Family-Centred Care in NICU: Parental Presence and Outcomes

Advancements on the family-centred care concept have evolved as a core principle of the nursing field of children by paying assent to the concept of families as stakeholders in the successful care of children hospitalised. Family-centred care contrasts with parental passivity in which parents are viewed as critical to the development of wellbeing due to their unique knowledge of their own child, their emotional investment, and because they are the main stakeholders in their own wellbeing. This philosophy would have special applicability in the context of the neonatal intensive care unit (NICU) particularly in a scenario where the babies are most prone and often excluded due to the severity of the medical condition (Reid et al., 2021). The precept is aligned with the values of respect, partnership and shared decision making, all of which result in improved outcomes for infants and families.

One of the possible primary types of family-centred care is the family presence in the NICU. It could entail physical presence at the bedside, direct participation in care processes, e.g., feeding or comforting, kangaroo care or skin to skin contact, among other things. These presences are not symbolic, they are actual means in which the parents are engaged with the health and cures of their infant and at the same time take care of their emotional state (North et al., 2022). Family presence cannot be exclusively related to mothers but is increasingly participating in fathers and extended family, and this coincides with conceptualization of multiform families in neonatal care.

The importance of family presence in both Irish and international policies is acknowledged. Future neonatal and paediatric nursing care in Ireland is given attention, where the National Standards for Safer Better Healthcare and the families strategy by the Office of the Director of Nursing and Midwifery Services underlines the need to implement family-centred approaches in the healthcare provided to the patients (Coutts et al., 2021). It is established internationally by organizations such as the World Health Organization (WHO) and UNICEF that parental participation is pivotal to the rights and development of the child pre-eminently in the initial years of life. Critiques of the pandemic of COVID-19 however emerged as these promises failed to deliver because the benefits of restricting family presence were overlooked by the restrictions on visitation enforced due to its psychological, relationship, and developmental consequences.

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This essay endeavours to discuss the advantages of presence of family in the NICU using empirical studies of fifteen studies conducted in recent years. The discussion will focus on the effects of parental presence on four important themes which include parent-infant relationship, parental anxiety, stress and psychological wellbeing, information giving, communication and participation in care, and parental confidence and infant health outcomes. The fifth theme will be related to the strengths and weaknesses of the existing body of literature (Almalki et al., 2025). When synthesising these findings, additional information on how family presence reveals itself in the context of the Irish context and how family-centred care engages with family context will be highlighted in the essay and implications to future practice and research identified.

Search Strategy

In order to find appropriate literature for this task, a systematic search strategy was employed in a number of electronic databases frequently utilized in nursing and health research, such as CINAHL, PubMed, PsycINFO, and Medline. The aim of the search was to find empirical studies that had investigated the advantages of family presence in neonatal intensive care units (NICUs), specifically on parental involvement, bonding, and infant outcomes. Keywords and Boolean operators were used in various combinations to narrow down searches. These were: “family presence,” “NICU,” “family-centred care,” “kangaroo care,” “skin-to-skin contact,” and “parental involvement.” Subject headings like MeSH terms were similarly employed where relevant to adequately retrieve pertinent articles.

The studies included in the review needed to be published between 2014 and 2024, be in English, and have empirical evidence from qualitative, quantitative, or mixed methods studies. Exclusion criteria were theoretical studies alone, editorial articles, or studies done outside the 10-year window. As a result of this screening process, fifteen empirical studies were then found to meet the selection criteria and were deemed to provide useful insights for analysis. These studies comprise the main evidence base for the exploration of themes in this essay, with supporting policy and contextual references added where appropriate. An appendix is added to demonstrate the flow of this research.

Theme 1: Parent-Infant Bonding

Among the most frequently marked advantages of having a family present in NICU is the fact that the parent-infant bonding is facilitated. Kangaroo care and in particular skin-to-skin contact has been reported as critical activities in nurturing the early emotional bond between the parent and the infants. Vasconcellos et al. (2022) studied the attitudes of parents regarding kangaroo care and proved that mothers and fathers appreciated the option as an opportunity to establish a strong emotional bond with a child, improve parental confidence, and evoke closeness. Their results are also linked to prior research works on the same topic that indicate the critical function of physical presence and touch which may help build attachment and lessen the experience of separation that often comes with NICU admission.

