Developmental Care Research Articles

FAMILY-BASED CARE USING THE OREM SELF-CARE MODEL IN FAMILIES WITH HYPERTENSION: A CASE STUDY

Introduction: Uncontrolled hypertension can negatively affect a person's physical well-being and quality of life. The implementation of family-based care helps families to achieve independence in maintaining family health. The Orem model approach can explain how the family's role in caring for family health independently. Objectives: This study aims to describe the application of family-based care with the Orem model approach in hypertensive families. Methods: This research was conducted with a case study approach, using a nursing process consisting of assessment with the Orem model, namely assessment of basic conditional factor data, strength components, universal self care, developmental self care, and health deviation and Hypertension Self Management Behavior (HSMB), formulation of nursing diagnoses using SDKI, nursing plans using SIKI, implementation and evaluation. Results: Intervention and implementation were carried out for four meetings including providing family-based health education using leaflet media, foot massage modality therapy and self-management monitoring sheets. The results obtained by both families experienced an increase in behavioral self-management scores and controlled blood pressure. Conclusions: Family-based care can improve behavioral self-management in compliant families.

Scoping review of systematic reviews of nursing interventions in a neonatal intensive care unit or special care nursery.

To identify, synthesise and map systematic reviews of the effectiveness of nursing interventions undertaken in a neonatal intensive care unit or special care nursery. This scoping review was conducted according to the JBI scoping review framework. Review included systematic reviews that evaluated any nurse-initiated interventions that were undertaken in an NICU or SCN setting. Studies that reported one or more positive outcomes related to the nursing interventions were only considered for this review. Each outcome for nursing interventions was rated a 'certainty (quality) of evidence' according to the Grading of Recommendations, Assessment, Development and Evaluations criteria. Systematic reviews were sourced from the Cochrane Database of Systematic Reviews and Joanna Briggs Institute Evidence Synthesis for reviews published until February 2023. A total of 428 articles were identified; following screening, 81 reviews underwent full-text screening, and 34 articles met the inclusion criteria and were included in this review. Multiple nursing interventions reporting positive outcomes were identified and were grouped into seven categories. Respiratory 7/34 (20%) and Nutrition 8/34 (23%) outcomes were the most reported categories. Developmental care was the next most reported category 5/34 (15%) followed by Thermoregulation, 5/34 (15%) Jaundice 4/34 (12%), Pain 4/34 (12%) and Infection 1/34 (3%). This review has identified nursing interventions that have a direct positive impact on neonatal outcomes. However, further applied research is needed to transfer this empirical knowledge into clinical practice. Implementing up-to-date evidence on effective nursing interventions has the potential to significantly improving neonatal outcomes. No patient or public involvement in this scoping review.

Application of the Adverse Childhood Experiences Framework to the NICU.

Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families. Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment. An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed. NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU. Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.

Ensuring Optimal Outcomes for Preterm Infants after NICU Discharge: A Life Course Health Development Approach to High-Risk Infant Follow-Up.

Children born prematurely (<37 weeks' gestation) have an increased risk for chronic health problems and developmental challenges compared to their term-born peers. The threats to health and development posed by prematurity, the unintended effects of life-sustaining neonatal intensive care, the associated neonatal morbidities, and the profound stressors to families affect well-being during infancy, childhood, adolescence, and beyond. Specialized clinical programs provide medical and developmental follow-up care for preterm infants after hospital discharge. High-risk infant follow-up, like most post-discharge health services, has many shortcomings, including unclear goals, inadequate support for infants, parents, and families, fragmented service provisions, poor coordination among providers, and an artificially foreshortened time horizon. There are well-documented inequities in care access and delivery. We propose applying a life course health development framework to clinical follow-up for children born prematurely that is contextually appropriate, developmentally responsive, and equitably deployed. The concepts of health development, unfolding, complexity, timing, plasticity, thriving, and harmony can be mapped to key components of follow-up care delivery to address pressing health challenges. This new approach envisions a more effective version of clinical follow-up to support the best possible functional outcomes and the opportunity for every premature infant to thrive within their family and community environments over their life course.

An enriched environment ameliorates the reduction of parvalbumin-positive interneurons in the medial prefrontal cortex caused by maternal separation early in life.

