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Measuring developmentally appropriate practice in neonatal intensive care units

Journal of Perinatology volume 28, pages 218–225 (2008)Cite this article

Abstract

Objective:

Neonatal intensive care units (NICUs) impose stressors on development. Comparative studies have focused mostly on the units’ medical qualities and less on their developmental ‘ecology’. The aim of the study was to develop a tool for measuring the various domains of a developmentally appropriate practice in the NICU environment, and to assess its implementation in Israel.

Study Design:

A questionnaire, designed for NICU senior staff members, was completed by 76 respondents representing 24 NICUs in Israel. The tool that measures developmentally appropriate practice as applied in the NICU environment includes the following three domains: (a) parental and family involvement, (b) environmental control and (c) individualized care and assessment. These measures jointly produce the developmentally appropriate neonatal intensive-care practice (DANIP) index.

Result:

High variability was found in the application of procedures and programs considered developmentally appropriate. Units with a relatively large multidisciplinary team scored high. Overall, the NICUs in Israel did not consistently follow an integrated form of the developmental care as provided by the Neonatal Individualized Developmental Care and Assessment Program. It was found that individualized care and assessment was significantly and positively linked to control of the environment (r=0.53, P<0.01) and to parental and family involvement (r=0.76, P<0.01); the latter two scales were not associated. Of the three DANIP domains, parental involvement was salient. Although the staff highly appreciated the importance of environmental control and individualized care, application was limited.

Conclusion:

The DANIP index provides a good starting point for comparative studies.

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Author information

Authors and Affiliations

  1. Department of Physiotherapy, University of Haifa, Mount Carmel, Haifa, Israel

    O Atun-Einy

  2. Department of Education, University of Haifa, Mount Carmel, Haifa, Israel

    A Scher

Authors
  1. O Atun-Einy
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  2. A Scher
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Corresponding author

Correspondence to A Scher.

Appendix 1 The scales of the DANIP index

Appendix 1 The scales of the DANIP index

1. Parental and family involvement scale (0–19)

  1. a)

    Active participation in caring for preterm baby

    • a1. parental guidance for care

    • a2. parental guidance for sensory stimulation

    • a3. encouragement for breastfeeding

  2. b)

    Discharge from the unit

    • b1. guiding towards discharge

    • b2. resuscitation course

    • b3. involvement of community in discharge

  3. c)

    Orientation programs at admission

  4. d)

    Parents’ groups

    • d1. support group

    • d2. multidisciplinary group

  5. e)

    Nurse-coordinator for each family

  6. f)

    End of follow-up service (age in years)

  7. g)

    Visits policy

    • g1. visiting hours

    • g2. other family members allowed

  8. h)

    Others

2. Environmental control scale (0–31)2.1 Noise control

  1. a)

    Staff behaviors

    • a1. lowering the volume of speech

    • a2. immediate response to alarms

    • a3. preference of incubator

  2. b)

    Modification of equipment

    • b1. low monitor

    • b2. radio turned off

    • b3. low phone ring

  3. c)

    Spatial design

    • c1. acoustic ceiling/walls

    • c2. signs

  4. d)

    Policy

    • d1. quiet hours

    • d2. restrict number of visitors

    • d3. sound measure

    • d4. unit noise-control protocol

  5. e)

    Application at intensive care

2.2. Light control

  1. a)

    Change in lighting

  2. b)

    Dark hours

  3. c)

    Darkening at the end of activity

  4. d)

    ‘Lights out’ in the evening and in the night

  5. e)

    Degree of lights-out

  6. f)

    Incubators covering

  7. g)

    Unit light-control protocol

  8. h)

    Application at intensive care

2.3. Care giving procedures

  1. a)

    Minimal handling protocol

  2. b)

    Pain relief

  3. c)

    Awareness of infants sleep

  4. d)

    Primary nursing care system

3. Individualized care and assessment scale (0–7)

  1. a)

    Matching care and stimulation

  2. b)

    Positioning

  3. c)

    Non-nutritive sucking (NNS)

  4. d)

    Kangaroo care

  5. e)

    Specific intervention for infants staying >3 months

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Atun-Einy, O., Scher, A. Measuring developmentally appropriate practice in neonatal intensive care units. J Perinatol 28, 218–225 (2008). https://doi.org/10.1038/sj.jp.7211908

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