Parent Participation in Houston NICU Produces Promising Results
Monday August 25, 2008
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Just minutes after giving birth to Nyla-Eve, the tiny preemie was rushed to the Neonatal Intensive Care Unit at nearby Children's Memorial Hermann Southwest Hospital in Houston. When Jolivette later joined Nyla-Eve at Children's, she was not ready for the reception she was about to receive. Soon after arriving, she was invited to participate in the NICU's weekly multi-disciplinary rounds to discuss Nyla-Eve's case.
"I couldn't believe it, I walked into the room and there were at least 13 hospital staff members in there," recalls Jolivette. "They talked about the care plan for Nyla and asked me for my input. It was awesome. It made me feel like this wasn't just a 9 to 5 job, these were people who were really concerned."
Throughout the next three months, Jolivette and Nyla-Eve's father Don Cross, were encouraged to comfort Nyla-Eve and participate in the care process whenever possible. "Nyla was very sick," says Jolivette. "I was expecting a very mechanical-like approach, not the warmth, encouragement and support we received from everyone of their staff members. They made me feel like I was a part of the team."
When nurses provided care, Jolivette and Cross comforted Nyla-Eve by holding her tiny hand or gently touching her tiny body.
Children's practices a comprehensive approach to care called the Newborn Individual Development Care and Assessment Program (NIDCAP). NIDCAP provides developmentally supportive and family-centered care that is individualized to an infant's goals and level of stability so that each infant may realize optimal health and developmental outcomes. Seeking to mirror the womb for these young preterm infants, the NIDCAP approach minimizes outside stimuli, uses gentle-touch interventions, pain control and other comfort measures to support the baby during care and at rest. It also involves using the NIDCAP observational tool to monitor premature infants' behavior and determine their individual needs.
Developed in 1984 by Heidelise Als, PhD, NIDCAP Federation International founder and president, early research conducted by Als and her colleagues shows that babies that receive individualized developmental care have improved growth and weight gain, decreased days on the ventilator, decreased severity of lung disease, fewer medical complications and shorter lengths of stay. Additional research on long-term outcomes reveals that babies cared for with NIDCAP also show better intellectual processing and improved neuropsychological functioning at later ages.
As the primary provider of bedside care to preterm infants, the nurse plays a primary role in delivering developmental care. "It's not about focusing on what the baby can't do, but what its needs and strengths are and how we can improve upon these," says Tiffany Choate, RNC, BSN, NICU navigator at Children's who is in the process of becoming NIDCAP certified.
When a baby shows signs of distress, developmental care promotes the use of comfort measures until the baby's vital signs return to baseline and the infant shows other positive cues. Comfort measures include techniques like placing one's hands gently over the baby in a method called "containment," which helps calm the baby; repositioning a baby so that their hands can reach their face; using pacifiers to help babies calm themselves, swaddling babies with blankets or "nesting" them with positioning aids so that they don't waste energy seeking boundaries; as well as managing their pain proactively.
"By providing these support measures, the baby expends less energy and is less stressed which allows them to get better faster," says Beverly Edwards, RNC, clinical manager at Children's. "Everyone in our unit has completed in-service training for developmental care. It has changed the culture. The staff is much more aware of being quiet, maintaining proper positioning of the babies and keeping them comfortable."
As Cross and Jolivette quickly discovered, the NIDCAP approach also involves providing a supportive environment for parents and families by engaging them in their baby's care. "The parents' involvement and ability to bond with their baby is just as important as the rest of their care," says Edwards. "Our unit is open to parents 24/7 so that they can be at the bedside whenever it's convenient for them."
Observing Baby's Behavior.
An important component of NIDCAP care involves the performance of NIDCAP observations and assessments on premature infants by certified observers. Using a detailed observational tool referred to as the NIDCAP observation, certified observers evaluate an infant's behavior and note when the baby is steady and relaxed and when the baby is experiencing stress or discomfort.
By observing and then interpreting behaviors of infants within their environment and the reactions to care they receive, the NIDCAP observer creates a developmental care plan with the care giving team that best supports the infant's overall goals and efforts at self-regulation, says Edwards.
Choate says once you see the difference in how babies respond to this type of care, you know you are doing the right thing. "The old way of providing care in which nurses were more task-oriented now seems foreign," says Choate. "Babies are definitely more content when you listen and respond to their cues. This is the only way to provide care."
Susan Meyers is a freelance writer.
To comment on this article e-mail editorSC@nurseweek.com.
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