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Is Your Developmental Care Practice Based on Perception or Reality?

Asheville, North Carolina

I remember this moment clearly.

I was invited to tour a newly redesigned NICU after giving a presentation at the hospital. It was a beautiful, functional and family-centered environment.

What struck me was that as the ‘tour leader’ described the design choices and the unit’s developmental care practices, the staff following her did one of two things:

  1. nodded enthusiastically in agreement with the leader
  2. looked at each other as if to say, "We do that here?"

This happens in every NICU, even this fantastic one. Just like all NICUs, they have strengths and challenges. What’s interesting is when the strengths and challenges vary depending on which staff member is reporting them. It makes me wonder if practices are rooted more in perception or reality.

Sometimes our declared strengths are measurable – i.e. outcome data. However sometimes practices are harder to measure than length of stay, days on the ventilator and PMA at discharge.

And sometimes we report our perception of our practices rather than anything objective. Especially things that are difficult to quantify, like developmental care, for example.

Developmental care should be a standard of care. Yet some staff members have more education than others in this realm which leads to inconsistent implementation of the practice.

So when a leader guides a guest on a tour of the NICU and says, "We encourage skin to skin holding early and often," and the staff behind her looks confused (or amused), it’s simply because it’s something the unit is supposed to be doing. But in reality, it’s not quite that way. Not with everyone, not yet. And the leadership assumes everything is going as planned because that is the leadership’s perception.

One reason NANT created a developmental care checklist for the NICU was so we can begin to at least look at developmental care practice honestly.

And interestingly, I’ve learned that what may best reflect your NICUs practice is how consistent the responses are regardless of the team member or shift that completed the checklist more so than your overall score.

It’s a simple checklist, but if utilized as a means to identify inconsistent practice – it is invaluable. Perhaps it gives your NICU a QI project for the year or helps you target educational needs more effectively, all the while improving care.

Many of you have this checklist already, some do not. If and when you decide to see if your developmental care practice is based more on reality or perception, follow these 7 simple steps with the checklist:

  1. Ask the NICU leadership (however you define this) to complete the checklist.
  2. Ask at least one member from each discipline in the NICU to complete the checklist. (You receive the checklist as a PDF so can print as often as you like- it’s yours).
  3. Ask at least 5 bedside nurses from each shift, including weekend option to complete the checklist.
  4. Divide the responses into groups – leadership, non-nursing staff and bedside nursing staff.
  5. Did each group identify the same strengths and challenges?
  6. If yes, then great! At least you know the next area to tackle.
  7. If not, then begin FIRST with improving the communication and education for the inconsistent areas. Why are there discrepancies between what the leadership believes is occurring and what’s really happening? Is it lack of education, access to equipment and resources, lack of accountability or ? The team will know the answers.

Whether you discover your next hurdle or establish where the breakdown occurs, at least you know where to begin. Yes, it can be overwhelming. Do you begin with family visitation, positioning and handling or feeding practice? Do you begin with education, ordering more products or a family survey?

The important thing is that you begin.

Meanwhile, the babies are waiting. ☺

(If you don’t already have the ‘Developmental Care in Real Time – A Checklist for the NICU’ click here to read more. It’s just one part of the Developmental Care in the NICU: From Theory to Practice, An Overview.)