The effectiveness of a standardised positioning tool and bedside education on the developmental positioning proficiency of NICU nurses

Utilization of the Nurse Champion Model to Improve Developmentally Supportive Positioning in the NICU

This evidence-based project was implemented and evaluated the impact of using the nurse champion model to increase compliance and facilitate best practices for developmental positioning in the NICU. Education provided by a newly developed nurse champion team reinforced the knowledge and skills needed to use developmental positioning. Measurements included compliance with documentation about positioning, nurse champions' effectiveness, and intent to use the nurse champion model. Participants included twenty-five female NICU registered nurses with varying levels of experience. The focus was on nurses caring for preterm infants that were 35 weeks or less. Electronic medical record data indicated compliance with developmental positioning for the target population. A postimplementation survey indicated participants supported use of nurse champions to implement change. The nurse champion model influenced change in electronic medical record documentation of developmental positioning and support for nurse champions.

Psychometric properties of the Turkish version of the developmental care scale for neonates with congenital heart disease

OBJECTIVE

Developmental care for newborns with congenital heart disease (CHD) improves cardiac and respiratory patterns. According to the American Heart Association, developmental care in newborns with CHD is important for improving neurodevelopmental outcomes. This study aimed to evaluate the validity and reliability of the Turkish version of the Developmental Care Scale for Neonates with Congenital Heart Disease.

METHODS

This was a methodological, descriptive study conducted with 169 nurses from a tertiary-level NICU. The Demographical Information Form and the Developmental Care Scale for Neonates with Congenital Heart Disease were used to collect the data. The scales' language and content validity, construct validity, and internal consistency were also assessed.

RESULTS

The scale consists of 31 items and four subscales. Factor loadings ranged from 0.44 to 0.82 and explained 65% of the total variance. Fit indices indicate that the model is acceptable. Cronbach's α was 0.95 for the entire instrument, 0.91 for developing the external environment subscale, 0.94 for assessing family well-being, 0.86 for the caregiver activities toward the neonate, and 0.82 for the basic need subscale. Item-total correlations ranged between 0.34 and 0.75, according to the item analysis results.

CONCLUSIONS

The Turkish version of the Developmental Care Scale for Neonates with Congenital Heart Disease is valid and reliable. The use of this scale could improve the performance of neonatal intensive care nurses in providing developmental care to newborns with CHD as well as the quality of care.

Optimising motor development in the hospitalised infant with CHD: factors contributing to early motor challenges and recommendations for assessment and intervention

BACKGROUND

Neurodevelopmental challenges are the most prevalent comorbidity associated with a diagnosis of critical CHD, and there is a high incidence of gross and fine motor delays noted in early infancy. The frequency of motor delays in hospitalised infants with critical CHD requires close monitoring from developmental therapies (physical therapists, occupational therapists, and speech-language pathologists) to optimise motor development. Currently, minimal literature defines developmental therapists' role in caring for infants with critical CHD in intensive or acute care hospital units.

PURPOSE

This article describes typical infant motor skill development, how the hospital environment and events surrounding early cardiac surgical interventions impact those skills, and how developmental therapists support motor skill acquisition in infants with critical CHD. Recommendations for healthcare professionals and those who provide medical or developmental support in promotion of optimal motor skill development in hospitalised infants with critical CHD are discussed.

CONCLUSIONS

Infants with critical CHD requiring neonatal surgical intervention experience interrupted motor skill interactions and developmental trajectories. As part of the interdisciplinary team working in intensive and acute care settings, developmental therapists assess, guide motor intervention, promote optimal motor skill acquisition, and support the infant's overall development.

Effectiveness of Nicu nurses' competence enhancement program for developmentally supportive care for preterm infants: A quasi-experimental study

Background

Developmental support care for preterm infants contributes toward their health and shortens their hospital stay. In many countries, programs for preterm infant development such as Newborn Individualized Developmental Care and Assessment Program and Philips Wee Care have not yet been disseminated.

Objectives

To evaluate the effectiveness of neonatal intensive care unit nurses' competence enhancement program for developmental support care of preterm infants.

Methods

A quasi-experimental study using pretest and posttest designs with a nonequivalent control group was conducted in five neonatal intensive care units of university hospitals in South Korea. A total of 39 nurses (20 in the experimental group and 19 in the control group) participated. The program was composed of family support, healing environmental support, stress and pain management, sleep support, position support, nutrition optimization, skin protection, and sensory stimulation. In addition, four sessions were provided using Zoom, Padlet, online quizzes, and performance diaries.

