Family-centered Developmental Care Research Articles

Assessing Family-Centered Care in Iranian NICUs from Perspective of Neonatal Individual Developmental Care

Background: Preterm deliveries and premature babies are among challenges for families and communities. A family-centered care model is a model that helps families become less challenged by preterm birth and learn how to care for their premature infants. The aim of this study was to evaluate the implementation of family-centered care in the Iranian neonatal intensive care units (NICUs).Methods: This national cross-sectional study was conducted on a total of 23 NICUs of 9 universities of medical sciences, where students were trained in the neonatology fellowship course, in seven provinces of Iran. Family-centered developmental care was assessed in six different domains, including the philosophy of nursery, family communication, family support, family resources, admission and discharge planning, and decision-making. In addition, a total of 29 items were asked. The data were analyzed using Stata software (version 13) using descriptive statistical tests.Results: The mean scores in all domains were weak, and the total score for all domains was 34.18 (95% CI: 33.75-34.60) out of 100. The mean scores were 30 in the philosophy of nursery, 43.47 in family communication, 26.71 in family support, 35 in family resources, 45 in admission and discharge planning, and 25 in decision-making. The lowest score was reported for decision-making, and the highest score was reported for admission and discharge planning.Conclusion: Since family-centered developmental care in Iran is not favorable, the obtained findings suggest the development of a suitable plan to upgrade family-centered developmental care as well as comprehensive NICU care, including developmental care, with regard to other domains.

Executive summary: standards, competencies, and recommended best practices for infant- and family-centered developmental care in the intensive care unit.

Developmental family-centered care is evolving as an essential intensive care practice component for newborns and families. Research supports developmental care and the resulting positive outcomes for infants and families. An interprofessional and parent committee utilized a systematic review and consensus process to evaluate the evidence for intensive care practice. Infant- and family-centered developmental care was described, practice components identified, and evidence-based standards and competencies articulated. Consensus process results included articulation of Standards, Competencies and Recommended Best Practices for Infant and Family Centered Developmental Care (IFCDC), including components of systems thinking, positioning and touch, sleep and arousal, skin-to-skin contact, reduction of pain and stress for infants and families, and feeding. Successful IFCDC-recommended practices provide opportunities to integrate the family with the interprofessional team, standardize practice, and improve outcomes.

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Observed Progression of Parents' Understanding of Preterm Infants' Behavioral Signs at 33 to 35 Weeks Corrected Age.

Interventions aimed at improving parental understanding of preterm infants' behavioral signs have drawn increased attention in recent years. However, there are limited data regarding parents' actual perceptions of infants' behavior during parent-infant interactions while infants are in a light-sleep state. (1) To describe parental perceptions of infants' behavior at 33 to 35 weeks' corrected age during light-sleep and (2) to identify changes in parental perceptions of preterm infants' behavior over time. This study used a qualitative, longitudinal design based on observations and interviews. Three sets of parents and their infants born between 29 and 30 weeks' gestational age were observed up to 3 times during light sleep states when the infants were 33 to 35 weeks' corrected age. Parents were interviewed regarding their perceptions of infant behavior/growth once at the time of observation and once more within 2 weeks of the final observation. The findings are based on the observation of parents' perception-driven interactions with infants. Four themes emerged describing the transition of parental perception that progresses to gain a better understanding of their infant's behavior through repeated interaction. The findings of this study inform caregivers in neonatal intensive care units regarding the unique experience of parent-infant dyads. This knowledge can help promote family-centered developmental care efforts in neonatal intensive care units. Further research should focus on studying a larger sample group to confirm the findings and refining strategies to incorporate the findings to enhance neonatal intensive care unit care.

Mothers' Perceptions of Quality of Family-Centered Care and Environmental Stressors in Neonatal Intensive Care Units: Predictors of and Relationships with Psycho-emotional Outcomes and Postpartum Attachment.

