Mothering a Preterm Infant Receiving NIDCAP Care in a Level III Newborn Intensive Care Unit

The newborn individualised developmental care and assessment program: A model of care for infants and families in hospital settings

AIM

The Newborn Individualised Developmental Care and Assessment Program (NIDCAP) is an intervention and education programme that uses developmental observation for multidisciplinary healthcare professionals (HCP) caring for high-risk infants and families. Infants prosper with the ongoing co-regulation process of infant and family that is influenced by the physical and social environment.

METHODS

The Template for Intervention Description and Replication (TIDieR) Guidelines were applied to the NIDCAP intervention. The estimation of the individual infant's current goals is described from direct observation of behaviour in the context of ongoing care delivery. The infant's behaviour guides all caregivers to articulate current strengths and functioning for the development of individualised plans of care and support. The NIDCAP Nursery Program supports the full integration of NIDCAP into the healthcare system.

RESULTS

NIDCAP is a system-based, process-oriented, attuned and responsive intervention for individualised developmental care for infants and families. Evidence shows NIDCAP significantly improves medical outcomes, with less time on the ventilator, improved weight gain, decreased length of stay, improved developmental outcomes and enhanced infant and family relationships. Evidence suggests that NIDCAP as an intervention improves parental competence, decreases stress for HCP teams and improves HCP satisfaction.

CONCLUSION

NIDCAP improves outcomes for infants and families requiring hospital care.

Caring for hearts and minds: a quality improvement approach to individualized developmental care in the cardiac intensive care unit

Introduction

Infants with congenital heart disease (CHD) are at high risk for developmental differences which can be explained by the cumulative effect of medical complications along with sequelae related to the hospital and environmental challenges. The intervention of individualized developmental care (IDC) minimizes the mismatch between the fragile newborn brain's expectations and the experiences of stress and pain inherent in the intensive care unit (ICU) environment.

Methods

A multidisciplinary group of experts was assembled to implement quality improvement (QI) to increase the amount of IDC provided, using the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), to newborn infants in the cardiac ICU. A Key Driver Diagram was created, PDSA cycles were implemented, baseline and ongoing measurements of IDC were collected, and interventions were provided.

Results

We collected 357 NIDCAP audits of bedside IDC. Improvement over time was noted in the amount of IDC including use of appropriate lighting, sound management, and developmentally supportive infant bedding and clothing, as well as in promoting self-regulation, therapeutic positioning, and caregiving facilitation. The area of family participation and holding of infants in the CICU was the hardest to support change over time, especially with the most ill infants. Infants with increased medical complexity were less likely to receive IDC.

Discussion

This multidisciplinary, evidence-based QI intervention demonstrated that the implementation of IDC in the NIDCAP model improved over time using bedside auditing of IDC.

Parents' Experience in an Italian NICU Implementing NIDCAP-Based Care: A Qualitative Study

Background: The birth of a preterm infant and his/her immediate admittance to the Neonatal Intensive Care Unit (NICU) are sudden, unexpected, stressful and painful events for parents. In the last decade, in response to the increased awareness of the stressful experiences of parents, much attention has been paid to Family-Centered Care (FCC) and the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). According to the NIDCAP model, the infant-parents' dyad is the core of the care provided by the NICU professionals to reduce the stress experienced by parents. So far, the literature does not show a clear correlation between parental experiences and the NICU practices according NIDCAP principles. Aims: To explore how parents of preterm infants experienced the NIDCAP-based care from admission to discharge, in particular, their relationships with NICU professionals and with other parents, and the organization of the couple's daily activities during this process. Design: Qualitative exploratory study. Methods: Twelve parents of preterm infants born between January 2018 and December 2020 at the NICU of Modena, with a gestational age at birth of less than 30 weeks and/or a birth weight of less than 1250 g, were recruited. Three couples had twins, and the total number of infants was 15. All infants were followed for up to 24 months post-term age (PTA) for neurological outcomes. Each couple was given a semi-structured online interview about their experience during their infant's hospitalization in the NICU up to discharge. The interview was developed around three time points: birth, hospitalization and discharge. The data analysis was conducted according to the template analysis method. Results: The admission to the NICU was unexpected and extraordinary, and its impact was contained by the skilled staff who were capable of welcoming the parents and making them feel they were involved and active collaborators in the care of their infant. The emotional experience was compared to being in a blender; they were overwhelmed by changing emotions, ranging from terrible fear to extreme joy. The couple's activities of daily life were reorganized after the infant's birth and admission to the NICU. Fathers felt unbalanced and alone in taking care of their partners and their children. Conclusions: This is the first study in Italy to explore parental experience in an NICU implementing NIDCAP-based care. The NIDCAP approach in the NICU of Modena helps parents to be involved early, to develop parental skills, and to be prepared for the transition home; and it also facilitates and enhances the relationship between parents and NICU staff.

