Barriers to Provision of Developmental Care in the Neonatal Intensive Care Unit: Neonatal Nursing Perceptions

ABSTRACT

The role of the neonatal nurse is vital for the successful implementation of developmental care and the provision of an optimal neonatal intensive care unit (NICU) environment. The goal was to identify nurses' perceived barriers to implementation or improving developmental care in their NICUs. Nursing perceptions related to barriers for implementing developmental care were assessed using a 12-point questionnaire during two New York City Neonatal Nursing regional conferences. One hundred forty-six (86%) of 170 nurses representing 24 regional hospitals returned the survey. Developmental care was viewed as essential by 136 nurses (93%), yet 125 nurses (86%) believed that their NICU was not providing optimal developmental care. Light and sound standards were viewed as important to providing care by 71% and 91% of respondents, respectively, yet only four NICUs (3%) had light and sound meters to identify or standardize this environmental source of pain. As a group, the perceived barriers to provision of optimal developmental care in order of decreasing importance were staff nurses and staff physicians (53%) > NICU funds (42%) > physician leadership (37%) > facility limitations (31%) > registered nurse leadership (25%). In contrast, 90% of nurses whose NICU did not use developmental multidisciplinary team meetings or developmental care champions or advocates were significantly more likely to identify nursing or physician colleagues as barriers to implementing or improving developmental care, compared with 38% of nurses whose NICU used such activities (p < 0.001). Developmental care is perceived by the neonatal nurse as a vital component to the care provided in the NICU. Use of simple light and sound measures may enhance perception of providing an optimal NICU environment. Neonatal nurses perceived barriers to care are often attributed to neonatal staff nursing and physician colleagues. This perception is decreased considerably in those NICUs in which multidisciplinary team meetings or champions are used to address the needs of caregivers by providing developmental care strategies.

Neonatal nurse - developmental care - neonatal intensive care unit

REFERENCES

• 1 Graven S N, Bowen Jr F W, Brooten D et al.. The high-risk infant environment. Part 2. The role of caregiving and the social environment.  J Perinatol. 1992;  12 267-275
• 2 Graven S N. Clinical research data illuminating the relationship between the physical environment & patient medical outcomes.  Journal of Healthcare Design. 1997;  9 15-19
• 3 Sauve R, Saigal S Optimizing the neonatal intensive care environment. In: Report of the Tenth Canadian Ross Conference in Pediatrics, GCI Communications. Montreal, Canada; Abbott Laboratories 1995: 47-62
• 4 American Academy of Pediatrics, Committee on Environmental Health . Noise: a hazard for the fetus and newborn.  Pediatrics. 1997;  100 724-727
• 5 Grunau R E, Whitfield M F, Petrie J. Children's judgments about pain at age 8-10 years: do extremely low birthweight (is less than or equal to 1000 g) children differ from full birthweight peers?.  J Child Psychol Psychiatry. 1998;  39 587-594
• 6 Johnston C C, Stevens B J. Experience in a neonatal intensive care unit affects pain response.  Pediatrics. 1996;  98 925-930
• 7 Als H, Lawhon G, Brown E et al.. Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia: neonatal intensive care unit and developmental outcome.  Pediatrics. 1986;  78 1123-1132
• 8 Pressler J L, Turnage-Carrier C S, Kenner C. Developmental care: an overview. In: Kenner C, McGrath J Developmental Care of Newborns & Infants: A Guide for Health Care Professionals. St. Louis, MO; Mosby 2004: 1-27
• 9 Als H, Lawhon G, Duffy F H et al.. Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects.  JAMA. 1994;  272 853-858
• 10 Hendricks-Munoz K D, Prendergast C C, Wasserman R S. Developmental care: impact on short term infant outcome and physician finances.  Newborn and Nursing Review. 2002;  2 39-45
• 11 Ashbaugh J B, Leick-Rude M K, Kilbride H W. Developmental care teams in the neonatal intensive care unit: survey on current status.  J Perinatol. 1999;  19 48-52
• 12 Baggs J G, Ryan S A, Phelps C E et al.. The association between interdisciplinary collaboration and patient outcome in medical intensive care.  Heart Lung. 1992;  21 18-24
• 13 Brown M S, Ohlinger J, Rusk C et al.. CARE Group. Implementing potentially better practices for multidisciplinary team building: creating a neonatal intensive care unit culture of collaboration.  Pediatrics. 2003;  111(4 Pt 2) e482-e488
• 14 Perlmutter D F, Suico C, Krauss A N et al.. A program to reduce discharge delays in a neonatal intensive care unit.  Am J Manag Care. 1998;  4 548-552
• 15 Peterson C D. Quality improvement in pharmacy: a prescription for change.  QRB Qual Rev Bull. 1990;  16 106-108