Developmental Care Within the Neonatal Intensive care unit - Essay Example

?DEVELOPMENTAL CARE WITHIN THE NEONATAL INTENSIVE CARE UNIT of Introduction Developmental care is defined as the strategies used in neonatal care units to enable in reduction of the level of stress that a premature infant goes through (Hamilton, Moore and Naylor, 2008, p. 190). According to Abbott and Israel (2008, p. 80), neonatal intensive care units organisation has effects on the development an infant’s brain and its organisation. Neonatal intensive care also influences the relationship between the parent and the infant. The particular strategies that comprise developmental care include that the infants are positioned in a comfortable and flexed position. Developmental care also calls for clustering of nursing care for instance carrying out blood pressure and temperature checks to ensure that the babies have longer periods for sleeping. The other strategies used in neonatal intensive care entails turning down the lights in the rooms and providing a quite and dark environment to ensure that infants are able to enjoy maximum sleeping time. In neonatal intensive care, parents are encouraged to visit the infants and adoption of kangaroo care. By adopting developmental care in neonatal intensive care units (NICUs), premature and sick child are able to make a smooth transition from the environment they were enjoying in the womb to the world easily (Abbott and Israel, 2008, p. 80). The area of developmental care within NICUs has been addressed by various bodies that authors and stakeholders in the sector. This paper will be a critical review of the various publications on the topic including a journal by Hamilton, Moore and Naylor; the Bliss initiative by Abbott and Israel and a journal by Sonya Louise. In addition, the paper will critically review the provisions under the Bliss Baby Charter, the Neonatal Toolkit and the British Association of Perinatal Medicine of 2010. Developmental care According to Hamilton, Moore and Naylor (2008, p. 190), developmental care should create a framework within which neonatal care processes are adapted and organised to ensure that they are able to support individual medical, developmental and psychological needs of premature infants and their families. Developmental care has been necessitated by the fact that despite the relentless efforts to prevent premature births; such births are still persistent recurrent with about 6 percent of all lives in UK being preterm in UK annually and these statistics are higher in USA where they are estimated to be 12 percent (Hamilton, Moore and Naylor, 2008, p. 190). Consequently, the demand for neonatal care has increased with more than 70 percent of NICUs admissions resulting from premature infants. In addition to the high costs of providing neonatal care among preterm infants, such infants experience developmental impairments compared to their counterparts. This is explained by the fact that the brain of preterm infants is usually undergoing rapid development and these kids are exposed to a strange environmental setting, repeated invasive assessments and protracted illness (Hamilton, Moore and Naylor, 2008, p. 190). This adversely affects their growth and organisation of hearing, vision and sleeping pattern having long term effects on the neuro-development of the infant. Developmental care exposes parents and premature infants to various stressors and negative feelings for instance guilt, anxiety, helplessness and depression (Hamilton, Moore and Naylor, 2008, p. 190). This is because the highly technical setting and the condition of the premature infant led to the disruption of parental roles and reduces parent-infant relationship. To deal with this problems Hamilton, Moore and Naylor (2008, p. 190) proposes the adoption of supportive care to optimise the development and reduce negative impacts of premature births. In light of this, developmental care must involve a range of interventions that will help reduce stress within NUICs including controlling the external stimuli such as vestibular, visual, tactile and auditory; clustering of nursery care procedures and integration of parents in the program (Hamilton, Moore and Naylor, 2008, p. 190). They also propose the adoption of individualized supportive behavioural procedures for instance kangaroo care and non-nutritive care. They further assert the supportive programs can be combined in an individualized care and assessment program and which helps in the reduction of costs and length of hospitalisation (Hamilton, Moore and Naylor, 2008, p. 190). Abbott and Israel (2008, p. 80) concurs that premature can have numerous impacts on a child varying from mild developmental delays to acute disability. Infants born before the elapse of 32 weeks show poor neuro-behavioural results compared to children born at the right time. The disorders include poor performance at school and lower attention rates. Additionally, given that NUICs are usually technology and tasks intensive in all