Maternal attachment to promote role development in mothers of preterm infants is critical for babies' optimal growth and development. However, few models specify how neonatal intensive care units (NICUs) and their environments work to foster postpartum attachment (PPA) after preterm birth. We investigated relationships of quality of family-centered care and NICU environmental stressors with maternal PPA, to determine whether these are mediated by mothers' psycho-emotional response and whether pathways to PPA are moderated by developmental immaturity (gestation, birthweight). A cross-sectional study using structural equation modeling was conducted on 294 mothers of premature infants with experience in NICUs in over 49 tertiary hospitals in 12 cities or provinces of South Korea. Data were collected using Korean versions of instruments including the Quality of Family-centered Care, Parental Stressor Scale: NICU, and Maternal Postpartum Attachment Scale. Maternal self-representation was a key predictor of PPA (β = .68), accounting for 42.2% of variance. Multi-group analysis indicated that NICU environmental stressor sensitivity (β = .26) and maternal self-representation (β = .67) were predictive of PPA in mothers of moderately preterm and low birthweight (32-36weeks' gestation, 1500-2499g birthweight) infants. Quality of family-centered developmental care (β = .11) and NICU environmental stressor sensitivity (β = - .16) had significant indirect effects on PPA through psycho-emotional responses. Healthcare professionals should be aware of the importance of family-centered interventions focusing on psychosocial support and family participation in baby care, based on their environmental role in promoting PPA.

The Growth and Development Unit. A proposed approach for enhancing infant neurodevelopment and family-centered care in the Neonatal Intensive Care Unit.

There is growing evidence that the neurosensory and social environment of the Neonatal Intensive Care Unit (NICU) has lasting effects on the neurodevelopment of the high-risk hospitalized infant. Thus, many NICUs are transitioning from traditional, medical healing approaches to enhanced family-centered developmental care approaches with the aim of improving infant outcomes and parental mental health. This commentary describes a transdisciplinary neurodevelopmental program based on key principles and recommendations from current and evolving evidence-based care practice guidelines. This clinical initiative, known as the Growth and Development Unit (GDU), was developed within the context of a 66-bed level III NICU. The process of program inception, key elements of program development, as well as program strengths and challenges are discussed.

Evaluation of “CLE” an Intermediate Family Centered Developmental Care Program Based on the Theoretical Concept of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

The Belgian government has always been very supportive con-cerning the implementation of individualized family-centered developmental care in newborn units. Since 2012 the implemen-tation of NIDCAP has been subsidized by the government. This project evolution demonstrated the benefit of NIDCAP on care practices1 and revealed the need for intermediate NIDCAP-based programs.2,3 This requires facilitation of NIDCAP implementation in Newborn Intensive Care Units (NICUs) on the one hand, and development of programs adapted to the reality of Intermediate Newborn Care Units on the other hand. These findings matched the observations of the Brussels NIDCAP training center.

Nurturescience versus neuroscience: A case for rethinking perinatal mother-infant behaviors and relationship.

Behavioral and emotional outcomes for babies who experienced maternal separation due to prematurity or birth defects have not improved significantly for the last 20 years. Current theories and treatment paradigms based on neuroscience have not generated explanatory mechanisms that work, or provided testable hypotheses. This article proposes a new field of scientific investigation, "nurturescience" within which new hypotheses can be tested with novel instruments. Key distinctions between neuroscience and nurturescience are described. Our definition of nurturescience is based on the basic needs of all newborns and of the needs of mothers and their families. This understanding is drawn from biology, anthropology, sociology, physiological, and clinical research. Mechanisms are described from studies on microbiota, epigenetics, allostasis, brain imaging, and developmental origins of health and adult disease. The converging message from these and other fields is that the mother-infant dyad should not be separated. Ongoing emotional connection is the cornerstone of development, leading to life-long resilience. This has implications for making the correct diagnosis (emotional disconnection vs. attachment disorder), providing the appropriate care (infant and family centered developmental care) in the biologically expected place (skin-to-skin contact), and potential for rehabilitation (calming cycle theory). Nurturescience has particular relevance to the care of "small and sick" infants, with profound potential for decreasing the "likelihood of developing developmental problems."

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

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. 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. 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. 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.

Commentary on "Effects of Instruction on Parent Competency During Infant Handling in a Neonatal Intensive Care Unit".