Emotional Closeness Among NICU Fathers: A Qualitative Descriptive Study

BACKGROUND

The unique perspective of fathers with an infant in the neonatal unit on the development of emotional closeness toward their infant is not well understood. The purpose of this study is to explore experiences and instances of emotional closeness from the perspective of fathers as well as factors influencing emotional closeness during an infant's hospitalization in the neonatal unit.

METHODS

This qualitative descriptive study employed one-on-one interviews with fathers recruited in a level 3 neonatal unit. The interview data were analyzed with thematic analysis, and emerging themes and subthemes were organized according to dimensional analysis.

RESULTS

Eight fathers agreed to take part in this study. According to the participants, emotional closeness was a complex process composed of multiple dimensions. More specifically, emotional closeness was a difficult-to-describe, mixed, and growing feeling influenced by multiple factors such as the environment, co-parenting, and the father-infant relationship. It occurred in the contexts of presence and separation in the neonatal unit and was part of the development of the father-infant relationship.

IMPLICATIONS FOR PRACTICE

The results presented in this article are important for neonatal intensive care unit nurses who support fathers in the development of their fathering role. By knowing more about the process and dimensions of emotional closeness, nurses can direct their interventions with fathers to enhance emotional closeness and better understand their experience.

IMPLICATIONS FOR RESEARCH

No previous study has addressed emotional closeness as a complex process with multiple components like the current study. These findings contribute to our understanding of the process of emotional closeness for fathers.

Psychological Processes of Postpartum Mothers with Newborns Admitted to the Intensive Care Unit

PURPOSE

This research aims to explore the psychological processes of postpartum mothers during the admission of their newborns to the intensive care unit. It is hoped that the findings from this study will serve as a reference for clinical medical staff in providing individual and holistic patient care.

METHODS

Using grounded theory methodology, we collected data through semi-structured, one-to-one in-depth interviews. When data saturation occurred, 12 participants were involved through the constant comparative analysis process.

RESULTS

The psychological processes consisted of a core category and three main categories. The core category was "worrying about the baby and striving to fulfill maternal responsibilities." The three main categories:" impact on the maternal role", "recognition of the maternal identity", and "exhibition of maternal role". The entire process may be affected by intrinsic and extrinsic factors, such as breast milk supply, skin-to-skin contact opportunities for mother and baby, seriousness of the newborn's health conditions, the support system, and the style of postpartum confinement care.

CONCLUSIONS

It is recommended that the neonatal intensive care unit should adopt family-centered care, taking an initiative to empathize and care for the mother, assisting skin-to-skin contact for the mother and baby as soon as possible, maintaining established breastfeeding, providing the correct concept of postpartum care, and encouraging participation in support groups. These activities can reduce the impact of the situation on the maternal role and improve maternal identity recognition.

Nurses’ strategies to provide emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit: A systematic review and meta-analysis

Aim:

To synthesize and integrate current international knowledge regarding nursing strategies for the provision of emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit.

Methods:

A systematic review and meta-analysis was undertaken. Four English-language databases including EMBASE, PubMed (including MEDLINE), Scopus, and Web of Science were searched from January 2010 to October 2021. Original quantitative studies that were written in English and focused on nursing strategies for the provision of emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit were included. Eligibility assessment, data extraction, and methodological quality appraisal were conducted independently by the review authors. A narrative synthesis of the review results and a meta-analysis were performed.

Results:

Twenty studies that were published from 2010 to 2021 were included in the review. Three categories concerning the review aims were identified: ‘nursing strategies related to mothers’ emotions and infant-mother attachment’, ‘nursing strategies related to mothers’ empowerment’, and ‘nursing strategies related to mothers’ participation in care process and support’. Eight interventional studies that reported mothers’ stress as the study outcome were entered into the meta-analysis. Interventions consisted of the educational programme, spiritual care, telenursing, parent support programme, skin-to-skin care, and guided family centred care. Significantly lower maternal stress was found in the intervention group compared with that of the control group (g: −1.06; 95% confidence interval: −1.64, −0.49; Z = 3.62, p < 0.001).

Conclusion:

This review identified and highlighted key nursing strategies used to provide emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit. They included family centred care, skin-to-skin care, parent support and education programmes, interpersonal psychotherapy, spiritual care, newborn individualized developmental care and assessment programme, and telenursing.

