Historically, open nurseries were the standard in neonatal intensive care units (NICUs), allowing staff to monitor multiple infants simultaneously. However, this design limited parental presence and privacy. The growing recognition of the importance of parental participation in a less stressful environment has led to a shift towards single family room NICUs (SFR-NICUs). Previous research suggests that SFR-NICUs lead to increased parental presence and involvement in infant care, strengthening the parent-infant emotional bond and facilitating interactions, including skin-to-skin contact (SSC). Benefits associated with SFR-NICUs include improved infant weight gain, reduced mortality and morbidity rates, better breastfeeding success, and enhanced cognitive development in very preterm infants. However, the mechanisms behind these benefits are not fully understood. Less is known about the effects of SFR-NICUs on parental experiences related to family-centered care (FCC). While beneficial for the parent-infant relationship, SFR-NICUs might introduce challenges in parent-staff communication. Studies have suggested difficulties in connecting with staff, feeling less informed about decision-making, and experiencing loneliness and isolation due to reduced opportunities for peer support. To assess the effectiveness of SFR-NICU architecture, more information is needed on parental experiences with FCC, including communication, shared decision-making, participation, and emotional support. A systematic change towards a strong FCC mindset and supportive care culture, beyond just environmental factors, is crucial for promoting parent-infant closeness and providing high-quality FCC. This study aimed to evaluate the effects of an SFR-NICU on parental presence, parent–infant SSC, and parental experiences with FCC quality by comparing a NICU before and after its transition to an SFR-NICU, while controlling for consistent staff and care policies.

Existing research indicates a positive correlation between single family room (SFR) NICU design and increased parental presence and involvement in infant care. Studies have shown that parents spend more time with their infants and participate more actively in their care in SFR-NICUs compared to open nurseries. This increased presence has been linked to a stronger parent-infant emotional bond and improved parent-infant interactions. Moreover, SFR-NICUs have been associated with various positive neonatal outcomes, including better weight gain, lower mortality and morbidity rates, improved breastfeeding, and enhanced cognitive development. While the benefits are apparent, the underlying mechanisms remain unclear. Furthermore, the impact of SFR-NICUs on parental experiences with family-centered care (FCC) requires further investigation. Some studies suggest that SFR-NICUs may present challenges in parent-staff communication and may lead to feelings of isolation among parents. These findings highlight the need for a comprehensive understanding of the effects of SFR-NICUs on both parent-infant relationships and the overall quality of family-centered care.

This pre-post study involved two cohorts of parents of preterm infants (<35 weeks gestation) admitted to the NICU of Turku University Hospital in Finland. The first cohort (September 2013–March 2014) was cared for in a unit with shared patient rooms (2-4 infants per room), while the second cohort (April 2018–February 2019) was cared for in the same unit after its transition to an SFR-NICU (11 single family rooms plus 3 shared rooms). The study aimed for a sample size of 30 families per cohort. Data collection included daily diaries (Parent-Infant Closeness Diary) completed by parents for two weeks or until discharge, recording parents’ presence in the NICU and duration of skin-to-skin contact (SSC). The quality of FCC was assessed using the Digital Family Centered Care–Parent Version (DigiFCC-P), a daily text message survey employing a 7-point Likert scale to evaluate nine core elements of FCC: active listening, parent participation in care, individualized education, participation in decision-making, trust in staff, staff trust in parents, involvement in medical rounds, individualized information, and emotional support. Infant characteristics (gestational age, birth weight, etc.) and parental background factors (age, education, socioeconomic status, etc.) were also recorded. Statistical analyses included Fisher’s exact test for categorical variables, Student’s t-test or Wilcoxon rank-sum test for quantitative variables, analysis of covariance (ANCOVA) to compare presence and SSC durations and FCC scores, and Pearson’s correlation to assess the association between workload and FCC scores. Ethical approval was obtained, and informed consent was obtained from all participating families.

Thirty-one families from the shared-room unit and 30 from the SFR-NICU participated. There were no significant differences in infant characteristics between the two cohorts, except for parents in the shared-room unit having a lower education level. The duration of parental presence increased significantly after the move to the SFR-NICU (from a median of 5.9 to 10.2 hours per day). This increase was similar for both daytime and nighttime hours, indicating that the SFR-NICU provided benefits beyond just sleeping accommodations. However, the duration of skin-to-skin contact (SSC) did not significantly increase (from a median of 3.0 to 4.1 hours per day). While the overall quality of FCC was already high in the shared-room unit, it did not significantly improve after the architectural change. Parents rated participation in medical rounds, emotional support, and participation in infant care as the weakest elements of FCC in both settings. The monthly staff workload did not significantly differ between the two unit configurations and showed no correlation with parental FCC evaluations. Several background factors, including parental education and the presence of siblings at home, influenced both parental presence and FCC ratings.

The study demonstrated a significant increase in parental presence in the SFR-NICU, aligning with previous research suggesting that improved physical access enhances parental involvement. The lack of a significant increase in SSC, despite increased presence, might be explained by the already high baseline SSC level in the shared-room unit. The high pre-existing levels of FCC, possibly due to a prior staff training program focused on collaboration with parents, could explain the absence of improvements in FCC after the architectural change, indicating a potential ceiling effect in the FCC measurement tool. The consistent high ratings of FCC despite lower levels of emotional support and parental involvement in medical rounds highlight areas for improvement in providing holistic FCC. Background factors, such as parental education and the presence of siblings, influenced both parental presence and FCC ratings. These observations underscore the importance of considering individual family needs and expectations when designing and implementing FCC strategies.

Transitioning to an SFR-NICU significantly increased parental presence but did not further increase SSC or parental satisfaction with already high levels of family-centered care. Future research should explore strategies to enhance emotional support for parents and improve parental participation in medical rounds. The study highlights the importance of considering both environmental factors and the broader care culture when aiming to optimize family-centered care in NICUs.

The relatively small sample size and the high baseline level of FCC, which may have limited the ability to detect improvements after the architectural change, are notable limitations. The study's focus on preterm infants might restrict the generalizability of the findings to other infant populations. The use of a diary-based method for data collection might have introduced reporting biases. Future research could benefit from employing automated data collection methods and larger sample sizes to further validate these findings.