The Developmental Participation Skills Assessment: Development and Content Validation.

Purpose: The Developmental Participation Skills Assessment (DPS) is designed to assist clinicians who work with hospitalized infants in thoughtfully and accurately identifying infant readiness and the capacity for an infant's participation during caregiving interactions as well as offering an opportunity for the caregiver(s) to reflect upon the experience. Non-contingent caregiving impairs an infant's autonomic, motor and state stability which interferes with regulation and negatively impacts neurodevelopment. By providing an organized way to assess readiness for care and capacity to participate in care, the infant may experience less stress and trauma. The DPS is completed by the caregiver following any caregiving interaction. Methods: Following a literature review, the development of the DPS items were extrapolated from well-established tools to achieve the most evidence-based criteria. Following item inclusion generation, the DPS went thru five phases of content validation: (a) Initial tool development and use by five NICU professionals as part of their developmental assessment. Expansion of the use of the DPS to include three more hospital NICUs within the health system (b) Item adjustment and use as part of a bedside training program at a Level IV NICU (c) Focus group of professionals using the DPS provided feedback and scoring was added (d) Pilot of DPS by multidisciplinary focus group in a Level IV NICU (e) Feedback form sent to 20 NICU experts and content of DPS finalized with reflective portion added. Main Outcome Variable: The establishment of an observational instrument, the Developmental Participation Skills Assessment, provides a means for identifying infant readiness, assessing the quality of infant participation, and prompting clinician reflective processing. Results: A total of 50 professionals across the Midwest (4 OT, 2 PT, 3 SLP, 41 nurses) utilized the DPS as a part of standard practice throughout the phases of development. Assessments were completed on both full-term and preterm hospitalized infants. Professionals within these phases utilized the DPS with infants within a wide range of adjusted gestational ages from 23 weeks to 60 weeks (20 weeks post term). Infants ranged in severity from breathing room air to being intubated on a ventilator. After all phases of development and expert panel feedback, with an additional 20 neonatal experts, the final result was the formation of an easy-to-use observational tool for assessing infant readiness prior to caregiving, participation during caregiving, and stability following caregiving. In addition, there is the opportunity for the clinician to reflect following the caregiving interaction in a concise, consistent way. Conclusion: Identifying readiness, and assessing the quality of the infant's experience while also prompting clinician reflection following the experience has the potential to reduce toxic stress for the baby and promote mindfulness and contingency in caregiving.

Psychometric Properties of the Early Feeding Skills Assessment Tool.

BACKGROUND: Supporting infants as they develop feeding skills is an essential component of neonatal and pediatric care. Selecting appropriate and supportive interventions begins with a thorough assessment of the infant's skills. The Early Feeding Skills (EFS) tool is a clinician-reported instrument developed to assess the emergence of early feeding skills and identify domains in need of intervention. PURPOSE: The purpose of this study was to identify the factor structure of the EFS and test its psychometric properties, including internal consistency reliability and construct validity. METHODS: EFS-trained interprofessional clinicians in 3 settings scored 142 feeding observations of infants 33 to 50 weeks' postmenstrual age. Redundant and rarely endorsed items were removed. Factor analysis methods clustered items into subscales. Construct validity was examined through the association of the EFS with (1) concurrently scored Infant-Driven Feeding Scale-Quality (IDFS-Q), (2) infant birth risk (gestational age), and (3) maturity (postmenstrual age). RESULTS: Principal components analysis with varimax rotation supported a 5-factor structure. The total EFS demonstrated good internal consistency reliability (Cronbach α= 0.81). The total EFS score had construct validity with the IDFS-Q (r =-0.73; P < .01), and with gestational age of a subsample of premature infants (r = 0.22; P < .05). IMPLICATIONS FOR PRACTICE: As a valid and reliable tool, the EFS can assist the interprofessional feeding team to organize feeding assessment and plan care. IMPLICATIONS FOR RESEARCH: The strong psychometric properties of the EFS support its use in future research.

Establishing a Foundation for Optimal Feeding Outcomes in the NICU.

Many infants in the NICU experience difficulties with oral feeding, which contribute to prolonged length of stay. Oral feeding is a complex task involving sensorimotor functioning of the face, mouth, and larynx, as well as coordination of sucking, swallowing, and breathing. The care provided in the NICU starting at birth sets the stage for future oral feeding. The purpose of this article is to describe strategies that will establish a positive foundation to support optimal oral feeding. Nurses can use these strategies to protect newborns from noxious stimuli and promote positive auditory, tactile, gustatory, and olfactory experiences to optimize neurodevelopment for the complex task of feeding.