Abstract
PURPOSE: Nurses in the neonatal intensive care unit (NICU) play a crucial role in health communication, yet their voices are often overlooked. This study explores communication challenges from nurses' perspectives to develop a sustainable communication infrastructure. METHODS: A workshop-based participatory design (WBPD) was used, where NICU nurses worked collaboratively to identify communication barriers. Thematic analysis was conducted using the culture-centered approach (CCA) to ensure context-specific solutions, integrating both researcher insights and NICU-based communication infrastructure design. FINDINGS: A multilevel communication infrastructure model was developed to enhance nurse-parent interactions in the NICU. Key findings highlight that effective communication hinges on three interconnected factors: (1) nurses' skills and access to resources, (2) institutional policies supporting standardized protocols and mentorship programs, and (3) systemic mechanisms for fostering shared understanding. Participants advocated for structured training, culturally responsive practices, and language support tools to address diverse needs. The proposed model integrates learner-centered training, interprofessional collaboration, communicative algorithms, and healthy boundaries to establish a cohesive, inclusive framework. CONCLUSIONS: Nurse-led, multilevel interventions are essential for improving NICU communication. The proposed model enhances training, policies, and culturally responsive strategies, supporting more effective nurse-parent interactions and improved neonatal care. Beyond the NICU, this framework offers a transferable model for enhancing communication in other high-stress healthcare environments, ensuring more inclusive and structured communication practices across diverse settings.