<p>To be preborn and treated in a hightech environment, will expose the child for an abnormal stimulance. Immature lungs and brain are accountable for the biggest healthrisks. The medical treatment will affect the childs future development. Nursing according to NIDCAP®, Newborn Individualized Developmental Care and Assessment Program, aims at reducing the surrounding disturbance in relation to the childs maturity.</p><p>The aim for this literature study is to survey the affects of NIDCAP®-nursing. The literature study is based upon scientific articles. Findings showed that NIDCAP® had several positive affects on the child such as less respirator-time, increasing growth and a better cognitive progress. The affect on the family showed an improved bond between the child and its mother. </p><p>There is a great demand for survey’s concerning preborn-nursing and its affect.</p>

To be preborn and treated in a hightech environment, will expose the child for an abnormal stimulance. Immature lungs and brain are accountable for the biggest healthrisks. The medical treatment will affect the childs future development. Nursing according to NIDCAP®, Newborn Individualized Developmental Care and Assessment Program, aims at reducing the surrounding disturbance in relation to the childs maturity. The aim for this literature study is to survey the affects of NIDCAP®-nursing. The literature study is based upon scientific articles. Findings showed that NIDCAP® had several positive affects on the child such as less respirator-time, increasing growth and a better cognitive progress. The affect on the family showed an improved bond between the child and its mother. There is a great demand for survey’s concerning preborn-nursing and its affect.

Neonatal Intensive Care Units have experienced profound advances in technology and treatment modalities over the last two decades. Infants born at the edge of viability are now surviving despite prolonged hospitalizations. These infants born preterm are prone to a high degree of stress from life sustaining and routine interventions. Much focus has been directed toward addressing noxious environmental factors such as noise, light, and infectious disease; however, little has been done to examine the stress experienced by the professional caregiver who work in these environments. Environmental press theory, which focuses on the interplay between human beings and their surroundings, is explored as a way to provide insight into understanding and mitigating the stress experienced by health care providers working in the newborn intensive care. A proposal for a research study with a cross-over design was approved to study the effect of “four handed care” on infants’ physiologic responses (oxygenation, heart rate, and stress) and behavioral responses (state, stress and defense, self-regulatory and approach behaviors) to and recovery from endotracheal suctioning when compared to routine care. Results of this study demonstrated no significant differences were noted when heart rate (HR) or oxygen saturation (SpO2) taken at baseline were compared to HR and SpO2 obtained during and after suctioning while in the routine care condition. In the four-handed care condition, mean SpO2 increased from pre-observation 95.49 to during observation saturation 97.75 (p = 0.001). Salivary cortisol did not differ between groups at baseline or post-suctioning. There was no significant difference in behavior state between the two conditions at any time point. More stress and defense behaviors were seen post-suctioning when infants received routine care as opposed to four-handed care (p = .001) and more self-regulatory behaviors were exhibited by infants during (p = .019) and after suctioning (p = .016) when receiving four-handed care as opposed to routine care. There was no statistical difference in the number of monitor call-backs post-suctioning. In conclusion, four-handed care during suctioning was associated with a decrease in stress and defense behaviors and an increase in self-regulatory behaviors. These findings, while based on a small sample, provide modest evidence that the four-handed care intervention for suctioning should receive further testing. Interventions such as four-handed care that are theoretically developmentally supportive of the sick preterm infant, need further research attention before recommending widespread adoption.

