The Wee Care Neuroprotective NICU Program (Wee Care): The Effect of a Comprehensive Developmental Care Training Program on Seven Neuroprotective Core Measures for Family-Centered Developmental Care of Premature Neonates

AbstractThe impact of neuroprotective care on preterm infants has been investigated at length, yet professional development and training related to this type of care has not been extensively examined. The Wee Care Neuroprotective NICU program (Wee Care; Philips Healthcare, Andover, MA), a comprehensive developmental care training program (Philips Healthcare) is an evidence-based total change management program designed to optimize the neonatal intensive care unit (NICU) environment and caregiving practices. The Wee Care Neuroprotective NICU program is based on a recently developed Neonatal Integrative Developmental Care Model (© Koninklijke Philips N.V., 2014. All rights reserved).), which utilizes a holistic approach in describing seven core measures for neuroprotective family-centered developmental care of premature neonates of the lotus flower. The seven core measures are depicted on petals of a lotus as the Healing Environment, Partnering with Families, Positioning and Handling, Safeguarding Sleep, Minimizing Stress and Pain, Protecting Skin, and Optimizing Nutrition. The overlapping petals of the Neonatal Integrative Developmental Care (IDC) model IDC model demonstrate the integrative nature of neuroprotective care (Fig. 1). Items on the inside of the lotus flower represent core measure 1, the Healing Environment; which highlight the significance of the developing sensory system, as well as the physical environment in which the neonate now lives. The aim of this quality improvement project was to determine the effect of the comprehensive Wee Care Neuroprotective NICU program (Wee Care) on seven neuroprotective core measures for neuroprotective family-centered neuroprotective developmental care of premature neonates. The sample consisted of 81 hospital NICU sites from 27 US states as well as Belgium and the Netherlands which had implemented the Wee Care comprehensive neuroprotective care training program and had completed pre- and post-site surveys. A secondary data analysis of the extant Wee Care database of pre and post-testing surveys was done to evaluate the training program. The results demonstrated that the Wee Care Neuroprotective NICU training program was effective in improving seven neuroprotective core measures for family-centered developmental care of premature neonates. Each core measure as well as the overall composite core measures score (core measures 1–7) showed statistically significant improvement post training (p < .001). The positive impact of the Wee Care program was independent of the level of NICU, the type of hospital, the presence of a labor and delivery service, or the program year of implementation. The Wee Care Program has been shown to be beneficial based on seven neuroprotective core measures for neuroprotective family-centered developmental care of premature and sick neonates. The transformational training program incorporates evidence-based literature, and standardizes clinical practices for all staff, therefore enhancing consistency in quality. The program improves overall neonatal care and practices and should be widely implemented in NICU's wanting to enhance neuroprotective care of premature and/or sick infants

Level 1 neonatal nursing staff perceptions of their role: A qualitative Framework Analysis study investigating the complex and diverse workload undertaken by nurses in special care baby units

This study investigated Level 1 Special Care Bay Unit (SCBU) nurses’ perceptions of the skills required for their role. Eight nurses from a UK inner city Level 1 neonatal unit participated in qualitative interviews about their role. Analyses were based on data collected from semi -structured interviews supported by open -ended questions and use of a topic guide. The SRQR (Standards for Reporting Qualitative Research) checklist was used as a framework to support the qualitative analytical methods undertaken. Level 1 neonatal nurses reported use of a wide range of skills with a high level of parent – infant engagement. Analysis of the participant interviews revealed six themes: a) balancing nursing workload and demands; b) delivering nursing care in a Level 1 SCBU; c) managing clinical risk and emergencies; d) function and sustainability of a SCBU neonatal team; e) delivering family-centered care; and f) external perceptions of Level 1 nursing care. Work on a Level 1 unit consists of a broad range of skills, possibly greater in scope in comparison with skills used by neonatal nurses on Level 2 and Level 3 units. Further in - depth analysis of this role would be useful for the development of practice skills and for recruitment and retention

Exploring modifiable risk factors for premature birth in the context of COVID-19 mitigation measures: A discussion paper

© 2020 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/.During the COVID-19 pandemic, parents with sick or premature babies have faced challenges following admission to a neonatal unit due to the imposed lock-down restrictions on social contact, hospital visitation and the wearing of personal protective equipment. The negative short-term impact on neonatal care in relation to the prevention of close proximity, contact and bonding between parents and babies is potentially significant. However, an interesting finding has been reported of a reduction in premature birth admissions to the neonatal intensive care unit during the pandemic, raising important questions. Why was this? Was it related to the effect of the modifiable risk-factors for premature birth? This discussion paper focuses on an exploration of these factors in the light of the potential impact of COVID-19 restrictions on neonatal care. After contextualising both the effect of premature birth and the pandemic on neonatal and parental short-term outcomes, the discussion turns to the modifiable risk-factors for premature birth and makes recommendations relevant to the education, advice and care given to expectant mothers.Peer reviewe

Developmentally Supportive Care in Congenital Heart Disease: A Concept Analysis

Theoretical principlesImproved survival of infants and children with congenital heart disease experience has led to recognition that up to half of congenital heart disease survivors also experience developmental delay. Developmentally supportive care is a care model shown in Neonatal Intensive Care Units to be associated with improved outcomes, but developmentally supportive practices with premature infants may not be equally effective in the cardiac population that includes all ages.Phenomena addressedThe purpose of this paper is to present a concept analysis using the Walker and Avant method in order to identify and define characteristics of developmentally supportive care as it may be applied to the population of neonates, infants, and children with congenital heart disease. A theoretical definition of developmentally supportive care is presented.Research linkagesThis concept analysis will provide nurses and allied health professionals with a theoretical basis to implement high quality, family-centered care that meets individual developmental needs in a population at high risk for developmental sequelae. Nursing implications for developmentally supportive care as it applies to infants and children with heart disease are discussed