Dissemination of newborn behavior observation skills after Newborn Individualized Developmental Care and Assessment Program (NIDCAP) implementation

Aim

To assess nurses’ ability to observe newborn behaviour after in situ training provided by caregivers with advanced practice certification in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).

Design

Prospective observational study.

Methods

Twelve nurses viewed 20‐min films showing the behaviour of 10 premature newborns before, during and after the usual caregiving. The behaviour was rated on an observation sheet with 88 items distributed into six systems. The responses were compared to the reference ratings established by two professionals certified for this programme.

Results

Despite less accurate observations during care and for some components, the nurses generally showed a satisfactory ability to observe newborn behaviour after training by NIDCAP expert professionals. The dissemination of observation skills among caregivers may result in an improved quality of patient care and better communication among professionals in a department of neonatology.

Parents' experiences of emotional closeness to their infants in the neonatal unit: A meta-ethnography

BACKGROUND

Physical and emotional parent-infant closeness activate important neurobiological mechanisms involved in parenting. In a neonatal care context, most research focuses on physical (parental presence, skin-to-skin contact) aspects; insights into emotional closeness can be masked by findings that overemphasise the barriers or challenges to parenting an infant during neonatal care.

AIM

To explore existing qualitative research to identify what facilitates and enables parents' experiences of emotional closeness to their infants while cared for in a neonatal unit.

STUDY DESIGN

A systematic review using meta-ethnographic methods. Search strategy involved searches on six databases, author runs, and backward and forward chaining. Reciprocal translation was used to identify and compare key concepts of parent-infant emotional closeness.

RESULTS

Searches identified 6992 hits, and 34 studies from 17 countries that involved 670 parents were included. Three overarching themes and associated sub-themes were developed. 'Embodied connections' describes how emotional closeness was facilitated by reciprocal parent-infant interactions, spending time as a family, and methods for parents to feel connected while physically separated. 'Inner knowing' concerns how knowledge about infant and maternal health and understanding the norms of neonatal care facilitated emotional closeness. 'Evolving parental role' relates to how emotional closeness was intertwined with parental identities of contributing to infant health, providing direct care, and being acknowledged as a parent.

CONCLUSION

Parent-infant closeness evolves and is facilitated by multifaceted biopsychosocial factors. Practice implications include creating private and uninterrupted family time, strategies for parents to maintain an emotional connection to their infant when separated, and neurobiology education for staff.

A Collaborative Learning Assessment of Developmental Care Practices for Infants in the Cardiac Intensive Care Unit

OBJECTIVE

Assess differences in approaches to and provision of developmental care for infants undergoing surgery for congenital heart disease.

STUDY DESIGN

A collaborative learning approach was used to stratify, assess, and compare individualized developmental care practices among multidisciplinary teams at 6 pediatric heart centers. Round robin site visits were completed with structured site visit goals and postvisit reporting. Practices of the hosting site were assessed by the visiting team and reviewed along with center self-assessments across specific domains including pain management, environment, cue-based care, and family based care coordination.

RESULTS

Developmental care for infants in the cardiac intensive care unit (CICU) varies at both a center and individual level. Differences in care are primarily driven by variations in infrastructure and resources, composition of multidisciplinary teams, education of team members, and use of developmental care champions. Management of pain follows a protocol in most cardiac intensive care units, but the environment varies across centers, and the provision of cue-based infant care and family-based care coordination varies widely both within and across centers. The project led to proposed changes in clinical care and center infrastructure at each participating site.

CONCLUSIONS

A collaborative learning design fostered rapid dissemination, comparison, and sharing of strategies to approach a complex multidisciplinary care paradigm. Our assessment of experiences revealed marked variability across and within centers. The collaborative findings were a first step toward strategies to quantify and measure developmental care practices in the cardiac intensive care unit to assess the association of complex inpatient practices with long-term neurodevelopmental outcomes.

Individualized Family-Centered Developmental Care: An Essential Model to Address the Unique Needs of Infants With Congenital Heart Disease

BACKGROUND

Infants born with critical congenital heart disease (cCHD) who require surgical intervention in the newborn period are often hospitalized in a cardiac intensive care unit (CICU). Cardiac surgery and the CICU environment are traumatic to infants and their families. Infants are exposed to overwhelming stress, which can result in increased pain, physiologic instability, behavioral disorganization, disrupted attachment, and altered brain development. Individualized Family-centered Developmental Care (IFDC) is a model that can address the unique needs and developmental challenges of infants with cCHD.

PURPOSE

The purpose of this article is to (1) clearly describe the uniqueness of the infant with cCHD, including the medical, neurological, and parental challenges, and (2) propose methods to apply IFDC to support recovery of infants with cCHD in the CICU.