Early child maltreatment, such as child abuse and neglect, is well known to affect the development of social skills. However, the mechanisms by which such an adverse environment interrupts the development of social skills remain unelucidated. Identifying the period and brain regions that are susceptible to adverse environments can lead to appropriate developmental care later in life. We recently reported an excitatory/inhibitory imbalance and low activity during social behavior in the medial prefrontal cortex (mPFC) of the maternal separation (MS) animal model of early life neglect after maturation. Based on these results, in the present study, we investigated how MS disturbs factors related to excitatory and inhibitory neurons in the mPFC until the critical period of mPFC development. Additionally, we evaluated whether the effects of MS could be recovered in an enriched environment after MS exposure. Rat pups were separated from their dams on postnatal days (PDs) 2-20 (twice daily, 3 h each) and compared with the mother-reared control (MRC) group. Gene expression analysis revealed that various factors related to excitatory and inhibitory neurons were transiently disturbed in the mPFC during MS. A similar tendency was found in the sensory cortex; however, decreased parvalbumin (PV) expression persisted until PD 35 only in the mPFC. Moreover, the number of PV+ interneurons decreased in the ventromedial prefrontal cortex (vmPFC) on PD 35 in the MS group. Additionally, perineural net formation surrounding PV+ interneurons, which is an indicator of maturity and critical period closure, was unchanged, indicating that the decreased PV+ interneurons were not simply attributable to developmental delay. This reduction of PV+ interneurons improved to the level observed in the MRC group by the enriched environment from PD 21 after the MS period. These results suggest that an early adverse environment disturbs the development of the mPFC but that these abnormalities allow room for recovery depending on the subsequent environment. Considering that PV+ interneurons in the mPFC play an important role in social skills such as empathy, an early rearing environment is likely a very important factor in the subsequent acquisition of social skills.

VALIDAÇÃO DE CURSO ON-LINE SOBRE CUIDADOS POSTURAIS AO RECÉM-NASCIDO PREMATURO

ABSTRACT Objectives: Validation of an online course content on postural care for newborns in the Neonatal Intensive Care Unit and assessment of participant satisfaction. Method: Methodological study of content validation by 13 judges with expertise in neonatology and online education who responded to the educational content validation instrument, and by 175 course participants who evaluated the course through a satisfaction questionnaire. The criterion for validation was agreement above 80.0%, analyzed through the Content Validity Index (CVI), Content Validation Coefficient (CVC), binomial test, and descriptive statistics for analyzing satisfaction variables. Data collection took place from January to June 2022 for the validation stage, and during June 2023 for the evaluation stage conducted by the course participants. Results: All items obtained agreement above 80.0% with a total CVI and CVC of 83.3% and 91.0%, respectively. The course participants positively evaluated the course regarding content organization, coherence between theory and practice, navigability, quality of materials, and applicability in professional practice. Conclusion: The online course was considered valid regarding its objectives, structure/presentation, and relevance. Therefore, it can be offered as an open educational resource in the training of healthcare and nursing professionals to provide postural care to newborns in critical environments, thereby enhancing the performance of developmental care.

Neurorazvojni ishod preterminske novorođenčadi

Preterm birth is the leading cause of neonate mortality and the second cause of death for children under 5 years of age in the world. The neonates born with very low birth weight (&lt;1500 g) and extremely low birth weight (&lt;1000 g), as well as neonates born very preterm and extremely preterm are at high risk for neurodevelopmental disabilities. Three common and frequent forms of brain injury in preterm neonates are intraventricular hemorrhage, white and gray brain matter injury. Motor developmental delay is early identified in premature neonates, especially during the first three years of life. The major motor deficit is cerebral palsy, but in school age, minor motor dysfunctions are diagnosed and named developmental coordination disorder. The second domain in which developmental delays are identified is cognitive development. Children born prematurely have lower intelligence quotient and a high risk of speech and language disabilities. The low gestational age and low birth weight are the risk factors for emotional disorders, attention deficit/hyperactivity disorders and autism spectrum disorders. The frequency of visual impairment and hearing loss decreased with enlarging gestational age at birth. Intracranial hemorrhage and neonatal seizures are identified as prominent risk factors for later-onset epilepsy. A key strategy to reduce neurodevelopmental disability is the prevention of preterm delivery. Transport of pregnant women with a risk of preterm delivery and delivery in tertiary centers, prenatal administration of glucocorticoids and magnesium sulfate decreases the risk of preterm brain injury and improves neurodevelopmental outcomes. Also, the program "Neonatal Individualized Developmental Care and Assessment Program" and the application of the "skin-to-skin contact" method (Kangaroo Mother Care) have favorable effects on the neurodevelopmental outcome in premature neonates. Future research should make new recommendations for neuroprotection of the preterm neonates.

