Judith A. Heermann

Nurses' experiences working with families in an NICU during implementation of family-focused developmental care.

Purpose: To explore and describe nurses’ experiences while working with parents and infants receiving family-focused developmental care (FFDC), to gain insight into the process of changing from a traditional model of care to FFDC. Design: The qualitative design was based on Spradley’s method. Sample: Data were collected by interviewing ten nurses who worked in an NICU during a pilot study of FFDC. Transcripts were analyzed using Spradley’s domain analysis. Findings: Four themes describe aspects of the transition from traditional care to FFDC: (1) negative experiences of FFDC, (2) transitions central to partnering with parents, (3) positive experiences of parental participation, and (4) organizational transitions necessary for the move to a family-centered model of care. Conclusion: Learning to share responsibility with families will require change in the NICU culture as well as in nurses’ role identity.

The effect of developmental care on preterm infant outcome

Using a retrospective comparative design, the investigators evaluated the effects of training 10% of a nursing staff in the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) on preterm infant outcomes. A convenience sample of 25 preterm infants (< 1500 grams) cared for during the NIDCAP implementation and training period were matched by birth weight and gestational age to infants born before NIDCAP implementation. Outcome measures collected through chart review showed NIDCAP infants had significantly fewer and less severe intraventricular hemorrhages, fewer days of ventilatory support, shorter hospitalizations, and greater rate of weight gain. Findings suggest that benefits of developmental care are achievable with only a portion of the staff being NIDCAP trained.

State-of-the-art Patient Care: The Impact of Doctorally Prepared Clinical Nurses

Delivery of state-of-the-art patient care requires new models to foster the development of professional nurses and integrate practice, research, and education. The Chief Nursing Officer of University Hospital/Associate Dean of the College of Nursing at a tertiary health science center positioned doctorally prepared nurses in clinical practice settings to assist in actualizing a vision of state-of-the-art patient care. Strategic targets for performance improvement included building collaboration between the college and hospital, supporting advanced education for nurses, moving the nursing culture from one of co-dependence to one of professionalism, fostering research at the unit level, and capitalizing on the strengths of nurse leaders. Creating an environment where staff nurses use critical thinking skills and access their advanced practice nurse (APN) resources as they do their work has been a win-win-win situation for the patients, the hospital, and the college at the health science center.

Identification and validation of competencies for use in objective structured clinical examinations for lay caregivers

Cancer care has shifted from the traditional hospital to alternative settings, thus requiring lay individuals to assume increased direct care responsibility. Cooperative Care is an example of an alternative acute care delivery model where a family member or a friend is responsible for care previously provided by healthcare professionals. The success of alternative models is dependent on effective educational programs with clearly defined expectations and methods for evaluating caregiver competence. Objective structured clinical examinations (OSCEs) provide a standardized approach to evaluating caregiver performance in a simulated situation. The purpose of the first phase of this instrument development project was to identify and validate competencies for inclusion in OSCEs to be used with lay caregivers in preparation for Cooperative Care. The study included multiple methods of data collection: analysis of documents, viewing videos, observation with note taking, and a focus group session. All classes and materials provided for lay caregivers were reviewed. Core content domains and competencies were identified and used to develop OSCEs. A focus group of healthcare providers responsible for the education and care of patients and their caregivers validated the competencies embedded within the OSCEs. This study demonstrated the efficacy of the approach used for the identification and validation of competencies for lay caregivers.