Implementation of a partnership involving parents in the care of critically ill children: an integrative review

Tuti Seniwati; Nani Nurhaeni; Dessie Wanda

doi:10.4266/acc.001896

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Review Article Nursing Implementation of a partnership involving parents in the care of critically ill children: an integrative review: Acute and Critical Care 2025;40(4):521-537.
DOI: https://doi.org/10.4266/acc.001896
Published online: November 24, 2025

Tuti Seniwati¹

, Nani Nurhaeni²

, Dessie Wanda²

¹Department of Pediatric Nursing, Faculty of Nursing, Hasanuddin University, Makassar, Indonesia

²Department of Pediatric Nursing, Faculty of Nursing, University of Indonesia, Depok, Indonesia

Corresponding author: Tuti Seniwati Department of Pediatric Nursing, Faculty of Nursing, Hasanuddin University, Jl. Perintis Kemerdekaan Kampus Tamalanrea KM.10 Makassar 90245, South Sulawesi, Indonesia Tel: +62-813-5491-5399 Fax Email: tutiseniwati@unhas.ac.id

• Received: January 9, 2024 • Revised: July 13, 2025 • Accepted: August 11, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
Infographics
INTRODUCTION
RESEARCH QUESTIONS AND OBJECTIVES
METHODS
FINDINGS
DISCUSSION
KEY MESSAGES
NOTES
REFERENCES

Abstract

The admission of a child to an intensive care unit, such as pediatric or neonatal intensive care units, serves as a significant stressor for parents. This condition is exacerbated when the child undergoes treatment in isolation from their parents. One strategy to address this challenge involves positioning parents at the bedside during the child’s care. This study aimed to identify and synthesize qualitative and quantitative research evidence on partnerships involving parents in the care of critically ill children. This research employed an integrative review method, and it was registered with the International Prospective Register of Systematic Reviews as a research-implementation protocol (ID no. CRD42023414924t). Six databases were searched for relevant literature, including ScienceDirect, Scopus, ProQuest, Sage Journals, PubMed, and Google Scholar. The evaluation of article quality used the 2018 version of the Mixed Methods Appraisal Tool, while content analysis was employed for data analysis. The results indicated that 18 articles fulfilled the inclusion requirements, out of the 5,435 articles found during the search phase. The analysis resulted in the discovery of three primary themes: partnership components, partnership outcomes and factors influencing partnerships. These three themes collectively constitute the conceptual model of partnerships in treating children with critical illness. It can be concluded that the active participation of parents in a child's critical care will yield positive outcomes for both the child and the parents. Existing empirical data underscore the significance of comprehending the factors influencing this specific situation.
Key Words: children; critical care; critical illness; parents; partnership

Infographics

INTRODUCTION

The admission of a child to an intensive care unit (ICU), such as the pediatric ICU (PICU) or neonatal ICU (NICU), constitutes a significant source of stress for parents. Various factors contribute to this stress, including the child's clinical condition, sensory environment (sights and sounds), medical procedures, parental role alterations, parental behavior changes and communication with healthcare providers [1-4]. Research findings reveal that approximately 39.3% of parents experience moderate to severe anxiety during their child's admission to the PICU [5]. This underscores the profound impact of the ICU admission on parental psychological well-being.

Parents exhibit various psychological responses that necessitate attention and intervention from nurses to facilitate their adaptation to their current situation [6]. Parental stress, a recognized factor influencing infant behavior and long-term outcomes, becomes more pronounced when parents are separated from their child, impeding their ability to fulfil the child's needs [7]. In these critical situations, parents seek assurance regarding their child's prognosis, require information about the child's development and desire a close connection with their child throughout their stay in the ICU [8].

Involving parents in the care of critically ill children is an intervention that has been shown to mitigate anxiety in parents [9]. Furthermore, the presence of parents is recognized as a factor that can also alleviate anxiety, depression and stress in children [10,11]. In care providers' capacity, nurses play a pivotal role in promoting parental engagement in nursing care [12]. This parental involvement finds expression in the application of partnerships, a concept widely acknowledged in pediatric nursing as indispensable for preserving family relationships and mitigating the detrimental psychological effects of hospitalization on children and parents. Partnership in care involves cultivating relationships and coexisting harmoniously to establish a collaborative approach to care [13].

Historically, partnership in care was introduced in 1988 by Anne Casey, who articulated that it involves nurses and parents collaboratively providing care for sick children [14,15]. Subsequent studies have contributed to developing various care models incorporating family involvement within the PICU and NICU. Such models have been identified by different terminologies, such as family-centered care [16], family-centered rounds [17], family-integrated care [18] and family participation [19]. Despite the diversity in nomenclature, the common thread among these models is the essence of a partnership [20]. Given the diversity of approaches focusing on parental involvement in care, differences in outcomes are inevitable. Therefore, through an integrative review, we systematically sought to identify and synthesize qualitative and quantitative research evidence on partnerships involving parents in the care of critically ill children.

RESEARCH QUESTIONS AND OBJECTIVES

This study aims to explore and synthesize partnerships entailing parental involvement in the care of critically ill children. The research seeks to address the following inquiries: (1) How are parents involved in providing care to critically ill children? (2) What outcomes arise from partnerships involving parents, and what factors contribute to the successful implementation of these partnerships?

METHODS

Design

This research adopts an integrative review approach following the framework proposed by Dhollande et al. [21]. The implementation of this integrative review involved a systematic process encompassing seven stages (Table 1). This integrative review research was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) and was assigned the ID number CRD42023414924. The primary purpose of this registration was to ascertain whether the title of this integrative review has been the subject of previous or ongoing research, as Page et al. [22] emphasized.

Studies that met the following inclusion criteria were selected for this review: (1) enrolled critically ill children aged 0–18 years and their parents; (2) published within the last 10 years (2014–2023); (3) published in a peer-reviewed journal; (4) a primary research article; (5) published in English language. Conversely, (1) articles presented in the form of reviews, conference proceedings, protocols, case reports, surveys or theses/dissertations and (2) articles not available as full texts or otherwise not fully accessible were excluded.

Article Search Strategy

Article searches were systematically conducted across six databases, including ScienceDirect, Scopus, ProQuest, Sage Journals, PubMed, and Google Scholar. The article search process commenced after the research protocol was registered in PROSPERO. Keywords used during search included (“partnership model” OR “parent partnership” OR “parent involvement” OR “parent participation” OR “parent collaboration”) AND (“critical illness” OR “critical care”) AND (“children” OR “pediatric”). The refined search focused on articles published within the last 10 years, from January 2014 to December 2023. Table 2 presents a detailed breakdown of the article search process.

Screening and Selection Process

The article screening process was carried out through the following stages. (1) Two authors (TS and DW) began the screening by entering relevant keywords into each predefined database. All articles found in the initial search stage were documented. Next, TS and DW conducted further screening by restricting articles based on the year of publication, article type, language used and ease of accessing the full text. Both authors then screened the articles by reading the titles and abstracts to ensure they met the eligibility criteria. If there was a difference of opinion between TS and DW in the selection of articles, NN reviewed the screening process to ensure the appropriateness of all steps. (2) TS and DW then proceeded with the double screening process by reading the full text of each article. TS, DW, and NN then discussed the screening results at this stage through a consensus mechanism to determine which articles met the eligibility criteria (eligible) and which should be excluded. All decisions made during this selection process were recorded in detail.