"The Nidcap gave me the impression of having a fairer and more objective perception of the child"

Certified Neonatal Individualized Developmental Care and Assessment Program (Nidcap) childcare worker, Fabienne Grillère first experimented with this practice in the neonatology department before doing so in maternal and child care. Indeed, the principle of Nidcap care can be applied indifferent professional sectors since they refer to the premature or sick newborn and its observation. Its use brings an undeniable advantage in the support offered to the child and his family.

Nidcap behavioral observation

Who says Neonatal Individualized Developmental Care and Assessment Program (Nidcap) says observation of the baby's behavior. But what is a Nidcap observation? Who are the professionals who can use this method and what are their objectives? How does an observation of this type take place? How do professionals approach their analyzes with parents? Which babies benefit from it? What does this practice bring to the caregiver who uses it? So many questions that are important to address to better understand the Nidcap observation.

Quick Evaluation on Preterm Baby Developmental Care Model Focusing on the Suitable Component and Intervention in Indonesia

Quick Evaluation on Preterm Baby Developmental Care Model Focusing on the Suitable Component and Intervention in Indonesia

Preterm Infant Care Practice among Nurses in Neonatal Care Units of Selected Hospitals of Nepal: A Cross-Sectional Study

Introduction. Preterm infants (PTIs) are vulnerable to morbidity, disability, and mortality. They require meticulous care for survival and development in neonatal care units (NCUs). PTI care in NCUs is a collaborative and team effort among different health professionals. However, nurses have a key role for quality care. This study aimed to assess nurses’ PTI care practices across different hospitals in Nepal. Methods. A descriptive cross-sectional study was conducted in NCUs of six randomly selected public hospitals in Nepal. After obtaining ethical approval, structured observation was completed among 40 NCU nurses using a practice checklist. After observation, a self-report questionnaire was administered among 102 nurses. Both descriptive and inferential statistics were used for data analysis. Results. The observation and self-reported mean infant care practices were 73.7% and 70.7%, respectively. The overall practice median score and the interquartile range (IQR) were 4.0 (3.5–4.3) with the highest score of (4.5 [4.1–4.7]) for daily supportive care and the lowest score of (2.8 [2.1–3.5]) for pain management. The care practice was strongly associated with the nurse-infant ratio (adjusted odd ratio (aOR) = 18.52, confidence interval (CI) = 5.83–58.77, and p=&lt;0.001) and training status (aOR = 4.95, CI = 1.59–15.39, and p=0.006). Conclusion. Nurses have adequate practice of thermal care, safe oxygen administration, nutritional care, and infection prevention in NCUs, whereas lacking is found regarding developmental supportive care components (sleep promotion and a supportive sensory environment), parental support, and pain management practices. Consideration of the proper nurse-infant ratio and continued professional development opportunities are essential for practice enhancement in NCUs. These findings might be useful to identify the gaps in PTI care practice in NCUs.

Non-pharmacological pain relief interventions in preterm neonates undergoing screening for retinopathy of prematurity: a systematic review

ObjectiveThe objective of this review was to determine the efficacy of non-pharmacological interventions for pain management during retinopathy of prematurity (ROP) screening.Methods and analysisElectronic search of Ovid MEDLINE, PubMed, EMBASE,...

Factors Contribute to Non Applicability of the Developmental Supportive Care by Neonatal Nurses at Intensive Care Unit

Factors Contribute to Non Applicability of the Developmental Supportive Care by Neonatal Nurses at Intensive Care Unit

Implementation of a universal screening and follow-up care system for pediatric developmental and behavioral health in federally qualified health center sites.

