Developmental care is a philosophy utilized by the entire interdisciplinary team to coordinate medical, nursing, and parental interventions based on the developmental needs for a particular patient. This philosophy of care is to support the infant and their families with a focus on environmental influences affecting neurologic development. Developmental care encourages frequent assessment and responses to a baby’s needs. These responses are meant to decrease the stress of the preterm neonates in the neonatal intensive care unit (NICU), according to the Northern Neonatal Network’s guideline for family-centered developmental care.
Why use developmental care?
Neonatal medicine is an ever-expanding field. Babies born at progressively earlier gestational ages are able to survive due to advancements in modern medicine. Mortality rates have declined with the fast-paced achievements of neonatal medicine. However, evidence exists to suggest increased morbidity for neonates born prematurely or acutely unwell. Long-term studies have identified more subtle problems including neurosensory impairments such as cognitive delays and behavioral difficulties. “These can have a significant influence on a child and their families’ way of life.” Developmental guidelines for interventions, handling, inclusion of family and nursing protocols help to optimize neurodevelopmental outcomes for NICU infants and their families.
What is the goal of developmental care?
As caregivers, we want to protect the infant’s brain and create an environment suitable for neurobehavioral development of the infant. According to the Network, the outside environment now needs to mimic the inside environment, which is crucial for normal brain development. The inside environment provides containment and allows for the baby to maintain a supported flexed posture with limited noise and light exposure, as well as, protected sleep cycles with no separation from the baby’s mother. The goal is to support more positive experiences for the baby and thus achieve more positive outcomes for even the littlest of our patients.
How do we implement developmental care?
In the NICU, we use developmental care to support the infant and their families with individualized care which focuses on the environmental influences including handling, positioning, light, and sounds. The amniotic fluid serves as tactile sensory stimulus for the infant while in utero. When the infant is in the NICU, they are exposed to various touch stimuli versus constant tactile stimulus. Studies suggest that even routine handling during procedures can have adverse effects on the infant such as bradycardia, hypoxia, sleep disruptions, increased intracranial pressure and behavioral agitation.
One way to overcome this overwhelming tactile stimuli is to swaddle the infant. A systemic review published in Pediatrics found that swaddled infants have improvement in physiological and behavioral states such as lower heart rate, alleviates pain, prevents hypothermia and calms the infant. It also induces and prolongs sleep with fewer startles. The Network’s guideline suggests that these same benefits can also be achieved by the practice of developmental positioning utilizing positioning aids. Developmental positioning also provides the musculoskeletal support of flexed & midline postures, encourages self soothing behaviors and helps to conserve the baby’s body temperature and energy thus growth and weight are promoted.
Gentle human massage and touch is another intervention that can help decrease stress levels of premature babies. A Research in Nursing & Health study found that gentle human touch increases respiratory regularity, improves sleep cycles, motor activity and behavioral distress during periods of gentle touch. Gentle massages have been reported to help improve weight gain, improved pain alleviation, reduced postnatal complications, improved physiological and behavioral states, shorter hospital stay and improved performance in developmental scores.
The NICU is quite often an overstimulating environment. Behaviors, which should be modeled by staff and taught to the parents can ease the constant stream of auditory and visual stimulation. The NICU staff can control the lights and sounds of the outside environment. A 2013 study published in Indian Pediatrics recommends that we keep the infant on a schedule to allow for uninterrupted rest and decrease stress by using non-nutritive sucking, kangaroo care with parents, swaddling, and containment.
In summary, developmental care should be utilized for all preterm infants during their adaption to extrauterine life. Creating a positive environment and protecting neurobehavioral development is crucial to an infant’s long term outcomes. Implementing developmental care practices such as positioning, swaddling, nonnutritive sucking, gentle human touch and massage can help alleviate pain and provide better outcomes for the premature babies and their families.
Mary Zerlan, DNP, CRNA, at Washington University School of Medicine in St. Louis, MO was recently named to the Nursing Board of the American Health Council. She was selected for her vast knowledge and expertise in anesthesia from three decades of experience in the healthcare industry.
The Department of Anesthesiology at Washington University’s School of Medicine emphasizes innovative education and comprehensive, personalized clinical training. Fostering an academic culture that integrates clinical care, research, and education, services provided include patient care in pre-operative evaluation, intraoperative anesthesia, post-operative critical care, and pain management.
In her role as a Certified Registered Nurse Anesthetist (CRNA) at the Washington University School of Medicine, Zerlan functions as an anesthesia provider at a Level I trauma center. Her scope of practice includes preoperative, intraoperative, and post-operative anesthesia care. After beginning her career as an ICU nurse, Zerlan began serving as an anesthesia provider upon completion of her master’s degree with a sub-specialty in anesthesia. Zerlan’s education background also includes a Doctor of Nursing Practice (DNP) degree from Loyola University Medical College in 2012.
Zerlan credits her success to a strong worth ethic, perseverance, and passion. To learn more about Mary Zerlan and her position on the Nursing Board for the American Health Council, visit here.