The implementation of developmental care in South Africa seems problematic. As an effective care approach, developmental care (DC) reduces short- and long-term sequelae for pre-term and sick infants. This study therefore investigates and documents how DC can be implemented successfully in a South African context. The research design chosen, intervention design and development, has six phases: problem analysis and project planning, information gathering and synthesis, design, implementation, evaluation and advanced development, and dissemination. The sixth phase fell outside this study’s scope. Phase One, problem analysis and project planning, involved analysing and describing the level of DC practiced at the research site before implementation, and planning the implementation of DC in a South African public NICU. Planning involved consulting relevant literature and the multidisciplinary team of the NICU. Phase Two, information gathering and synthesis, consisted of identifying the factors involved in DC implementation from national and international examples of such implementation in neonatal intensive care. These factors were derived from available literature and other resources, including institutions where DC and kangaroo-mother care have been implemented, to provide a contextual framework for the intervention plan. The intervention plan for DC implementation at the research site was designed in Phase Three, based on the information gathered in Phase Two. The plan consisted of descriptive representations of the realities of clinical practice combined with applicable theoretical perspectives on the practice of DC. Guidelines for implementing DC were established as part of the plan. Phase Four involved the execution of the intervention plan in a South African public NICU, with participation from members of the multidisciplinary team. The intervention plan was refined and developed further in Phase Five, through monitoring and evaluating DC principles in the NICU. The guidelines were validated by an expert group. The study used Lincoln and Guba’s model (1985: 305) to ensure trustworthiness. No experimental and control groups were used as DC was implemented uniformly in the NICU, with all infants receiving this care. Harm or damage to research participants were not expected, as DC implementation benefits them and improves their working environment. Confidentiality was ensured for all participants and institutions involved. Informed consent for participation was obtained from individual members of the multidisciplinary team. Clearance was obtained from the ethics committee of the University of Pretoria, and institutional consent was obtained from the necessary organisations. This intervention study targeted the multidisciplinary team where medical, nursing, allied health profession and non-medical support personnel were involved in implementing DC. Phase One’s targets and goals included improving the quality of care rendered at the research setting, reducing developmental delays for preterm and sick infants and improved the working environment for the multidisciplinary team. Personnel targets were increasing the staffs’ knowledge and skills, and improving staff morale and job satisfaction. These targets and goals were achieved. / Thesis (PhD (Nursing Science))--University of Pretoria, 2006. / Nursing Science / unrestricted

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No description available.

Kangaroo care (KC) is a cost-efficient method to increase infant-parent bonding and neonatal health outcomes worldwide. Despite evidence supporting KC in critically ill infants, nursing perceptions regarding patient safety and interrupted work flow continued to impede practice in the local high-tech neonatal intensive care unit (NICU). Their current policy failed to address the 2-person transfer method recommended for safe practice. In addition, both staff and parents lacked training and education regarding the benefits and feasibility of KC. This doctoral project aimed to decrease practice barriers and promote earlier and more frequent KC by developing and integrating an evidence-based clinical pathway within a multifaceted champion-based simulated educational training program for NICU staff and parents. Published outcomes and generated organizational data for program synthesis connected the gap in practice. Kolcaba's comfort theory served as the guiding framework to ensure a partnership in care. This quasi-experimental quantitative study used the generalized liner model for data analysis. Study findings indicated that KC occurred 2.4 more times after the intervention compared to before (p = 0.001). Descriptive data revealed that KC episodes for intubated patients nearly doubled after implementation (11.1% from 6.2%). Post-survey scores for nursing knowledge and comfort level also improved after the intervention. Although earlier KC practice was non-conclusive (p = 0.082), future trials should control groups for day of life since admission. Disseminating the KC pathway can have a positive social change on family-centered care by increasing NICU nurses' knowledge, comfort, and adoption of this evidence-based practice as an expected routine standard of care.

Currently, the care of premature newborn infants and their parents is mainly focused on the so-called Newborn Individualized Developmental Care and Assessment Program (NIDCAP) that is aimed at protection of the developing central nervous system of a premature child.The aim of nursing care is to help premature child to cope with the premature delivery. To adjust the environment and the way of care so it suits the individual needs of every child. The support of the parental role and the efforts to involve parents in the care of a newborn infant as early as possible are stressed. The following objectives were defined in the diploma thesis. To process experience with introducing new forms of the developmental care of excessively or extremely premature newborn infants from the point of view of nursing. To characterize current provision of individualized developmental care of newborn infants born before week 32 of gestation. To map the role of the nurse in delivering individualized developmental care and to find out how parents perceive the developmental care of excessively and extremely premature newborn infants. 4 research questions were raised on the basis of the objectives of the thesis. Which forms of the individualized developmental care are used in care of a newborn infant born before week 32 of gestation most? Which problems do nurses have to cope when employing individualized developmental care in the day-to-day care of newborn infants born before week 32 of gestation with and which roles of nurses are applied most when providing care? How do parents of newborn infants born before week 32 of gestation perceive the care of their child included in the individualized developmental care? The theoretical part of the thesis deals with the issue of excessively and extremely premature newborn babies, characteristics of the individualized developmental care and the nursing strategies, the role of a nurse and the role of parents. The practical part is focused on the qualitative research. The results of the research suggest the nurses have included the individualized developmental care into the nursing care of premature newborn infants at the Department of Neonatal Medicine in the Hospital in České Budějovice, however, not in its full extent. The parents perceive the included aspects of this care positively,the nursing staff is important. The research has identified problems nurses have to cope with when they implement this care and what the reserves in the implementation are. A map of the individualized developmental care that can be used by nurses in practice is the result of the research.