Study Quality Assessment

TS independently evaluated the quality of the selected studies and subsequently discussed the assessment with DW and NN. The assessment of study quality in this review employed the 2018 version of the Mixed Methods Appraisal Tool (MMAT), as detailed by Hong et al. [23]. The MMAT is a critical appraisal tool specifically designed for evaluating mixed systematic study reviews incorporating various designs, such as qualitative, quantitative and mixed-methods studies [23]. This instrument, tested for content validity using the Delphi technique, is tailored to assess the quality of articles across diverse methodological or design types, eliminating the need for multiple tools [24]. The 2018 version encompasses five study design categories: qualitative, quantitative randomized controlled trials (RCTs), quantitative non-RCTs, descriptive quantitative and mixed methods. For each study design, there are five questions, and respondents are required to answer with “yes,” “no” or “do not know” [23].

Data Extraction and Data Analysis

TS extracted and analyzed the data from the studies independently, then reviewed the results with DW and NN. Data extraction involved capturing essential characteristics of a study in a structured and standardized form based on the information provided in the journal article [25]. The manual data-extraction process used the grid synthesis format, which encompassed several key pieces of information, including the author and year of publication, country, purpose, setting, design, sample, implementation, implementation overview and results. The grid synthesis was organized in a tabular form and used internally by the research team to facilitate the systematic entry of articles that met the specified inclusion criteria, ensuring ease of reference during the review process.

Data analysis in this study employs content analysis, a methodology applicable to qualitative and quantitative data within the context of integrative review research [26]. Furthermore, content analysis is adaptable to studies using a mixed-methods design [27]. The content analysis process encompasses three key phases: preparation, categorization and reporting [27,28]. Data were read and extracted from primary sources in the preparation phase into a review matrix. Subsequently, the researcher organized the data into categories, sub-themes and central themes based on similarities in content. The final phase involved analysis by creating a report to address the research questions. This research report is structured as a conceptual model, derived from the clustering undertaken in the preceding phases [28].

FINDINGS

Article Search Results

The researchers initially retrieved 5,435 articles from six databases during the primary search phase. The database searches yielded 208 ScienceDirect articles, 18 Scopus articles, 2,289 ProQuest articles, 60 Sage Journals articles, 10 PubMed articles and 2,850 Google Scholar articles. After applying stringent inclusion criteria, the ultimate compilation for this review included just 18 articles (Figure 1). The studies included in this review spanned several countries globally, reflecting a diverse geographical distribution; these included the United States of America [29-32], South Korea [33-36], Canada [37,38], the United Kingdom [39,40], the Netherlands [41,42], China [43] and Australia [44]. Furthermore, one study conducted research across several European countries [45], and another study conducted research in three countries (i.e. Canada, Australia and New Zealand) [46]. Regarding the research setting, 10 studies were conducted in the NICU, five were performed in the PICU, two took place in the pediatric cardiac ICU and one was completed in the pediatric post-anesthesia care unit. Of the 18 identified studies, 7 used a qualitative design, 10 employed a quantitative design (including 3 RCTs, 5 non-RCTs and 2 descriptive studies) and 1 used mixed methods (Table 3).

Study Quality

Table 4 presents an assessment of study quality in this integrative review, employing the 2018 version of the MMAT developed by Hong et al. [23]. The seven studies adopting a qualitative design demonstrated a 100% affirmative response rate, indicating a high level of quality. Among the three studies using an RCT design, two (67%) failed to report blinding information for the intervention [32,46], while the remaining study (33%) provided unclear information [37]. Overall, RCT studies exhibited an 80% positive response rate, suggesting a high quality of research. Non-RCT studies also demonstrated a high quality, with the majority (100%) receiving affirmative responses. Notably, one of the five non-RCT studies did not account for confounding variables in its analysis [43].

Moreover, among the two studies employing quantitative methods with a descriptive design, one study provided unclear information regarding the outcome measures taken [45], while the other study was ambiguous concerning the risk of non-response bias [34]. However, overall, both descriptive studies demonstrated high quality, with affirmative responses reaching 80%. Out of the total of 18 studies reviewed, only one study used a mixed-methods design, where it remained unclear whether the different components of the study adhered to the quality criteria of each of the methodological traditions involved [39]. Nevertheless, this mixed-methods study fell into the high-quality category, as it achieved an 80% affirmative response rate.

Theme Analysis

The integrative review analysis delineated the categories, sub-themes and central themes derived from the examination of the 18 reviewed articles (Table 5). The format of the analysis table adheres to the modification proposed by Younas et al. [47]. Three main themes were generated, including partnership components, partnership outcomes and influencing factors. These themes, as delineated in this review, collectively formulate a conceptual model of partnership in the care of critically ill children (Figure 2).

Theme 1: partnership components

The central theme identified through the analysis of the 18 reviewed articles was the partnership component. This theme included four sub-themes: participation in care, caring, information and decision-making (Table 5). In the sub-theme of participation in care, 11 studies indicated that parents were actively engaged in medical or daily rounds. Parental involvement in rounds varied in duration, spanning most of the day [45], early mornings [29] and afternoons [31]. Additionally, all 11 studies highlighted parental participation in routine daily care activities, such as bathing, dressing, diaper changing, oral care, administering oral medication, changing bed linens, providing positioning and offering skin-to-skin contact. Conversely, only four studies reported parental involvement in monitoring or observing their child's condition in the ICU [37,40,42,43]. Four studies indicated that parents experienced kindness, affection and established close relationships with their children during their stay in the ICU. Moreover, five studies reported that care providers valued and respected parents. This sense of respect was seen not only among care providers but also extended to within the parent community [44]. Most studies underscore the significance of information as an essential component for parents, encompassing details about the child's condition, procedures, diagnosis, prognosis, treatment plan and any information sought by the parents themselves [44,41]. For mothers, such information serves as a source of courage to navigate through the day while their child is admitted to the PICU [36]. Other critical pieces of information parents require include an understanding of the rounds to be conducted and introductions from the room and staff, along with clarification of their respective roles [30,33]. In the sub-theme of decision-making, parents were involved in decisions concerning the child's treatment plan alongside the care provider. However, some parents mentioned that they were occasionally not consulted regarding decisions related to the weaning process in the PICU [40].

Theme 2: partnership outcomes

Partnership outcomes include two sub-themes, including outcomes for parents and outcomes for children (Table 5). Integrating partnerships in the PICU/NICU setting positively impacts parents, including by increasing or improving understanding, satisfaction, self-efficacy, interpersonal relationships and psychological responses. The most frequently mentioned outcomes were positive psychological responses, such as reduced stress and anxiety. Parents expressed that they experience anxiety when separated from their children and that this anxiety was alleviated upon reuniting with their children [44]. Furthermore, parents noted increased comfort when actively participating in morning rounds [29] and monitoring their child's behavior in the PICU room [40].

A positive physical response is an outcome of the partnership in the child’s care. The involvement of parents in daily care facilitates increased breastfeeding among mothers, leading to enhanced infant weight gain [37,38,43]. Moreover, findings from an experimental study revealed a shorter average length of stay for children, specifically fewer than 12 days [32], and a diminished risk of complications like bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis [43].

Theme 3: factors that influence partnerships

Factors influencing partnerships can be categorized into two main types: internal and external. Internal factors include elements such as parents' and care providers' knowledge, care providers' attitudes, the trust relationship, parents' confidence and the child's condition (Table 5). Some parents opted not to participate in care due to a lack of knowledge about what tasks to perform [29,34]. This lack of knowledge can also impact parents' self-confidence [38,39]. Furthermore, care providers' knowledge is considered a crucial internal factor in the partnership. Two studies highlighted that nurses' deficiencies in knowledge, skills or experience in collaborating with parents could lead to conflicts [31,37]. Additionally, a child's evolving or unstable condition is another internal factor that plays a vital role in influencing parents' decisions to participate in care [34,35,36,40]. External factors encompass policy, the environment and human resources. Ambiguity in policies within the PICU/NICU can restrict parents' engagement in care [39,45]. The physical environment of the PICU/NICU and the prevailing culture within it also serve as predictors of parental involvement [31,35]. Finally, having enough care providers, such as nurses, is essential to support the implementation of nurse–mother partnerships in daily care [34].

