Implementing infant and family-centred developmental care: Exploring the impact of an innovative educational initiative.

AIM: Evidence-based standards for infant and family-centred developmental care are shaping neonatal care. However, the translation of theory and evidence into practice is challenging. This study aimed at exploring the mechanisms by which a structured learning and mentoring model influences the implementation of infant and family-centred developmental care within neonatal practitioners' own clinical practice. METHODS: The study used a descriptive qualitative design. Five neonatal practitioners participated in semistructured interviews. Interviews were audio-recorded and transcribed for thematic analysis. RESULTS: The qualitative analysis gave rise to four themes and nine subthemes. The four primary themes were motivation and preparedness for FINE 2; learning experiences during FINE 2; post-training reflections and experiences; and anticipating the future. CONCLUSION: Neonatal practitioners reported positive outcomes from their participation in relation to the development of their knowledge and skills, their performance of their clinical role and the influence on their relationships with other neonatal staff. Being adequately prepared for the programme in terms of managing the time demands, enabling peer support, the role of additional reading and ensuring realistic line management support were identified as important mechanisms for successful engagement and are being used to support further enhancements of the FINE 2 programme.

Non-evidence-based beliefs increase inequalities in the provision of infant- and family-centred neonatal care.

AIM: To identify barriers that might explain why healthcare staff struggle to implement infant- and family-centred developmental care programmes in two neonatal intensive care units in Mexico. METHODS: Ethnographic fieldwork over the course of 10 months examined interactions among healthcare professionals, parents and babies in two Mexican publicly funded hospitals. Data are drawn from interviews with 29 parents and 34 healthcare professionals and participant observations in the hospitals' neonatal units. RESULTS: Healthcare professionals believed they acted in babies' best interests by excluding parents from the neonatal unit. Professional frustration with working conditions seemed to be increased by the belief that parents were ignorant and unhygienic. Parents were perceived as a source of infection; in contrast, healthcare professionals failed to see themselves as a possible source of cross-contamination. CONCLUSIONS: Beliefs and biases increase health inequalities when evidenced-based measures to prevent cross-infection and potentially life-saving programmes, such as kangaroo mother care and breastfeeding, are not implemented. It is imperative to develop context-appropriate education and practice guidelines to implement basic programmes.

Creating a Holding Environment for Caregivers.

The quality of care that families and infants receive during their time on the neonatal unit will be influenced by the well-being of the people who care for them. The emotional work of caring for infants and families in this demanding setting often goes unrecognized and can result in stress, burnout, and compassion fatigue, which in turn are a threat to the quality of care. Resilience and well-being can be fostered by encouraging self-maintenance, supportive systems organization, providing a healthy working environment, education, and opportunities for reflection.

The validity and reliability of the EValuation of INtervention Scale: preliminary report.

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.

Parental involvement and kangaroo care in European neonatal intensive care units: a policy survey in eight countries.

OBJECTIVE: To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out. DESIGN: Prospective multicenter survey. SETTING: Neonatal intensive care units in eight European countries (Belgium, Denmark, France, Italy, The Netherlands, Spain, Sweden, and the United Kingdom). PATIENTS: Patients were not involved in this study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A structured questionnaire was mailed to 362 units (response rate 78%); only units with ≥50 very-low-birth-weight annual admissions were considered for this study. Facilities for parents such as reclining chairs near the babies' cots, beds, and a dedicated room were common, but less so in Italy and Spain. All units in Sweden, Denmark, the United Kingdom, and Belgium reported encouraging parental participation in the care of the babies, whereas policies were more restrictive in Italy (80% of units), France (73%), and Spain (41%). Holding babies in the kangaroo care position was widespread. However, in the United Kingdom, France, Italy, and Spain, many units applied restrictions regarding its frequency (sometimes or on parents request only, rather than routinely), method (conventional rather than skin-to-skin), and clinical conditions (especially mechanical ventilation and presence of umbilical lines) that would prevent its practice. In these countries, fathers were routinely offered kangaroo care less frequently than mothers (p < .001) and less often it was skin-to-skin (p < .0001). CONCLUSIONS: This study showed that, although the majority of units in all countries reported a policy of encouraging both parents to take part in the care of their babies, the intensity and ways of involvement as well as the role played by mothers and fathers varied within and between countries.

Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines.

