Intensive Care Nursery (ICN) - Dartmouth Health Children’s at Dartmouth Hitchcock Medical Center, Lebanon, NH

The Intensive Care Nursery (ICN) at Dartmouth Hitchcock Medical Center in Lebanon, NH has had a long-time commitment to family-centered care. The clinical leaders and staff have had a deep understanding that the family is an essential partner in their infant’s care. Fifty years ago, when the space for specialized newborn intensive care was only three beds in the adult ICU, physician leaders and nurses understood families’ importance to the health, well-being, and development of their infants and integrated them into the care team. Today, this commitment is evident in policy and practice and shown on the website. A video further describes the important roles of families in the ICN.

The ICN clinical leadership has had a long-standing commitment to family leadership. This commitment is important to shaping the culture of the unit. Joanna Celenza, a mother of twins who were cared for in the ICN, serves as a family support specialist. She is employed by the hospital in partnership with the March of Dimes NICU Family Support® Program. She is an integral member of the ICN Leadership Team. This Team meets weekly with a standing agenda item for her to present on family concerns and issues.

The ICN creates positive, welcoming first impressions that reinforce the unit’s philosophy. The philosophy of care statement is strategically placed on the wall beside where families wash their hands prior to entering the unit.

One of the many ways that Joanna connects with families is through “Coffee Chats” in the unit’s family lounge. These are informal, two-hour drop-in times held weekly. Families can come, listen, talk, and seek new information or connection with other families. Families seem to feel safe talking about issues in this format, away from their baby's bedside. These issues and needs are tracked through an online form, and then this depersonalized information is shared with the leadership team and ICN Parent Council for continuous improvement.

Voices is another program that has been part of Dartmouth Health for over 20 years. Voices Volunteers meet with patients and their family members, to listen to what they choose to share about their experience of care at Dartmouth Health Children’s. From hearing the patient and family’s story, the Voices Volunteer can then be able to understand what has been going well, and how the experience could be improved. Those points are shared anonymously with Nurse Managers.

CHaD’s Family Advisory Board and ICN Parent Council look at the trends that come from patient stories so that they can find ways to help support improvements. The ICN has had an ICN Parent Council since 1999. It meets monthly via Zoom at 8:00 pm on Sunday evenings. One of its projects is providing an annual three-part education series on communicating effectively with families for the neonatology fellows. Fellowship Program Director attends these educational sessions with the fellows and each session is typically facilitated by the ICN Social Worker. Each of these interactive sessions is planned for one hour. Topics have included: “Sharing ‘Hard’ News” and “Communicating an Understanding for the Complexity of Different Needs Within a Family.” A neonatology fellow commented recently: “This is one of the most powerful education sessions I have had in my training.” The ICN Parent Council also provides education for new graduate nurses working in the ICN. This is a three-hour interactive discussion over lunch. The format is mainly the sharing of stories and the exploration of ways to be supportive to families.

There is a hospital-sanctioned private ICN Families Facebook group that has been a safe place for families to have constructive and supportive conversations for over 13 years. Joanna serves as the administrator for the group and an ICN Parent Council member serves as moderator. There are guidelines for posting. It was an especially valuable resource for information sharing during the COVID 19 pandemic. Today, there are more than 1,000 members in the ICN Facebook group.

The ICN Facebook group has been an effective means for reaching out to families respectfully and offer opportunities to participate in research that might be of interest to them. Recently over forty families participated in an occupational therapy student’s Capstone project. They were interviewed about their needs and perception of the experience in newborn intensive care. The online group provides not only a space for connection, but also provides the opportunity to help improve the care experience for families in the future.

The vision of Dartmouth’s neonatology clinical leaders fifty years ago to integrate families into the care team is certainly a reality today in the ICN at Dartmouth Health Children’s.