DEVELOPMENTAL CARE OF PREMATURE NEWBORNS: STUDY ON PRACTICES IN PORTUGUESE NEONATAL UNITS

Ferraz, Liliana Patrícia Leitão; Fernandes, Ananda Maria; Gameiro, Manuel Gonçalves Henriques

doi:10.1590/1980-265X-TCE-2021-0235en

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Original Article • Texto contexto - enferm. 31 • 2022 • https://doi.org/10.1590/1980-265X-TCE-2021-0235en copy

DEVELOPMENTAL CARE OF PREMATURE NEWBORNS: STUDY ON PRACTICES IN PORTUGUESE NEONATAL UNITS

ATENCIÓN DEL DESARROLLO DEL RECIÉN NACIDO PREMATURO: ESTUDIO SOBRE LAS PRÁCTICAS EN UNIDADES NEONATALES PORTUGUESAS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

the present and future well-being of hospitalized newborns and their parents are connected to analyze the application frequency of the central practices of developmental care to premature newborns in Portuguese neonatal care units and to identify their relationship with organizational variables.

Method:

cross-sectional, descriptive-correlational study. Using a non-probabilistic network sampling technique, a sample of 217 nurses from Portuguese neonatal units who answered the Quantum Caring Practice Self-Assessment online questionnaire was obtained, previously translated and validated for Portuguese nurses.

Results:

the results revealed that for 65.4% of nurses, Developmental Care practices are sometimes performed and 14.3% consider that they are rarely performed. Only 18.9% of the nurses in the study consider that these practices are performed frequently. The most frequent practices were those related to the therapeutic environment and prevention of pain and stress. The least frequent was positioning and skin care. The results also showed that the frequency of developmental care practices differs depending on the geographical location of the units and is higher in units with a higher level of treatment differentiation and that have established a specific program/protocol of developmental care.

Conclusion:

although feasible, Developmental Care practices are not performed consistently in Portuguese neonatal care units. A global change in team culture, more training, implementation of protocols and organizational investment in this area is needed.

DESCRIPTORS:
Nursing; Neonatal Intensive Care Units; Premature newborn; Child development; Neonatology

UTIN*		Geographic Region
		Center		Lisbon and Tagus Valley		North		Autonomous Regions		On		Total
		n	% region	n	% region	n	% region	n	% region	n	% region	n	% total
Number of Beds	≤10 beds	33	47.1	16	24.2	15	39.5	8	33.3	8	42.1	80	36.9
Number of Beds	>10 beds	37	52.9	50	75.8	23	60.5	16	66.7	11	57.9	137	63.1
Invasive Ventilation	Yes	52	74.3	64	97	31	81.6	24	100	15	78.9	186	85.7
Invasive Ventilation	No	18	25.7	2	3	7	18.4	-	-	4	21.1	31	14.3
DC program^†	Without	52	74.3	44	66.7	21	55.3	9	37.5	7	36.8	133	61.3
	NIDCAP^‡	5	7.1	5	7.6	12	31.6	1	4.2	9	47.4	32	14.7
	Other	13	18.6	17	25.8	5	13.2	14	58.3	3	15.8	52	24

Central Practices of DC*	Md.	x̄	s	Min.	Max.
D^†1. Therapeutic environment	2.76	2.76	0.53	0.80	3.80
D^†2. Prevention, assessment and management of pain and stress	2.70	2.64	0.71	0.60	4.00
D^†3. Sleep Protection	2.40	2.33	0.62	0.20	3.60
D^†4. Age-appropriate activities of daily living	2.35	2.31	0.62	0.71	3.68
SD^‡1. Positioning	2.10	2.08	0.73	0.10	3.60
SD^‡2. Feeding	2.59	2.59	0.65	0.50	4.00
SD^‡3. Skin care	2.33	2.29	0.85	0.33	4.00
D^†5. Family-centered care	2.54	2.52	0.51	0.38	3.69
Total	2.52	2.49	0.52	0.67	3.58

