title: Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice.
abstract: 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.
authors.affiliation: Children's Medical Ventures, Norwell, Massachusetts, USA. marycoughlin@childmed.com
authors.forename: Mary
authors.initials: M
authors.lastname: Coughlin
authors.forename: Sharyn
authors.initials: S
authors.lastname: Gibbins
authors.forename: Steven
authors.initials: S
authors.lastname: Hoath
mesh_terms: 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
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