“How should I apply this information?” The neonatal intensive care unit (NICU) environment is challenging for parent-infant interaction experiences. Promoting family-centered developmental care and parental efficacy in the NICU is important to infants’ neurodevelopmental outcomes. Parents benefit from support in learning how to respond to their infants’ cues and how to provide developmentally appropriate handling. It is unclear how to best educate parents in these important interactions. This study explores 3 commonly used instructional methods for teaching parents procedural motor tasks: direct, video, and written-pictorial. Direct and video instructions were most effective in parent performance of positioning and handling of their preterm infants in comparison to written-pictorial only. Neonatal therapists should consider the possible advantages of allocating time and resources toward direct or video instruction when providing developmental education to parents, as well as matching instructional strategies to parent education level. “What should I be mindful of when applying this information?” This study limited the parent education to a one-time instructional session with evidence that the effect of instruction was not sustained at follow-up, nor were long-term effects measured. This finding is not surprising, given that parents in the NICU are under stress, which often limits their learning efficiency. This raises a further question as to whether continual, repetitive instruction throughout an infant's hospitalization might support long-term carryover of parents’ perceived effectiveness of the instruction, in turn, promoting parental efficacy. The aim of the study was to promote improved parent-infant interaction by increasing parent competence in infant handling; however, this was not specifically investigated. Further research on the impact of the positioning and handling technique instruction on parent-infant interaction may provide more meaningful data for the clinician. Maria D'Amore, PT, PCS Jenn Gonya, PhD Nationwide Children's Hospital Columbus, Ohio

EFFECT OF IMPLEMENTING AN EDUCATIONAL PROGRAM ABOUT FAMILY CENTERED DEVELOPMENTAL CARE ON NEONATAL NURSES' KNOWLEDGE AND PRACTICES AT NEONATAL INTENSIVE CARE UNITS

Background: Preterm infant is a live born infant delivered before 37 completed weeks of gestation. Prematurity is responsible for the largest number of admissions to neonatal intensive care unit (NICU). Family centered developmental care (FCDC), is defined as a group of nursing interventions formulated to reduce the effects of the NICU environmental stressors on preterm infants, and integration of family in their infants' care in order to improve outcomes of preterm infants, and their families. Neonatal nurses are in a unique position to implement neuroprotective interventions. Aim of the study this study was done to evaluate the effect of implementing an educational program about FCDC on neonatal nurses' knowledge and practice. Design: A quasi experimental research design using (pre- test & post-test measures) was used. Method: The study was conducted at the NICUs related to El-Mansoura General Hospital and El-Mansoura New General Hospital at Mansoura City, Egypt. The study included all nurses (=51), recruited over six months’ period. Two tools were used to collect data; nurses' knowledge about family centered developmental care structured questionnaire, and nurses' practices of family centered developmental care observational checklist. Results: The finding of this study showed that, the minority of nurses (13.7%) had sufficient knowledge about FCDC before the program implementation, the percentage was improved to 100% immediately after the program, and at follow up In addition, the FCDC program implementation resulted in significant improvements in nurses' practices from totally unsatisfactory before the program implementation to 100 % satisfactory immediately after and slightly declined to 95.7% at follow up phase and the difference was statistically significant at p=0. 000. Conclusion & recommendations: it was concluded that the educational program has positive effect on nurses’ knowledge and practice regarding FCDC. The study recommended including FCDC interventions into nurses’ curriculum and creates developmental care team with physicians, and nurses to follow the application of family centered developmental care. As well as assessing mothers' barriers that hindering them from being a part of their preterm infant life at NICU. In addition, continuous training is essential to change the attitude of medical team toward including family in care plan for the preterm infants.

A Nurse-Based Model of Psychosocial Support for Emotionally Distressed Mothers of Infants in the NICU

Mothers whose infants are hospitalized in the NICU are frequently emotionally distressed, particularly early in the hospitalization. The Family-Centered Developmental Care philosophy, widely adopted by NICUs, calls for an expanded focus on the well-being of the entire family. In this article, we describe an innovative, nurse-delivered program for emotionally distressed mothers of infants in the NICU that includes screening and an empirically supported counseling approach: Listening Visits.

