Presentation
Incorporating Caregivers into the NICU Team: Family Perspectives on Teamwork
SessionPoster Session 2
DescriptionThe neonatal intensive care unit (NICU) is one of the most complex and high-stakes hospital environments, where effective teamwork is vital to ensure patient safety and meet myriad demands (Braithwaite, 2008). In fact, teamwork breakdowns are a leading contributor for perinatal deaths and injuries in the NICU (Thomas et al., 2007). Recently, there has been a push to incorporate patient families into the care team more fully (Celenza et al., 2017; Vanderveen et al., 2009) and acknowledge that parents and caregivers are essential team members in the NICU (Traylor & Ohning, 2025). While there have been calls to understand how to incorporate family members and caregivers in patient-centered care, we know little about the way in which this is effectively accomplished. Broadly speaking, effective NICU teamwork requires coordination between medical team members (i.e., physicians, nurse practitioners, RNs) and the patient family. For example, reports on how a baby is breastfeeding often come from the baby’s mother but are essential to understand how a baby is progressing. Although caregivers and medical team members share common goals surrounding infant health and family discharge preparedness, several factors can undermine team effectiveness. For example, caregivers often have barriers to being physically present at the bedside or may lack an understanding of the medical context, making it difficult to develop a shared mental model (i.e., team’s shared understanding of their situation, roles, and responsibilities, DeChurch & Mesmer-Magnus, 2010) with medical team members (Traylor & Ohning, 2025). Despite these challenges, researchers have noted opportunities for the medical team to effectively engage parents in teamwork (e.g., shared decision making, rounding participation, task delegation where appropriate, Bell et al., 2023). While this work provides some guidance for patient-centered care, it is vital to understand patient family members’ experiences of teamwork in the NICU to make more concrete recommendations for family-centered care in the NICU.
Accordingly, we conducted a longitudinal, interview-based study with parents of NICU patients in a Southeastern United States hospital to identify the behaviors medical teams engage in to promote effective teamwork in the NICU. The central research question in this study was, "What do NICU medical teams do to effectively engage parents in patient family-centered teamwork?". To answer this question, we recruited patient family members from a Level 1 NICU. Participants were interviewed 2-3 times: the first interview occurred 1-2 weeks after admission to the NICU, the second occurred after the patient was transferred to the hospital’s lower acuity NICU, and the third occurred after the patient was discharged from the hospital. In the initial interview, participants completed a demographic questionnaire (e.g., infant gestational age at birth, current age, household distance from hospital, etc.), after which they provided consent to the audio-recorded interview. The interview consisted of structured interview questions focused on participants’ experiences in the NICU and targeted key teamwork processes and emergent states including communication, shared mental models, psychological safety (i.e., the shared belief amongst team members that a team is safe for interpersonal risk taking, Edmondson, 1999), and trust (i.e., positive expressions toward and a willingness to be vulnerable within a team, Feitosa et al., 2020). Each interview lasted roughly 15-30 minutes. Every participant was awarded $25 following each interview. Subsequently, the interviews were transcribed and analyzed through directed content analysis, a directed approach guided by existing theoretical frameworks (Hsieh & Shannon, 2005). Specifically, the research team analyzed the data to understand what behaviors the medical team engaged in that enhanced teamwork in the NICU.
Accordingly, the first aim of this presentation is to discuss our findings. More specifically, how parents’ and caregivers’ perspectives reveal engagement (or lack of engagement) in teamwork behaviors and opportunities for involvement in the NICU. Preliminary findings show that families frequently lack critical information about unit NICU processes, including policies, rules, and rounding schedules, which limits their ability to engage as effective team members. Initial interviews also indicate that parents/caregivers report higher psychological safety when staff use accessible language, invite questions, and demonstrate consistent support. For instance, patient families were more likely to speak up and voice their opinions and concerns when the medical team translated medical terminology into lay terms. This was also the case when the medical team prompted the parents to ask questions (e.g., "Do you have any questions?"). At the same time, families described conflicting messages on their ability to be involved in their baby’s care (e.g., skin-to-skin, feeding, diaper change), and breakdowns in handoffs between providers. These experiences demonstrate both the facilitators (e.g., communication) and barriers (e.g., inconsistent messaging) to teamwork. In understanding how the medical team communicates and involves families, we can identify areas where medical staff may need to adjust behaviors to better accommodate parents and caregivers as members of the care team (Traylor & Ohning, 2025). Additionally, by discussing the behaviors and team needs, we underscore the need for deliberate strategies to more intentionally “loop in” the caregiver teammate, aligning with broader calls to include patient families in NICU teams (Griffin, 2006; Oude Maatman et al., 2020).
The second aim of this presentation is to highlight exploratory themes regarding the caregivers' teamwork related behaviors. More specifically, we will discuss the behaviors that caregivers engage in that enhance teamwork. For example, when caregivers voice their concerns over a team members communication, this can create opportunities to enhance subsequent interactions and performance, consistent with the team science literature (Edmonson, 1999). Additionally, by drawing attention to conflicting information given by the medical team, the team could work to build a better shared mental model and ensure consistency in communication. By sharing the behaviors of both the medical team and caregivers, we help provide a more comprehensive understanding of teamwork in the NICU that acknowledges caregivers as active contributors to the team. Additionally, this helps us better understand real-world experiences of patient family team members and the relevant implications.
