randomized control trials, quasi experimental studies, and one case study. Assessment of individual study quality revealed four graded as high quality (Cho et al., 2016; Heo and Oh, 2019; Kim et al., 2017; Vahdati et al., 2017), 10 graded as good quality (Barlow et al., 2016; Ettenberger et al., 2017; Kleberg et al., 2007; Kurt et al., 2020; Lariviere and Rennick, 2011; McGregor and Casey, 2012; Pour and Raghibi, 2016; Tessier et al., 1998; Vittner et al., 2018, 2019), and two graded as low quality (Metgud and Honap, 2015; Whipple, 2000).
Studies graded as high quality used power analysis for sample size calculations, had homogenous experimental and control groups (Cho et al., 2016; Kim et al., 2017; Vahdati et al., 2017), employed reliable and valid instruments (Cho et al., 2016; Heo and Oh, 2019; Kim et al., 2017; Vahdati et al., 2017), and/or clearly presented a conceptual framework (Heo and Oh, 2019). Studies graded as good quality were primarily limited due to subjective instruments (Barlow et al., 2016; Lariviere and Rennick, 2011; Tessier et al., 1998), not reporting reliability of measurements (Lariviere and Rennick, 2011; Tessier et al., 1998; Vittner et al., 2018, 2019), small sample sizes (Barlow et al., 2016; Ettenberger et al., 2017; Kleberg et al., 2007; Pour and Raghibi, 2016; Vittner et al., 2018, 2019) variation in intervention lengths and frequency (Ettenberger et al., 2017), or lacked random assignment (Ettenberger et al., 2017; Kurt et al., 2020; Pour and Raghibi, 2016). The systematic review (McGregor and Casey, 2012) included a range of designs and did not provide a flow diagram or matrix table. Studies graded as low-quality had small sample sizes (Whipple, 2000), experienced possible bias (Whipple, 2000), and did not provide sufficient information about sample characteristics, instruments, and interventions (Metgud and Honap, 2015; Whipple, 2000).
Study outcomes
Fourteen of the sixteen articles reported significant improvements in parent-infant bonding following different types of parental presence and involvement practices. Five studies (Barlow et al., 2016; Cho et al., 2016; Heo and Oh, 2019; Kim et al., 2017; Vittner et al., 2018) reported effect sizes, which ranged between 0.50 (Vittner et al., 2018) and 1.29 (Kim et al., 2017). Ettenberger and colleagues (2017) could not find a significant difference in bonding as a result of KC with music therapy. Likewise, although Barlow and colleagues (2016) found VIG intervention had a nonsignificant effect on parent-infant interaction, the effect size was large, which the authors suggested a need for a larger sample size. In the systematic review, five of six eligible studies showed significant improvements in mother-infant bonding following kangaroo care.
Discussion
In this systematic review, we investigated whether different types of NICU FCC interventions support bonding between parents and infant. Generally, findings tend to suggest that a variety of FCC practices enhance parent-infant bonding. Secondarily, this care model was significantly associated with a greater parental response to infants’ cues (Kim et al., 2017), increased feelings of closeness (Kleberg et al., 2007; Lariviere and Rennick, 2011; Metgud and Honap, 2015), an improved nurse-parent partnership (Heo and Oh, 2019), decreased maternal stress, (Cho et al., 2016; Tessier et al., 1998), and greater maternal sense of competence (Tessier et al., 1998). Although Kleberg and colleagues (2007) found a significantly higher anxiety level among mothers in the experimental group, Ettenberger and colleagues (2017) and Vittner and colleagues (2018, 2019) reported significant improvements in parents’ anxiety level.
Interventions varied across studies, but all included physical contact or interactive presence consistent with principles of FCC. The most common practice was kangaroo care (skin-to-skin contact), followed by tactile stimulation. Book reading and video interaction were the least studied. While interpreting results, it is crucial to consider the methodological flaws of included studies as some were conducted with small sample sizes (Barlow et al., 2016; Ettenberger et al., 2017; Kleberg et al., 2007; Pour and Raghibi, 2016; Vittner et al., 2018, 2019; Whipple, 2000). Also, all but four studies (Barlow et al., 2016; Lariviere and Rennick, 2011; Tessier et al., 1998; Vittner et al., 2018) used self-report tools to measure bonding, potentially resulting in report and recall bias. It is possible that participants may have provided socially desirable answers in their responses to instruments. All studies provided data procedures in detail; thus, they can be effectively replicated to validate results. Only the study by Metgud and Honap (2015) did not report clear information about the tactile-kinesthetic stimulation intervention process.
Among five studies that reported effect sizes, TS was the most effective FCC intervention (effect size 1.29), followed by VIG (effect size 0.87, though statistically nonsignificant) and then KC (effect size ranged from 0.5 to 0.7). Although KC was the most frequently investigated FCC intervention, its effect size was lower than others (i.e., TS and VIG). Additionally, there may be a variety of confounding variables associated with parent participation such as neonatal gestational age, which ranged from 24.0 to 37.3 weeks. None of the studies looked at confounding variables related to breastfeeding, parental attendance, and/or neonatal philosophy.
Limitations
Although evidence suggests certain FCC practices involving parental interactive presence improves parent-infant bonding, several limitations in our review are worth noting. First, the heterogeneity of the interventions make it difficult to interpret findings or generalize results across different NICU sizes and cultures. Similarly, most included studies examined mother-infant bonding, limiting external validity to this parental group. Expanding the search to include qualitative research could have provided a richer understanding of parents’ experiences with FCC practices. Finally, other eligible studies may have been identified if gray literature was included or if screening of articles was completed by a second researcher.
Implications for practice
The interventions identified in this systematic review include FCC practices that are generally low cost and low risk, yet potentially beneficial, to many infants cared for in the NICU setting. For infants who have an E-tube, a catheter inserted in the umbilical cord, a possible risk for infection and skin disease, kangaroo care may not be an optimal choice due to concerns over dislodging equipment. However, lower risk alternatives, such as having a parent read a book to the neonate or providing tactile stimulation, were also found to support bonding in several studies. Despite limited number of studies including fathers, they do provide an important role in infant development. Therefore, nurses should encourage fathers or other parental groups to be present and involved in their infant’s care to promote bonding.
This systematic review revealed several gaps in research related to the effectiveness of parental presence and involvement in NICU care on parental bonding. First, more studies of higher quality are needed with larger sample sizes as well as valid and reliable metrics. Additionally, future research should specifically include fathers and other parental groups to support their involvement in FCC. Finally, investigating nurses’ perceptions of implementing these interventions in the NICU setting would help determine their feasibility.
Conclusions
This systematic review aimed to evaluate evidence on whether FCC interventions with newborns admitted at least one week to the NICU could enhance parent-infant bonding. We identified several FCC practices that include parental presence and involvement in infant care that help create a connection between a parent and their newborn. By supporting the important bond between parents and infant, these FCC practices may ultimately contribute towards improved patient outcomes. This review adds to a growing body of research on the many benefits of FCC to patients, families, and nurses. By facilitating active participation and presence, FCC may be regarded as a necessary and useful intervention for NICU care of critically ill infants.
Supplemental Material
Supplemental Material - Effects of family-centered care on bonding: A systematic review
Supplemental Material for Effects of family-centered care on bonding: A systematic review by Nesibe S Kutahyalioglu and Katherine N Scafide in Journal of Child Health Care
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Supplemental Material
Supplemental material for this article is available online.
References
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