Does it Matter?

I'm working with this wicked amazing team in Scotland, NHS Grampian's Aberdeen Maternity Hospital.  We are working on a 6-month quality improvement initiative (Quantum Caring) focused on the Pain & Stress Core Measure, one of the 5 core measure standards for trauma-informed newborn care.

(Click HERE for more info on the core measures).  

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In addition to staff education and the testing and implementation phases of the project, it's imperative that there is support, engagement and buy-in from all the key stakeholders.  This includes the physician group.

I look forward to meeting with the docs.  They always pose interesting questions. Doctors think differently and this group expressed their different way of thinking with me. 

I like how these conversations give me the opportunity to understand where the medical team is coming from, gain insight into their concerns and to demonstrate the importance of this work for their patients, the families and society at large. 

 One question, posed by one of the residents stuck in my head:  

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"As we know, socio-economic status is one of the biggest influencers for long term outcomes in children.  With that being said, does it really matter if we provide developmental care during the hospital stay when these babies are discharged into these challenging circumstances that play a bigger role in their life?"

Fair enough question for sure, 'Does it Matter?'

Does developmental care matter in the big scheme of these infant's lives?  Well, I guess it depends on how you define developmental care.  If you define developmental care as something you do to the patient every three or four hours with your cares maybe it doesn't matter as much as we might like to think. 

When we look at the studies evaluating the impact of various care practices that fall under the umbrella of developmental care we often find a fair bit of inconsistency.  Many papers present barriers and challenges to providing consistent developmental care (here's an example).  

We do know however in NICUs that consistently provide high quality developmental care, this practice does make a difference in the short term and long-term outcomes of the infants. Montirosso et al published a series of papers highlighting the impact of developmental care on over 5 years, the NEO-ACQUA project.  The researchers defined developmental care by the 5 core measure standards and the principles of NIDCAP (Newborn Individualized Developmental Care and Assessment Program).  

The common denominator for impactful developmental care is THE FAMILY!

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Knowing that family-centered, family collaborative, developmental care makes a difference in the short term and long term outcomes of infants and families MUST COMPEL us to partner with parents and families right from the get-go, on admission!

Are the parents scared? YES! Are they vulnerable? YES!  But none of that changes the fact that they are the everything for this tiny person who presents to the NICU fighting for their life. 

The answer to the question 'Does it Matter' I think rests in how we engage parents and families right from the beginning of their NICU journey. How do we empower them?  How do we capitalize on this defining moment in their lives? How do we validate their role identity? How do we cultivate their confidence and competence in parenting their new child?

We can do lots of things to and for the baby but without love, without a sense of belonging, a feeling of security and connectedness with their family nothing really matters.  The adversity of the NICU experience will overshadow any attempts we make 'to do developmental care' without the family.  

We've a long way to go to humanize healthcare.  Let's step out of our silos and together, as fellow human beings appreciate what is really needed for our patients and their families. 

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All we need is love!

Take care and care well,

Mary

P.S.  To learn more about how you can become a leader for change and a champion for trauma-informed newborn care schedule a Get Acquainted Call with me this week! 

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