OBJECTIVE: To describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations. METHODS: Information on use of heel blood sampling and associated procedures (oral sweet solutions, non-nutritive sucking, swaddling or positioning, topical anaesthetics and heel warming) were collected through a structured mail questionnaire. 284 NICUs (78% response rate) participated, but only 175 with ≥50 very low birth weight admissions per year were included in this analysis. RESULTS: Use of heel blood sampling appeared widespread. Most units in the Netherlands, UK, Denmark, Sweden and France predominantly adopted mechanical devices, while manual lance was still in use in the other countries. The two Scandinavian countries and France were the most likely, and Belgium and Spain the least likely to employ recommended combinations of evidence-based pain management measures. CONCLUSIONS: Heel puncture is a common procedure in preterm neonates, but pain appears inadequately treated in many units and countries. Better compliance with published guidelines is needed for clinical and ethical reasons.

Parents, siblings and grandparents in the Neonatal Intensive Care Unit. A survey of policies in eight European countries.

OBJECTIVE: To describe policies towards family visiting in Neonatal Intensive Care Units (NICU) and compare findings with those of a survey carried out 10 years earlier. METHODS: A questionnaire on early developmental care practices was mailed to 362 units in eight European countries (Sweden, Denmark, the UK, the Netherlands, Belgium, France, Spain and Italy). Of them 78% responded, and among those responded, 175 reported caring for at least 50 very low birth weight infants every year and their responses were analysed further. RESULTS: A majority of all units allowed access at any time for both parents. This was almost universal in northern Europe and the UK, whereas it was the policy of less than one-third of NICU in Spain and Italy, with France in an intermediate position. Restrictions on visiting of grandparents, siblings and friends, as well as restricting parents' presence during medical rounds and procedures followed the same pattern. A composite visiting score was computed using all the variables related to family visiting. Lower median values and larger variability were obtained for the southern countries, indicating more restrictive attitudes and lack of national policy. CONCLUSIONS: The presence of parents and other family members in European NICUs has improved over a 10-year period. Several barriers, however, are still in place, particularly in the South European countries.

Lower stress responses after Newborn Individualized Developmental Care and Assessment Program care during eye screening examinations for retinopathy of prematurity: a randomized study.

OBJECTIVE: Screening examination for retinopathy of prematurity is distressing and painful. The aim of the present study was to investigate whether a Newborn Individualized Developmental Care and Assessment Program intervention during a retinopathy of prematurity examination results in less adverse behavioral, pain, and stress responses as compared with standard care. METHODS: The first 2 eye examinations in 36 preterm infants were evaluated. The infants were randomly assigned at the first eye examination to receive either Newborn Individualized Developmental Care and Assessment Program care or standard care. At the second examination, crossover of subject assignment was performed. The assessments included behavioral responses; recordings of heart rate, respiration, and oxygenation; pain scores (premature infant pain profile); and salivary cortisol at defined time points up to 4 hours after the eye examination. The nursing support given during the eye examinations (intervention score) were scored using predefined criteria. RESULTS: Altogether, 68 examinations were evaluated. Newborn Individualized Developmental Care and Assessment Program care was associated with better behavioral scores during the examination but there was no difference in heart rate, respiratory rate, oxygenation, or premature infant pain profile score between the 2 care strategies before or after the eye examination. Salivary cortisol increased from baseline to 30 minutes after the eye examination independent of care strategy and decreased significantly between 30 and 60 minutes when infants were subjected to Newborn Individualized Developmental Care and Assessment Program care but not after standard care. During the study period the intervention score for standard care increased and approached the score for Newborn Individualized Developmental Care and Assessment Program care at the later eye examinations. CONCLUSION: A Newborn Individualized Developmental Care and Assessment Program-based intervention during eye examination does not decrease pain responses but results in faster recovery, as measured by lower salivary cortisol 60 minutes after the examination. The differences were seen despite the influence from the Newborn Individualized Developmental Care and Assessment Program intervention on the standard care treatment that occurred during the study period.

Facilitating infant adaptation: the nursery environment.

The physical and social environment of the nursery is a direct and indirect influence on the development of premature infants. Qualities in the environment affect physiological stability and provide sensory experience that is relevant to brain development. Adaptation of the prematurely born infant to the unexpected surroundings of the neonatal intensive care unit can be facilitated when the infant's developmental needs are understood and characteristics of the environment are adapted accordingly. The need for environmental change is revealed by the infant's behaviour, that is, his interactions with the environment. The environment also affects the behaviour of caregivers, who like the baby need to be able to do their best in this challenging situation.