3/20/2014
Age-Appropriate Care in the NICU
Mary Coughlin RN, MS, NNP
President and Global Learning Officer
Caring Essentials Collaborative
Boston, MA
Objectives
Upon completion the participant will be able to:
1. Describe Erikson’s first stage of psycho-social
development
2. List the 5 core measures for age appropriate care
3. Identify 1 evidence based outcome associated with the
application of the core measures in clinical practice.
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Erikson Life-Stage Virtues
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•
•
•
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HOPE – basic trust vs. mistrust (0-1)
WILL – autonomy vs. shame & doubt (1-3)
PURPOSE – initiative vs. guilt (3-6)
COMPETENCE – industry vs. inferiority (6-11)
FIDELITY – identity vs. role confusion (12-mid
20’s)
• LOVE – intimacy vs. isolation (young adult – mid
20’s to early 40’s)
• CARING – generativity vs. stagnation (40’s to
60’s)
• WISDOM – ego integrity vs. despair (>60’s)
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© 2014 Caring Essentials Collaborative, LLC
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Nightingale Legacy
‘The nurse is responsible
for creating and
maintaining an
environment conducive to
the healing process.’
• Compassion
• Commitment to patient
safety
• Diligent & thoughtful
hospital administration
• Teamwork
Nightingale 1860
Clinical Audit Pioneer
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Experience of Care
Quality of Developmental Care Impacts
Neurobehavioral Performance
Montirosso et al 2012
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Protected Sleep
• Assess
• Protect
• Support
Healing Environment
• Physical – sensory, space,
aesthetics
• Human –
communication, caring,
collaboration
• System – standards,
accountability, resources
Pain & Stress Assessment and
Management
CORE MEASURES for AGE APPROPRIATE CARE
• Assess
• Manage
• Mitigate
Activities of Daily
Living
Family Centered Care
• Define
• Assess
• Empower & Educate
• Posture/mobility
• Alimentation
• Hygiene
Coughlin et al 2009; Coughlin 2011;
Coughlin 2014
Human
Physical
Systems
Healing
Environment
Prevention
Pain &
Stress
Management
Assessment
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Protect
Support
Educate
Sleep
Alimentation
Posture /
Mobility
Hygiene /
Skin Care
Activities
of Daily
Living
Assess
Access
Family Central
Care
Partnership
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Clinical Outcomes
Maton & Francoise 2011
Clinical outcomes
• Observational cohort : all <32W admissions
• Comparaison of 3 periods
– BEFORE
– AFTER 1.
– AFTER 2.
1/2006 til 6/2007
11/2007 til 4/2009
5/2009 til 10/2010
+ f/up @ 2yrs
• Based on NICAUDIT criteria
– Belgian neonatal network registry
– Major clinical outcomes
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© 2014 Caring Essentials Collaborative, LLC
Population
total
Male sex (%)
Before
Period 1
106
130
Period 2
117
54 (50,9)
81(62,3)
69 (58,9)
<26
4
11
17
26-<28
23
22
18
28-<32
79
97
82
28,9 (1,9)
28,7 (1,9)
28,9 (2,2)
1226 (333)
1331 (377)
1250 (355)
7,9
7,9
8,1
Mean GA
(SD)
Mean BW
(SD)
Mean
5’Apgar
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Neurological outcomes (%)
30
25
20
before
15
after
after2
10
5
0
ICH
ICH >2
PVL
treated ROP
Other outcomes (%)
40
35
30
25
before
20
after
15
after2
10
5
0
NEC
GERD
Late onset sepsis
2yrs Followup data
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Before (106)
After (130)
Discharged
91
120
Post NN death
1
0
Followed up @
2yrs
65 (71%)
102 (85%)
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Neurodevelopmental
disability (%) as per BAPM
90
80
70
60
50
pre
40
post
30
20
10
0
nl
mild
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moderate
severe
© 2014 Caring Essentials Collaborative, LLC
Neurodevelopmental
outcomes II (%)
50
45
40
35
30
25
pre
20
post
15
10
5
0
behaviour
externalization
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internalization
sleep
© 2014 Caring Essentials Collaborative, LLC
Other outcomes (%)
45
40
35
30
25
pre
20
post
15
10
5
0
feeding problems
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mild respiratory
parental conflict
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References
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Carter, MA. (2009). Trust, power, and vulnerability: a discourse on
helping in nursing. Nursing Clinics of North America, 44, 393-405.
Coughlin, M. (2014). Transformative Nursing in the NICU: Traumainformed Age-appropriate Care. New York, NY: Springer Publishing.
Coughlin, M. (2011). Age-Appropriate Care of the Premature and
Critically Ill Hospitalized Infant: Guideline for Practice. Glenview IL:
National Association of Neonatal Nurses.
Coughlin, M., Gibbins, S., & Hoath, S. (2009). Core measures for
developmentally supportive care: theory, precedence, and practice.
Journal of Advanced Nursing, 65(10), 2239-2248.
Gibbins, S., Coughlin, M., Hoath, S. (2010). Quality indicators for
developmental care: using the universe of developmental care model
as an exemplar for change. In C. Kenner & J. McGrath (Eds.)
Developmental Care of Newborns and Infants: A Guide for Health
Professionals (2nd ed., pp. 43-59). Glenview, IL: National Association of
Neonatal Nurses.
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© 2014 Caring Essentials Collaborative, LLC
References
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Gibbins, S., Hoath, S.B., Coughlin, M.E., Gibbins, A., and Franck, L.
(2008). The universe of developmental care: a new conceptual model
for application in the neonatal intensive care unit. Advances in
Neonatal Care, 8(3), 141-147.
Gorovitz, S. (1994). Is caring a viable component of health care?
Health Care Analysis, 2, 129-133.
Liaw, J-L., Yang, L., Chou, H-L., et al. (2010). Relationships between
nurse care-giving behaviours and preterm infant responses during
bathing: a preliminary study. Journal of Clinical Nursing, 19, 89-99.
Maton, P., & Francoise, A. (2011, June 18). Global care program. Oral
presentation at the XXVII rencontre de néonatologie (Rocourt): The
neonatal environment, Rocourt, Belgium.
Montirosso, R., Del Prete, A., Bellu, R., Tronick, E., Borgatti, R., et al.
(2012). Level of NICU quality of developmental care and
neurobehavioral performance in very preterm infants. Pediatrics,
129(5), e1129-e1137.
Nightingale, F. (1969). Notes on Nursing. Mineola, NY: Dover
Publications, Inc.
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