Developmental Care: Past, Present, Future

Carole Kenner, PhD, RNC-NIC, FAAN

Dean/Professor School of Nursing

Associate Dean Bouvé College of Health Sciences

President, Council of International Neonatal Nurses

Boston, MA, USA

Objectives

Discuss the past, present, and future of developmental care

Describe the goals of developmental care

Individualized, Family-Centered Developmental Care (IFDC)

Framework for providing care to support positive neurodevelopment of the infant and emotional support of family

What is Developmental Care

An awareness of the interaction between the environment and the infant and family Macroenvironment Microenvironment

Responsibility of the interdisciplinary team-including the family

Requires a partnership with the family

No Visitors Please

Used to be a common policy Still is in some countries

Minimum Handling Protocol

Can be Overused

Evolution of Developmental Care

1976 Toward Improving the Outcome of Pregnancy Planning guidelines for Neonatal Intensive Care

Units (NICUs) March of Dimes 1978 Assembly Bill AB 757 for High Risk Infants

Family needs and services Follow up Care

1979 Kangaroo Care in Bogotá, Columbia Drs. Rey and Martinez

1980’s Newborn Individualized Developmental Care and Assessment Program (NIDCAP) starts

The Evolution Continues

1987 Graven Conference for Physical and Developmental Environment of the High Risk Newborn

1991 Developmental Care Concepts based on work from Dr. Heidelise Als in Boston, MA

1992 Recommend Standards for Newborn ICU Design 1992 Institute for Patient- And Family-Centered Care 1993 Kenner Comprehensive Neonatal Nursing Text 1998 the Philosophy of Developmental Care

introduced at East Tennessee Children’s Hospital

The Evolution Continues

1999 For Profit Company Children’s medical Ventures started producing Developmental Care Products

2000 Brussels, Belgium reports on impact of NICU environment on Premature Infants

2001 NIDCAP (The Newborn Individualized Developmental Care and Assessment Program) Federation International formed

2004 Littleton Adventist Hospital (Littleton, CO) completes $2.5 Million (US dollar) NICU that supports neurodevelopmental, family-centered, and high tech care

The Evolution Continues

2005 Journal of Perinatology article discusses decline in mortality among NICU infants-medical residents include developmental care

2008 Cincinnati Children’s Hospital (Cincinnati, Ohio USA) designated at a Training Center for Optimal Developmental Care for Infants

One of 17 worldwide-10 US NIDCAP Centers, 6-Europe, 1-South America

Since then has spread to Australia, New Zealand, Asia, Middle East

http://www.nidcap.org/training_centers.aspx#Europe

National Association of Neonatal Nurses (NANN)

2008 Blueprint for Developmental Care Competencies Council of International Neonatal Nurses (COINN)

supported NANN’s efforts Consider this a “standard” of care Yet….

The Universe for Developmental Care

New Conceptual Framework Gibbins, Hoath, Coughlin, Gibbins, & Franck, 2008 Includes Institute of Medicine’s (IOM) emphasis on

patient focused care, safety, and quality improvement.

Developmental Care

2002 Declared a useless therapy in a US professional journal

Interdisciplinary support grows – Nurses, Doctors, Occupational Therapists, Physical Therapists

Text

PREDICTIONS FOR DEVELOPMENTAL CARE IN THE 21ST CENTURY

Developmental care will be embraced as the philosophy of newborn, infant, and family-centered care.

Use of a “core curriculum” by health professionals and families will grow and foster its use as a standard of neonatal care.

Developmental care will be a model for interdisciplinary education and healthcare management.

Developmental care will be a part of standard orientation and continued competency evaluation for health professionals who work with newborns, infants, children, and their families

PREDICTIONS FOR DEVELOPMENTAL CARE IN THE 21ST CENTURY

Developmental care will become the framework from which neonatal care is delivered.

Developmental care will be incorporated as an essential part of health professional education—basic and advanced, no matter what the discipline.

Families will be partners in care and not visitors in the NICU any longer.

Developmental care teams will be an expectation in neonatal care delivery.

PREDICTIONS FOR DEVELOPMENTAL CARE IN THE 21ST CENTURY

Evidence will mount to support positive healthy outcomes for newborns, infants, and their families when developmental care is the overarching philosophy of care.

Interdisciplinary research studies will increase to examine various aspects of developmental care.

European Foundation for the Care of Newborn Infants (EFCNI) (Karlsfeld, Germany)

http://www.efcni.org/