DISCUSSION

Participation in care emerged as the most frequently highlighted component in the 18 studies under review. This observation aligns with earlier studies emphasizing that parental participation or involvement in the care of critically ill children is a pivotal aspect of partnership in this context [20]. The findings of the present analysis reveal that parents were actively engaged in daily rounds, providing primary care and monitoring the child's condition. This active involvement was deemed supportive and enriching for parents in their childcare role within the context of the PICU/NICU [20,30].

Compassion and respect stand out as the primary characteristics of partnership in this setting [48]. Compassion encompasses human traits involved in caring for children or building relationships with others, such as kindness, gentleness and empathy [49]. On the other hand, respect denotes the attitude or behavior of valuing and appreciating others, particularly patients and their families [50,51]. In the context of caring for children with critical illnesses, providing care providers with compassion and respect emerges as an essential component for parents [44,41].

Information is a crucial element for parents during their children's admission to the PICU. The American College of Critical Care Medicine recommends a meeting between care providers and families to convey information regarding the patient's condition within 24–48 hours after admission to the ICU [52]. Parents desire nurses to offer transparent and honest information about the child's condition, explaining procedures and addressing their specific concerns [38,53]. Mothers recognize that receiving up-to-date information from nurses can enhance the partnership [36,54]. Furthermore, the information parents receive is vital in helping them make informed decisions regarding their child's treatment [55].

The implementation of partnerships in the care of critically ill children has a positive impact on both children and their parents. The mother's active participation in care, particularly through skin-to-skin contact, facilitates direct breastfeeding, allowing her to provide essential breast milk to her baby [37,39]. Breast milk is rich in macronutrients, including proteins, fats and carbohydrates, which can significantly contribute to increased body weight in premature infants [56,57]. Additionally, breast milk contains various bioactive molecules such as immunoglobulins, hormones, growth factors, antimicrobials and immune cells. These components play a crucial role in safeguarding the infant's body from complications such as necrotizing enterocolitis, sepsis, retinopathy of prematurity, chronic lung disease and neurological disorders [58-61]. Reducing complications among premature infants also decreases the length of stay and overall NICU care cost [62].

Involving parents as partners in the ICU positively impacts the child and has beneficial effects on the parents. Providing information through education by nurses contributes to increased understanding, satisfaction and self-efficacy, while concurrently reducing stress in parents [29,30,33]. The findings of this study align with previous research, which reports that partnerships in child care lead to heightened parental satisfaction and self-efficacy while alleviating anxiety in parents [63].

Various factors influence the implementation of partnerships. A qualitative study noted that some parents hesitated to engage in their child's care in the PICU due to a lack of knowledge about what actions to take [34]. Providing bedside teaching support can enhance parents' confidence in caring for their children [38]. This boost in parental confidence increases willingness to participate in care [64]. Moreover, nurses, serving as a primary source of information for parents, must possess a strong foundation in knowledge and basic critical skills [65]. A deficiency in these aspects may lead to bedside conflicts [37]. Partnerships are strengthened when parents place trust in nurses to care for their children, and, in turn, nurses believe that parents can provide direct care to their children under supervision [36]. Parents also trust in nurses' abilities to provide care and perceive them as credible and reliable experts [66]. Conversely, nurses have confidence in parents' ability to cooperate and be effective partners in caring for their children [67].

The lack of clarity in policies within the PICU/NICU can restrict parents' involvement in care [39,45,68]. A qualitative study found that nurses and parents perceived rigid visitation times as barriers to partnership [69]. Some parents preferred unrestricted visitation policies, ideally available 24 hours a day [70]. Moreover, Ramirez et al. [2] revealed that aspects of the physical environment in the PICU/NICU, such as strong odors, lights and monitor sounds, act as stressors for parents. These stressors pose barriers to parents' active participation in care. Finally, the inadequacy of care providers is considered ineffective in implementing partnerships [34,38]. Nurses, as crucial contributors to promoting parental participation, must be available in sufficient numbers and possess competency. The required number of nurses is determined based on the available number of beds and the workload level in the ICU [71].

A limitation of this study is the requirement for articles explicitly covering "partnership in pediatric nursing with critical illness." Currently, literature specifically addressing the partnership between nurses and parents in the PICU or NICU is limited. Further, the outcomes of the article search primarily focused on family-centered care and family-integrated care models; however, it is noteworthy that both models emphasize the pivotal aspect of parental involvement in care, which serves as the cornerstone of the partnership [20]. Subjectivity may still be a possibility, especially in the synthesis and interpretation of results, even though three authors were involved in the screening, selection, research quality assessment and data-extraction procedures to lower the risk of individual bias.

Based on the findings of this study, several recommendations can be made. In particular, there is a need for a PICU policy that regulates parents' presence at the patient's bedside. This policy should be formulated based on the needs of patients and their parents, with a primary focus on patient well-being and parental support. Additionally, further research is essential to develop a partnership model that emphasizes parents as integral partners for nurses in nursing care for children with critical illnesses. The active involvement of parents in their child's daily care is imperative for the successful implementation of partnerships in nursing.

In conclusion, a proper partnership involving parents encompasses four main components: participation in care, caring, information and decision-making. The impact of its implementation is anticipated to include increased understanding, heightened satisfaction, enhanced self-efficacy, improved interpersonal relationships and positive psychological responses for parents. Furthermore, existing empirical evidence underscores the importance of understanding the influencing factors in this context.

KEY MESSAGES

▪ Active involvement of parents in critical care delivery, which includes participation in daily rounds, basic caregiving tasks and monitoring of the child's condition, emerges as an essential imperative.

▪ Adopting a parent partnership-oriented approach to nursing practice in pediatric critical care settings is an appropriate strategy to alleviate the psychological burden that parents experience in critical situations.

NOTES

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

The Indonesian Education Scholarship funded this research under the auspices of the Education Fund Management Agency, Ministry of Finance, Republic of Indonesia (LPDP Scholarship).

ACKNOWLEDGMENTS

We are grateful to the Republic of Indonesia's Ministry of Finance for providing the first author with the Education Fund Management Agency (LPDP Scholarship), which allowed her to finish this study. Also acknowledged by the authors for their invaluable assistance with the research are Universitas Indonesia and Universitas Hasanuddin.

While preparing this work, the authors used ChatGPT, which OpenAI developed, and QuillBot to proofread and paraphrase. After using this tool/service, the authors reviewed and edited the content as needed, and they take full responsibility for the publication’s content.

AUTHOR CONTRIBUTIONS

Conceptualization: TS, NN, DW. Methodology: TS NN, DW. Formal analysis: TS NN, DW. Data curation: TS NN, DW. Visualization: TS. Funding acquisition: TS. Writing - original draft: TS NN, DW. Writing - review & editing: TS. All authors read and agreed to the published version of the manuscript.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart.

Figure 2.

Conceptual model of partnership in nursing for critically ill children.

Table 1.

Stages of an integrative review

Stage	Description
1	Writing down the research question
2	Determine article search strategy
3	Assessing the quality of the article (critical appraisal)
4	Summarize search results
5	Perform data extraction
6	Conduct analysis
7	Write nursing conclusions and implications

Table 2.