Despite guidelines from the American Academy of Pediatrics (AAP), many pediatric practices still do not have standardized screening processes in place to identify children with developmental delays. From April 2014 to April 2017, six federally qualified health center (FQHC) sites in Northern California implemented an intervention to increase (a) standardized developmental screening at recommended intervals and (b) follow-up care and support for early intervention services. The intervention aimed to optimize each site's screening processes, supported by an automated electronic tablet-based system. To improve follow-up support, social workers were hired to conduct follow-up clinical assessments, provide psychosocial education and treatment, provide referrals and case management support, and collaborate with service partners. We analyze operational and implementation data to characterize site adoption, patient reach, implementation processes, and intervention effectiveness. During the intervention's final year, when tablet-based screening was adopted, the sites screened an estimated 6,550 children ages 0-18 at 23 intervals in three domains (developmental, autism, and psychosocial/behavioral), compared to a baseline where they screened ages 0-3 at four intervals in one domain. Screening rates increased from 65.3% to 75.5% after automation was extended from the first to the second site, then to 91.8% after automation was expanded to the remaining sites. Follow-up visit rates ranged between 74% and 88%. Implementation of a multicomponent developmental and behavioral health screening and follow-up care intervention enabled FQHC sites to meet AAP recommendations and provide follow-up support. Disseminating the intervention may support population-level improvement in early detection and intervention for developmental delays and behavioral health concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

How NICU design and infant and family-centered developmental care act synergistically to support babies and families.

Recommended NICU Design Standards and Infant and Family Centered Developmental Care standards have complementary goals. Design standards focus on environmental modifications necessary to enhance NICU baby and family experiences and outcomes. Infant and Family Developmental Care Standards focus on the functional aspects of babies' and families' experience, including the caregiving environment. When applied in the NICU environment of care, both complementary evidence-based standards can function synergistically to promote better outcomes for babies and families.

Unlocking Potential: The Impact of Physical Therapy on ASD and ADHD Care

This white paper highlights the critical role of physical therapy in the lives of children diagnosed with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). The review encompasses diagnostic insights, prevalence considerations, and nuanced clinical perspectives. Emphasizing the crucial role of occupational therapy, it elucidates strategies spanning sensory processing, motor skill development, and adaptive techniques. A core theme advocates for collaborative, multidisciplinary practices involving physical therapists, medical professionals, educators, and caregivers. The synergistic efforts of these stakeholders are highlighted, aiming to craft individualized and holistic treatment plans. Furthermore, the review underscores physical therapy’s impact on fostering independence and self-confidence in affected children. Through illustrative case studies, this synthesis contributes to the evolving landscape of pediatric neuro developmental care. The overarching objective is to champion a paradigm shift towards holistic interventions that address the interconnected facets of physical, cognitive, and emotional well-being. In envisioning an inclusive future, this review advocates for the empowerment of every child, regardless of their neuro developmental profile, to realize their fullest potential.

Effect of intervention of music-assisted therapy on physiological parameters of premature babies - A randomized trial

PurposeTo investigate the effect of intervention of music-assisted therapy (MAT) on the physiological parameters of premature babies. MethodsA two-arm parallel-group randomized controlled trial. This study randomly enrolled a total of 41, 28-to-34-week-old premature babies as the subjects to measure their physiological parameters (body temperature, heartrate, respiration, and blood oxygen level). The control group (n = 20) received general routine care, the experimental group (n = 21) received the intervention of MAT (oriental Nanguan music) for three consecutive days, and the data were collected for the following three days after the intervention. ResultsThe results showed that compared with the premature babies receiving general routine care, there were statistically significant differences (p < 0.05) in the heartrate and blood oxygen level in those receiving the MAT (experimental group). However, there was no statistically significant difference in body temperature and respiration. ConclusionThe heartrate, respiration, and blood oxygen level in the premature babies receiving the MAT were gradually stabilized. In addition, this study also verified that oriental Nanguan music, which has a low frequency and a simple melody, could stabilize the physiological parameters and sleep behavior of premature babies. This study could provide an auxiliary care method for the developmental care of premature babies. In the future, it is hoped that MAT can be included into the regular curriculum of nursing education to provide family-centered holistic care, reduce the stress and anxiety of parents of premature babies, and improve the clinical quality of care indicators.

