New Approach to NICU Parent Education Delivers Widespread Benefits

Educating parents of newborns in the Neonatal Intensive Care Unit (NICU) is a vital step in preparing families to go home from the hospital. Being unprepared can intensify family anxiety, increase the risk for patient readmission and emergency department visits, and lead to infant care issues at home.

Because their babies are high-risk, NICU parents need comprehensive, specialized education to provide the best care for their infant at home. Although families receive an abundance of information during the discharge process, the experience can be overwhelming. Research indicates that only about 20% of the information provided is retained.

When Dawn Howard, MSN, RNC-NIC, became Cleveland Clinic Fairview Hospital’s first NICU Discharge Coordinator, she sought to improve parental readiness and create a more engaging discharge program.

“At the time, we were using traditional methods of discharge teaching, including in-person classes and information binders,” Howard says. “We were giving each family a small packet of paper handouts to ensure topics were covered, but we found that parents were often too stressed to absorb the information.”

About 65% of patients in the Fairview NICU are late pre-term infants, so they don’t remain in the hospital for long. Furthermore, only some families attend the classes, so much of the education falls to the nursing staff.

“I wanted something that was easily accessible and convenient for parents with newborns,” Howard explains. “I also wanted to alleviate the burden of the education process on nurses so they could focus more on patient care.”

After researching alternative teaching methods, Howard decided the best way forward was to adopt an e-learning educational platform to complement the unit’s in-person classes and nurse discharge discussions.

Helping families take charge of their education

Howard worked with Cleveland Clinic marketing, media and NICU interdisciplinary team members – nurses, social workers, physical and occupational therapists, speech therapists and dieticians – to compile content for the creation of 18 short, informative e-learning modules.

The modules were professionally produced by the Cleveland Clinic media production team and covered important topics such as caring for your baby at home, feeding your premature baby, tummy time and other strength-building exercises, developmental milestones, safe sleep practices, infection prevention, home safety, car seat safety and installation, and more.

“Each module is only a few minutes in length, so parents can essentially watch all of them within one hour — although that isn’t the goal,” Howard says. “Ideally, we’d like parents to start watching the videos when they’re admitted and continue watching them to absorb the information little by little.”

The modules, which are available 24/7, are accessed through the patient’s electronic health records portal using a mobile phone or other electronic device. A pamphlet in the admission folder provides access instructions, which the admitting nurse reviews with parents.

“This allows for parent education to start early and independently,” says Virginia Summers, MSN, RN, CPN, who works in the Fairview NICU and was a member of the e-learning project education committee. “The modules provide information that can be reinforced by the bedside staff nurse during parent visits, reviewed by the NICU discharge coordinator during the discharge class, and provided in written discharge instructions.”

Emphasizing the teach-back method

The goal of “teaching back” is to reinforce and assess parents’ understanding of the content they’ve received. When Howard teaches discharge classes now, she always asks families what they learned in the videos.

“Questions like ‘What did you learn about giving medication to your preemie?’ help prompt group discussions and are a great way to engage parents,” she says. “Before we used the videos, the families in my classes knew very, very little about safe sleep or car seats. Now, they arrive much better prepared – many having already installed their own car seat bases.”

Improvements across the board

The e-learning platform is also helping lower readmissions. “This can be attributed, in part, to the video on temperature taking,” explains Howard.

Feedback from parents praises the ease of the e-learning modules. Additionally, Press Ganey patient satisfaction scores have markedly improved for the Fairview NICU since the modules have been introduced. The unit’s most recent top-box scores in the “Prepared for Discharge” category of the survey were 73.66 in 2023 and 75.73 to date in 2024.

After seeing the success of the e-learning program at Fairview Hospital, the NICUs at Cleveland Clinic Hillcrest and Main Campus were quick to adopt it. Since adopting the protocol, three units have maintained greater than 90% program compliance by NICU parents.

Cleveland Clinic Akron General recently became a Level III NICU and has also introduced the program to new parents. In the future, modules will be simplified and tailored for use in all Cleveland Clinic post-partum units.

“The program continues to grow and expand,” Howard says. “We’ve added more modules, captioned them in different languages and more. Using the modules streamlines education across the health system, which also decreases costs substantially. We estimated that cutting down on paper handouts saved a few thousand dollars a year in the Fairview NICU alone.”

Nurses appreciate the effective, efficient discharge education process. NICU nurses have reported improved satisfaction with the quality of education parents receive prior to discharge, as well as time saved for them.

“It’s definitely made things easier and takes the pressure off the nurses,” Howard says. “Instead of spending so much time on education, they can reinforce what the family is learning. As a result, the program has improved both patient and nurse satisfaction.”

Summers agrees.

“In my 38 years with Cleveland Clinic, I have always been an advocate for patient teaching – and our discharge process gives families a wonderful educational opportunity as they prepare to take their precious infant home,” she says. “My personal goal is for our families to be comfortable with the care of their baby well before the discharge date for optimal outcomes at home. This program contributes significantly to that.”