Article search description

Article search	Description
Database	ScienceDirect, Scopus, ProQuest, Sage Journals, PubMed, and Google Scholar
Keyword	("partnership model" OR "parent partnership" OR "parent involvement" OR "parent participation" OR "parent collaboration") AND ("critical illness" OR "critical care") AND (children OR pediatric)
Year of publication	January 2014 to December 2023
Article type	Research article
Source type	Scientific journal

Table 3.

Data extraction of included articles

Study/country	Research objective	Setting	Design	Sample	Implementation	Implementation overview	Result
Skene et al. (2019) [39]/England	Develop, implement, and evaluate family-centered interventions to promote parental involvement in caregiving in the neonatal intensive care unit	NICU	A participatory action research approach	Nurses (n=109) and parents aged ≥18 (n=80)	Family-centered care	Parental involvement in infant care through increased skin-to-skin contact and parental presence at the patient's bedside	· There was increased family involvement in decision-making, increased provision of information and support, and increased competencies that support parents in providing care to their infants.
Stickney et al. (2014) [29]/United States	To compare perceptions, goals, and expectations of healthcare providers and parents regarding parent participation in morning rounds and targeting specific areas of opportunity for educational intervention	PICU	Qualitative with semi-structured interviews	Parents (n=21) and health workers (n=24)	Family participation	Parental presence at the child's bedside during morning rounds	· Parents are comfortable and happy to be involved in regular rounds or meetings.
							· Parents expect accurate information about their child's disease.
							· Healthcare providers consider that the presence of parents can improve the efficiency of communication in care
Uhm and Kim (2019) [33]/South Korea	To evaluate the impact of the mother-nurse partnership program on parental satisfaction, parental self-efficacy, perceptions of Partnership, and maternal anxiety	PCICU	Quasi-experimental	Infants and their mothers; intervention group (n=36) and control group (n=37)	Mother-nurse partnership program	The mother-nurse partnership program focused on information sharing, negotiation, and participation in care	· There was a significant increase in parental satisfaction, self-efficacy, perceived Partnership, and lower anxiety in the intervention group compared to the control group.
Gustafson et al. (2016) [30]/United States	To evaluate the effect of parental presence during multidisciplinary rounds on NICU-related parental stress	NICU	Quasi-experimental	Baby's parents (n=132)	Parental presence during multidisciplinary rounds	Implementation involves the presence of parents during multidisciplinary rounds in the NICU. Parents participate in discussions related to their baby's health condition.	· Reduced parental stress levels
Gustafson et al. (2016) [30]/United States		NICU	Quasi-experimental	Baby's parents (n=132)	Parental presence during multidisciplinary rounds		· Improved parental understanding of their baby's health condition, involvement in decision-making, and feeling more connected to the healthcare team.
O’Brien et al. (2018) [37]/Canada	To analyze the effect of FICare on outcomes in infants and parents	NICU	Cluster-randomized controlled trial	Infants and their parents; intervention group (n=895) and control group (n=891)	FICare	FICare implementation focuses on education programs (small group education, bedside parent coaching, parent involvement in medical rounds), psychosocial support to parents, and staff training programs with education on the importance of family involvement in infant care.	· Significant increase in infant weight and exclusive breastfeeding
O’Brien et al. (2018) [37]/Canada		NICU	Cluster-randomized controlled trial		FICare		· Significant reduction in parents' stress and anxiety levels while in the NICU.
Uhm and Choi (2019) [34]/South Korea	To investigate the needs of mothers in forming partnerships with nurses based on postoperative recovery in the pediatric cardiac intensive care unit	PCICU	Descriptive study	A total of 36 mothers enrolled in the mother-nurse partnership program	Mother and nurse partnership	The program engages nurses to identify what mothers can do or want at each phase of the baby's recovery and encourages mothers to participate in care.	· Mothers want open and transparent communication, precise and easy-to-understand information, ongoing emotional support from nurses, and involvement in the baby's care while in the PCICU.
Hill et al. (2019) [31]/United States	To examine parents' perceptions of how the physical and cultural environment of the pediatric intensive care unit impacts the implementation of family-centered care	PICU	Qualitative with secondary analysis	Parents of infants with complex congenital heart defects (n=3)	Family-centered care	Implementation of family-centered care that focuses on the core components of information sharing, participation, respect, and dignity	· Parents revealed that the physical and cultural environment of the PICU had a significant impact on the delivery of the core components of family-centered care.
Hill et al. (2019) [31]/United States		PICU	Qualitative with secondary analysis		Family-centered care		· Parents consider open communication and active involvement in care as essential factors in the delivery of family-centered care.
Craske et al. (2019) [40]/England	To explore parents' experiences of dealing with withdrawal syndrome in their child and preferences for involvement and participation in withdrawal assessment	PICU	Qualitative	Parents of children aged 0–5 years who have completed sedation weaning (n=11)	Partnership between nurses and parents	Implementation focuses on involving parents by nurses in the process of assessing their child's withdrawal syndrome.	· Parents experience a range of emotions and challenges when dealing with withdrawal syndrome in their children.
Craske et al. (2019) [40]/England		PICU	Qualitative		Partnership between nurses and parents		· Parents' experience in dealing with withdrawal syndrome encourages a mutually beneficial partnership between nurses and parents.
Kim et al. (2020) [35]/South Korea	To identify the association of family-centered quality of care and NICU environmental stressors with maternal postpartum attachment	NICU	Cross-sectional	Mothers of premature/low birth weight infants (n=294)	Family-centered care	Implementation focused on evaluating the family‑ centered care received by the infant's mother and involved measuring environmental stress during her child's stay in the NICU.	· The quality of family-centered care and environmental stressors in the NICU can affect mothers' experiences, psycho-emotional well-being, and emotional attachment to their infants.
Taranto et al. (2022) [44]/Australia	To explore parents' experiences of FCC during non-clinical delays in the PACU	PACU	Qualitative	A total of 15 parents of 10 children were admitted to the PACU	Family-centered care	The implementation of this research focuses on exploring parents' understanding of the implementation of FCC at PACU.	· Parents' experiences of non-clinical delays focused on the three essential elements of the FCC: respect and dignity, information sharing, and participation.
Park and Oh (2022) [36]/South Korea	To investigate how PICU nurses and mothers of hospitalized children perceive their Partnership and identify detailed differences regarding common partnership domains	PICU	Qualitative	Mothers of children admitted to the PICU (n=7) and nurses who have worked in the PICU for more than 2 years (n=12)	The partnership between nurse and mother	The study was conducted by exploring the perceptions of nurses and mothers regarding the implementation of partnerships that they felt during their time in the PICU through face-to-face and telephone semi-structured interviews.	· The partnership domain consists of expectations of trust, information sharing and communication, participation in care, equality in the relationship, and coordination.
Park and Oh (2022) [36]/South Korea		PICU	Qualitative		The partnership between nurse and mother		· Parents want an equal partnership with nurses, while nurses prefer a robust and nurse-led partnership.
Lv et al. (2019) [43]/China	To evaluate family-centered care interventions on clinical outcomes of deficient birth weight infants	NICU	Quasi-experimental	Three hundred nineteen infants and their parents; intervention group (n=156) and control group (n=163)	Family-centered care	Implementing FCC involves parents' participation in care for 4 hours a day. Parents are taught about primary care, infant development, hand hygiene, feeding methods, skin-to-skin contact, and infection control.	· Increased baby weight at hospital discharge
							· Nutrition outcomes improved: breastfeeding rate, parenteral nutrition days, and gastric feeding days
							· Length of hospitalization and hospital charges did not differ between the two groups.
							· The incidence of complications in infants was lower in the intervention group compared to the control group
van den Hoogen et al. (2021) [41]/Netherlands	To explore parents' experiences of involvement in the VOICE program during their baby's stay in the NICU	NICU	Qualitative	A total of 13 parents of 11 infants born at <27 wk gestation (nine mothers and two mother-father pairs)	VOICE program	The program was developed to support and empower parents who have babies admitted to the NICU. The VOICE program includes at least five structured one-on-one meetings between parents, nurses, and other health professionals from birth, NICU, and follow-up.	· Parents feel strengthened and empowered in developing their role as primary caregivers.
van den Hoogen et al. (2021) [41]/Netherlands		NICU	Qualitative		VOICE program		· The VOICE program helps to increase parental involvement in parenting, improve parents' understanding of their baby's condition, increase parents' confidence, and reduce anxiety.
Ferreira et al. (2021) [38]/Canada	To explore parents' views on strengthening partnerships in infant care in the NICU	NICU	Qualitative	Baby's parents (n=10) consisted of 9 mothers and one father	Partnership between parents and health professionals	The research explored parents' perspectives, experiences, and expectations regarding Partnership in infant care in the NICU.	Essential factors in strengthening partnerships are
							· Interactions and communication strategies of parents and staff
							· Supportive healthcare professionals
							· Consistency in care and staffing
							· Family, partner, and peer support
							· Newborn status
							· Resources and education for parents
							· NICU Environment
							· Academic and research participation
Aija et al. (2019) [45]/Countries in Europe	To evaluate parents' attendance and their level of participation in discussions during medical rounds in 11 NICUs in Europe	NICU	Survey	A total of 241 families of premature infants (211 mothers and 144 father)	Parent attendance and participation	Parents were invited to attend and participate in a medical roundtable session involving care teams and doctors in 11 NICUs across Europe.	· Maternal attendance in medical rounds is higher than paternal attendance
							· Parental attendance increases with increasing gestational age, paternal education, and NICU room policy
							· High participation during medical rounds is associated with high levels of other FCC attributes
Michelson et al. (2020) [32]/United States	To compare the outcomes reported by parents who received the navigator-based support intervention (PICU Support) with parents who received the information brochure	PICU	Randomized trial	A total of 382 parents (intervention group=190, and control group=192)	PICU navigator-based parent support	PICU support involves adding a trained navigator to the patient's healthcare team to provide emotional support, communication, decision-making, information, and transition support	· The main results showed that the average score was excellent on the level of family satisfaction in terms of the decision-making component in the intervention group compared to the control group.
Michelson et al. (2020) [32]/United States		PICU	Randomized trial		PICU navigator-based parent support		· Secondary outcomes included parental psychological and physical morbidity and perceived team communication.
Cheng et al. (2021) [46]/Canada, Australia, and New Zealand	To identify how FICare affects maternal stress and anxiety	NICU	Cluster randomized controlled trial	Infant mothers (n=1,383) consisting of the intervention group (n=710) and control group (n=673)	FICare	The FICare model intervention consists of four pillars, including parent education, NICU team education and support, parent environmental support, and parent psychosocial support.	FICare significantly reduced the level of stress and anxiety in mothers, especially stress related to the role of parents in the NICU environment and the state anxiety subscale.
van Veenendaal et al. (2022) [42]/Netherlands	To determine the association of the FICare model with mental health outcomes in fathers while their babies are hospitalized	NICU	Cohort study	A total of 182 fathers of premature infants consisted of 89 in the FICare group and 93 in the standard care group	FICare	The FICare model is provided to parents where infants are cared for with mothers in the same family room, and fathers can continue to accompany them while in care.	· Fathers in the FICare group experienced less stress and had higher participation scores than those in the standard care group.
van Veenendaal et al. (2022) [42]/Netherlands		NICU	Cohort study		FICare		· Indirectly, fathers' participation had a favorable association between the FICare model and fathers' depressive symptoms and bonding with their newborns.