Results

For nursing knowledge, no significant interaction effect was observed between groups and time (F = 1.38, p = .258). However, the main effect on the group (F = 10.81, p < .001), and the main effect of time were significant (F = 12.97, p < .001). For nursing attitude, the interaction effect between group and time (F = 2.06, p = .142), and the main effect on the group were not significant (F = 0.23, p = .635). Finally, for nursing competence, the interaction effect between group and time was significant (F = 4.46, p = .019).

Conclusions

The educational program was effective in improving nursing knowledge and competence in developmentally supportive care for preterm infants. This program is expected to contribute toward the growth and development of premature infants.

Improving Developmental Positioning in a Level III NICU Using Evidence-Based Teaching and a Standardized Tool: An Evidence-Based Quality Improvement Project

Positioning and handling is a core measure of developmental care that has been universally difficult to implement in the technical NICU environment. Appropriate positioning has been shown to not only improve postural and musculoskeletal outcomes, but enhance sensory development, physiologic stability, thermal regulation, behavioral organization, sleep facilitation, and brain development. In order to improve the developmental positioning practices of bedside nurses in a level III neonatal intensive care unit, a quality improvement project was initiated. Guided by the Iowa Model for Evidence-Based Practice, this project included an evidence-based educational intervention and a standardized positioning assessment tool. After the intervention, there was improvement in knowledge scores, and positioning scores increased from an average of 8.81 +/- 0.19 to 10.93 +/- 0.15.

Development and effectiveness of an educational program on developmental positioning for neonatal intensive care unit nurses in South Korea: a quasi-experimental study

PURPOSE

This study aimed to develop and evaluate the effectiveness of an educational program on developmental positioning (EPDP) for nurses in neonatal intensive care units (NICUs).

METHODS

The study utilized a non-equivalent control group pretestposttest design. Sixty NICU nurses were recruited from two university hospitals in Daejeon, South Korea. The EPDP consisted of a 7-week program: 3 weeks of education and practice, followed by 4 weeks of encouragement messages using social networking services. Developmental positioning (DP) posters and DP aids were also provided during the intervention period. The intervention group (n=30) received the EPDP, but not the control group. The data were analyzed using the x2 test, the Fisher exact test, the independent t-test, and repeated-measures analysis of variance.

RESULTS

Participants' knowledge (t=7.49, p<.001), attitudes (t=1.99, p=.001), self-efficacy (t=2.99, p=.004), performance of DP (t=2.98, p=.004) and Infant Positioning Assessment Tool (IPAT) scores (F=29.50, p<.001) were significantly higher in the intervention group than in the control group.

CONCLUSION

The EPDP can be an effective and useful program for improving the performance of DP among NICU nurses by increasing their knowledge, attitudes, and self-efficacy of DP. However, further research involving various NICU settings is needed to gather more empirical evidence.

Developmentally Supportive Positioning Policy for Preterm Low Birth Weight Infants in a Tertiary Care Neonatal Unit: A Quality Improvement Initiative

Objective

Methods

Results

Conclusions

Transition to a Safe Home Sleep Environment for the NICU Patient

Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (<2500 g [5.5 lb]) and 10% were born preterm (gestational age of <37 completed weeks). Many of these infants and others with congenital anomalies, perinatally acquired infections, and other disease require admission to a NICU. In the past decade, admission rates to NICUs have been increasing; it is estimated that between 10% and 15% of infants will spend time in a NICU, representing approximately 500 000 neonates annually. Approximately 3600 infants die annually in the United States from sleep-related deaths, including sudden infant death syndrome International Classification of Diseases, 10th Revision (R95), ill-defined deaths (R99), and accidental suffocation and strangulation in bed (W75). Preterm and low birth weight infants are particularly vulnerable, with an incidence of death 2 to 3 times greater than healthy term infants. Thus, it is important for health care professionals to prepare families to maintain their infant in a safe sleep environment, as per the recommendations of the American Academy of Pediatrics. However, infants in the NICU setting commonly require care that is inconsistent with infant sleep safety recommendations. The conflicting needs of the NICU infant with the necessity to provide a safe sleep environment before hospital discharge can create confusion for providers and distress for families. This technical report is intended to assist in the establishment of appropriate NICU protocols to achieve a consistent approach to transitioning NICU infants to a safe sleep environment as soon as medically possible, well before hospital discharge.

Improving clinical outcomes of very low birth weight infants: Implementation of standardized management guidelines in tertiary care hospital in Haryana

BACKGROUND

Standardized written guidelines and protocols in NICU are known to impact neonatal outcomes and improve survival.

OBJECTIVE

To study and compare the morbidity and mortality outcomes of very low birth weight (VLBW) neonates before and after introduction of structured approach to standardized management guidelines on four interventions in a tertiary care hospital in North India.