Thesis (MOccTher (Interdisciplinary Health Sciences. Occupational Therapy))--University of Stellenbosch, 2010. / AFRIKAANSE OPSOMMING: AGTERGROND Dit is bekend dat vroeggebore babas met ʼn baie lae geboortemassa ʼn hoër insidensie van ontwikkelings-, gedrags- en mediese agterstande en verskeie leerprobleme toon teen die tyd dat hulle skoolgaande ouderdom bereik. Kommer bestaan ook oor die omgewingseffek van die neonatale intensiewe sorgeenheid op die sensoriese ontwikkeling van die vroeggebore baba en hoe dit tot bogenoemde agterstande kan bydra. Daar is verskillende benaderings wat daarop aanspraak maak dat hulle die probleem kan oplos, met kangaroemoedersorg (‘kangaroo mother care’) en ontwikkelingsorg (‘developmental care’) wat in die literatuur uitgesonder is as besonders belowend. Met die aanvang van hierdie studie was daar nog geen empiriese studies in die literatuur gerapporteer wat enige aansprake van hierdie benaderings bevestig het nie. Daar was dus ʼn behoefte vir ʼn empiries-nagevorsde program wat prakties in die neonatale intensiewe eenheid toegepas kon word met die oog op die vermindering van omgewingstressors ten opsigte van die vroeggebore baba se sensoriese sisteme. DOEL Die doel met die studie was om die invloed te bepaal van ʼn Sensoriese Ontwikkelingsorgprogram (‘Sensory Developmental Care Programme’), wat ʼn spesifieke kangaroemoedersorg- protokol insluit, op die sensoriese ontwikkeling van die vroeggebore baba met 'ʼn baie lae geboortemassa tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). METODOLOGIE ʼn Ewekansig-gekontroleerde studie is uitgevoer. Die studiesteekproef het bestaan uit 89 vroeggebore babas met ʼn baie lae geboortemassa wat in ʼn periode van 24 maande toegelaat is tot die neonatale eenheid van Tygerberg Hospitaal in Kaapstad, Suid-Afrika. Die babas is gewerf op grond van sekere kriteria en is dan daarna ewekansig aan een van twee groepe toegeken: 1) die intervensiegroep het sorg ontvang volgens die Sensoriese Ontwikkelingsorgprogram vir 10 dae; en 2) die kontrolegroep het ook vir 10 dae die standaardsorg van die eenheid ontvang. Die intervensiegroep het uit 45 babas bestaan, van wie 22 die studie voltooi het, terwyl die kontrolegroep uit 44 babas bestaan het van wie 20 die studie voltooi het. Beide studiegroepe is opgevolg op 6, 12 en 18 maande (gekorrigeerde ouderdom), by welke geleentheid die Sensoriese Funksietoets vir Babas (‘Test of Sensory Functions in Infants’) telkens toegepas is vir die assessering van sensoriese ontwikkeling. Op 18 maande (gekorrigeerde ouderdom) is ʼn assessering met die Griffiths Ontwikkelingskaal ook gedoen om funksies in die ander ontwikkelingsareas van die babas te bepaal. Toetsresultate is geanaliseer met behulp van herhaalde ANOVAmetings en die Bonferoni t-prosedure om die effek van die Sensoriese Ontwikkelingsorgprogram op die sensoriese ontwikkeling van die babas tot en met 18 maande (gekorrigeerde ouderdom) te bepaal. RESULTATE Die resultate van die vergelyking van die prestasie van beide groepe (groep-effek), gemeet met behulp van die Sensoriese Funksietoets vir Babas, is van groot belang vir hierdie studie. Die intervensiegroep het betekenisvol verskil op die totale telling (p<0.00), sowel as op die volgende vier van die vyf subtoets-tellings: respons op diepdruk (‘tactile deep pressure’) (p<0.03); motoriese aanpassingsreaksies (p<0.03); visuele tas-integrasie (p<0.00); en respons op vestibulêre stimulasie (p<0.01). GEVOLGTREKKING Die resultate van die studie dui aan dat die babas in die intervensiegroep baat gevind het by die Sensoriese Ontwikkelingsorgprogram met betrekking tot hul sensoriese funksies tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). Die Sensoriese Ontwikkelingsorgprogram het geblyk prakties sowel as suksesvol te wees met betrekking tot sy doel. Die Program sou daarom met vrug in ander neonatale intensiewe sorgeenhede aangewend kon word. / ENGLISH ABSTRACT: BACKGROUND Premature infants of very low birth weight are known to be inclined to developmental, medical, behavioural and various learning deficiencies by the time they reach schoolgoing age. Concerns have been raised about the effect of the neonatal intensive care unit environment on the sensory development of the premature infant and how this could contribute to these deficiencies. Various approaches claim to address this problem, of which kangaroo mother care and developmental care have in the literature been singled out as particularly promising. However, at the commencement of this study no empirical studies had been reported in the literature to confirm any of the claims of these approaches. Therefore, a need existed for an empirically researched programme that could be practically applied in the neonatal intensive care unit with a view to reducing environmental stressors regarding the sensory systems of the premature infant. AIM The aim of this study was to determine the influence of a Sensory Developmental Care Programme, which incorporated a specific kangaroo mother care protocol, on the sensory development of the very low birth weight premature infant, up to the age of 18 months (corrected age). METHODOLOGY A randomised controlled study was conducted. The study sample consisted of 89 very low birth weight premature infants, admitted during a 24-month period to the neonatal care unit at Tygerberg Hospital in Cape Town, South Africa. The infants were recruited by means of certain criteria and then randomly assigned to one of two groups: 1) the intervention group was cared for according to the Sensory Developmental Care Programme for ten recorded days; and 2) the control group that received the standard care of the unit, also for ten days. The intervention group consisted of 45 infants of whom 22 completed the study, while the control group consisted of 44 infants of whom 20 completed the study. Both study groups were followed up at six, 12 and 18 months (corrected age) when the Test of Sensory Functions in Infants was used to do a sensory developmental assessment. At 18 months (corrected age) a Griffiths Developmental Scale assessment was also conducted to determine function in other areas of development. Test results were analysed using repeated measures of ANOVA, and the Bonferoni t procedure to determine the effect that the Sensory Developmental Care Programme had on the sensory development of the infant up to 18 months (corrected age). RESULTS The results of the comparison of the performance of both groups (group effect), measured by the Test of Sensory Functions in Infants are of great importance to this study. The intervention group had a significant difference on the total score (p<0.00), as well as on the following four of the five sub-tests scores: reactivity to tactile deep pressure (p<0.03); adaptive motor functions (p<0.03); visual-tactile integration (p<0.00); and reactivity to vestibular stimulation (p<0.01). CONCLUSION The results of this study signify that the infants in the intervention group benefited from the Sensory Developmental Care Programme concerning their sensory functions up to the age of 18 months (corrected age). The Sensory Developmental Care Programme was demonstrated to be both practical and successful in terms of its aims. The Programme could therefore be fruitfully utilised in other neonatal intensive care units.