NICU: neonatal intensive care unit; PICU: pediatric intensive care unit; PCICU: pediatric cardiac intensive care unit; FICare: family integrated care; FCC: family-centered care; PACU: post-anaesthetic care unit; VOICE: Values, Opportunities, Integration, Control, and Evaluation.

Table 4.

Instrument quality assessment using the MMAT version 2018

Study
1. Qualitative study	1.1. Is a qualitative approach appropriate to answer the research question?	1.2. Are the qualitative data collection methods adequate to answer the research questions?	1.3. Are the findings adequately derived from the data?	1.4. Is the interpretation of the results sufficiently supported by the data?	1.5. Is there coherence between qualitative data sources, collection, analysis, and interpretation?
Stickney et al. (2014) [29]	Yes	Yes	Yes	Yes	Yes
Hill et al. (2019) [31]	Yes	Yes	Yes	Yes	Yes
Craske et al. (2019) [40]	Yes	Yes	Yes	Yes	Yes
Taranto et al. (2022) [44]	Yes	Yes	Yes	Yes	Yes
Park and Oh (2022) [36]	Yes	Yes	Yes	Yes	Yes
van den Hoogen et al. (2021) [41]	Yes	Yes	Yes	Yes	Yes
Ferreira et al. (2021) [38]	Yes	Yes	Yes	Yes	Yes
2. RCT study	2.1 Is randomization done appropriately	2.2 Are the groups comparable at the start?	2.3 Is there complete outcome data?	2.4. Are outcome assessors not blinded by the intervention?	2.5 Did the participants adhere to the intervention?
O’Brien et al. (2018) [37]	Yes	Yes	Yes	Not clear	Yes
Michelson et al. (2020) [32]	Yes	Yes	Yes	No	Yes
Cheng et al. (2021) [46]	Yes	Yes	Yes	No	Yes
3. Non-RCT study	3.1. Are the participants representative of the target population?	3.2. Does the measurement match the outcome and intervention (or exposure)?	3.3. Is there complete outcome data?	3.4. Were confounders taken into account in the design and analysis?	3.5. During the study period, was the intervention provided (or exposure occurred) as intended?
Uhm and Kim (2019) [33]	Yes	Yes	Yes	Yes	Yes
Gustafson et al. (2016) [30]	Yes	Yes	Yes	Yes	Yes
Lv et al. (2019) [43]	Yes	Yes	Yes	No	Yes
van Veenendaal et al. (2022) [42]	Yes	Yes	Yes	Yes	Yes
Kim et al. (2020) [35]	Yes	Yes	Yes	Yes	Yes
4. Descriptive study	4.1. Is the sampling strategy relevant to answering the research question?	4.2. Is the sample representative of the target population?	4.3. Is the measurement appropriate?	4.4. Is the risk of nonresponse bias low?	4.5. Is the statistical analysis appropriate to answer the research question?
Uhm and Choi, (2019) [34]	Yes	Yes	Yes	Not clear	Yes
Aija et al. (2019) [45]	Yes	Yes	Not clear	Yes	Yes
5. A mixed-methods study	5.1. Is there a sufficient reason to use a mixed methods design to answer the research question?	5.2. Are the various components of the research effectively integrated to answer the research question?	5.3. Are the outputs from integrating qualitative and quantitative components adequately interpreted?	5.4. Have differences and inconsistencies between quantitative and qualitative results been adequately addressed?	5.5. Do the different components of the study adhere to the quality criteria of each method tradition involved?
Skene et al. (2019) [39]	Yes	Yes	Yes	Yes	Not clear

MMAT: mixed methods appraisal tool; RCT: randomized controlled trial.

Table 5.

