Parallel to structural changes, there is an ongoing change in the care culture in neonatal units to support parenting in the context of neonatal intensive care. Even though there has been a change in the attitude in neonatal care towards a more family-centred approach, there is still a medical and technical focus and there seems to be a gap between care policies/practices and evidence from family and infant research (53
). Furthermore, parents’ visits to their infants on NICU are still limited in many European countries and many units do not allow parents present during medical ward rounds, nursing shift handovers and ‘quiet periods’(52
). Whilst very few studies have looked at parents’ visiting patterns, Franck & Spencer (54
) showed most mothers visited the NICU daily with a mean length of 3 h. Only a third of the fathers visited on a daily basis and their visits were shorter. Infrequent maternal visits have been identified as a risk factor for later psychological development in preterm infants (55
). However, some parents have fewer means to be with their preterm infant during the hospital stay. Older siblings, long travelling distance to hospital or short parental leave limit the parents’ opportunities to be present at NICU. In such cases, modern technology could be utilized to support parent–infant contact. Web camera connection for parents has been used as a method for ‘virtual visitation’ of a neonatal unit (56
To facilitate physical contact between parents and their infants, neonatal unit staff need to welcome parents’ participation in the care but also guide parents when adapting parental touch into daily care, as touch may induce stress in very ill infants (57
). In a genuinely family-centred culture, institutional powers are limited and the role of the staff is altered from ‘doing’ and supervising to becoming a resource and a facilitator. Hence, when family-centred care is implemented in a professional-centred caring culture, this can highlight issues about control and power or unclear responsibilities (58
), which pose a considerable challenge for the current care culture. Thus, an important aspect of organizational culture centres upon the ways in which staff are facilitated to build relationships with parents. As parent–infant bonding is a primary goal, successful transition requires education and feedback to the staff as particular demands on staff and care will follow (46
). Different interventions to increase parental involvement and empowerment during the neonatal care have already been performed and reported on: parents have been involved in pain management by holding the preterm infant (15
); parents have been supported in observing and interpreting their infants behaviour (29
); parents have been encouraged to give extended skin-to-skin care (59
). Supporting parents’ abilities to interpret their infant and supporting their empowerment has significantly shortened the length of hospitalization (29
), decreasing separation of the infants from family and home. Although many short- and long-term benefits have been shown after these types of interventions, there is a lack of research on how these interventions change care culture and affect parent–infant closeness during neonatal care.
Large and systematic differences related to cultural and contextual issues in neonatal units, such as parental involvement, implementation of family-centred care and staff practices, might influence differences shown in breastfeeding rates, maternal depression, and short- and long-term outcomes of the children (60
). There is a need to evaluate differences in parent–infant closeness/separation between the units and structural, cultural and socio-economic factors affecting the differences. These factors could be evaluated using qualitative and quantitative techniques including ethnography.