The Neonatal Integrative Developmental Care Model: Advanced Clinical Applications of the Seven Core Measures for Neuroprotective Family-centered Developmental Care

The Neonatal Integrative Developmental Care Model, which outlines seven core measures for neuroprotective family-centered developmental care of premature infants, is a framework that guides clinical practice in many neonatal intensive care units (NICUs) around the globe. The seven neuroprotective core measures are depicted as overlapping petals of a lotus as the 1) healing environment, 2) partnering with families, 3) positioning & handling, 4) safeguarding sleep, 5) minimizing stress and pain, 6) protecting skin, and 7) optimizing nutrition. Skin to Skin Contact (SSC) is considered the foundation for care of infants in the NICU and its importance as the “normal environment” and the ideal place of care is described. The mother/child dyad is the center of the lotus surrounded closely by symbols representing various aspects of the healing environment, highlighting the physical, extra-uterine environment in which the infant now lives, the significance of the developing infant's sensory system, and the influence of people (patient, family, and staff) who help to create a healing environment for hospitalized infants and their families. The Neonatal Integrative Developmental Care Model utilizes neuroprotective interventions as strategies to support optimal synaptic neural connections, promote normal neurological, physical, and emotional development and prevent disabilities.

Recommendations for involving the family in developmental care of the NICU baby.

Family involvement is a key to realize the potential for long-lasting positive effects on physical, cognitive and psychosocial development of all babies, including those in the neonatal intensive care unit (NICU). Family-centered developmental care (FCDC) recognizes the family as vital members of the NICU health-care team. As such, families are integrated into decision-making processes and are collaborators in their baby's care. Through standardized use of FCDC principles in the NICU, a foundation is constructed to enhance the family's lifelong relationship with their child and optimize development of the baby. Recommendations are made for supporting parental roles as caregivers of their babies in the NICU, supporting NICU staff participation in FCDC and creating NICU policies that support this type of care. These recommendations are designed to meet the basic human needs of all babies, the special needs of hospitalized babies and the needs of families who are coping with the crisis of having a baby in the NICU.

Psychosocial program standards for NICU parents.

This article provides a rationale for and brief description of the process of developing recommendations for program standards for psychosocial support of parents with babies in the neonatal intensive care unit (NICU). A multidisciplinary workgroup of professional organizations and NICU parents was convened by the National Perinatal Association. Six interdisciplinary committees (family-centered developmental care, peer-to-peer support, mental health professionals in the NICU, palliative and bereavement care, follow-up support and staff education and support) worked to produce the recommendations found in this supplemental issue. NICU parents contributed to the work of each committee.

Seven Core Measures of Neuroprotective Family-Centered Developmental Care: Creating an Infrastructure for Implementation

The Neonatal Integrative Developmental Care Model utilizes neuroprotective interventions as strategies to support optimal synaptic neural connections, promote normal development and prevent disabilities. Seven neuroprotective core measures for family-centered developmental care of the premature neonate are depicted on petals of a lotus as the Healing Environment, Partnering with Families, Positioning & Handling, Safeguarding Sleep, Minimizing Stress & Pain, Protecting Skin, and Optimizing Nutrition. The overlapping petals of the model demonstrate the integrative nature of developmental care. The Developmental Care Committee in our hospital created an infrastructure around the Neonatal Integrative Developmental Care Model by forming a Steering Committee to oversee seven Neuroprotective Core Measure Committees. The following article describes the organization of this model along with each Core Measure Committee's goals, interventions, and results during their first year.

The Wee Care Neuroprotective NICU Program (Wee Care): The Effect of a Comprehensive Developmental Care Training Program on Seven Neuroprotective Core Measures for Family-Centered Developmental Care of Premature Neonates