Themes, sub-themes, and categories

Theme	Sub-theme	Category	Description	Reference
Partnership components	Participation in care	Round	Parents attend and participate in medical rounds or daily rounds	[30-32,37-39,41,42, 45]
		Round	Parental presence at the child's bedside during morning and evening rounds	[29,31]
		Basic care	Parents are involved in infant care, such as bathing, dressing, changing diapers, oral care, administering oral medication, changing bed linens, and providing positioning.	[31,34,36-39,42-44]
		Basic care	Providing touch (skin-to-skin contact)	[39,37,38,41-43]
		Monitoring	Parents are involved in assessing the child's behavior after weaning from sedation.	[40]
			Take the child's temperature	[37,43]
			Newborn monitoring	[42]
	Caring	Compassion	Staff demonstrating compassion, kindness, and caring attitudes.	[41,44]
			Emotional bonding between parents and children, such as maintaining eye contact or calling the child by name	[34]
			Increased interaction between father and baby triggers more substantial emotional reciprocity	[42]
		Respect	Parents feel valued and respected.	[31,38,41,44]
		Respect	Information is delivered carefully to avoid inconvenience.	[36]
	Information	Type of information	Providing information regarding the infant/child's condition, procedure, primary care, diagnosis, prognosis, treatment plan, and anything the parents would like to know.	[29,33,34,36,38-41,44]
		Type of information	Overview of the program/rounds to be implemented, introduction to the room and staff, and their respective roles	[30,33]
		Information Sharing	Parents are allowed to exchange information with the care team.	[30,31,39,40]
	Decision making	Shared decision	Parents are involved in decision-making with health professionals.	[30,32,34,37,40-42,46]
	Decision making	Shared decision	Parents want time to decide on a course of action.	[38]
Partnership outcomes	Outcomes for parents	Understanding	Improving parents' understanding	[29,30]
		Satisfaction	Increased parental satisfaction	[29,32,33,39]
		Interpersonal relationships	Increase bonding between mother and baby/child	[34,35,38]
			Improving relationships between parents and care providers	[30,33,36]
			Creating relationships and mutual support with other parents	[38,41]
		Psychological response	Parents feel safer and more comfortable.	[29,30,38,40,44]
		Psychological response	Reduces stress, anxiety, and trauma in parents	[30,33,35,37,42,44,46]
		Self-efficacy	Improve parents' self-efficacy, self-confidence, and self-control	[30,33,38,41]
	Outcomes in children	Physical response	Getting more breast milk and baby/child weight gain	[37,38,43]
	Outcomes in children	Physical response	Reduce length of stay and complications.	[32,43]
Factors that influence partnerships	Internal factors	Knowledge	Teaching support to parents when at the child's bedside	[37,38,40]
			Ignorance (confusion) in parents	[29,34]
			Knowledge, skills, or experience possessed by the care provider	[31,37]
		Attitude	Attitude of the care provider	[38,41]
		Trust-relationship	Mutual trust between parents and caregivers	[34,36]
		Trust-relationship	Transparency from the care provider team	[29]
		Self-confidence	The confidence that parents have to be involved in care	[38,39]
		Child condition	The child's condition changes or becomes unstable.	[34-36,40]
	External factors	Policy	PICU/NICU room policy	[39,45,46]
		PICU/NICU environment	The physical environment of the PICU/NICU influences parental engagement	[31,35,38]
		PICU/NICU environment	Traditions or culture within the PICU/NICU environment	[31,35,39]
		Number of human resources	Number of nurses or care providers	[34,38]

PICU: pediatric intensive care unit; NICU: neonatal intensive care unit.

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Implementation of a partnership involving parents in the care of critically ill children: an integrative review

Acute Crit Care. 2025;40(4):521-537. Published online November 24, 2025

DOI: https://doi.org/10.4266/acc.001896

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Implementation of a partnership involving parents in the care of critically ill children: an integrative review

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart.

Figure 2. Conceptual model of partnership in nursing for critically ill children.

Graphical abstract

Figure 1.

Figure 2.

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Implementation of a partnership involving parents in the care of critically ill children: an integrative review

Stage	Description
1	Writing down the research question
2	Determine article search strategy
3	Assessing the quality of the article (critical appraisal)
4	Summarize search results
5	Perform data extraction
6	Conduct analysis
7	Write nursing conclusions and implications

Article search	Description
Database	ScienceDirect, Scopus, ProQuest, Sage Journals, PubMed, and Google Scholar
Keyword	("partnership model" OR "parent partnership" OR "parent involvement" OR "parent participation" OR "parent collaboration") AND ("critical illness" OR "critical care") AND (children OR pediatric)
Year of publication	January 2014 to December 2023
Article type	Research article
Source type	Scientific journal

