Title : The neonatal integrative developmental care: Research and training for a path of innovation and development of practices
Abstract:
Introduction: Developmental care models date back to Florence Nightingale, and her focus was on the importance of environment to provide the patient health and improve outcomes. Since 1970, the health care providers know the impact of the NICU environment on the infant's developing Brain. Als' “Synactive Theory,” building on the earlier work of Brazelton interpreted the developmental process to be based on neurodevelopmental interaction between caregivers, the environment and newborn neurodevelopmental subsystems.
Mary Coughlin and colleagues developed five neonatal core measures, that later was recategorized and expanded into seven distinct family-centered developmental core measures of neuroprotective neonatal care. The core measures described in the Neonatal Integrative Developmental Care Model include the following:
- Healing environment
- Partnering with families
- Position and handling
- Safeguarding sleep
- Minimizing stress and pain
- Protecting skin, and
- Optimizing nutrition.
The Neonatal Integrative Developmental Care Model (NIDCM) was developed to simplify aspects from the Universe of Developmental Care Model (UDC) that is a recent reformulation of neonatal developmental care theory.
Aim: To qualify and develop nursing practice and discipline through innovation, research and training, producing positive results in the NICU provided to newborns and families and in the service directed to the organization.
Methodology: Based on NIDCM, ESEL, UI and DE in partnership with NICUs in Lisbon, we developed some research projects integrated in the area of research, “Innovation and Development of Practices”. In oral feeding, the skin protection, the positioning of the newborn does not have a specific evaluation methodology associated with a standardized instrument. We can consider that the observation principles are not consistent for all observers, thus, it is important that a general and specific observation of the newborn positioning through a placement assessment scale can be done, in the Neonatal Intensive Care Unit (NICU). We begin with translation and statistical validation of instruments and now with other supplementary research projects.
Results: Work with some neuroprotective core measures for family-centered developmental care described in NIDCM: optimizing nutrition: Validation of the Early Feeding Skills Assessment Scale for the portuguese population, The Promotion of Oro-motor. Competences in the Preterm Newborn, for its food autonomy (in progress); protecting skin: Observation Neonatal Skin Risk Assessment Scale: statistical validation with newborns, Clinical and statistical validation of the Neonatal Skin Condition Score for Portuguese newborns (in progress); position and handling: Infant Position Assessment Tool. Cultural Adaptation and Statistical Validation with newborns (in progress); partnering with families: kangaroo care in NICU: a parental decision (in progress).
Conclusions and Implications for Practices: Accompany projects of improvement, quality and innovation, and change in the practice of care. Demonstrate the results of intervention in the care practices and in the overall performance of training, research and clinical organizations. Promote research and publication skills. Recognize the hospitalization units, services and other structures of health services such as Practice Development Units.
