Meredith D. Burt and Professor Catherine Coverston, Nursing
There is a striking and jarring difference between the world in the womb and the outside world. This great difference in environments can be very stressful on preterm and newborn infants. There is significant emphasis in neonatal intensive care units (NICU) on medical interventions to support and protect underdeveloped organs. Nutritional and environmental needs have received less attention. However, significant work is being done in both these areas. This project focuses on the effects of environmental factors.
Developmental Care is a little known program that helps preterm infants cope with their new environment outside the womb. Developmental Care uses low technology interventions to reduce the stress of the hospital environment on premature and sick infants. Created and developed by Heidelies Als, a psychologist. This program utilizes simple and inexpensive interventions to aid premature infants in their adjustment.
Adjustments in light, sound, position and other environmental factors are the tools used in developmental care (DC). Studies have shown DC improves short-term growth and feeding outcomes, decreases respiratory support, decreases length and cost of hospital stay, and improves long-term neurodevelopmental outcomes (Symington A. & Pinelli J, 2000). It is a program that heavily involves the family in the care of the child, contributing to greater well-being for both the infant and family.
As I studied DC, I came to see the value this program could have in a developing country because of its cost-effectiveness and use of easily devised, low technology supplies. It is also easy to learn, teach, and implement, even with language and culture differences, making it an even better fit for most underdeveloped nations. I chose to take this program to Egypt, where spending on health is only $153 dollars per capita per year (World Health Organization, 2003).
To prepare to teach the program in a hospital in Egypt, I received special training at Utah Valley Regional Medical Center. I worked with Annie Miller, a specialist in DC, to learn the interventions and techniques of the program. Such interventions include covering infants’ eyes from bright hospital lights, reducing volume on nearby machinery, special positioning that allows the infant to calm themselves, and more. I also learned the signs of stress that infants exhibit when they are struggling, and what to do in response to those signs. With this knowledge and training, I developed a plan of teaching that could be utilized in a neonatal intensive care unit. This included a teaching session and handouts with step-by-step instructions that could be distributed among health care providers and parents of preterm infants.
In Egypt, the handouts were translated into the native language of Arabic. Handouts were distributed among the staff in the NICU. A local physican translated during the teaching session to help overcome the language and cultural barriers. Interventions were demonstrated on a baby model and participants had time to ask questions to ensure the best understanding possible.
However, the project was not without problems. The first and most difficult problem was finding a hospital in which to teach.. It took time to establish myself in the city, and to locate hospitals. Many hospitals in Egypt do not have a NICU. A prestigious pediatrician offered to help me find a place to teach, and, after several weeks, I learned the cultural lesson that an Egyptian can promise something and it may never happen. Finally, through word-of-mouth, I found a government hospital with a NICU that consented to the teaching.
Producing the handouts and scheduling the teaching session also presented small problems that were overcome with minimal difficulty. Another problem came from a cultural barrier that had not been anticipated. Egyptian culture assigns the majority of infant care to the mother. The family oriented style of DC which includes care from the father was not acceptable. This resulted in the removal of certain pictures and references to fathers from the teaching materials, making it more culturally appropriate.
Overall, the project was successful. Not only did I realize on my first visit to the crowded and poorly funded government hospital that it was much needed, but the doctors, nurses and other health care providers were impressed and excited about the program. One doctor commented, “I learned a lot today. This is going to be a very good thing for our hospital.” Another nurse stated, “I didn’t know all of this. We can do these things for our babies.” Their enthusiasm convinced me that this program could be beneficial to other hospitals and developing nations.