CONCLUSIONS

The experiences in the CICU shape the developing brain and alter recovery and healing, thus adversely impacting development. Individualized Family-centered Developmental Care is a promising model of care that nurses can integrate into the CICU to promote neuroprotection and development. Nurses can effectively integrate IFDC into the CICU by understanding the unique characteristics of infants with cCHD and applying IFDC interventions that include both maturity and recovery perspectives.

CLINICAL IMPLICATIONS

The incorporation of IFDC interventions is essential for the infant with cCHD and should be a standard of care. Applying IFDC with a recovery perspective in all aspects of caregiving will provide opportunities for individualization of care and parent engagement, allowing infants in the CICU to recover from surgery while supporting both short- and long-term neurodevelopment.

Close Collaboration with Parents intervention improves family-centered care in different neonatal unit contexts: a pre-post study

BACKGROUND

The quality of family-centered care and parental participation in care in neonatal units differ widely across the world. Appropriate education might be an effective way to support medical staff in neonatal units to collaborate with parents and implement family-centered care. The aim of this study was to evaluate the effects of the educational intervention on the quality of family-centered care in eight Finnish neonatal intensive care units from both the staff and parent perspectives.

METHODS

A mixed-method pre-post intervention study was conducted in eight neonatal intensive care units in Finland. Data were collected from staff and parents using the Bliss Baby Charter audit tool and semi-structured interviews.

RESULTS

The quality of family-centered care, as assessed by staff and parents, increased significantly after the intervention in all eight units. The intervention was able to help staff define and apply elements of family-centered care, such as shared decision making and collaboration between parents and staff. In interviews, staff described that they learned to support and trust the parents' ability to take care of their infant.

CONCLUSIONS

The educational intervention increased the quality of family-centered care and enabled mutual partnership between parents and staff.

IMPACT

This study shows that the educational intervention for the whole multi-professional staff of the neonatal unit improved the quality of family-centered care. The Close Collaboration with Parents intervention enabled mutual partnership between parents and staff. It also provides evidence that during The Close Collaboration with Parents intervention staff learned to trust the parents' ability to take care of their infant.

Nurses' and Physicians' Experiences of the NIDCAP Model Implementation in Neonatal Intensive Care Units in Iran

PURPOSE

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides comprehensive newborn focused family-centered care in the Neonatal Intensive Care Unit (NICU). The purpose of this study was to investigate nurses' and physicians' experiences of implementing the NIDCAP model to optimize its implementation for both caregivers, infants, and families in the NICU.

DESIGN & METHODS

A purposes sample of 11 nurses and four physicians participated in this qualitative study. Data were collected by face-to-face and semi-structured interviews and analysis were guided by principles of thematic analysis as per Graneheim and Lundman (2004).

RESULTS

Six themes and 20 sub-themes were constructed during data analysis. These included; NIDCAP as a milestone, Helping to rebuild the core of the family, Caregiver excellence, Realism towards the feasibility of NIDCAP, Proper managerial position of NIDCAP specialists in the health system, and Caring for the caregiver.

CONCLUSIONS

The findings of this study highlight how NIDCAP provides a comprehensive and effective care model for premature infants, with the goal to promote neonatal growth and development while also facilitating the self-efficacy of caregivers. Implementation of the NIDCAP model requires attention to be paid to social context, infrastructure, adjustment of the program according to the facilities and resources of each country, and the needs of caregivers.

PRACTICE IMPLICATIONS

Health care resources are required to sustain NIDCAP specialists and a favorable environment as the necessary conditions for its multidimensional application across NICU units around the world.

Structured Educational Intervention Leads to Better Infant Positioning in the NICU

PURPOSE

The purpose is to test the effectiveness of an educational intervention in improving infant positioning because positioning may interfere with neuromotor development.

METHODS

A quality improvement (QI) project was initiated to increase knowledge and improve the compliance of nurses and physicians in infant positioning using the Infant Positioning Assessment Tool (IPAT). The project was part of Neonatal Individualized Developmental Care Assessment Program (NIDCAP) training. It included informal discussion and practice about infant positions.

MAIN OUTCOME VARIABLES

Staff knowledge, IPAT score.

RESULTS

Fifty-two pediatric residents and 39 NICU nurses participated in this project. The mean knowledge assessment test score improved significantly for both nurses (p < .0001) and residents (p < .0001) postintervention; IPAT scores increased significantly from 3.4 (±2. 5) to 8.1 (±2.7) (p < .001).