The Marian University Leighton School of Nursing is set to begin offering a Doctor of Nursing Practice (DNP) degree program starting in May 2017. The DNP program will offer two tracks: Family Nurse Practitioner (FNP) and Certified Registered Nurse Anesthetist (CRNA).
Marian’s DNP programs are open to registered nurses (RNs) who want to be educated to the highest level for advanced clinical practice and leadership roles. The DNP curriculum uses hybrid methods of on-campus and web-based instruction with courses in systems leadership, evidence-based practice, quality improvement, policy and advocacy, informatics, and other courses to improve patient and organizational outcomes.
The new CRNA curriculum will be the first program of its kind to be offered in Indiana. Students in the state who wanted to train to become nurse anesthetists previously had to complete programs in Cincinnati, Chicago, and other out-of-state nursing programs. The new DNP program tracks are intended to help meet local, regional, and national employment demand for advanced practice registered nurses (APRNs). Graduates of the Marian University DNP program will be fully prepared to provide primary care in hospitals and clinical settings, work in research facilities, and teach at the university level.
To learn more about Marian University’s new DNP program, visit here.
With a mental health professional shortage occurring in Northeast Florida and across the country, six Jacksonville health care systems have joined together to collectively donate $900,000 to the University of North Florida (UNF). The funding will help alleviate the mental health crisis by funding UNF’s Mental Health Graduate Nursing Program which educates mental health nurse practitioners who hold doctorate degrees in nursing practice.
Northeast Florida is experiencing higher suicide rates across all age sectors compared to the rest of the state, according to 2014 statistics from the Jacksonville Community Council Inc. Studies estimate that 270,000 of the 1.1 million adults in Northeast Florida are living with mental illness, with 4 percent of those adults living with severe mental illness.
Part of the health systems funding will go toward establishing a non-endowed professorship in Mental Health Graduate Nursing for a five-year period, paying the salary of an outstanding faculty member in the field of psychiatric/mental health nursing. UNF will take over funding for this position once the donated funding stream has ended.
UNF’s Brooks College of Health (BCH) already offers a Master of Science in Clinical Mental Health Counseling which prepares mental health counselors to provide direct counseling services to individuals, groups, and families. Combined with the new Mental Health Graduate Nursing Program, BCH will prepare mental health professionals who will significantly impact Northeast Florida. BCH also hopes for improved mental health care, and decreased social issues like homelessness and addiction.
To learn more about UNF’s mental health graduate nursing programs and the new health care systems funding, visit here.
The Clemson University School of Nursing recently received a $5,000 scholarship from the CVS Health Foundation to assist students in their studies to become family nurse practitioners. CVS’s grant is part of the new Advance Practice Nurse and Physician Assistant Scholarship program which launched this year.
The program is aimed at reducing the nationwide shortage of family nurse practitioners and physician assistants by supporting these promising future health care professionals. Scholarships will be provided to accredited academic institutions around the nation to be distributed to family nurse practitioner and physician assistant students for covering costs of tuition, books, and other academic fees.
Clemson is thankful for the scholarship funds which will go towards helping deserving students become excellent family nurse practitioners. Eileen Howard Boone, president of the CVS Health Foundation, credits the scholarship as one of many steps that the foundation is taking to increase the number of qualified healthcare professionals in South Carolina and around the nation. Boone tells The Newsstand at Clemson.edu,
“We know how important having a strong pipeline of family nurse practitioners and physician assistants is to making high-quality, convenient and affordable health care services more accessible. We’re proud to support schools like the Clemson University School of Nursing who are providing quality education to students pursuing a career as a family nurse practitioner.”
The scholarship will be awarded to students in good academic standing who are pursuing advanced practice nursing master’s degrees, doctorate family nurse practitioner degrees, or master’s degrees as a physician’s assistant. Scholarship recipients are also required to intern or volunteer with an organization supporting underserved populations, and at least 25 percent of the scholarship funds will be awarded to bilingual students.
After establishing a Nurse Anesthesia Program on its Hattiesburg campus in 2012, the University of Southern Mississippi (USM) recently welcomed it’s fifth class consisting of 20 new students. The university is thrilled to welcome a new cohort who were successfully selected out of many highly-qualified applicants.
Students in the Nurse Anesthesia Program complete three years of learning didactic anesthesia principles in the classroom and practicing in clinical settings through the state. Students who successfully complete the program graduate with their Doctor of Nursing Practice (DNP) degrees and become eligible to take the Certified Registered Nurse Anesthetist (CRNA) exam.
USM’s College of Nursing offers the only nurse anesthesia program in state of Mississippi and is one of only 116 programs in the nation as accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. Dr. Lachel Story, Interim Chair of the Department of Advanced Practice, tells News.USM.edu,
“The College of Nursing is proud to be the home of the only Nurse Anesthesia Program in Mississippi. Our graduates are improving health care, not only in the state and region but across the country.”
To learn more about the University of Mississippi Nurse Anesthesia Program, visit www.usm.edu/nursing.