Neonatal development supportive care: a modified Delphi study to obtain a concensus definition of neonatal developmental supportive care as practiced in New Zealand

Abstract

Neonatal developmental supportive care (NDSC) practices are used extensively in the care of neonatal (preterm) infants in New Zealand. These practices have been based on descriptions of NDSC published in the international (predominantly North American) literature, but there are currently no national guidelines or protocols developed for the New Zealand context. As a consequence, NDSC care practices are not well described in the New Zealand clinical setting. The objective of the research described in this thesis was to ascertain a consensus definition of neonatal developmental supportive care as practiced in New Zealand by asking the question: "What level of Consensus Exists in Relation to Neonatal Developmental Supportive Care as it is practiced throughout neonatal units in New Zealand?" It was anticipated that this would provide a definition that would enable further research into the effectiveness of NDSC in New Zealand. A modified Delphi technique was used as the method of inquiry, involving 21 neonatal units and 70 neonatal nurses nominated as experts by their neonatal unit colleagues. Participants were sent an initial questionnaire, via their unit manager to maintain anonymity, asking them to determine the content of NDSC practices in their neonatal unit. The initial questionnaire was followed by a further two rounds of questionnaires, each accompanied by summative feedback of the panel responses to the previous questionnaire, in order to determine consensus around the NDSC practices to be included in a definition. After three rounds of questions a consensus was reached that indicated neonatal developmental supportive care is a framework for providing care that enhances the development of an infant. While the practices that comprise NDSC generally agreed with the NANN (National Association of Neonatal Nurses, USA) guidelines for neonatal developmental supportive care, there was evidence of New Zealand cultural influences on the neonatal developmental supportive care given. This research showed the New Zealand definition congruent with international research but requiring more context and principles than are currently available in the NANN (USA) definition. It proposes a principle-based definition of neonatal developmental supportive care, sited culturally in New Zealand, with overarching principles of individualised infant care and family partnership reflected in all components of care. The actual care practices, central to the care provided, are based on theory, education, protocols, care descriptions and safety, and provided in an individually modified environment. By encouraging examination of our practice, it is hoped that this research will raise awareness in the neonatal nursing population of the importance of neonatal developmental supportive care, and in turn improve the health and developmental outcomes of New Zealand infants and their families.