Patricia T. Becker

Outcomes of developmentally supportive nursing care for very low birth weight infants.

Numerous aspects of the intensive care environment are stressful for low birth weight infants and may play a role in adverse developmental and behavioral outcome. The purpose of this study was to determine whether staff education in care protocols designed to make the environment less stressful and thereby support the infants development would improve short-term outcomes. Twenty-one infants (< 1,501 gms) were studied during the preeducation period and 24 infants were studied following staff education. The educational program successfully altered nursing care. Experimental infants had more optimal respiratory and feeding status, lower levels of morbidity, shorter hospitalization, and improved behavioral organization.

Effects of developmental care on behavioral organization in very-low-birth-weight infants.

The purpose of this study was to determine whether modifying care to reduce stressors in the neonatal intensive care unit and support infant development affected physiological, motor, and behavioral state organization. Twenty-one infants weighing less than 1501 g were studied prior to a nursing staff-training program (control) and 24 infants were studied posttraining (study). Nurses were taught to lower environmental stress, reduce procedural stress, and facilitate motor and sleep-wake organization. Oxygen saturation, motor activity, posture, and sleep-wake states were measured biweekly during routine care. Study infants showed higher oxygen saturation levels, fewer disorganized and jerky movements, more flexor movements, more flexed posture, and more alert-wakefulness than controls. Results suggest that this approach to care may have potential to improve behavioral organization during the preterm period.

Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 4: Parent–Child Relationships at Risk

PURPOSE The purpose of this integrative review is to synthesize nursing scholarship on parent-child relationships considered fragile because of parent-childs chronic condition or occurrence within a risky context. CONCLUSIONS Most reviewed studies demonstrated negative effects of risk conditions on parent-child relationships and documented importance of child, parent, and contextual variables. Studies were predominately single investigations. Varying theoretical perspectives complicated interpretation. Mainly White, middle-class, and small samples limited generalizability. Important areas for further research were identified. PRACTICE IMPLICATIONS Nurse researchers identified factors that may interfere with the parent-child relationship. Nurses are in a position to support families under these circumstances.

Motor organization in very low birth weight infants during caregiving: effects of a developmental intervention.

The purpose of this study was to determine whether an individualized approach to handling very low birth weight (VLBW) infants designed to support development would result in less motor disorganization than the task-oriented approach in traditional use. Using a quasi-experimental crossover design, motor responses were investigated in 38 infants (< or = 1700 g, 53% male, 89% white) observed at 28, 32, and 36 weeks post-conceptional age. Subjects served as their own controls. Motor responses were coded from direct observation and videotapes. Results demonstrated that during developmental handling, (1) the overall amount of movement was less, the number of organized movements was greater, and the number of disorganized movements was less than during traditional handling; and (2) the amount of movement increased over time, but in the traditional condition, it peaked at 32 weeks. Results support positive effects of developmental handling and suggest the potential for reducing the prevalence of minor motor impairments in VLBW infants.

Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 3: Interaction and the Parent–Child Relationship—Assessment and Intervention Studies

PURPOSE This integrative review concerns nursing research on parent-child interaction and relationships published from 1980 through 2008 and includes assessment and intervention studies in clinically important settings (e.g., feeding, teaching, play). CONCLUSIONS Directions for research include development of theoretical frameworks, valid observational systems, and multivariate and longitudinal data analytic strategies. PRACTICE IMPLICATIONS Observation of social-emotional as well as task-related interaction qualities in the context of assessing parent-child relationships could generate new questions for nursing research and for family-centered nursing practice.

Organization of sleeping and waking states in infants: Consistency across contexts ☆

The sleep and waking states of infants are described from direct behavioral observations made in the home for a 7-hour period on weeks 2, 3, 4, and 5. States were analyzed separately for two contexts: infant alone and infant with the mother. States analyzed included Alert, Waking (Non-Alert) Activity, Fussing or Crying, Drowse or Sleep-Wake Transition, Active Sleep, Quiet Sleep, and Unclassified Sleep. Individual state profiles for each context were obtained for each week. A quantitative measure of profile consistency over weeks was calculated as an index of stability of state organization. Infants showed considerable range in state stability over weeks. State stability when alone was significantly correlated with state stability when with the mother (r = .67), even though there were differences in sleep-wake distributions and in level of stimulation in these contexts. These findings demonstrate within-individual consistency in CNS control of behavioral states, across sleep and wakefulness and throughout the diverse activities of the caretaking environment.

Infant age, context, and family system influences on the interactive behavior of mothers of infants with mental delay

Interactive behavior of 30 mothers of infants with mental delay and 30 comparison mothers and infants was examined in relation to child age (first and second year), context (feeding versus teaching), maternal characteristics (family stress, coping resources), and family social system (maternal education). Groups were compared from two perspectives: with infants matched on mental age (9 and 19 months MA), and on chronological age (8 and 18 months CA). Study mothers scored lower than comparison mothers during teaching but not during feeding in year 1 with both MA and CA match, but only with the CA match in year 2. Study infants scored lower than comparison infants in both contexts in year 1, but not in year 2. Groups did not differ on maternal or family measures. In year 1, group status, coping, and maternal education were predictive of mother interaction. In year 2, only maternal education was predictive. Results confirm the importance of type of match, context, and family system variables in understanding effects of child mental delay on maternal interactive behavior.

Behavioral state organization of very low birth weight infants: Effects of developmental handling during caregiving

Handling infants for nursing care in the neonatal intensive care unit has been associated with physiological and behavioral distress. The purpose of this study was to determine whether an individualized approach to nursing care designed to reduce stressors and support behavioral organization would positively affect behavioral state organization during caregiving. The developmental approach was contrasted with a traditional approach in 38 infants (< 1700 g, 53% female, 85% white) at 28, 30, and 32 weeks postconceptional age. Subjects served as their own controls in a cross-over design, with assessment of four caregiving sessions at each age. Results showed that with developmental caregiving, time spent in sleep and drowsy wakefulness was higher, and time in alert and non-alert wakefulness and fuss/cry was lower than with traditional caregiving. Results demonstrate a positive effect of developmental handling for behavioral state organization. However, the findings for the alert state were unexpected and require further exploration of how alertness may be promoted without the physiological and behavioral costs of disorganized arousal.

Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 1: Introduction

PURPOSE Understanding the parent-child relationship is fundamental to nursing of children and families. The purpose of this integrative review is to explore nursing scholarship published from 1980-2008 concerning parent-child relationships. Study approaches are examined, critiqued, and future directions for research identified. CONCLUSIONS A historical review of nursing research is presented and methods described as an introduction to a review series of the parent-child relationship. IMPLICATIONS Definition and explication of the parent-child relationship is a first-step in understanding factors amenable to nursing intervention. A clear definition of the concept of parent-child relationship will support further study using appropriate theoretical frameworks, and enable development and testing of supportive nursing interventions.