the interventions leading to increased stress to the child and affecting their neuoro-developmental stability. To deal with this problems, Abbott and Israel (2008, p. 80) advocates the adoption of developmental care encompassing a range of interventions as this would have significant impacts to the infant and the child. Abbott and Israel (2008, p. 80) propose that development care should strive to control stimuli and involvement of parents in the program. Moreover, NUICs should offer specific supportive techniques including kangaroo care and positioning of the infant. However, they contend that developmental care should be individualised. Abbott and Israel (2008, p. 81) supports the work of BLISS which is a premature infants organisation and promotes the adoption of developmental care. They explain that within the NIUCs environment, carers must strive to ensure that noise is kept at minimal and the lights should be off. Moreover, the parent should be encouraged to give their child a positive touch and provision of care. BLISS allows the parents and care givers on their experiences in provision of neonatal care (Abbott and Israel, 2008, p. 82). The issues that emerged due to sharing of information included a recommendation for development of guidelines to establish professional reputation. According to Rick (2006, p. 56), the most critical development of an infant happens within the last years of pregnancy and this period may occur in NIUCs for child born before the elapse of 35 weeks. In these facilities, child and their families undergo stressful procedures and therefore there is need to put these children in developmental care. Developmental care strives to mimic the intrauterine conditions and offer them in nurseries (Rick, 2006, p. 56). Through review of other authors work, Rick argues that infants who are provided with developmental care show positive results and are less exposed to disabilities in the future and they do not show behavioural problems. Furthermore, parents experience low levels of stress and they form mutual relations with such children. The only challenge in providing developmental care is due to the high costs and there is need to observe careful planning as any mistake can lead to fatal consequences (Rick, 2006, p. 56). Rick (2006, p. 58) discusses some other benefits of developmental care to the infant which includes enhanced organisation in their lives, regulation of their behaviours and growth and support proper development of homeostatic processes. Rick (2006, p. 58) also observes that adoption of development care helps to reduce the stress that families usually have to go through after their infants have to be placed in a NIUCs. Neonatal care standards In 2009, the Department of Health developed a toolkit intended to ensure provision of high quality neonatal services. The toolkit sets out the vision of neonatal services as that of providing the best services to both the infants and their families. To achieve this vision, neonatal services must be provided within a managed clinical system where constituent neonatal and allied services collaborate and decisions affecting every family are reached based on the best interests and after clear discussions (Department of Health, 2009, p. 15). The clinical network must be family centred and must incorporate strong leadership. In achieving the vision of neonatal services, the system should be as near to the family as possible and should rely on strategies that supported by research (Department of Health, 2009, p. 15). These conditions are met by development care given that it is evident that health professionals and families report higher success rates and positive outcomes. Within all the NIUCs, there should be availability of transfer services throughout to ensure that emergences are dealt with promptly. The Department of Health (2009, p. 21) proposed various principles that should be adhered in provision of neonatal care. The first principle deals with organisation of neonatal care where organisations must ensure equitable access of these services and in the highest standards. The second principle deals with staffing where it is recommended that NICUs must be availed with adequate staff and competent staff having diverse skills and competencies. This is critical in ensuring that they can manage the conditions of the children and those experienced by their families (Department of Health, 2009, p. 21). The third principle asserts that NIUCs should be family centred and must assist the families in coping with the stress, anxiety, and changed parenting responsibilities that come with preterm births. Another principle in provision of neonatal care deals with transfers requiring that these services should be available throughout the period (Department of Health, 2009, p. 21). Department of Health requires provision of professional competences to caregivers. The NIUCs must also have the ability to provide surgical services within the facility and should adhere to clinical governance requirements (Department of Health, 2009, p. 22). As discussed earlier, Bliss was formed to address the issues touching on preterm children. The organisation also came up with a charter that contains various principles to ensure preterm infants are handled with care, respect and support (Bliss, 2011, p. 3). The first principle adhere to the recommendation by Abbott and Israel for individualised care where the organisation asserts that all infants should received personalized care that respects their dignity and meets their social and emotional and developmental needs. This calls for respecting the privacy of the infant and the family and referring to the infants by names. Bliss (2011, p. 5) explains that the rationale behind this principle is that it can help improve the developmental results of the child and enhance the relationship between the baby and family. The second principle proposed by Bliss (2011, p. 8) explains that decisions in neonatal care should be provided based on the interests of the baby and the family should be engaged actively in the care. Moreover, Bliss (2011, p. 8) assert that care should be evidence based and uphold the best practices. The standards developed by British Association of Perinatal Medicine are incorporated in the Toolkit for High Quality Neonatal services discussed above (Field, 2010, p. 12). The association which is generally involved in providing services to neonatal staff to enhance the quality of services they offer is based on evidence and calls for individualised care where in NICU, the facilities must ensure that there is one on one nursing to the infants and in case a child is undergoing severe conditions, there should be two nurses. The standards also require that there should be a specialist neonatal transportation service and the services should be close to the family (Field, 2010, p. 12). In concurrence to the Department of Health principle discussed earlier, preterm children should receive a national level of specialist care and the NIUCs must be a close to the family as possible (Bliss, 2011, p. 11). This enables parents to access visit their children regularly and allows them to participate in the developmental care. Bliss (2011, p. 13) recommends under its principle four that NIUCs should encourage parents to get involved in planning and programs that ensure continuous improvement in provision of services and all the outcomes must be assessed against national and local standards. Another principle that ought to be upheld is that parents must receive updates on the conditions of their infants and should be guided and supported. This will help reduce any amount of stress and depression that parents face in addition to helping them to prepare for the discharge. NIUCs should promote breastfeeding and mothers should be availed with practical support for lactation (Bliss, 2011, p. 17). This is given the significant role that mothers milks plays in the development of the child. The last principle recommended by Bliss (2011, p. 19) is that planning for discharge should be well facilitated by the NIUCs and should begin from the day the baby is admitted. Coordinated discharge takes care of the safety of the child and allows for continuous provision of social and health care. Conclusion Developmental care has been found by different caregivers as the most effective strategy for addressing the needs of children born prematurely and the needs of their families. If well planned, developmental care helps to ensure does not experience long term disabilities and the parents do not go through stress, anxiety and depression. Developmental care involves various strategies in an attempt to mimic the uterine environment. For developmental care to be effective, it should be well planned and individualized. To achieve success in neonatal care, various bodies have come up with various standards and principles. However, these principles deal with similar areas which they require NICUs to ensure that they adopt strategies that are backed by adequate evidence. The facilities should also be close to the families and must involve the parent in making decisions. Moreover, the standards require that such children are accorded the privacy and dignity they deserve. Bibliography Abbott J. and Israel C., 2008, ‘‘Developmental care –mapping the way forward in the UK: a BLISS initiative’’. Infant 4(3): 80-83. Bliss, 2010, ‘’The Bliss Baby Charter Standards’’, Bliss Publications: pp 1-24. Department of Health, 2009, ‘’Toolkit for high-quality neonatal services’’ Neonatal Taskforce pp. 1-106. Field, D. 2010, ‘‘Service standards for hospitals providing neonatal care’’ The British Association of Perinatal Medicine, pp 1-22 Hamilton, K., Moore, R. and Naylor, H., 2008, ‘‘Developmental care: the carers perspective’’ Infant, 4(6) 190-95. Rick, S. L., 2006, ‘‘Developmental care on newborn intensive care units: nurses’ experiences and neurodevelopmental, behavioural, and parenting outcomes’’, A critical review of the literature. J Neonat Nurs, 12(2):56-61. Read More