Bonding applies to the development of infants, as well. In their research on the obstacles to kangaroo anecdotes in Canada, British Columbia, Coutts et al. (2021) results revealed that although the practice was logistically daunting, families, who practiced, displayed enhanced feelings of comfort and wellbeing of their baby. These participants observed that skin-to-skin contact (over a prolonged period of time) was related to breastfeeding initiation and maternal confidence. Equally, North et al. (2022) determined that the parental presence was a predictor of positive developmental effects, especially the neurobehavioral regulation, thus bonding practices were not limited to the effects of emotional proximity, but also were applied to physical and cognitive development.

Irish and European settings offer an additional reason as to the relevance of having family around to bond. Reporting a study on the topic of the medical rounds conducted in 11 European neonatal units, it is found that parents who were invited to be physically present and engage in talking felt more connected to the way an infant was taken care. This interactive interaction was an influence contributing to increased sense of continuity and closeness between the infant and parent.

It is also found that parent infant closeness was also varied in six European countries in the Irish case with units containing more focus on an unbound parental presence reporting higher levels of felt bonding. Developments have increased in terms of practice in Irish neonatal wards, such as Dublin and Cork, to accommodate parents staying overnight by the bedside and recliner chairs and family rooms are in place. This has led to the achievement of the HSE vision of family-centred care and has been shown to promote more positive bonding and parental confidence in the everyday caregiving tasks. These results support the role of policy frameworks at the national level in defining the potential parental involvement and even Ireland turns more in line with other nations in terms of the standards, which are set concerning family-centred care.

Other than maternal bonding, studies which mentioned fathers are being mentioned too. Zauche et al. (2019) defined that influencing the fathers to spend more time in the NICU ensured that their presence would translate to an objective and measurable shift in the betterment of bonding and infant responsiveness. The results can be applied to the Irish context where cultural norms regarding the involvement of the father are ever-changing and healthcare policy is gradually recognizing the value of both parents during the neonatal care process.

The overall evidence of all the studies suggests that the NICU families do not only take part in the immediate attachment by entering the physical proximity and bonding the child, but they also precondition the later developmental and psychosocial processes. Through the application of both the Irish and global lenses, it is evident that parent-based interventions which are vociferous in declaring the parental presence especially through such applications as kangaroo care are a necessity in attaining maximum neonatal care.

Theme 2: Parental Stress, Anxiety, and Psychological Well-being

Infant NICU-admission tends to be a distressful and traumatic experience to parents. Psychological distress may be heightened by the environment as it is marked by strange machinery, bodily medical tests and limitation of further parent involvement. Outcomes of recent research are consistently attempting to reaffirm the part played by the appearance of family in soothing these challenges and assisting parents with keeping their emotional stability in check.

Mahoney et al. (2020) illustrated how state censorship of parental proximity under the effects of the COVID-19 pandemic had a strongly dramatic impact by infuriating parents. Parents who could not be near their infants felt isolated, powerless and became more anxious. This had been duplicated by Giordano et al. (2023), who illustrated how the untrammelled presence policy caused detrimental impacts on parent wellbeing, and, as a result, infant comfort and regulation effects. Outcomes in these findings show a linear relationship between untrammelled presence and less stress, which illustrates that family-led practice is by nature not only beneficial but a requirement in addressing the mental well-being of parents.

Conversely, when parents are enabled to be physically present and take part in care, anxiety and stress are significantly lower. Abukari and Schmollgruber (2024) examined perceived barriers to family-centred care and concluded that parents felt more relaxed, safe, and less anxious when they were involved in their baby’s daily activities. The sense of empowerment gained from being acknowledged as partners in care improved their coping capacity and reduced psychological burden. Likewise, Schmid et al. (2024) documented that both healthcare workers and parents linked unregulated presence with positive emotional outcomes since parents felt comforted by touch, dialogue, and participation in decisions.

