Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice

Abstract

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.

Individualized Developmental Care in Neonatal Intensive Care Unit: Current Approaches: Review

“…16 Gelişimsel bakım, yüksek riskli yenidoğanların/prematürelerin ve ebeveynlerinin fiziksel, psikolojik ve duygusal gereksinimlerini tanımaya ve hastanede yatışa bağlı kısa ve uzun vadeli gelişebilecek komplikasyonları en aza indirmeye odaklanmaktadır. 17 Gelişimsel bakımın temel aldığı ve gelişimsel bakım uygulamalarına yön veren en önemli teori Sinaktif teoridir.…”

“…Teori, yenidoğa-nın sürekli ve aktif olarak gelişimsel yetkinliğe karşı davranışları aracılığıyla bağlantı kurduğu varsayımına dayanmaktadır. 17,19,20 Teori, yenidoğanın çevre (uterus, yenidoğan ünitesi ya da ev) ile entegre beş alt sistemden oluştuğunu vurgulamaktaTuba ARPACI ve ark.…”

Developmentally Supportive Care in Congenital Heart Disease: A Concept Analysis

“…Developmentally supportive care is also family-centered (Altimier & Phillips, 2013;Coughlin et al, 2009;Gibbins et al, 2008;Torowicz et al, 2012). Family-Centered Care is the pediatric nursing care model adopted and endorsed by the American Nurses Association and the Society of Pediatric Nursing (American Nurses Association, 2008;Harrison, 2010).…”

“…The UDC model defines developmental care as a patient and family-centered process in which caregivers interact with the infant and the NICU environment at the level of the shared care surface to implement an individualized plan of care (Gibbins et al, 2008). Core measures of DSC include protected sleep, pain and stress assessment and management, developmental activities of daily living, family-centered care, and the healing environment (Coughlin, Gibbins, & Hoath, 2009). Further modification of the UDC model into the Neonatal Integrative Developmental Care Model re-categorized core measures of neuroprotective neonatal care into healing environment (both physical and sensory), partnering with families, positioning and handling, safeguarding sleep, minimizing stress and pain, protecting skin, and optimizing nutrition (Altimier & Phillips, 2013).…”

Authors’ Response: NIDCAP: A Systematic Review and Meta-analyses of Randomized Controlled Trials

“…9 Nursing researchers have identified 5 categories or "core measure sets" to represent the first step in operationalizing evidence-based developmental care. 40 The core measures are protected sleep, pain and stress assessment and management, activities of daily living (positioning, feeding, and skin care), family-centered care, and the healing environment. We recommend that large, well-designed, well-conducted, and timely reported RCTs be undertaken in the preterm population of various combinations of these core measures, starting in the resuscitation area and using well-defined long-term clinical and neurodevelopmental outcomes (the composite of death or major sensorineural disability at 18 months' CA or later in childhood) as the main end points.…”