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Butler SC, Rofeberg V, Smith-Parrish M, LaRonde M, Vittner DJ, Goldberg S, Bailey V, Weeks MM, McCowan S, Severtson K, Glowick K, Rachwal CM. Caring for hearts and minds: a quality improvement approach to individualized developmental care in the cardiac intensive care unit. Front Pediatr 2024; 12:1384615. [PMID: 38655280 PMCID: PMC11037267 DOI: 10.3389/fped.2024.1384615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024] Open
Abstract
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.
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Affiliation(s)
- Samantha C. Butler
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA, United States
- Department of Psychiatry (Psychology), Harvard Medical School, Boston, MA, United States
| | - Valerie Rofeberg
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Melissa Smith-Parrish
- Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, United States
| | - Meena LaRonde
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Dorothy J. Vittner
- Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT, United States
- Connecticut Children's Medical Center, NICU, Hartford, CT, United States
| | - Sarah Goldberg
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Valerie Bailey
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Malika M. Weeks
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Sarah McCowan
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Katrina Severtson
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Kerri Glowick
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
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Bertoncelli N, Lugli L, Bedetti L, Lucaccioni L, Bianchini A, Boncompagni A, Cipolli F, Cosimo AC, Cuomo G, Di Giuseppe M, Lelli T, Muzzi V, Paglia M, Pezzuti L, Sabbioni C, Salzone F, Sorgente MC, Ferrari F, Berardi A. Parents' Experience in an Italian NICU Implementing NIDCAP-Based Care: A Qualitative Study. Children (Basel) 2022; 9:children9121917. [PMID: 36553360 PMCID: PMC9776912 DOI: 10.3390/children9121917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Natascia Bertoncelli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Luca Bedetti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Arianna Bianchini
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Alessandra Boncompagni
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Federica Cipolli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Anna Cinzia Cosimo
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Giovanna Cuomo
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Michela Di Giuseppe
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Tamara Lelli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Veronica Muzzi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Martina Paglia
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Lucia Pezzuti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Claudia Sabbioni
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Francesca Salzone
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Maria Cristina Sorgente
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41125 Modena, Italy
- Correspondence: ; Tel.: +39-59-422-2522; Fax: +39-59-422-3770
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Charafeddine L, Masri S, Sharafeddin SF, Kurdahi Badr L. Implementing NIDCAP training in a low-middle-income country: Comparing nurses and physicians' attitudes. Early Hum Dev 2020; 147:105092. [PMID: 32502945 DOI: 10.1016/j.earlhumdev.2020.105092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides developmentally supportive environment for preterm infants and their families. Few studies evaluated staff perceptions about NIDCAP implementation and its effect on infant and parents and working conditions. AIMS To assess the perception and experience of NICU staff during the NIDCAP implementation. STUDY DESIGN Cross-sectional anonymous online survey. SUBJECTS 57 NICU staff (29 nurses and 28 doctors) who were present at least one year prior to and during the implementation of NIDCAP training in a tertiary care center. OUTCOME MEASURES A standard questionnaire addressing attitude, perceived behavioral control, subjective norm, intention, behavior and NIDCAP impact related to NICU conditions was used after initiating developmental care activities and NIDCAP training in the unit from June 2014 to May 2018. RESULTS Forty-six doctors and nurses filled the questionnaire; they scored ≥3 out of 5 on all the questionnaire items. Nurses scored significantly higher than doctors (mean 4.00 ± 036) versus (3.57 ± 0.30) (p < 0.001) on the overall NIDCAP score. Specifically, nurses scores were significantly higher for attitude (p < 0.001), perceived behavioral control (p = 0.029); subjective norm (p = 0.011), intention (p = 0.024) and behavior (p < 0.001) questions. CONCLUSION The implementation of NIDCAP in a low-middle income country was perceived as a positive experience for both nurses and doctors: It was thought to have improved infant care and wellbeing as well as the staff relationship with parents, however working conditions remained a challenge. More studies are needed to address areas of improvement for implementation.
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Affiliation(s)
- Lama Charafeddine
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut (AUB), Beirut, Lebanon.
