Barriers to Provision of Developmental Care in the Neonatal Intensive Care Unit: Neonatal Nursing Perceptions

Abstract

The role of the neonatal nurse is vital for the successful implementation of developmental care and the provision of an optimal neonatal intensive care unit (NICU) environment. The goal was to identify nurses' perceived barriers to implementation or improving developmental care in their NICUs. Nursing perceptions related to barriers for implementing developmental care were assessed using a 12-point questionnaire during two New York City Neonatal Nursing regional conferences. One hundred forty-six (86%) of 170 nurses representing 24 regional hospitals returned the survey. Developmental care was viewed as essential by 136 nurses (93%), yet 125 nurses (86%) believed that their NICU was not providing optimal developmental care. Light and sound standards were viewed as important to providing care by 71% and 91% of respondents, respectively, yet only four NICUs (3%) had light and sound meters to identify or standardize this environmental source of pain. As a group, the perceived barriers to provision of optimal developmental care in order of decreasing importance were staff nurses and staff physicians (53%) > NICU funds (42%) > physician leadership (37%) > facility limitations (31%) > registered nurse leadership (25%). In contrast, 90% of nurses whose NICU did not use developmental multidisciplinary team meetings or developmental care champions or advocates were significantly more likely to identify nursing or physician colleagues as barriers to implementing or improving developmental care, compared with 38% of nurses whose NICU used such activities (p < 0.001). Developmental care is perceived by the neonatal nurse as a vital component to the care provided in the NICU. Use of simple light and sound measures may enhance perception of providing an optimal NICU environment. Neonatal nurses perceived barriers to care are often attributed to neonatal staff nursing and physician colleagues. This perception is decreased considerably in those NICUs in which multidisciplinary team meetings or champions are used to address the needs of caregivers by providing developmental care strategies.