The impact of neuroprotective care on preterm infants has been investigated at length, yet professional development and training related to this type of care has not been extensively examined. The Wee Care Neuroprotective NICU program (Wee Care; Philips Healthcare, Andover, MA), a comprehensive developmental care training program (Philips Healthcare) is an evidence-based total change management program designed to optimize the neonatal intensive care unit (NICU) environment and caregiving practices. The Wee Care Neuroprotective NICU program is based on a recently developed Neonatal Integrative Developmental Care Model (© Koninklijke Philips N.V., 2014. All rights reserved).), which utilizes a holistic approach in describing seven core measures for neuroprotective family-centered developmental care of premature neonates of the lotus flower. The seven core measures are depicted on petals of a lotus as the Healing Environment, Partnering with Families, Positioning and Handling, Safeguarding Sleep, Minimizing Stress and Pain, Protecting Skin, and Optimizing Nutrition. The overlapping petals of the Neonatal Integrative Developmental Care (IDC) model IDC model demonstrate the integrative nature of neuroprotective care (Fig. 1). Items on the inside of the lotus flower represent core measure 1, the Healing Environment; which highlight the significance of the developing sensory system, as well as the physical environment in which the neonate now lives. The aim of this quality improvement project was to determine the effect of the comprehensive Wee Care Neuroprotective NICU program (Wee Care) on seven neuroprotective core measures for neuroprotective family-centered neuroprotective developmental care of premature neonates. The sample consisted of 81 hospital NICU sites from 27 US states as well as Belgium and the Netherlands which had implemented the Wee Care comprehensive neuroprotective care training program and had completed pre- and post-site surveys. A secondary data analysis of the extant Wee Care database of pre and post-testing surveys was done to evaluate the training program. The results demonstrated that the Wee Care Neuroprotective NICU training program was effective in improving seven neuroprotective core measures for family-centered developmental care of premature neonates. Each core measure as well as the overall composite core measures score (core measures 1–7) showed statistically significant improvement post training (p < .001). The positive impact of the Wee Care program was independent of the level of NICU, the type of hospital, the presence of a labor and delivery service, or the program year of implementation. The Wee Care Program has been shown to be beneficial based on seven neuroprotective core measures for neuroprotective family-centered developmental care of premature and sick neonates. The transformational training program incorporates evidence-based literature, and standardizes clinical practices for all staff, therefore enhancing consistency in quality. The program improves overall neonatal care and practices and should be widely implemented in NICU's wanting to enhance neuroprotective care of premature and/or sick infants.

NIDCAP and developmental care

Perinatal mortality in very low birth weight infants has dramatically decreased during the last decades. However, 15-25% of these infants will show neurodevelopmental impairment later on. The aim of implementing early developmental care (EDC), emerged as a new field in neonatology, is to create an intervention program designed to provide support for optimal neurobehavioral development during this highly vulnerable period of brain growth. The theoretical framework, which underlies the approach, is supported by research in different scientific fields, including neuroscience, psychology, medicine and nursing. EDC utilizes a range of medical and nursing interventions that aim to decrease the stress of preterm neonates in neonatal intensive care units (NICUs). The Neonatal Individualized Developmental Care Assessment Program (NIDCAP) is an integrated and holistic form of family-centered developmental care. Changing the traditional NICU towards an EDC-NICU includes training nursing and medical staff, investing in their quality and most importantly keeping parents in proximity to the infants. The new challenge of modern neonatology is to restore the mother-infant dyad applying “couplet care” starting at birth until discharge. Most of the European NICUs apply some elements of EDC, but it is more consistent in northern Europe. The development of NIDCAP training centers in Europe demonstrates the evolution of care. It is likely that future research and intervention programs will optimize our practices. Developmental care could prove to be an important recent step in improving outcome in extremely preterm neonates. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

Factors Influencing Implementation of Developmental Care Among NICU Nurses in China.

The main aim of this article is to describe current developmental care nursing practices among registered nurses (RNs) working in neonatal intensive care units (NICUs) in China and to explore selected personal and unit characteristics related to developmental care implementation. A convenience sample of 207 RNs participated in this descriptive, cross-sectional exploratory study. A tool of Practice Standards for Individualized, Family-Centered Developmental Care was used to collect the data. The findings indicate that Chinese NICU nurses are not implementing developmental care consistently. Higher patient caseloads, fewer work hours per day, higher level of education, and fewer years worked in NICUs are the significant predictors for lower implementation of developmental care. NICU nurses in China currently carry out developmental care based mainly on their accumulated clinical experience rather than their educational experience. More systematic developmental care training for NICU nurses and more support at both unit and hospital levels are necessary in China.

The Neonatal Integrative Developmental Care Model: Seven Neuroprotective Core Measures for Family-Centered Developmental Care

Neuroplasticity refers to the ability of the brain to make short- or long-term modifications to the strength and number of its synaptic neuronal connections in response to incoming stimuli associated with activity and experience. Neuroplasticity is a lifelong property of the human brain, which peaks during early life during the period of most rapid brain growth. The Neonatal Integrative Developmental Care Model uses neuroprotective interventions as strategies to support optimal synaptic neural connections, promote normal development, and prevent disabilities. Seven neuroprotective core measures for family-centered developmental care of the premature neonate are addressed: healing environment, partnering with families, positioning and handling, minimizing stress and pain, safeguarding sleep, protecting skin, and optimizing nutrition.