| | - Saadieh Masri
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut (AUB), Beirut, Lebanon
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Bembich S, Trappan A, Galimberti A, Taglieri J, Scolz S, Risso FM, Sanson G. The role of weighing-bathing sequence and postmenstrual age in eliciting adaptive/maladaptive responses in very low birth weight preterm infants. J SPEC PEDIATR NURS 2020; 25:e12292. [PMID: 32291889 DOI: 10.1111/jspn.12292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/19/2020] [Accepted: 04/02/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE In the neonatal intensive care unit, preterm infants are exposed to several stressful stimuli. Inappropriate stimulation led to high risk for short- and long-term neurocognitive disabilities. This study aimed to evaluate whether the sequence of execution of weighing/bathing nursing procedures and postmenstrual age (PMA) have any effect on preterm infants' stress responses. DESIGN AND METHODS Prospective cross-sectional study on a sample of 21 preterm infants. Responses to the procedures were assessed using an observational sheet based on Als's Synactive Theory of Development. Autonomic and motor responses were scored according to five-point Likert scales. The order of execution of weighing/bathing nursing procedures and PMA were documented. Effects of weighing/bathing execution sequence and PMA on autonomic and motor response scores were analyzed by linear multiple regression analysis. RESULTS The sequence of execution had a significant effect on the autonomic score during weighing (p = .035), evidencing more stress when weighing was executed first. A higher level of stress response on the autonomic score during both weighing (p = .015) and bathing (p = .018) procedure was independently associated with a lower infant PMA. CONCLUSIONS AND PRACTICE IMPLICATIONS The real-time recognition of adaptive/maladaptive responses allows nurses to personalize their approach to preterm infants, taking into account PMA and adjusting the appropriate sequence of execution of weighing/bathing nursing procedures.
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Affiliation(s)
- Stefano Bembich
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCSS "Burlo Garofolo", Trieste, Italy
| | - Antonella Trappan
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCSS "Burlo Garofolo", Trieste, Italy
| | - Alice Galimberti
- Department of Medicine, Surgery, and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
| | - Jessica Taglieri
- Department of Medicine, Surgery, and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
| | - Sabrina Scolz
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCSS "Burlo Garofolo", Trieste, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCSS "Burlo Garofolo", Trieste, Italy
| | - Gianfranco Sanson
- Department of Medicine, Surgery, and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
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Miller TA, Lisanti AJ, Witte MK, Elhoff JJ, Mahle WT, Uzark KC, Alexander N, Butler SC. A Collaborative Learning Assessment of Developmental Care Practices for Infants in the Cardiac Intensive Care Unit. J Pediatr 2020; 220:93-100. [PMID: 32147219 DOI: 10.1016/j.jpeds.2020.01.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/12/2020] [Accepted: 01/15/2020] [Indexed: 12/25/2022]
Abstract
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.
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Mirlashari J, Fomani FK, Brown H, Tabarsy B. Nurses' and Physicians' Experiences of the NIDCAP Model Implementation in Neonatal Intensive Care Units in Iran. J Pediatr Nurs 2019; 45:e79-88. [PMID: 30630639 DOI: 10.1016/j.pedn.2018.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 12/29/2018] [Accepted: 12/29/2018] [Indexed: 11/23/2022]
Abstract
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.
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Nelson AM, Bedford PJ. Mothering a Preterm Infant Receiving NIDCAP Care in a Level III Newborn Intensive Care Unit. J Pediatr Nurs 2016; 31:e271-82. [PMID: 26883058 DOI: 10.1016/j.pedn.2016.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 01/05/2016] [Accepted: 01/09/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED The purpose of the study is to describe the unique meaning and significance of the essential elements of mothering a preterm infant receiving Newborn Individualized Developmental Care and Assessment Program (NIDCAP) care in a level III NICU. The overall aim was to promote an increased understanding among healthcare practitioners of the experience of this group of women. DESIGN AND METHODS The authors utilized an existential-phenomenologic method to investigate the experience of 7 mothers of a preterm infant 30weeks gestation or less at birth. RESULTS Analysis of interview transcripts revealed one overarching theme, parenting with permission, and three essential themes with nine underlying subthemes: choosing to participate (subthemes: managing, settling in, making friends), dealing with people (subthemes: meeting needs, facing judgment, and recognizing not everyone is 'on board,' and coming to feel like a mother (subthemes: overcoming fear, gaining understanding, and feeling empowered). CONCLUSIONS/PRACTICE IMPLICATIONS Mothers universally praised NIDCAP for the education and support it provided them. However findings also suggest that great sensitivity and patience is required by professionals to assist mothers to overcome their fear, gain confidence, and participate in NIDCAP without feeling judged. In addition private rooms were found to hold great significance for mothers and should be maintained for the entire hospitalization whenever possible. Finally, ongoing NIDCAP education/support for staff and regular team meetings to discuss and problem-solve concerns are suggested. This might address inconsistent adherence to the NIDCAP care plan by some nurses, which is the greatest source of maternal conflict and frustration.
