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Core Measures for Age-Appropriate Care in the NICU Mary Coughlin, MS, NNP President and Global Learning Officer Caring Essentials Collaborative, LLC, Boston, MA
The speaker has signed a disclosure form and indicated she has no significant financial interest or relationship with the companies or the manufacturer(s) of any commercial product and/or service that will be discussed as part of this presentation.
Session Summary
The five primary drivers of an exceptional inpatient experience for patients/families include commitment of leadership, engagement of the hearts and minds of staff, respectful partnerships, reliable care, and evidence-based care. These drivers are embodied in the five core measures for age-appropriate care (developmental care): protected sleep, pain and stress assessment and management, attention to age-appropriate activities of daily living, family-centered care, and the healing environment. Linking age-appropriate care practices with the Joint Commissions standards that all clinicians meet the age-appropriate needs of the patient population served legitimizes and mandates this practice model and provides a framework for the consistent and reliable delivery of age-appropriate care.
Session Objectives
Upon completion of this presentation, the participant will be able to:
describe Eriksons first stage of psycho-social development;
list the five core measures for age-appropriate care;
identify one evidence-based outcome associated with the application of the core measures in clinical practice.
References
Carter, M.A. (2009). Trust, power, and vulnerability: A discourse on helping in nursing. Nursing Clinics of North America, 44: 393-405.
Coughlin, M. (2014). Transformative nursing in the NICU: Trauma-informed age-appropriate care. New York, NY: Springer Publishing.
Coughlin, M. (2011). Age-appropriate care of the premature and critically ill hospitalized infant: Guideline for practice. Glenview, IL: National Association of Neonatal Nurses.
Coughlin, M., Gibbins, S. & Hoath, S. (2009). Core measures for developmentally supportive care: Theory, precedence, and practice. Journal of Advanced Nursing, 65(10): 2239-2248.
Gibbins, S., Coughlin, M. & Hoath, S. (2010). Quality indicators for developmental care: Using the universe of developmental care model as an exemplar for change. In C. Kenner & J. McGrath (Eds.) Developmental care of
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newborns and infants: A guide for health professionals (2nd ed., pp. 43-59). Glenview, IL: National Association of Neonatal Nurses.
Gibbins, S., Hoath, S.B., Coughlin, M.E., Gibbins, A. & and Franck, L. (2008). The universe of developmental care: A new conceptual model for application in the neonatal intensive care unit. Advances in Neonatal Care, 8(3): 141-147.
Gorovitz, S. (1994). Is caring a viable component of health care? Health Care Analysis, 2: 129-133.
Liaw, J-L., Yang, L., Chou, H-L., et al. (2010). Relationships between nurse care-giving behaviours and preterm infant responses during bathing: A preliminary study. Journal of Clinical Nursing, 19: 89-99.
Maton, P. & Francoise, A. (2011, June 18). Global care program. Oral presentation at the XXVII rencontre de nonatologie (Rocourt): The neonatal environment, Rocourt, Belgium.
Montirosso, R., Del Prete, A., Bellu, R., Tronick, E., Borgatti, R., et al. (2012). Level of NICU quality of developmental care and neurobehavioral performance in very preterm infants. Pediatrics, 129(5): e1129-e1137.
Nightingale, F. (1969). Notes on Nursing. Mineola, NY: Dover Publications, Inc.
Session Outline
See presentation handout on the following pages.
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Core Measures for Age-Appropriate Care in the NICU
Mary Coughlin RN, MS, NNPPresident and Global Learning Officer
Caring Essentials CollaborativeBoston, MA
Disclosure
Mary Coughlin is President and Founder of Caring Essentials Collaborative, LLC, has nothing to disclose
Objectives
Upon completion the participant will be able to: 1. Describe Eriksons first stage of psycho-social
development2. List the 5 core measures for age appropriate care3 Id tif 1 id b d t i t d ith th3. Identify 1 evidence based outcome associated with the
application of the core measures in clinical practice.
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Age Appropriate
Erikson Life-Stage Virtues
HOPE basic trust vs. mistrust (0-1) WILL autonomy vs. shame & doubt (1-3) PURPOSE initiative vs. guilt (3-6) COMPETENCE industry vs. inferiority (6-11)y y ( ) FIDELITY identity vs. role confusion (12-mid 20s) LOVE intimacy vs. isolation (young adult mid
20s to early 40s) CARING generativity vs. stagnation (40s to 60s) WISDOM ego integrity vs. despair (>60s)
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Nightingale Legacy
The nurse is responsible for creating and maintaining an environment conducive to the healing process.g p
Compassion Commitment to patient
safety Diligent & thoughtful
hospital administration Teamwork
Clinical Audit PioneerNightingale 1860
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Experience of Care
Quality of Developmental Care Impacts Neurobehavioral Performance
Montirosso et al 2012
Protected Sleep Assess Protect Support
Pain & Stress Assessment and Management Assess Manage Mitigate
Healing Environment Physical
sensory, space, aesthetics
Human communication, caring,
ll b ti
COREMEASURESforAGEAPPROPRIATECARE
Activities of Daily Living Posture/mobility Alimentation Hygiene
Family Centered Care Define Assess Empower &
Educate
collaboration System
standards, accountability, resources
collaboration System
standards, accountability, resources
Coughlin et al 2009; Coughlin 2011; Coughlin 2014
Physical
Human
Systems
Healing Environment
Prevention
Pain & Stress
AssessmentManagement
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Educate
SupportProtect
Sleep
Educate
Posture / Mobility
Alimentation
Hygiene / Skin Care
Activities of Daily Living
Family Central Care
Access
Assess
Care
Partnership
Clinical Outcomes
Maton & Francoise 2011
Clinical outcomes
Observational cohort : all
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Neurological outcomes (%) Other outcomes (%)
2yrs Followup data
Before (106) After (130)
Discharged 91 120
Post NN death 1 0
Followed up @ 2yrs
65 (71%) 102 (85%)
Neurodevelopmentaldisability (%) as per BAPM
Neurodevelopmentaloutcomes II (%) Other outcomes (%)
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http://www.youtube.com/watch?v=cDDWvj_q-o8
A Person is a Person
http://www.youtube.com/watch?v=HLRVr_Mp8T8
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A12 Core Measures-DRAFTSession SummarySession ObjectivesReferencesSession Outline
A12 Core Measures-BWPPT