In the study, touch, particularly kangaroo care, was found to be an effective stress reliever to the parent. Vasconcellos et al. (2022) emphasised the direct role of skin-to-skin contact as a bonding tool, as well as a concept that triggered a decreased level of maternal anxiety and ensured the environment in which a parent felt more in charge of infant wellbeing. The same research by Coutts et al. (2021) also revealed that parental relief and confidence arose when parents overcame logistical challenges when offering kangaroo care, which helps to reduce the feeling of powerlessness associated with the admission of the baby to the NICU.

The limitation of these studies lies in the measurement of the psychological results but they present valuable insights and help us get more clarity about that relation. Some of them are based on self-reported anxiety and stress assessment, which, although useful, could be affected by the bias in recalling or social desirability (Giordano et al., 2023). On the other hand, qualitative research projects, such as those by Abukari and Schmollgruber (2024), are characterised by small samples limiting the generalization of the study to different populations. However, the richness of qualitative material does allow for elaborated descriptions of parental experiences which might not be captured by quantitative surveys (Lee, 2023). The use of mixed-methods, for instance, the one that employed, gives a more convincing account of the findings that parental presence has resulted to a reduction of the anxiety and relates them to measurable later infant developmental outcomes, thereby, availing a stronger evidence base.

The story of the neonatal family-centred care policies in Ireland (Reid et al., 2021) is also the history of the understanding of parental wellbeing as the main factor in neonatal care. The absence of stress and anxiety in the case of parental presence results in healthier family relationships, and infants become healthier because the parents who are relaxed and confident can perform parenting skills better. Usually, the literature refers to the family presence as a vital measure to facilitate parental psychological health in the NICU (Lee, 2023).

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Theme 3: Information Giving, Communication, and Participation in Care

Firstly, the family being around the baby in the NICU not only reduces stress and helps the family members get better acquainted but also is the most useful way to offer the information to the parents at the right time and enable relevant participation in the care. The NICU is a sophisticated environment where the parents are frequently confused with the very technical communication, unfamiliar routines, and rapid decision-making. Physical presence allows parents to interact directly with the healthcare team, to be told things in real time, and to be involved in care planning, thus creating openness and partnership.

Almalki et al. (2025) showed unequivocally in their research on parental involvement in medical rounds in eleven European neonatal units. The interviews conducted with parents who were present during the ward rounds indicated that they did feel empowered and their inquiries were swiftly addressed and their concerns heard. This direct access to information not only brought reassurance to the parents but it also boosted the confidence of the parents to the healthcare team. Another concern mentioned in the course of the study was that the involvement during rounds enabled parents to feel more responsible and competent in the care of their infant.

In the same way, Van Veenendaal et al. (2022) have found that there were differences in parent presence depending on various countries, and communication styles directly influenced such differences. Parents were actively involved, with units actively encouraging parents to remain at bedside and actively participate in the staff, which in turn encouraged more parents to bring their participation to decision-making. Conversely, the restriction policies could more likely leave out parents hence losing their trust and satisfaction. The results here indicate that open presence needs not be a physical presence as such but rather at the heart of creating viable and inclusive lines of communication.

In another study by Zauche et al. (2019), predictors that indicated parental presence including socio-economic status and institutional policy were highly significant with regard to how much family-related communication and care existed. The more facilitated parents showed more informational knowledge and showed more confidence in coping with the needs of their infant. In the context of Ireland, Reid et al. (2021) note the development of the neonatal family-centred care and the necessity to introduce communication channels, which would make parents co-workers, as it is a part of the national value on inclusive and transparent healthcare. Practically, the reviewed studies point to the fact that the presence of family changes the parent-professional relationship into an active partnership (rather than passive).

Abukari and Schmollgruber (2024) observed that in cases when parents were not included in the decision-making process, they felt frustrated and insecure when they were not involved but felt less confused as well as more emotionally secure when they became active participants. This was echoed by Schmid et al. (2024) where they reported that even the healthcare professionals were interested by the concomitant improvement of communication and understanding that emerged due to parental presence, which resulted in more family-centred and coordinated care.

