TitleCore measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice.AimThis paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units.BackgroundInconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America’s Joint Commission’s concept of ‘core measures’ for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model.Data sourcesElectronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue.DiscussionFive core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads.ConclusionStandardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes.

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The use of age-appropriate care as an organized framework for care delivery in the neonatal intensive care unit is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the ''universe of developmental care'' conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the neonatal intensive care unit. These guidelines were recently revised and expanded. In alignment with the Joint Commission's requirement for health-care professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of theses core measures requires a strong framework for institutional operationalization, presented in these guidelines. Part A of this article will present the background and rationale behind the present guidelines and their condensed table of recommendations.

Developmental care for high-risk infants is practiced in most neonatal units around the world. Despite its wide acceptance, inconsistency in its definition and application has resulted in criticism regarding its scientific merit. The universe of developmental care model proposed in this article is the first major reformulation of neonatal developmental care theory since Als' synactive theory. Neither the developing brain nor the environment exists in isolation, and therefore are dependent on each other for all caregiving activities. Central to this model is the concept of a shared surface, manifested most obviously by the skin that forms the critical link between the body/organism and environment and becomes the focal point for human interactions. The components of the model and its theoretical underpinnings, its practical application and direction for future clinical practice, education, and research are presented.

“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk on water without getting wet. This sort of denial is no small matter”1The concept of trauma and traumatic stress emerged in the field of mental health over forty years ago and is a widespread public health concern.  The paradigm of trauma-informed care acknowledges that trauma and traumatic stress overwhelm an individual’s ability to cope while simultaneously changing their biology with both short term and lifelong implications for health and wellbeing. The Substance Abuse and Mental Health Services Administration (SAMHSA) was the first to implement a trauma-informed care framework which “(1) realizes the widespread impact of trauma; (2) recognizes the signs and symptoms of trauma in clients, families, staff, and others; (3) responds by fully integrating knowledge about trauma into policies, procedures, and practices; and (4) actively seeks to resist re-traumatization.”2