Impacts of Integrating Family-Centered Care and Developmental Care Principles on Neonatal Neurodevelopmental Outcomes among High-Risk Neonates.

Integrating family-centered care (FCC) and developmental care (DC) principles in neonatal care settings may improve neurodevelopmental outcomes for high-risk neonates. However, the combined impact of FCC and DC has been underexplored. This study aimed to investigate the effects of integrated FCC and DC on neurodevelopment and length of hospital stay in high-risk neonates. A quasi-experimental pre-post study was conducted among 200 high-risk neonates (<32 weeks gestation or <1500 g) admitted to neonatal intensive care units (NICU) in Saudi Arabia. The intervention group (n = 100) received integrated FCC and DC for 6 months. The control group (n = 100) received standard care. Neurodevelopment was assessed using the Bayley Scales of Infant Development-III. Length of stay and readmissions were extracted from medical records. The intervention group showed significant improvements in cognitive, motor, and language scores compared to controls (p < 0.05). The intervention group had a 4.3-day reduction in the mean length of stay versus a 1.4-day reduction in controls (p = 0.02). Integrated care independently predicted higher cognitive scores (p = 0.001) and shorter stays (p = 0.006) in regression models. Integrating FCC and DC in neonatal care enhances neurodevelopmental outcomes and reduces hospitalization for high-risk neonates compared to standard care. Implementing relationship-based, developmentally supportive models is critical for optimizing outcomes in this vulnerable population.

Bibliometric analysis with reference publication year spectroscopy showed how key programmes drove developmental care in newborn infants.

We investigated the historical origins of developmental care for newborn infants using Reference Publication Year Spectroscopy (RPYS), an innovative method of bibliometric analysis. A Web of Science search query that combined infant and intervention-related synonyms was performed on 2 February 2022. RPYS analysis was performed on this dataset to identify the most referenced historical publications for developmental care in newborn infants. Median deviation analysis identified the peak publication years, including the most cited historical references. Landmark publications were defined as those belonging to the top 10% of the most frequently referenced publications for at least 20 years. The RPYS peaks showed an early phase (1936-1986), during which infant development was studied and analysed, leading to a conceptualisation of developmental care for newborn infants. The following years (1987-2020), showed an explosion of interest in developmental care and highlighted two main programmes. The Neonatal Individualized Developmental Care Assessment Program (NIDCAP) and the Infant Health and Development Program (IHDP) inspired numerous publications during those years, which strove to demonstrate evidence of their clinical benefits. Developmental care has become increasingly important, thanks to the implementation of NIDCAP and IHDP.

Parental Experiences of Neonatal Care: A Nationwide Study on Determinants of Excellence

Introduction: Infant- and family-centered developmental care can reduce adverse outcomes in both infants and parents. Parents’ experiences of the care and staff treatment remain to be evaluated. Methods: Parents of infants admitted to neonatal units in Sweden from July 2020 to May 2022 responded to a questionnaire with standardized questions about in-hospital care. Exposures were hospital, gestational age, length of hospital stay, unit level, and bed density. The proportions of parents rating aspects of neonatal care as excellent, defined as five on a Likert scale, and the determinants of excellence were described. The results were benchmarked with ratings in adult somatic care. Results: A total of 4,475/13,108 (34%) parents responded. The ratings of excellent care varied by question from 65% to 90%. The largest variation in excellence between neonatal units (range 43–80%) was found for “participation and involvement.” The proportion of excellence was significantly lower among parents of extremely preterm infants. Confidence in the staff was lower in parents of extremely preterm infants than in parents of term infants (56% vs. 83%). Longer hospital stays affected the experience of neonatal care adversely, whereas level of care and bed density were overall unrelated to the parental experience. Parents in neonatal care rated the care as excellent to a higher extent than patients cared for in adult medicine. Conclusion: A majority of parents rated neonatal care in Sweden as excellent. The less frequent ratings of excellence among parents of extremely preterm infants indicate that more could be done to optimize parental involvement and support.