Neonatology is a branch of medicine which consists of the medical care not only of healthy newborn infants, but also of the ill or premature ones. The number of the premature born infants increases constantly worldwide. It might be caused by women postponing their pregnancies, and very likely also by the growing number of pregnancies achieved by the assisted reproductive technologies. Thanks to improvements in perinatal care of risk pregnancies, guiding preterm labour, and development of neonatal intensive care, it has become possible to save more infants born at the very margin of viability with an extremely low birth weight. The diagnostic, therapeutic and nursing techniques have been developing steadily. It's the methods providing maximum comfort for the child and ensuring the quality of their later life that have been put into forefront. They are a set of measures, which do not disturb the child's reflex behaviour; they support its physiological stability, and thus foster growth and development of the immature organism. The aim of this diploma work is to map the specific needs of the newborn infants with an extremely low birth weight, to find out how these needs are satisfied during the first days after birth, and to determine, how the nursing care supporting the development of the infants takes place in the real life. The theoretical part of the diploma work is based on the scientific papers and resources. The empirical part is based on an observation method, which was carried out at the Neonatal Intensive Care Unit of the University Hospital in Pilsen. The survey proved that the infants' needs are not only on the biological level, but also on the emotional level, and they need appropriate sensomotoric stimulation. The outcomes of the observation show that the greatest problem of the newborn infants with an extremely low birth weight is to satisfy the biological needs i.e. breathing, feeding and defecation. The need of safety and stimulation was satisfied only partly. Based on the information collected by observing the nursing staff, it was possible to lay out areas with a potential to improve the individualized care of the newborns with an extremely low birth weight. These are, above all, the increased level of noise at the unit and thus the sense of sleep and wakefulness of the infants. Furthermore, it's the stimulation of the children and the communication with the parents. The outcomes of the empirical part of this diploma work will be presented at the seminar of the perinatal centre.