NANN Practice Guideline
A joint position statement from the Canadian Association of Neonatal Nurses (CANN), the Canadian Association of Perinatal and Women's Health Nurses (CAPWHN), the Council of International Neonatal Nurses (COINN), and the National Association of Neonatal Nurses (NANN) was published in 2017 in the Canadian Journal of Nursing Research. This new position statement provides an evidence-based framework for the institutional implementation of developmentally supportive, neuroprotective care in the neonatal intensive care unit (NICU).1,2
BACKGROUND AND SIGNIFICANCE
The use of age-appropriate care as an organized framework for care delivery in the NICU is founded on the work of Als3 and her synactive theory of development. This theoretical construct has been advanced by the work of Gibbins and colleagues4 with the “universe of developmental care” conceptual model and developmentally supportive care core measures.5 The core measures for developmentally supportive care were endorsed by NANN in 2011 as its clinical practice guidelines for Age-Appropriate Care of the Premature and Critically Ill Hospitalized Infant6 and have been recently revised and expanded to reflect the most current evidence-based best practices in developmentally supportive, neuroprotective care.7 The core measures for developmentally supportive care outline disease-independent core competencies for professionals serving premature and critically ill hospitalized infants.
Supported by The Joint Commission and the Primer Standards of Accreditation and Health Canada, the institutional implementation of these core measures requires a strong framework for institutional operationalization. This framework is presented in the newly published guidelines for the institutional implementation of developmental neuroprotective care in the NICU and summarized at http://dx.doi.org/10.1177/0844562117706882 and http://dx.doi.org/10.1177/0844562117708126.1,2
These 2-part guidelines include the first international joint position statement between 4 sister nursing associations, as well as best practice recommendations to adopt and integrate developmental neuroprotective care at the institutional level.
Part A of the guidelines presents the background and rationale for the development of institutional implementation guidelines. This includes a thorough literature review of the history, levels of evidence, and support for developmental care in the NICU, as well as implementation strategies extracted from the implementation science literature.8 Part B of the guidelines presents detailed recommendations for each implementation phase supported and justified by the current evidence.2
The guidelines are operationalized over 5 phases: Plan, Educate, Prioritize, Evaluate, and Ensure Sustainability. Each phase includes different steps over time to ensure their implementation. These phases and steps might sometimes occur in parallel, whereas others might be delayed, depending on the need and priorities of each unit. Likewise, they can work in circularity, where one change might influence another. However, the best chance for successful adoption and integration of a developmentally supportive, neuroprotective care philosophy and subsequent implementation within an organization are patience, endurance, and persistence.9 Clearly defined standards, accountability metrics, and strong leadership are needed to facilitate and sustain a cultural transformation.
As the professional voice of neonatal nurses around the world, NANN, CANN, CAPWHN, & COINN recommend the use of these guidelines to provide a framework for the standardization of the implementation of developmentally supportive, neuroprotective care. These guidelines provide flexibility to support the individual needs of each unit and organization by providing an evidence-based systematic approach to implementation in NICUs. The full joint position statement can be accessed at Milette et al Part A1 and Part B.2 The articles are open access and freely available to all. See the full articles for more guidance in this area.
- Isabelle Milette, MScN, NNP, developmental care specialist, Neonatal Intensive Care Unit, CHU Sainte-Justine; and Co-founder and President, Developmental Care Partnership.
- Marie-Josée Martel, PhD, Professor, Nursing Department, Université du Québec à Trois-Rivières; and Co-founder and Vice president, Developmental Care Partnership.
- Margarida Ribeiro da Silva, MScN, NNP, Neonatal Intensive Care Unit, Montreal Children's Hospital; and Collaborator in Developmental Care Partnership.
- Mary Coughlin, MS, BSN, RN, NNP, RNC-E, Founder and President, Caring Essentials Collaborative.
1. Milette I, Martel MJ, Ribeiro da Silva M, Coughlin M. Guidelines for the institutional implementation of developmental neuroprotective care in the NICU. Part A: background and rationale. A joint position statement from the CANN, CAPWHN, COINN, NANN. Can J Nurs Res. 2017;49(2):46–62. doi:10.1177/0844562117706882.
2. Milette I, Martel MJ, Ribeiro da Silva M, Coughlin M. Guidelines for the institutional implementation of developmental neuroprotective care in the NICU. Part B: recommendations and justification. A joint position statement from the CANN, CAPWHN, COINN & NANN. Can J Nurs Res. 2017;49(2):63–74. doi:10.1177/0844562117708126.
3. Als H. A synactive model of neonatal behavioral organization: framework for the assessment of neurobehavioral development in the premature infant and for support of infants and parents in the neonatal intensive care environment. Phys Occup Ther Pediatr. 1986;6(3/4):3–53.
4. Gibbins S, Hoath SB, Coughlin M, Gibbins A, Franck L. The universe of developmental care: a new conceptual model for application in the neonatal intensive care unit. Adv Neonatal Care. 2008;8(3):141–147. doi:10.1097/01.anc.0000324337.01970.76.
5. Coughlin M, Gibbins S, Hoath S. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. J Adv Nurs. 2009;65(10):2239–2248. doi:10.1111/j.1365-2648.2009.05052.x.
6. Coughlin M. Age-Appropriate Care of the Premature and Critically Ill Hospitalized Infant: NANN Guideline for Practice. Glenview, IL: National Association of Neonatal Nurses; 2011. ISBN 978-0-8261-3197-3.
7. Coughlin M. Trauma-Informed Care in the NICU: Evidence-Based Practice Guidelines for Neonatal Clinicians. New York, NY: Springer Publishing; 2016.
8. Bertram RM, Blase KA, Fixsen DL. Improving programs and outcomes: implementation frameworks and organization change. Res Soc Work Pract. 2015;25(4):477–487. doi:10.1177/1049731514537687.
9. McGrath JM, Valenzuela G. Integrating developmentally supportive caregiving into practice through education. J Perinat Neonatal Nurs. 1994;8(3):46–57.