A Model of Care For a Whānau/Family-Centred Newborn Transitional Care Unit in Aotearoa New Zealand: An Implementation Science Study

Abstract In Aotearoa New Zealand, an increasing number of low medical risk infants are removed from their mothers and family/whānau and admitted to a neonatal intensive care unit (NICU) or special care baby unit (SCBU), despite needing only minimal interventions such as blood sugar monitoring and supplementary feeding. Internationally, the introduction of newborn transitional care (NTC) units, an intermediary option between NICU/SCBU and standard postnatal wards, has led to several evidence-based successes, including the non-separation of mother and infant, improved breastfeeding rates, shorter lengths of hospital stay and a decrease in readmission rates. However, the applicability of NTC has not been explored in the context of Aotearoa, which has unique contextual factors, including Māori as the indigenous people and our obligations under Te Tiriti o Waitangi, (Treaty of Waitangi), alongside the needs of at risk populations.

This research hypothesised that it was possible to create a model of care for NTC in Aotearoa that meets the individual medical, neurodevelopmental and cultural needs of infants and their family/whānau. Underpinned by an implementation science methodology and the Practical Robust Implementation and Sustainability Model (PRISM), a thorough exploration of the complex contextual factors related to maternal and infant healthcare delivery was undertaken. Using the PRISM framework, the principles of a model of care incorporate the perspectives of the whānau/family and the healthcare service organisation while exploring factors such as sustainability, implementation and external influences. A mixed-methods design was employed to create research data and findings; these included stakeholder questionnaires, focus groups, individual interviews and hospital data sources.

The findings demonstrate parents’ distress when they are separated from their infant, their desire to remain together as whānau/family and the difficulties they experience when their support networks are disrupted because of the current healthcare model. In addition, the findings show that NICU/SCBU admission creates barriers to parental access to their infant and that these are experienced differently by different groups, thereby widening current health disparities. From a healthcare professional and broader organisation perspective, there is recognition that the current model of care is not meeting the needs of infants or their whānau/family. The findings show overall support for NTC across whānau/families, professional groups and the wider community, and have informed a model of care for NTC that can support its implementation.

An implementation science methodology supported by the PRISM framework enabled stakeholder engagement and an exploration of complex contextual factors, to build on a previous international model of NTC, thereby proving it is possible to develop a model of care for NTC that meets the individual medical, neurodevelopmental and cultural needs of infants and their whānau/family in the context of Aotearoa New Zealand. This model of care would enable at risk families to receive equitable, culturally safe, holistic care that sets them up on a trajectory for improved wellbeing and health outcomes.