Study/country	Research objective	Setting	Design	Sample	Implementation	Implementation overview	Result
Skene et al. (2019) [39]/England	Develop, implement, and evaluate family-centered interventions to promote parental involvement in caregiving in the neonatal intensive care unit	NICU	A participatory action research approach	Nurses (n=109) and parents aged ≥18 (n=80)	Family-centered care	Parental involvement in infant care through increased skin-to-skin contact and parental presence at the patient's bedside	· There was increased family involvement in decision-making, increased provision of information and support, and increased competencies that support parents in providing care to their infants.
Stickney et al. (2014) [29]/United States	To compare perceptions, goals, and expectations of healthcare providers and parents regarding parent participation in morning rounds and targeting specific areas of opportunity for educational intervention	PICU	Qualitative with semi-structured interviews	Parents (n=21) and health workers (n=24)	Family participation	Parental presence at the child's bedside during morning rounds	· Parents are comfortable and happy to be involved in regular rounds or meetings.
							· Parents expect accurate information about their child's disease.
							· Healthcare providers consider that the presence of parents can improve the efficiency of communication in care
Uhm and Kim (2019) [33]/South Korea	To evaluate the impact of the mother-nurse partnership program on parental satisfaction, parental self-efficacy, perceptions of Partnership, and maternal anxiety	PCICU	Quasi-experimental	Infants and their mothers; intervention group (n=36) and control group (n=37)	Mother-nurse partnership program	The mother-nurse partnership program focused on information sharing, negotiation, and participation in care	· There was a significant increase in parental satisfaction, self-efficacy, perceived Partnership, and lower anxiety in the intervention group compared to the control group.
Gustafson et al. (2016) [30]/United States	To evaluate the effect of parental presence during multidisciplinary rounds on NICU-related parental stress	NICU	Quasi-experimental	Baby's parents (n=132)	Parental presence during multidisciplinary rounds	Implementation involves the presence of parents during multidisciplinary rounds in the NICU. Parents participate in discussions related to their baby's health condition.	· Reduced parental stress levels
Gustafson et al. (2016) [30]/United States		NICU	Quasi-experimental	Baby's parents (n=132)	Parental presence during multidisciplinary rounds		· Improved parental understanding of their baby's health condition, involvement in decision-making, and feeling more connected to the healthcare team.
O’Brien et al. (2018) [37]/Canada	To analyze the effect of FICare on outcomes in infants and parents	NICU	Cluster-randomized controlled trial	Infants and their parents; intervention group (n=895) and control group (n=891)	FICare	FICare implementation focuses on education programs (small group education, bedside parent coaching, parent involvement in medical rounds), psychosocial support to parents, and staff training programs with education on the importance of family involvement in infant care.	· Significant increase in infant weight and exclusive breastfeeding
O’Brien et al. (2018) [37]/Canada		NICU	Cluster-randomized controlled trial		FICare		· Significant reduction in parents' stress and anxiety levels while in the NICU.
Uhm and Choi (2019) [34]/South Korea	To investigate the needs of mothers in forming partnerships with nurses based on postoperative recovery in the pediatric cardiac intensive care unit	PCICU	Descriptive study	A total of 36 mothers enrolled in the mother-nurse partnership program	Mother and nurse partnership	The program engages nurses to identify what mothers can do or want at each phase of the baby's recovery and encourages mothers to participate in care.	· Mothers want open and transparent communication, precise and easy-to-understand information, ongoing emotional support from nurses, and involvement in the baby's care while in the PCICU.
Hill et al. (2019) [31]/United States	To examine parents' perceptions of how the physical and cultural environment of the pediatric intensive care unit impacts the implementation of family-centered care	PICU	Qualitative with secondary analysis	Parents of infants with complex congenital heart defects (n=3)	Family-centered care	Implementation of family-centered care that focuses on the core components of information sharing, participation, respect, and dignity	· Parents revealed that the physical and cultural environment of the PICU had a significant impact on the delivery of the core components of family-centered care.
Hill et al. (2019) [31]/United States		PICU	Qualitative with secondary analysis		Family-centered care		· Parents consider open communication and active involvement in care as essential factors in the delivery of family-centered care.
Craske et al. (2019) [40]/England	To explore parents' experiences of dealing with withdrawal syndrome in their child and preferences for involvement and participation in withdrawal assessment	PICU	Qualitative	Parents of children aged 0–5 years who have completed sedation weaning (n=11)	Partnership between nurses and parents	Implementation focuses on involving parents by nurses in the process of assessing their child's withdrawal syndrome.	· Parents experience a range of emotions and challenges when dealing with withdrawal syndrome in their children.
Craske et al. (2019) [40]/England		PICU	Qualitative		Partnership between nurses and parents		· Parents' experience in dealing with withdrawal syndrome encourages a mutually beneficial partnership between nurses and parents.
Kim et al. (2020) [35]/South Korea	To identify the association of family-centered quality of care and NICU environmental stressors with maternal postpartum attachment	NICU	Cross-sectional	Mothers of premature/low birth weight infants (n=294)	Family-centered care	Implementation focused on evaluating the family‑ centered care received by the infant's mother and involved measuring environmental stress during her child's stay in the NICU.	· The quality of family-centered care and environmental stressors in the NICU can affect mothers' experiences, psycho-emotional well-being, and emotional attachment to their infants.
Taranto et al. (2022) [44]/Australia	To explore parents' experiences of FCC during non-clinical delays in the PACU	PACU	Qualitative	A total of 15 parents of 10 children were admitted to the PACU	Family-centered care	The implementation of this research focuses on exploring parents' understanding of the implementation of FCC at PACU.	· Parents' experiences of non-clinical delays focused on the three essential elements of the FCC: respect and dignity, information sharing, and participation.
Park and Oh (2022) [36]/South Korea	To investigate how PICU nurses and mothers of hospitalized children perceive their Partnership and identify detailed differences regarding common partnership domains	PICU	Qualitative	Mothers of children admitted to the PICU (n=7) and nurses who have worked in the PICU for more than 2 years (n=12)	The partnership between nurse and mother	The study was conducted by exploring the perceptions of nurses and mothers regarding the implementation of partnerships that they felt during their time in the PICU through face-to-face and telephone semi-structured interviews.	· The partnership domain consists of expectations of trust, information sharing and communication, participation in care, equality in the relationship, and coordination.
Park and Oh (2022) [36]/South Korea		PICU	Qualitative		The partnership between nurse and mother		· Parents want an equal partnership with nurses, while nurses prefer a robust and nurse-led partnership.
Lv et al. (2019) [43]/China	To evaluate family-centered care interventions on clinical outcomes of deficient birth weight infants	NICU	Quasi-experimental	Three hundred nineteen infants and their parents; intervention group (n=156) and control group (n=163)	Family-centered care	Implementing FCC involves parents' participation in care for 4 hours a day. Parents are taught about primary care, infant development, hand hygiene, feeding methods, skin-to-skin contact, and infection control.	· Increased baby weight at hospital discharge
							· Nutrition outcomes improved: breastfeeding rate, parenteral nutrition days, and gastric feeding days
							· Length of hospitalization and hospital charges did not differ between the two groups.
							· The incidence of complications in infants was lower in the intervention group compared to the control group
van den Hoogen et al. (2021) [41]/Netherlands	To explore parents' experiences of involvement in the VOICE program during their baby's stay in the NICU	NICU	Qualitative	A total of 13 parents of 11 infants born at <27 wk gestation (nine mothers and two mother-father pairs)	VOICE program	The program was developed to support and empower parents who have babies admitted to the NICU. The VOICE program includes at least five structured one-on-one meetings between parents, nurses, and other health professionals from birth, NICU, and follow-up.	· Parents feel strengthened and empowered in developing their role as primary caregivers.
van den Hoogen et al. (2021) [41]/Netherlands		NICU	Qualitative		VOICE program		· The VOICE program helps to increase parental involvement in parenting, improve parents' understanding of their baby's condition, increase parents' confidence, and reduce anxiety.
Ferreira et al. (2021) [38]/Canada	To explore parents' views on strengthening partnerships in infant care in the NICU	NICU	Qualitative	Baby's parents (n=10) consisted of 9 mothers and one father	Partnership between parents and health professionals	The research explored parents' perspectives, experiences, and expectations regarding Partnership in infant care in the NICU.	Essential factors in strengthening partnerships are
							· Interactions and communication strategies of parents and staff
							· Supportive healthcare professionals
							· Consistency in care and staffing
							· Family, partner, and peer support
							· Newborn status
							· Resources and education for parents
							· NICU Environment
							· Academic and research participation
Aija et al. (2019) [45]/Countries in Europe	To evaluate parents' attendance and their level of participation in discussions during medical rounds in 11 NICUs in Europe	NICU	Survey	A total of 241 families of premature infants (211 mothers and 144 father)	Parent attendance and participation	Parents were invited to attend and participate in a medical roundtable session involving care teams and doctors in 11 NICUs across Europe.	· Maternal attendance in medical rounds is higher than paternal attendance
							· Parental attendance increases with increasing gestational age, paternal education, and NICU room policy
							· High participation during medical rounds is associated with high levels of other FCC attributes
Michelson et al. (2020) [32]/United States	To compare the outcomes reported by parents who received the navigator-based support intervention (PICU Support) with parents who received the information brochure	PICU	Randomized trial	A total of 382 parents (intervention group=190, and control group=192)	PICU navigator-based parent support	PICU support involves adding a trained navigator to the patient's healthcare team to provide emotional support, communication, decision-making, information, and transition support	· The main results showed that the average score was excellent on the level of family satisfaction in terms of the decision-making component in the intervention group compared to the control group.
Michelson et al. (2020) [32]/United States		PICU	Randomized trial		PICU navigator-based parent support		· Secondary outcomes included parental psychological and physical morbidity and perceived team communication.
Cheng et al. (2021) [46]/Canada, Australia, and New Zealand	To identify how FICare affects maternal stress and anxiety	NICU	Cluster randomized controlled trial	Infant mothers (n=1,383) consisting of the intervention group (n=710) and control group (n=673)	FICare	The FICare model intervention consists of four pillars, including parent education, NICU team education and support, parent environmental support, and parent psychosocial support.	FICare significantly reduced the level of stress and anxiety in mothers, especially stress related to the role of parents in the NICU environment and the state anxiety subscale.
van Veenendaal et al. (2022) [42]/Netherlands	To determine the association of the FICare model with mental health outcomes in fathers while their babies are hospitalized	NICU	Cohort study	A total of 182 fathers of premature infants consisted of 89 in the FICare group and 93 in the standard care group	FICare	The FICare model is provided to parents where infants are cared for with mothers in the same family room, and fathers can continue to accompany them while in care.	· Fathers in the FICare group experienced less stress and had higher participation scores than those in the standard care group.
van Veenendaal et al. (2022) [42]/Netherlands		NICU	Cohort study		FICare		· Indirectly, fathers' participation had a favorable association between the FICare model and fathers' depressive symptoms and bonding with their newborns.