When one is reflecting on clinical practice, one could easily see how meaningful of an impact it has had. When advised parents remain at the bedside, they tend to experience a change where they tend to feel more effective in taking care of the infant which might entail feeding, providing comfort, and keeping an eye on infant signals. It is the competence that is caused by the continuing communication with nurses delivering instructions and assurance on the spot. On the other hand, restrictive interventions can alienate family members to employees and hence, encourages parental ineptitude rather than being assisted.

Theme 4: Parental Confidence and Infant Health Outcomes

The presence of family at the NICU has a very high relationship with parental confidence and healthy infants. North et al. (2022) found active parent involvement led to the development of stronger self-efficacy that was converted into healthier discharge caregiving behaviour. Formal education boosted confidence, but most importantly practice and learning under the supervision of a professional, which points at the advantages of the experiential approach to learning (Almalki et al., 2025).

Family presence itself has also been found to be correlated with the best infant outcome. Van Veenendaal et al. (2022) related parent-child intimacy to increased rates of breastfeeding, optimal weight gain, and reduced length of stay in the hospital. This set of findings suggests that a family-centred care may attain psychosocial and clinical advantages. Vasconcellos et al. (2022) also showed that kangaroo care enabled infants’ physiological stability along with enhanced parental empowerment. However, the evidence is not straightforward.

Mahoney et al. (2020) and Giordano et al. (2023) stated that external pressures like pandemic restrictions negatively affected parental presence, changing the situations in which they could gain confidence and practice caregiving skills. Several researchers including Abukari and Schmollgruber (2024) indicate that parental confidence largely depends on the extent of support provided by the staff which implies that presence alone may not be enough without a favourable environment. Although there are some differences in viewpoints, the majority of evidence acknowledges that family presence without restrictions is a key factor in parental empowerment and infant well-being.

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Theme 5: Strengths and Limitations of the Literature

The chosen set of literature presents valuable information on the advantages of having a family in the NICUs but is cohorted with a number of strengths and weaknesses. One of the strengths is the variability of the methods used by different authors, as some use such approaches as large-scale international surveys (Van Veenendaal et al., 2022), some employ a qualitative approach that describes the experiences of parents in question (Abukari and Schmollgruber, 2024). In this range it is possible to have breadth and depth of understanding.

However, there are obvious shortcomings. Numerous studies, especially qualitative studies, also use small sample sizes limiting the ability to generalise to larger populations. Differences in cultural and health care systems as mentioned in the comparative European literature imply that the results cannot necessarily be specifically applied in the Irish context. Moreover, the time frame of follow-up rarely goes beyond a few weeks in various studies making it impossible to make conclusions concerning the long-term effects of family presence on infants and parents. Parental self-report measures on even quantitative research, are prone to recall/response bias (Almalki et al., 2025). Future research ought to focus on these limitations through the emphasis on longitudinal designs, larger and more divergent samples, and culturally saffron studies. To appraise the quality of each study systematically, a table (Appendix) has been added which is called a CASP table.

Conclusion

This review has considered the benefits of having relatives in the NICU close to the five interconnected themes of parent-infant attachment, parental anxiety and stress, communication and involvement, parental ability, and infant health results. The evidence from the fifteen studies synthesised here consistently indicates that unrestrained parental presence optimises bonding, reduces psychological distress, facilitates contemporaneous communication, and develops parental skill, as well as being linked to measurable improvements in infant outcomes such as increased weight gain and reduced hospital stay.

From an Irish perspective, these findings resonated strongly with the development of national values of family-centred care . Active parental participation is not just a moral and ethical imperative but is also an effective practical measure for health gain and building trust in healthcare systems. Institutions, resource limitations, and cultural values continue to be important determinants, however, to the degree of family presence achieved in practice.

Implications for paediatric nursing include the provision of staff education to facilitate parental presence, regular enforcement of family-centred policies, and continued practice evaluation to ensure evidence-based care. Future research must use sound, longitudinal designs and investigate culturally distinct facilitators and barriers present in the Irish healthcare system. Prioritizing family presence is ultimately a reflection of the essence of family-centred care philosophy and guarantees optimal outcomes for infants and their families.