CONCLUSION

Nurses' education with hands-on practice improved infant positioning in the NICU; this may lead to fewer positional deformities and possibly an improved developmental outcome.

Parent-Infant Closeness, Parents' Participation, and Nursing Support in Single-Family Room and Open Bay NICUs

This was a prospective survey study, comparing parent-infant closeness, parents' perceptions of nursing support, and participation in medical rounds in single-family room (SFR) and an open bay (OB) neonatal intensive care units. Nurses' assessments of provided support were also measured. In total, 115 parents of 64 preterm infants less than 35 weeks' gestational age and 129 nurses participated. Parents recorded the presence and skin-to-skin care. Parents were sent 9 text message questions in random order. Nurses answered corresponding Internet-based questions. SFR mothers were more present, 20 hours daily (median) versus 7 hours (P < .001), initiated skin-to-skin contact (SSC) at 4 versus 12 hours (P = .03), and preformed SSC 180 min/24 h versus 120 min/24 h for mothers in the OB unit (P = .02). SFR fathers were also more present, 8 versus 4 hours (P < .001), initiated SSC at 3 versus 40 hours (P = .004), and performed SSC 67 min/24 h versus 31 min/24 h (P = .05). SFR parents rated participation in medical rounds and emotional support higher than OB parents. Parental trust was rated higher by nurses in the OB unit (P = .02). SFR facilitated parent-infant closeness, parents' participation in medical rounds, and increased support from nurses.

Filling a significant gap in the cardiac ICU: implementation of individualised developmental care

Mortality rates among children with CHD have significantly declined, although the incidence of neurological abnormalities and neurodevelopmental impairment has increased. Research has focussed on outcomes, with limited attention on prevention and intervention. Although some developmental differences and challenges seen in children with CHD are explained by the cumulative effect of medical complications associated with CHD, many sequelae are not easily explained by medical complications alone. Although cardiac intensive care is lifesaving, it creates high levels of environmental and tactile stimulation, which potentially contribute to adverse neurodevelopmental outcomes. The therapeutic method of individualised developmental care, such as the Newborn Individualized Developmental Care and Assessment Program, provides early support and preventive intervention based on each child's behavioural signals of stress, comfort, and strength. Implementing developmental care practices in a cardiac ICU requires a thoughtful and well-planned approach to ensure successful adoption of practice changes. This paper reviews how developmental care was introduced in a paediatric inpatient cardiac service through multidisciplinary collaborative staff education, clinician support, child neurodevelopment assessment, parent support, and research initiatives. Given the known risk for children with CHD, cardiac medical professionals must shift their focus to not only assuring the child's survival but also optimising development through individualised developmental care in the cardiac ICU.

Parents' Perspectives of Closeness and Separation With Their Preterm Infants in the NICU

OBJECTIVE

To discover parents' perceptions of closeness to and separation from their preterm infants in the NICU.

DESIGN

Qualitative descriptive.

SETTING

Urban Level III NICU.

PARTICIPANTS

Twenty parents of preterm infants in the NICU.

METHODS

After ethics approval, data were collected with a smartphone application created for this study. Parents recorded their descriptions of moments of closeness and separation over a 24-hour period in the NICU. Data were transcribed verbatim and content was analyzed.

RESULTS

Five themes related to parents' perceptions of closeness and separation were identified: Having a role as a parent: Feeling autonomous and making decisions; Providing for and getting to know the infant: Feeding, holding, and interacting; Support from staff; Reluctantly leaving the infant's bedside; and NICU environment.

CONCLUSION

Autonomy is a key element of a parent's perception of closeness. Staff in the NICU can facilitate autonomy by involving parents in the care of their preterm infants as much as possible to reinforce the parental role. Parents described leaving their infants' bedsides as very difficult.

Continuing Education Module-Kangaroo Mother Care 2: Potential Beneficial Impacts on Brain Development in Premature Infants

Kangaroo mother care (KMC) involves infant skin-to-skin contact with the mother from as soon as possible after birth, exclusive breastfeeding, early discharge from the health facility, and supportive follow-up at home. Much evidence supports use of KMC clinically as an aid to mitigating some detrimental features of prematurity. This article-the second of two-explores impairments in brain development because of uncongenial inputs from the postnatal therapeutic environment of premature infants, not encountered in utero, and some of their negative neurobehavioral, psychosocial, sociocultural, and economic implications. It is concluded that evidence favoring the use of KMC in stable preterm infants is very strong and that, as noted by others, barriers to implementation of KMC, apart from infant infirmity, are mainly because of hesitancy from parents, health-care professional, and/or institutions, which may be unfounded.