Central Practices of DC^† (Dimensions and Subdimensions)		USIN Geographical Location^‡				Number of NICU beds^‡				Invasive ventilation in the NICU^‡				DC program^†
Central Practices of DC^† (Dimensions and Subdimensions)		Center	Lisbon and Tagus Valley	North	Autonomous Regions	On	Test Kruskal-Wallis	≤10 beds	>10 camas	Mann-Whitney Test	No	Yes	Mann-Whitney Test	Without	NIDCAP^§	Other	Kruskal-Wallis Test
D^\|\| 1. Therapeutic environment	n	70	66	36	23	19	X²⁼13.085 p=0.011^*	78	136	U=4189.0 p=0.011*	30	184	U⁼2110.00 p=0.039^*	130	32	52	X²=44.14 p=0.000^*
	Md	2.62	2.73	2.90	3.13	3.00		2.70	2.83		2.60	2.80		2.60	3.10	3.10
	𝑥	2.66	2.72	2.82	3.07	2.81		2.62	2.85		2.61	2.79		2.58	3.03	3.07
	s	0.48	0.57	0.48	0.42	0.66		0.59	0.48		0.48	0.54		0.52	0.37	0.42
D^\|\| 2. Prevention, assessment and management of pain and stress	n	70	66	3.8	24	19	X²⁼22.100 p=0.000^*	80	137	U=4550.0 p=0.037^*	31	186	U⁼2292.50 p=0.068	133	32	52	X²=46.76 p=0.000^*
	Md	2.50	2.80	2.60	3.30	2.50		2.65	2.80		2.60	2.80		2.50	2.84	3.25
	𝑥	2.46	2.68	2.61	3.20	2.54		2.49	2.73		2.45	2.67		2.39	2.89	3.12
	s	0.72	0.72	0.71	0.48	0.61		0.73	0.69		0.59	0.73		0.69	0.47	0.59
D^\|\| 3. Sleep protection	n	69	66	38	24	18	X²⁼5.925 p=0.205	79	136	U=3560.0 p=0.000^*	30	185	U⁼2218.00 p=0.078	132	31	52	X²=47.25 p=0.000^*
	Md	2.30	2.40	2.25	2.70	2.60		2.20	2.50		2.22	2.40		2.20	2.70	2.84
	𝑥	2.29	2.39	2.21	2.49	2.33		2.07	2.48		2.19	2.35		2.11	2.64	2.72
	s	0.518	0.67	0.60	0.65	0.75		0.68	0.52		0.44	0.64		0.59	0.50	0.48
D^\|\| 4. Age-appropriate activities of daily living	n	67	65	37	24	19	X²⁼14.027 p=0.007^*	77	135	U=3431.0 p=0.000^*	29	183	U⁼2157.00 p=0.106	129	32	51	X²=46.15 p=0.000^*
	Md	2.04	2.50	2.50	2.40	2.46		2.08	2.46		2.15	2.37		2.12	2.68	2.71
	𝑥	2.10	2.41	2.41	2.33	2.42		2.07	2.44		2.13	2.33		2.07	2.63	2.69
	s	0.59	0.62	0.66	0.52	0.62		0.61	0.58		0.53	0.63		0.54	0.47	0.61
SD^¶1. Positioning	n	69	65	37	24	19	X² =19.250 p=0.001^*	77	137	In =2918.0 p=0.000^*	30	184	In =1743.00 p=0.001^*	130	32	52	X² =62.13 p=0.000^*
	Md	1.70	2.30	2.25	2.30	2.70		1.62	2.30		1.61	2.20		1.72	2.68	2.70
	𝑥	1,79	2.20	2.17	2.29	2.32		1.71	2.29		1.69	2.15		1.77	2.57	2.56
	s	0.65	0.71	0.75	0.65	0.88		0.72	0.65		0.57	0.74		0.64	0.56	0.62
SD^¶2.Feeding	n	66	64	37	24	17	X²⁼7.027 p=0.134	75	133	U=4619.5 p=0.377	27	181	U⁼2003.00 p=0.130	127	31	50	X²=13.41 p=0.001^*
	Md	2.50	2.73	2.75	2.37	2.50		2.57	2.62		2.75	2.50		2.50	2.57	2.94
	𝑥	2.54	2.66	2.75	2.36	2.54		2.53	2.63		2.78	2.56		2.48	2.60	2.88
	s	0.60	0.67	0.71	0.54	0.71		0.70	0.62		0.59	0.65		0.62	0.58	0.68
SD^¶3.Skin care	n	67	65	32	21	17	X²⁼8.093 p=0.088	74	128	U=3604.0 p=0.005^*	25	177	U⁼1735.50 p=0.081	126	30	46	X²=29.53 p=0.000^*
	Md	1.83	2.50	2.50	2.33	2.33		2.00	2.50		1.67	2.33		1.83	2.67	2.67
	𝑥	2.07	2.44	2.39	2.34	2.42		2.08	2.42		2.03	2.33		2.05	2.74	2.70
	s	0.93	0.78	0.94	0.72	0.59		0.85	0.82		0.92	0.83		0.82	0.57	0.83
D^\|\| 5. Family-Centered Care	n	67	65	34	23	19	X²⁼8.093 p=0.088	78	130	U=3105.5 p=0.000^*	29	179	U⁼1790.50 p=0.007^*	129	30	49	X²=35.57 p=0.000^*
	Md	2.38	2.69	2.54	2.61	2.25		2.32	2.64		2.18	2.54		2.38	2.66	2.85
	𝑥	2.39	2.61	2.59	2.66	2.33		2.31	2.64		2.30	2.55		2.36	2.69	2,83
	s	0.46	0.55	0.46	0.32	0.64		0.51	0.46		0.44	0.51		0.48	0.41	0.44
Total	n	69	66	37	24	19	X²⁼13.499 p=0.009^*	79	136	U=3590.0 p=0.000^*	31	184	U=3590.00 p=0.000^*	132	32	51	X²=58.85 p=0.000^*
	Md	2.31	2.53	2.64	2.69	2.67		2.37	2.61		2.36	2.55		2.32	2.80	2.94
	𝑥	2.35	2.55	2.54	2.68	2.49		2.29	2.61		2.33	2.52		2.28	2.77	2.86
	s	0.48	0.55	0.51	0.39	0.59		0.52	0.48		0.39	0.53		0.46	0.35	0.44
^* p-0.05; ^†Developmental-Focused Care; ^‡Neonatal Intensive Care Units; ^§Newborn Individualized Developmental Care and Assessment Program; ^\|\| Dimension; ^¶Subdimension

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[1] CORRESPONDING AUTHOR
Liliana Patricia Leitão Ferraz liliferraz@gmail.com