P2.F113: Provider perceptions of communication with families of low socioeconomic status and/or limited English proficiency in a level IV neonatal intensive care unit

Background: The practice of family-centered care (FCC) is becoming increasingly prevalent within neonatal intensive care units (NICU). FCC allows for improvement of family psychosocial well-being, empowers families to be participating members of the care team, and encourages collaborative relationships between patients, their families, and the health care team. Race-, ethnicity-, and socioeconomic status-based outcome disparities remain present in the NICU and it remains crucial to consider these additional challenges when practicing FCC to ensure equitable care. Furthermore, the literature reveals that parent-provider communication is an important determinant for parental well-being and satisfaction with care. The NewYork-Presbyterian (NYP) Weill Cornell NICU is a 60-bed level IV NICU that sees around 700 admissions annually. This project aims to develop a simulation-based culturally responsive curriculum to improve FCC among families with limited English proficiency (LEP) and/or low socioeconomic status (SES) in a level IV NICU using key themes identified from focus group discussions conducted with NICU staff and families of NICU patients.

Methods: This is an ongoing qualitative study among NICU frontline providers, including neonatal nurses, nurse practitioners, and neonatal-perinatal fellows, to identify prevailing themes regarding communication between staff and families. Participants were recruited via emails and flyers and received compensation for their time. Sixty-minute focus group sessions were conducted over Zoom to explore communication methods, resources, barriers to communication, and differences in communication. Qualitative transcripts were assessed by members of the study team to identify key concepts and areas of need regarding FCC in the NICU. Data analysis and coding was performed using the Dedoose platform.

Results: In November 2023, three focus groups were conducted with 2 to 5 participants in each group. The participants include 5 nurses, 4 nurse practitioners, and 2 neonatal-perinatal fellows. Eleven parent-themes emerged from qualitative analysis: collaboration, empowering families, flexibility, information sharing, listening and respect, presence of family, time spent with family, quality of healthcare delivery, social work, social determinants of health, and quality improvement. Parent-themes were then further divided into 48 additional child-codes. Notable themes identified in the transcripts included barriers to information sharing (111 excerpts), interpretation services/tools used (73 excerpts), modes of communication (85 excerpts), and discharge readiness (53 excerpts) (Word Cloud, Fig. 1).

Conclusion: Focus groups conducted with NICU staff members show strong themes including barriers to information sharing, discharge readiness, and variable interpreter utilization which are critical to address when developing a simulation-based communication curriculum. The study team is conducting structured interviews with NICU families to assess similar themes regarding communication and FCC in the NICU. Key concepts identified will be used to develop a pilot-based curriculum aimed to improve perceived gaps in care and disparities in communication in the NICU for families with LEP and/or low SES.