The third and final aim, is to translate these findings into evidence-based recommendations for the NICU. We will discuss potential interventions and strategies that could enhance teamwork behaviors and processes to better incorporate patient families. This is particularly important given the high stakes nature of the NICU. Additionally, this effort may provide recommended changes that could be embraced hospital-wide when thinking about ways to incorporate patients (or patient families) onto the team. Given the connection between medical team members intention to engage in family centered care and inadequate staffing, stress, and burnout (Vittner et al., 2022), some recommendations may translate across units.
All references are available upon request.
Accordingly, we conducted a longitudinal, interview-based study with parents of NICU patients in a Southeastern United States hospital to identify the behaviors medical teams engage in to promote effective teamwork in the NICU. The central research question in this study was, "What do NICU medical teams do to effectively engage parents in patient family-centered teamwork?". To answer this question, we recruited patient family members from a Level 1 NICU. Participants were interviewed 2-3 times: the first interview occurred 1-2 weeks after admission to the NICU, the second occurred after the patient was transferred to the hospital’s lower acuity NICU, and the third occurred after the patient was discharged from the hospital. In the initial interview, participants completed a demographic questionnaire (e.g., infant gestational age at birth, current age, household distance from hospital, etc.), after which they provided consent to the audio-recorded interview. The interview consisted of structured interview questions focused on participants’ experiences in the NICU and targeted key teamwork processes and emergent states including communication, shared mental models, psychological safety (i.e., the shared belief amongst team members that a team is safe for interpersonal risk taking, Edmondson, 1999), and trust (i.e., positive expressions toward and a willingness to be vulnerable within a team, Feitosa et al., 2020). Each interview lasted roughly 15-30 minutes. Every participant was awarded $25 following each interview. Subsequently, the interviews were transcribed and analyzed through directed content analysis, a directed approach guided by existing theoretical frameworks (Hsieh & Shannon, 2005). Specifically, the research team analyzed the data to understand what behaviors the medical team engaged in that enhanced teamwork in the NICU.
Accordingly, the first aim of this presentation is to discuss our findings. More specifically, how parents’ and caregivers’ perspectives reveal engagement (or lack of engagement) in teamwork behaviors and opportunities for involvement in the NICU. Preliminary findings show that families frequently lack critical information about unit NICU processes, including policies, rules, and rounding schedules, which limits their ability to engage as effective team members. Initial interviews also indicate that parents/caregivers report higher psychological safety when staff use accessible language, invite questions, and demonstrate consistent support. For instance, patient families were more likely to speak up and voice their opinions and concerns when the medical team translated medical terminology into lay terms. This was also the case when the medical team prompted the parents to ask questions (e.g., "Do you have any questions?"). At the same time, families described conflicting messages on their ability to be involved in their baby’s care (e.g., skin-to-skin, feeding, diaper change), and breakdowns in handoffs between providers. These experiences demonstrate both the facilitators (e.g., communication) and barriers (e.g., inconsistent messaging) to teamwork. In understanding how the medical team communicates and involves families, we can identify areas where medical staff may need to adjust behaviors to better accommodate parents and caregivers as members of the care team (Traylor & Ohning, 2025). Additionally, by discussing the behaviors and team needs, we underscore the need for deliberate strategies to more intentionally “loop in” the caregiver teammate, aligning with broader calls to include patient families in NICU teams (Griffin, 2006; Oude Maatman et al., 2020).
The second aim of this presentation is to highlight exploratory themes regarding the caregivers' teamwork related behaviors. More specifically, we will discuss the behaviors that caregivers engage in that enhance teamwork. For example, when caregivers voice their concerns over a team members communication, this can create opportunities to enhance subsequent interactions and performance, consistent with the team science literature (Edmonson, 1999). Additionally, by drawing attention to conflicting information given by the medical team, the team could work to build a better shared mental model and ensure consistency in communication. By sharing the behaviors of both the medical team and caregivers, we help provide a more comprehensive understanding of teamwork in the NICU that acknowledges caregivers as active contributors to the team. Additionally, this helps us better understand real-world experiences of patient family team members and the relevant implications.
The third and final aim, is to translate these findings into evidence-based recommendations for the NICU. We will discuss potential interventions and strategies that could enhance teamwork behaviors and processes to better incorporate patient families. This is particularly important given the high stakes nature of the NICU. Additionally, this effort may provide recommended changes that could be embraced hospital-wide when thinking about ways to incorporate patients (or patient families) onto the team. Given the connection between medical team members intention to engage in family centered care and inadequate staffing, stress, and burnout (Vittner et al., 2022), some recommendations may translate across units.
All references are available upon request.
Event Type
Poster Presentation
TimeTuesday, March 244:45pm - 6:15pm EDT
LocationRhinelander Gallery
Patient Safety Research and Initiatives