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Affiliation(s)
| | - Pamela J Bedford
- Pediatric Services, Elliot Health System, New Hampshire's Hospital for Children, Manchester, NH
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Warren I, Hicks B, Kleberg A, Eliahoo J, Anand KJS, Hickson M. The validity and reliability of the EValuation of INtervention Scale: preliminary report. Acta Paediatr 2016; 105:618-22. [PMID: 26896153 DOI: 10.1111/apa.13370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 01/15/2016] [Accepted: 02/15/2016] [Indexed: 11/26/2022]
Abstract
AIM Pain management is a priority for infants receiving neonatal care as they undergo many necessary painful and stressful interventions, which are associated with negative short- or long-term consequences. This study aims to validate the content, and test the reliability, of the EValuation of INtervention Scale (EVIN), which is designed to evaluate the use of widely recommended nonpharmacological strategies to reduce neonatal pain and stress during procedures. METHODS The content of the EVIN was validated with multidisciplinary participation (N = 80), and consistency was established via observations on preterm infants (N = 12, at 31-34 weeks' gestation) during interventions in a neonatal unit. A revised scale was tested for inter-rater reliability with observations of invasive (blood sampling, N = 16) and noninvasive (nappy change, N = 18) interventions. The intraclass correlation coefficient (ICC) was used to determine inter-rater reliability. SPSS (PASW Statistics) version 18 was used for analysis. RESULTS Very good intraclass correlation coefficients (>0.8) for both invasive (0.962) and noninvasive procedures (0.970) were achieved. CONCLUSION These results indicate that the EVIN is suitable for the evaluation of nonpharmacological support during painful or stressful interventions.
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Affiliation(s)
- Inga Warren
- Therapy Services; Imperial Neonatal Service; Imperial College Healthcare NHS Trust; London UK
| | - Beverley Hicks
- Therapy Services; Imperial Neonatal Service; Imperial College Healthcare NHS Trust; London UK
| | - Agneta Kleberg
- Astrid Lindgren Children Hospital; Karolinska University Hospital; Stockholm Sweden
| | - Joseph Eliahoo
- Statistical Advisory Service; Imperial College; London UK
| | | | - Mary Hickson
- Therapy Services; Imperial College Healthcare NHS Trust; London UK
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Sannino P, Giannì ML, De Bon G, Fontana C, Picciolini O, Plevani L, Fumagalli M, Consonni D, Mosca F. Support to mothers of premature babies using NIDCAP method: a non-randomized controlled trial. Early Hum Dev 2016; 95:15-20. [PMID: 26900776 DOI: 10.1016/j.earlhumdev.2016.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/26/2015] [Accepted: 01/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is based on preterm infant's observation during hospitalization and considers infant's behavior as the key to evaluate the level of neurobehavioral maturation. OBJECTIVES To evaluate the effectiveness of NIDCAP program on mother's support and infant development. STUDY DESIGN Non-randomized controlled study, including 43 infants of 32 weeks gestation receiving either a Standard Care (SC) or NIDCAP assessment. The Nurse Parent Support Tool (NPST) was given to mothers before discharge to evaluate the support given by NICU staff. Infants' motor, visual and auditory development was investigated by a neurofunctional assessment (NFA) at term and at 3 months. The effect of NIDCAP assessment on length of hospital stay and feeding status at discharge were also evaluated. RESULTS Mothers in the NIDCAP group awarded higher scores in the majority of the NPST items than mothers in the SC group. NFA at term resulted to be normal in a significant higher percentage of infants that underwent NIDCAP, while no difference could be detected at 3 months. CONCLUSIONS NIDCAP is an effective program to promote mothers' involvement in infants' care, that, in turn, could endorse infants' neurofunctional development in the short term.
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Affiliation(s)
- Patrizio Sannino
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector, Milano, Italy.
| | - Maria Lorella Giannì
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Giovanna De Bon
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Camilla Fontana
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Odoardo Picciolini
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Laura Plevani
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Monica Fumagalli
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Dario Consonni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Epidemiology Unit, Department of Preventive Medicine, Via San Barnaba 8, 20122 Milan, Italy.
| | - Fabio Mosca
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
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López Maestro M, Melgar Bonis A, de la Cruz-Bertolo J, Perapoch López J, Mosqueda Peña R, Pallás Alonso C. [Developmental centered care. Situation in Spanish neonatal units]. An Pediatr (Barc) 2013; 81:232-40. [PMID: 24290892 DOI: 10.1016/j.anpedi.2013.10.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Developmental centered care (DC) is focused on sensorineural and emotional development of the newborns. In Spain we have had information on the application of DC since 1999, but the extent of actual implementation is unknown. OBJETIVE To determine the level of implementation of DC in Spanish neonatal units where more than 50 infants weighing under 1500g were cared for in 2012. A comparison was made with previous data published in 2006. MATERIAL AND METHODS A descriptive observational cross-sectional study was performed using a survey with seven questions as in the 2006 questionnaire. RESULTS The survey was sent to 27 units. The response rate was 81% in 2012 versus 96% in 2006. Noise control measures were introduced in 73% of units in 2012 versus 11% in 2006 (P<.01). The use of saccharose was 50% in 2012 versus 46% in 2006 (P=.6). Parents free entry was 82% in 2012 versus 11% in 2006 (P<.01). Kangaroo care was used without restriction by 82% in 2012 compared to 31% in 2006 (P<.01). CONCLUSIONS The implementation of the DC in Spain has improved. There is still room for improvement in areas, such as the use of saccharose or noise control. However, it is important to highlight the positive change that has occurred in relation to unrestricted parental visits.
