Assessing Factors Influencing the Quality of Developmental Care in Neonatal Intensive Care Units of Tehran

Abstract

Background: Neonatal intensive care unit (NICU) developmental care refers to interventions in the infant's environment in neonatal intensive care unit to reduce environmental stresses and provide greater family-infant compatibility. Objectives: The aim of this study was to assess current developmental care performance and factors influencing implementation of this care at NICUs in Tehran, Iran. Methods: This cross-sectional study as part of a larger mixed method study assessed the quality of developmental care in Tehran NICUs. The study was performed on 400 nurses working in level III NICUs in 27 hospitals of Tehran during years 2014 and 2015. Data were collected using two scales, "NICU developmental care assessment (NDCA) scale " and "NICU developmental care structural (NDCS) checklist". The scales validity was detected by content, face and construct and reliability by internal consistency and testretest. The overall and each domain score were calculated in percentages. Data were analyzed using the SPSS-21 software using descriptive statistics tests and regression analysis. Results: The total score of quality of providing developmental care was 74.84%. Among all domains, "daily routine care" had the highest score (85.67%) and "sleep and pain care" had the lowest score (66.63%). Total score of structure was 43.06%. The number of neonates admitted per day (B -0.328, P = 0.019) and number of infants managed by each nurse (B -2.543, P = 0.019) were significant predictor variables for better quality of total developmental care. Conclusions: The number of infants cared and admitted were the only significant factors contributing to high quality of developmental care. Therefore, it is reasonable to assume that in case of Tehran, work-load and structure of services should receive greater attention.

Does the Implementation of Multidisciplinary Developmental Care Rounds Increase the Utilization of Developmental Caregiving Interventions in the Neonatal Unit?

“…26 Further studies investigating the implementation of developmental care interventions into routine practice also reported that insufficient time, higher patient caseloads, lack of neonatal experience, and inadequate knowledge and skills all had a negative impact on the delivery of developmental care in the neonatal setting. [31][32][33][34][35] Enhancing individualized caregiving and promoting developmental care practice may be seen as additional rather than essential by staff members who are struggling to meet the physiological care requirements of the babies they are caring for. Despite being aware of the importance of developmental caregiving interventions, it has been reported that bedside clinicians believe that the provision of medical treatments and attending to the infant's basic physical needs for survival often outweigh consideration of their developmental needs.…”

“…Barriers they listed included nursing and medical colleagues, facility limitations, leadership, and a lack of parental involvement 26. Further studies investigating the implementation of developmental care interventions into routine practice also reported that insufficient time, higher patient caseloads, lack of neonatal experience, and inadequate knowledge and skills all had a negative impact on the delivery of developmental care in the neonatal setting 31–35. Enhancing individualized caregiving and promoting developmental care practice may be seen as additional rather than essential by staff members who are struggling to meet the physiological care requirements of the babies they are caring for.…”

The effects of education levels of developmental care in Australia: Perceptions and challenges

“…12 Research exploring the practice of developmental care in different countries has been published since the early 2000s resulting in the global spread of the practice across many settings. [13][14][15][16][17][18][19][20][21] Clinician perspectives of developmental care is predominately explored through questionnaire based research designs, 14-18, 20, 21 with two studies examining qualitative perspectives through interviews. 13,19 In Sweden, a questionnaire of neonatologists (n=139) found 93% believed NIDCAP had a positive influence on the infant.…”

“…The authors cited inconsistencies in application occurred due to a lack of personal knowledge and hospital policies. 20,21 Developmental care practices are based on cumulative experience rather than education exposure, leading to variability in practice and its application. 21,21 Developmental care has been practiced in Australia since the late 1990s.…”

“…20,21 Developmental care practices are based on cumulative experience rather than education exposure, leading to variability in practice and its application. 21,21 Developmental care has been practiced in Australia since the late 1990s. Its implementation was likely driven by personal interest from the global spread of the practice through conference presentations and publications.…”