All Eyes on Baby
Monday July 14, 2008
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The Nurse’s Role in Developmental Care
The baby might stretch out his or her arms and legs or spread his or her fingers in a stop-like gesture.
If a baby shows signs of distress, the nurse will stop an intervention and soothe the baby. The nurse might place his or her hands gently over the baby in a method called containment, which helps calm the baby. When the baby’s vital signs return to normal and the infant shows other positive cues, the nurse then will proceed with care.
Comfort measures are an important part of developmental care. If babies are uncomfortable or flailing, they are swaddled with blankets or braced so they don’t waste energy seeking boundaries. They are repositioned so their hands can reach their faces.
Pacifiers are used for babies who show a desire to suck, and kangaroo care (skin-to-skin contact) is encouraged between baby and parent. When interventions are performed, a second nurse or parent also participates solely to provide comfort to the infant.
“As a nurse, you feel better about the care you are providing because you feel more in tune to the baby’s emotions and sensations,” says Pat Pearlman, RN, staff nurse in the NICU at the Children’s Regional Hospital at Cooper University Hospital. It is much more fulfilling.”
NIDCAP also involves providing a supportive environment for parents and families by engaging them in their baby’s care. Parents are encouraged to participate in everyday caregiving by performing tasks such as diaper changes, bottle feeding, kangaroo care, and comfort measures when the baby is in distress.
“We try to include the family so that they can begin to develop a nurturing relationship with their son or daughter while they are here,” says Joanne Fox, RNC, BSN, clinical nurse manager for the NICU at Children’s Regional. “By the time the baby is ready to go home, the family feels comfortable taking over the care of the baby. We don’t hear ‘I’m afraid’ anymore.”
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Babies who receive individualized developmental care are more content, says Pearlman. They engage in deeper sleep. They gain weight faster, their cognitive function improves, they feed better, and they go home earlier.
Pearlman wishes developmental care had been in practice 19 years ago when her 32-week-old son, Michael, spent more than two months in the NICU at Children's Regional.
At that time, it was widely believed that the neurosensory system of preterm infants was underdeveloped and, therefore, they did not feel nor remember pain. She recalls watching Michael being circumsized and undergoing interventions such as blood draws and intravenous lines with little or no pain-control measures. He slept in a large room with a dozen or more other preterm infants. The room was brightly lit and often filled with the noises of chirping medical equipment, beeping alarms, crying babies, and even loud rock music.
Some time after bringing Michael home, Pearlman noticed that every time she turned on the rock radio station, Michael went into a crying fit. Today, Pearlman is quite sure the rock music served as a distressing reminder to Michael of the pain he had experienced in his first weeks of life.
The Children's Regional Hospital at Cooper University Hospital is one of 17 facilities worldwide (10 in the United States) recognized by the not-for-profit NIDCAP Federation International as a NIDCAP training center. The hospital's NICU uses an observational tool called a NIDCAP neurobehavioral observation to monitor premature infants' behavior and determine their individual needs. As a training center, the facility helps staff at other hospitals.
According to research conducted in the early 1980s by NIDCAP Federation International Founder and President Heidelise Als, PhD, and her colleagues, babies who receive individualized developmental care experience improved growth and weight gain, decreased days on the ventilator, decreased severity of lung disease, and fewer medical complications. They also have shorter lengths of stay in the hospital. Additional research on the long-term outcomes of NIDCAP care has shown these babies have better intellectual processing and improved neuropsychological functioning at later ages.
"Nearly every NICU or special care nursery in the country today practices some form of developmental care, although it may not include the full NIDCAP methodology," says gretchen Lawhon, RN, PhD, cofounder and vice president of the NIDCAP Federation and director of the Mid Atlantic NIDCAP Center at Children's Regional. (Lawhon spells her first name with a lowercase "g" in honor of the premature babies she cares for.) "While it has not yet spread into the fiber of learning and education, that is one of our major goals."
The physical environment at Children's Regional has incorporated environmental changes that support a baby's growth and development. For instance, no more than four infants share a room; sound level is kept at a minimum; and lighting is regulated — dimmers are used as well as indirect lighting, filtered shades, and darkened rooms at night. Overnight accommodations are available for parents.
"Developmental care is care adapted to the baby's needs," says Pearlman. "In the past, care was dictated by the nurse's time schedule. Now we do things like changing diapers, feedings, and vital signs on the baby's schedule. If the baby is sleeping, we come back."
More Info
New Certification in Neonatal Care
Developmental care is a philosophy that embraces the concept of dynamic interaction between infant, family, and environment. Developmentally supportive care provides a framework in which the environment of care and the process of delivering care are modified and structured to support the individualized needs of the developing newborn and family. In support of developmental caregiving, NANN has established the Advanced Competency in Developmental Care.
Candidates who meet all criteria and pass the online examination will receive a certificate acknowledging completion of the NANN Advanced Competency in Developmental Care Program. Visit the NANN website at www.nann.org for complete information.
By observing and interpreting behavior of infants within their environment and in reaction to care they receive, the NIDCAP observer creates a developmental care plan with the caregiving team that best supports the infant's overall goals and efforts at self-regulation. This is shared with the parents and all clinicians providing care to the infant.
NIDCAP is not just for nurses. Children's Regional provides NIDCAP training to all clinicians and consultants who provide care in the NICU, including neonatologists; physical, occupational, and speech/language therapists; and infant or developmental specialists. All NICU nursing staff members receive a 12-week orientation that includes education in NIDCAP. Additional half-day developmental educational seminars are offered twice yearly for other clinicians.
"This approach to care gives nurses a much better sense of being able to control the environment and the care of the baby," says Joanne Fox, RNC, BSN, NICU clinical nurse manager. "Nurses are more satisfied and fulfilled, babies are more content and progress better, and parents go home more prepared and confident. Once you begin to practice developmental care, you can't help but become a believer."
Susan Meyers is a freelance writer. To comment, e-mail editorPA@nursingspectrum.com.
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