Developmental care

[sofiam]

hi| whats your opinion and experience about the results of using this kind of philosophy in nicu? and what about the team; do they had adhered well when it was implemented? were doing " developmental care" of course , but not quite official... im trying to develop an official protocol in my unit and i would like to know about your experience on this...thanks

[Sweeper933]

We have a whole "team" of people on our developmental care team. We have a developmental specialist - she will evaluate the babies (if they qualify... under 1500g... any other special concerns) before they go home. We then set up these babies with a developmental follow-up appointment for about 3 months after they have been home. We also have several PT/OT personel that work only here on our unit that provide PT for the babies, help with difficult feeders, teach the parents the home exercises... things like that.

We also have what we call a "long-term care" plan. It is for those chronics that we know are going to be here a while after their due dates. We usually put them on this care plan when they are about 38weeks gestation - depending on the situation. Each month there is a meeting in which the primary nurses, the doc on that service that month, PT/OT, developmental specialist, social worker assigned to that family, and nutritionist/pharmicist if needed all meet to discuss each baby on the long-term care plan. It pretty much just gives us a way to get everybody together on the same plan for that particular baby, to discuss certain issues... things like that. We also put a sign at the bedside stating that the baby is now on the long-term care plan, which lets other nurses know to read the notes for the specific plans: like not chasing them on their oxygen if they're desatting... things like that. We also put up a sheet at the bedside with "tips for caring for the baby", things that help other nurses know what the parents are able to do independently, what calms the baby down, things like that.

Sorry for going on for a while, hope it helped!

[wee one rn]

We also have a developmental care team to help out our little ones. We recently starting using several positioning products, instead of millions of linens to acheive the same effect. The staff has been pretty receptive to this change and the babies seem comfortable and happy. As with anything, it does take a little while for people to get used to the change but now it's just the norm. We also work closely with OT/PT to help identify any issues that they are seeing regularly so that we can help educate the staff on how to avoid these problems and treat them when they arise. Below is a link to the company that makes the positioning products that we use. I hope this helps!

http://chmv.respironics.com/Products.asp#Positioning

[GrowingBabies]

We have a great developmental team (st/pt/OT) who evaluate all premature infants and most of our term kids per MD order (it's included on admit orders).

They make up signs at individual babies bedside for feeding (which nipple and position to feed baby). They will also make up signs and teach nursing (on days) and parents how to use any special devices or braces they make for each baby and sometimes "tidbits" unique to each baby.

We use special position devices depending on each kid and medical equipment they have. Snugglies and gel pillows are popular in our unit as well as crowns and rolls. We use proper fitting diapers, reposition babies q3-4hrs (more or less frequently depending on dr orders). Avoid overstimulation by keeping rooms quiet (private rooms for micros if possible). Isolette covers are a must and we cover babies eyes if bright lights (or phototherapy) is necessary.

[dixRN]

As soon as the nurses realize that there are lifelong consequences for poor positioning, etc. of preemies they will be very supportive of a developmental program. NICU nurses are very attached to their small patients & usually only want what's best for the babies. "Toaster head" preemies have dental problems with lack of space for teeth coming in, babies without boundaries that have hip abduction will not walk right. Give the staff information & demonstrations on how to correctly position & use developmental aids. But also what the possible consequences are to the infant for not doing so. Your staff will gladly comply. Years ago I worked at a regional level III, Sacred Heart in Pensacola & they brought in an expert from Atlanta at great expense for mandatory classes for all the staff. It had a profound effect & the unit went developmentally proactive overnight. They had developmental guidelines & protocols in books in the various care areas.

I suspect that now you can probably purchase a DVD & have your nursing education dept. set up a CEU class & have the nurses watch it at work.