References

Abukari, A. S., & Schmollgruber, S. (2024). Perceived barriers of family‐centred care in neonatal intensive care units: A qualitative study. Nursing in Critical Care, 29(5). https://doi.org/10.1111/nicc.13031

Almalki, M., Gildea, A., & Boyle, B. (2025). Parents’ experiences of family-centred care in neonatal intensive care units: A qualitative thematic synthesis. Journal of Neonatal Nursing, 31(3), 101–655. https://doi.org/10.1016/j.jnn.2025.101655

Coutts, S., Woldring, A., Pederson, A., De Salaberry, J., Osiovich, H., & Brotto, L. A. (2021). What is stopping us? An implementation science study of kangaroo care in British Columbia’s neonatal intensive care units. BMC Pregnancy and Childbirth, 21(1). https://doi.org/10.1186/s12884-020-03488-5

Giordano, V., Fuiko, R., Witting, A., Unterasinger, L., Steinbauer, P., Bajer, J., Farr, A., Hoehl, S., Deindl, P., Olischar, M., Berger, A., & Schrehof, K. K. (2023). The impact of pandemic restrictive visiting policies on infant wellbeing in a NICU. Pediatric Research, 94(3), 1098–1103. https://doi.org/10.1038/s41390-023-02562-w

Lee, J. (2023). Neonatal family-centered care: evidence and practice models. Clinical and Experimental Pediatrics, 67(4). https://doi.org/10.3345/cep.2023.00367

Mahoney, A. D., White, R. D., Velasquez, A., Barrett, T. S., Clark, R. H., & Ahmad, K. A. (2020). Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019. Journal of Perinatology, 40(1), 36–46. https://doi.org/10.1038/s41372-020-0753-7

North, K., Whelan, R. L., Folger, L. V., Lawford, H. L. S., Olson, I. R., Driker, S., Bass, M. B., Edmond, K., & Lee, A. W. M. (2022). Family Involvement in the Routine Care of Hospitalized Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics, 150(Supplement 1). https://doi.org/10.1542/peds.2022-057092o

Reid, S., Bredemeyer, S., & Chiarella, M. (2021). The evolution of neonatal family centred care. Journal of Neonatal Nursing, 27(5). https://doi.org/10.1016/j.jnn.2021.03.002

Schmid, S. V., Arnold, C., Jaisli, S., Bubl, B., Harju, E., & Kidszun, A. (2024). Parents’ and neonatal healthcare professionals’ views on barriers and facilitators to parental presence in the neonatal unit: a qualitative study. BMC Pediatrics, 24(1). https://doi.org/10.1186/s12887-024-04758-3

Van Veenendaal, N. R., Labrie, N. H. M., Mader, S., van Kempen, A. A. M. W., van der Schoor, S. R. D., van Goudoever, J. B., Bertino, E., Bhojnagarwala, B., Bodrogi, E., Bohlin, K., Bracht, M., Bührer, C., Domellöf, M., Embleton, N., Endl, C., Ertl, T., Funke, S., Gangi, S., Garg, S., & Guimarães, H. (2022). An international study on implementation and facilitators and barriers for parent‐infant closeness in neonatal units. Pediatric Investigation, 6(3), 179–188. https://doi.org/10.1002/ped4.12339

Vasconcellos, M. T. V., Brantes, A. L. G., Cruz, I. R., & Curado, M. A. S. (2022). Parental opinions about the benefit of kangaroo care in the Neonatal Intensive Care Unit. Journal of Neonatal Nursing, 29(1). https://doi.org/10.1016/j.jnn.2022.03.009

Zauche, L. H., Zauche, M. S., Dunlop, A. L., & Williams, B. L. (2019). Predictors of parental presence in the neonatal intensive care unit. Advances in Neonatal Care, 20(3). https://doi.org/10.1097/anc.0000000000000687

Appendices

Appendix 1: CASP Critical Appraisal Table of Selected Studies (2017–2024)

Appendix 2: Search Strategy Flow Diagram (PRISMA-style)