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Affiliation(s)
- M López Maestro
- Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España; Red de Salud Materno Infantil y del Desarrollo (RED SAMID).
| | - A Melgar Bonis
- Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España
| | - J de la Cruz-Bertolo
- Departamento de Epidemiología e Investigación clínica, Hospital 12 de Octubre, Madrid, España
| | - J Perapoch López
- Red de Salud Materno Infantil y del Desarrollo (RED SAMID); Servicio de Neonatología, Hospital Vall d'Hebrón, Barcelona, España
| | - R Mosqueda Peña
- Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España
| | - C Pallás Alonso
- Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España; Red de Salud Materno Infantil y del Desarrollo (RED SAMID)
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Mosqueda R, Castilla Y, Perapoch J, Lora D, López-Maestro M, Pallás C. Necessary resources and barriers perceived by professionals in the implementation of the NIDCAP. Early Hum Dev 2013; 89:649-53. [PMID: 23701747 DOI: 10.1016/j.earlhumdev.2013.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 04/19/2013] [Accepted: 04/23/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) requires a significant effort from all professionals involved. AIM To determine the necessary requirements and barriers perceived by health professionals in the implementation of the NIDCAP. STUDY DESIGN A questionnaire covering requirements and obstacles perceived in the implementation of the NIDCAP was developed and validated in two Spanish level III neonatal intensive care units. The questionnaire was answered by 305 health professionals (response rate of 85%). RESULTS The requirements identified in the questionnaire were considered by most respondents as necessary to implementing the NIDCAP, especially more time, education, and staff. Nurses, compared to doctors, thought that more staff was necessary (93% vs. 74%; p < .01). The main obstacle identified in the survey was lack of coordination among different professionals (77%), followed by noise level in the unit (35%). Doctors, in comparison to nurses, considered noise level (61% vs. 23%; p < .01) and nursing staff (56% vs. 29%; p = .05) the most relevant obstacles to NIDCAP implementation. The more experienced professionals perceived their own colleagues as an obstacle, particularly among nursing staff. CONCLUSIONS The implementation of the NIDCAP requires a series of conditions that confirm it is not a trivial process but rather a somewhat laborious one. The lack of coordination among different professionals is often considered the main obstacle.
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Affiliation(s)
- Rocío Mosqueda
- Neonatal Unit, 12 de Octubre Hospital, SAMID Network, Madrid, Spain.
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Als H, McAnulty GB. The Newborn Individualized Developmental Care and Assessment Program ( NIDCAP) with Kangaroo Mother Care (KMC): Comprehensive Care for Preterm Infants. Curr Womens Health Rev 2011; 7:288-301. [PMID: 25473384 PMCID: PMC4248304 DOI: 10.2174/157340411796355216] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
State-of-the-art Newborn Intensive Care Units (NICUs), instrumental in the survival of high-risk and ever-earlier-born preterm infants, often have costly human repercussions. The developmental sequelae of newborn intensive care are largely misunderstood. Developed countries eager to export their technologies must also transfer the knowledge-base that encompasses all high-risk and preterm infants' personhood as well as the neuro-essential importance of their parents. Without such understanding, the best medical care, while assuring survival jeopardizes infants' long-term potential and deprives parents of their critical role. Exchanging the womb for the NICU environment at a time of rapid brain growth compromises preterm infants' early development, which results in long-term physical and mental health problems and developmental disabilities. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) aims to prevent the iatrogenic sequelae of intensive care and to maintain the intimate connection between parent and infant, one expression of which is Kangaroo Mother Care. NIDCAP embeds the infant in the natural parent niche, avoids over-stimulation, stress, pain, and isolation while it supports self-regulation, competence, and goal orientation. Research demonstrates that NIDCAP improves brain development, functional competence, health, and life quality. It is cost effective, humane, and ethical, and promises to become the standard for all NICU care.
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Affiliation(s)
- Heidelise Als
- Department of Psychiatry, Harvard Medical School, and Neurobehavioral Infant and Child Studies, Department of Psychiatry (Psychology) Children’s Hospital Boston
| | - Gloria B. McAnulty
- Department of Psychiatry, Harvard Medical School, and Neurobehavioral Infant and Child Studies, Department of Psychiatry (Psychology) Children’s Hospital Boston
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