Study
1. Qualitative study	1.1. Is a qualitative approach appropriate to answer the research question?	1.2. Are the qualitative data collection methods adequate to answer the research questions?	1.3. Are the findings adequately derived from the data?	1.4. Is the interpretation of the results sufficiently supported by the data?	1.5. Is there coherence between qualitative data sources, collection, analysis, and interpretation?
Stickney et al. (2014) [29]	Yes	Yes	Yes	Yes	Yes
Hill et al. (2019) [31]	Yes	Yes	Yes	Yes	Yes
Craske et al. (2019) [40]	Yes	Yes	Yes	Yes	Yes
Taranto et al. (2022) [44]	Yes	Yes	Yes	Yes	Yes
Park and Oh (2022) [36]	Yes	Yes	Yes	Yes	Yes
van den Hoogen et al. (2021) [41]	Yes	Yes	Yes	Yes	Yes
Ferreira et al. (2021) [38]	Yes	Yes	Yes	Yes	Yes
2. RCT study	2.1 Is randomization done appropriately	2.2 Are the groups comparable at the start?	2.3 Is there complete outcome data?	2.4. Are outcome assessors not blinded by the intervention?	2.5 Did the participants adhere to the intervention?
O’Brien et al. (2018) [37]	Yes	Yes	Yes	Not clear	Yes
Michelson et al. (2020) [32]	Yes	Yes	Yes	No	Yes
Cheng et al. (2021) [46]	Yes	Yes	Yes	No	Yes
3. Non-RCT study	3.1. Are the participants representative of the target population?	3.2. Does the measurement match the outcome and intervention (or exposure)?	3.3. Is there complete outcome data?	3.4. Were confounders taken into account in the design and analysis?	3.5. During the study period, was the intervention provided (or exposure occurred) as intended?
Uhm and Kim (2019) [33]	Yes	Yes	Yes	Yes	Yes
Gustafson et al. (2016) [30]	Yes	Yes	Yes	Yes	Yes
Lv et al. (2019) [43]	Yes	Yes	Yes	No	Yes
van Veenendaal et al. (2022) [42]	Yes	Yes	Yes	Yes	Yes
Kim et al. (2020) [35]	Yes	Yes	Yes	Yes	Yes
4. Descriptive study	4.1. Is the sampling strategy relevant to answering the research question?	4.2. Is the sample representative of the target population?	4.3. Is the measurement appropriate?	4.4. Is the risk of nonresponse bias low?	4.5. Is the statistical analysis appropriate to answer the research question?
Uhm and Choi, (2019) [34]	Yes	Yes	Yes	Not clear	Yes
Aija et al. (2019) [45]	Yes	Yes	Not clear	Yes	Yes
5. A mixed-methods study	5.1. Is there a sufficient reason to use a mixed methods design to answer the research question?	5.2. Are the various components of the research effectively integrated to answer the research question?	5.3. Are the outputs from integrating qualitative and quantitative components adequately interpreted?	5.4. Have differences and inconsistencies between quantitative and qualitative results been adequately addressed?	5.5. Do the different components of the study adhere to the quality criteria of each method tradition involved?
Skene et al. (2019) [39]	Yes	Yes	Yes	Yes	Not clear

Theme	Sub-theme	Category	Description	Reference
Partnership components	Participation in care	Round	Parents attend and participate in medical rounds or daily rounds	[30-32,37-39,41,42, 45]
		Round	Parental presence at the child's bedside during morning and evening rounds	[29,31]
		Basic care	Parents are involved in infant care, such as bathing, dressing, changing diapers, oral care, administering oral medication, changing bed linens, and providing positioning.	[31,34,36-39,42-44]
		Basic care	Providing touch (skin-to-skin contact)	[39,37,38,41-43]
		Monitoring	Parents are involved in assessing the child's behavior after weaning from sedation.	[40]
			Take the child's temperature	[37,43]
			Newborn monitoring	[42]
	Caring	Compassion	Staff demonstrating compassion, kindness, and caring attitudes.	[41,44]
			Emotional bonding between parents and children, such as maintaining eye contact or calling the child by name	[34]
			Increased interaction between father and baby triggers more substantial emotional reciprocity	[42]
		Respect	Parents feel valued and respected.	[31,38,41,44]
		Respect	Information is delivered carefully to avoid inconvenience.	[36]
	Information	Type of information	Providing information regarding the infant/child's condition, procedure, primary care, diagnosis, prognosis, treatment plan, and anything the parents would like to know.	[29,33,34,36,38-41,44]
		Type of information	Overview of the program/rounds to be implemented, introduction to the room and staff, and their respective roles	[30,33]
		Information Sharing	Parents are allowed to exchange information with the care team.	[30,31,39,40]
	Decision making	Shared decision	Parents are involved in decision-making with health professionals.	[30,32,34,37,40-42,46]
	Decision making	Shared decision	Parents want time to decide on a course of action.	[38]
Partnership outcomes	Outcomes for parents	Understanding	Improving parents' understanding	[29,30]
		Satisfaction	Increased parental satisfaction	[29,32,33,39]
		Interpersonal relationships	Increase bonding between mother and baby/child	[34,35,38]
			Improving relationships between parents and care providers	[30,33,36]
			Creating relationships and mutual support with other parents	[38,41]
		Psychological response	Parents feel safer and more comfortable.	[29,30,38,40,44]
		Psychological response	Reduces stress, anxiety, and trauma in parents	[30,33,35,37,42,44,46]
		Self-efficacy	Improve parents' self-efficacy, self-confidence, and self-control	[30,33,38,41]
	Outcomes in children	Physical response	Getting more breast milk and baby/child weight gain	[37,38,43]
	Outcomes in children	Physical response	Reduce length of stay and complications.	[32,43]
Factors that influence partnerships	Internal factors	Knowledge	Teaching support to parents when at the child's bedside	[37,38,40]
			Ignorance (confusion) in parents	[29,34]
			Knowledge, skills, or experience possessed by the care provider	[31,37]
		Attitude	Attitude of the care provider	[38,41]
		Trust-relationship	Mutual trust between parents and caregivers	[34,36]
		Trust-relationship	Transparency from the care provider team	[29]
		Self-confidence	The confidence that parents have to be involved in care	[38,39]
		Child condition	The child's condition changes or becomes unstable.	[34-36,40]
	External factors	Policy	PICU/NICU room policy	[39,45,46]
		PICU/NICU environment	The physical environment of the PICU/NICU influences parental engagement	[31,35,38]
		PICU/NICU environment	Traditions or culture within the PICU/NICU environment	[31,35,39]
		Number of human resources	Number of nurses or care providers	[34,38]

Table 1. Stages of an integrative review

Table 2. Article search description

Table 3. Data extraction of included articles

Table 4. Instrument quality assessment using the MMAT version 2018

MMAT: mixed methods appraisal tool; RCT: randomized controlled trial.

Table 5. Themes, sub-themes, and categories

PICU: pediatric intensive care unit; NICU: neonatal intensive care unit.