Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice.
OBJECTIVE
This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units.


BACKGROUND
Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America's Joint Commission's concept of 'core measures' for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model.


METHODS
Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue.


CONCLUSIONS
Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads.


CONCLUSIONS
Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes.
Coughlin
Mary
M
Children's Medical Ventures, Norwell, Massachusetts, USA. marycoughlin@childmed.com
Gibbins
Sharyn
S
Hoath
Steven
S
D000203:Activities of Daily Living; D000328:Adult; D002657:Child Development; D055318:Evidence-Based Nursing; D005192:Family Health; D006272:Health Facility Environment / Q000458:organization & administration; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D015931:Intensive Care, Neonatal / Q000379:methods*; D016294:Models, Nursing; D009732:Nursing Care / Q000379:methods; D009742:Nursing Theory; D010146:Pain / Q000175:diagnosis / Q000517:prevention & control; D010290:Parents / Q000193:education; D016032:Randomized Controlled Trials as Topic; D012890:Sleep / Q000502:physiology
J Card Fail. 2008 Mar;14(2):95-102
18325454
Nurs Res. 2003 Sep-Oct;52(5):307-17
14501545
AMIA Annu Symp Proc. 2005;:674-8
16779125
Adv Neonatal Care. 2004 Apr;4(2):92-104
15138992
Clin Perinatol. 2004 Jun;31(2):353-82, ix
15289038
Biol Res. 2007;40(4):471-8
18575679
J Altern Complement Med. 2004;10 Suppl 1:S7-14
15630818
Am J Health Syst Pharm. 2007 Jun 1;64(11 Suppl 7):S25-9
17519443
Pediatrics. 2006 Mar;117(3 Pt 2):S9-S22
16777824
J Obstet Gynecol Neonatal Nurs. 2001 Jan-Feb;30(1):41-51
11277161
J Pediatr Nurs. 2005 Apr;20(2):145-7
15815579
J Perinatol. 2007 Dec;27 Suppl 2:S4-S19
18034180
Pediatrics. 2003 Apr;111(4 Pt 2):e482-8
12671168
Arch Dis Child Fetal Neonatal Ed. 2004 Jan;89(1):F71-5
14711862
J Clin Sleep Med. 2007 Mar 15;3(2):201-40
17557427
N Engl J Med. 2005 Jul 21;353(3):265-74
16034012
Pediatrics. 2003 Apr;111(4 Pt 2):e471-81
12671167
Pediatrics. 2006 Jul;118(1):e9-19
16818541
J Altern Complement Med. 2004;10 Suppl 1:S141-6
15630831
J Perinat Neonatal Nurs. 2002 Jun;16(1):58-70
12083295
Nurs Res. 2003 Jan-Feb;52(1):22-33
12552172
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001071
16235279
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD001814
16625548
Neonatal Netw. 2003 Sep-Oct;22(5):45-50
14598979
Adv Neonatal Care. 2008 Jun;8(3):141-7
18535418
AWHONN Lifelines. 2005 Oct-Nov;9(5):382-7
16359077
Pediatr Pulmonol. 1998 Oct;26(4):241-9
9811073
Clin Perinatol. 2002 Sep;29(3):459-68
12380469
Adv Neonatal Care. 2002 Aug;2(4):198-221
12881934
J Pediatr. 2002 Jun;140(6):699-706
12072873
Health Aff (Millwood). 2007 Jul-Aug;26(4):1104-10
17630453
Pediatrics. 2005 Nov;116(5):1245-55
16216901
Dev Psychol. 2002 Mar;38(2):194-207
11881756
Pediatrics. 2006 May;117(5):e909-23
16651294
Pediatrics. 2006 Nov;118 Suppl 2:S78-86
17079627
Eur J Paediatr Neurol. 2004;8(1):21-34
15023372
Eval Health Prof. 1999 Sep;22(3):283-97
10557860