METHODOLOGY

Structured approach to standardized management guidelines on four interventions were implemented for VLBW infants in NICU. a) Humidified and Heated High Flow Nasal Cannula (HHHFNC) as the initial mode of ventilator support in preterm VLBW babies. b) Expressed breast milk for feeding preterm VLBW babies and absolutely no formula milk. c) Hand washing and following "Bundle Care Approach" for Central lines as the cardinal cornerstones for maintaining strict asepsis. d) Development and supportive care to be regularly followed. Data was collected prospectively from July 2015 to December 2016 (Intervention Group) and compared with retrospective matched controls from the previous year (July 2014-June 2015) (Control Group).

RESULTS

There was a significant decrease in culture positive sepsis in the intervention group compared to control group (3 (2.97%) CI:0.006-0.08 vs 11 (19.64%) CI:0.10-0.32; P = .0004). There was no significant difference in the mortality (5.35% vs3.96% P = .74) amongst the two groups.

CONCLUSION

Implementing structured approach to above mentioned interventions in the form of standardized management guidelines for preterm VLBW neonates was associated with significant reduction in culture proven sepsis and mechanical ventilation days without affecting mortality or other co-morbidities.

Promoting developmental supportive care in preterm infants and families in a level III neonatal intensive care unit (NICU) setting in India

Despite evidence of short- and long-term benefits of developmental care, several studies have documented nurses' lack of knowledge and skills related to developmental care concepts. This study aims to enhance neonatal nurses' abilities to acquire care practices (knowledge and skills) regarding Developmental Supportive Care (DSC). A nonrandomized before and after intervention design was adopted to improve the knowledge and skills of staff nurses in DSC practices for preterm infants in Level III B NICU. The study included 50 level III B NICU nurses (25 in interventional group, 25 in control group) located within a tertiary care hospital in India. A significant increase in the mean knowledge score was seen among participants in the intervention group (pre-test: 16.6 ± 3.1, post-test: 29.9 ± 4.1, p = 0.01) but not in the control group (pre: 16.4 ± 2.2, post: 18.6 ± 3.6, p = 0.98). The improvement in the skills of providing DSC among neonatal nurses was also higher in the intervention group (106.4 ± 7.4) relative to the control group (65.8 ± 3.6), p < 0.01, at 0.05 level of significance. The Developmental Supportive Care Program (DSCP) had a significant impact in improving the knowledge and skills of nurses in providing care and preventing complications in preterm infants.

Factors Influencing Developmental Care Practice Among Neonatal Intensive Care Unit Nurses

PURPOSE

This study aimed to examine factors that influence developmental care practice among neonatal intensive care unit nurses.

DESIGN AND METHODS

This descriptive, cross-sectional study was conducted using a questionnaire. Data were collected from 141 neonatal intensive care unit nurses from 6 hospitals in South Korea. Multiple linear regression analysis was used to examine factors influencing developmental care practice.

RESULTS

This study found that professional efficacy had the largest influence on developmental care practice, followed by perception of developmental care and a task-oriented organizational culture. Clinical and educational experience regarding developmental care and working environment was not associated with developmental care practice among NICU nurses.

CONCLUSIONS

To enhance nurses' practice of developmental care, enhancement of nurses' individual competency, positive perception of developmental care, and organizational efforts are required. A practical training program should be provided to nurses to promote confidence in implementing developmental care for preterm infants.

IMPLICATIONS

A trained nurse should provide staff nurses with useful information on developmental care to encourage them to have a positive attitude towards developmental care. The nurse manager should create an organizational culture in which nurses perceive developmental care to be an essential nursing task in their unit.

Targeted educational program improves infant positioning practice in the NICU

Quality problem or issue

Infant positioning may interfere with neuromotor development. Bedside education and Infant Positioning Assessment Tool (IPAT) improve nurses' and doctors' proficiency in applying proper infant positioning.

Initial assessment

Nursing compliance with proper positioning is suboptimal due to many factors. One factor was the inadequate knowledge and practice of infant positioning, since the baseline mean IPAT score was 3.4.

Choice of solution

Three experienced neonatal intensive care unit (NICU) nurses were chosen as position champions to help other NICU nurses apply proper positioning and monitor IPAT scores. Education and hands-on demonstration sessions were developed based on the observed baseline practice.

Implementation

Periodic education with hands-on demonstration was given to NICU nurses and residents. Infants' positions were objectively scored using IPAT. Two Plan, Do, Study and Act cycles were completed and adjustments were made based on each cycle's achieved results.

Evaluation

Mean IPAT scores increased from 3.4 at baseline and 6.3 in the second cycle to 7.3 in the third cycle of intervention.

Lessons learned

A systematic approach targeting infants' positioning succeeded in improving nurses' and residents' clinical performance. Not reaching significant change until after 18 months highlights the difficulty and complexity in changing behaviors.