Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.

2'& 2'13

www.iiste.org

Effect of Instructional Sessions on Nurses' and Doctors' Knowledge and Practice regarding Developmental Care in NICU in Ab a Cit!
)ssist. Prof. *e+an E, Na-aw. )+/ed1& )ssist. Prof. 0ane/ )-dulla+ 1o+a//ad 12 3r.1ufare+ 0asan )ssiri2& 3r.)+/ed Naser )/eri3 1.PediatricNursing 3epart/ent& 4acult. of Nursing& 5ing 5+alid 6ni7ersit.& )-+a& 5S). 2.8onsultant Neonatologist& 1edical director& )-+a 1aternit. 8+ildren 0ospital& )-+a& 5S) 3.8onsultant Neonatologist& )-+a 1aternit. 8+ildren 0ospital& )-+a& 5S). 2E-/ail9 /uf1+sn:.a+oo.co/ Abstract Preter/ ; low -irt+ weig+t (,<= infant is a li7e -orn infant deli7ered -efore 37 wee>s fro/ t+e first da. of last /enstrual period (,1P . It represents t+e +ig+est percentage of +ig+ ris> group and accounts for t+e largest nu/-er of ad/issions to neonatal intensi7e care unit (NI86 . Preter/ infants can de7elop a range of pro-le/s -ecause t+eir organs are not /ature and an unfa7ora-le en7iron/ent in t+e neonatal intensi7e care unit /a. co/pound t+is /or-idit.. 3e7elop/ental care (38 is a non-traditional >ind of care and it represents a fra/ewor> for practice in NI86 w+ic+ opti/i?es t+is en7iron/ent t+roug+ reducing its stresses& +elp preter/ infants cope -etter wit+ t+is en7iron/ent and +as -een proposed to ensure +ealt+. outco/es for pre/ature -a-ies. @+ese inter7entions include reducing noise and lig+t& control of eAternal sti/uli& /ini/al +andling& >angaroo care ( 58B s>in-to-s>in contact -etween an infant and parent & co--edding& positioning or swaddling& clustering of nurser. care acti7ities& and gi7ing longer rest periods. @+e ai/ of t+e current stud. was to e7aluate t+e effect of instructional sessions on nursesC and doctorsC >nowledge and practice regarding de7elop/ental care in NI86 in )-+a cit.. @+e stud. was conducted at Neonatal Intensi7e 8are 6nit in -ot+ )-+a *eneral 0ospital and )sser 8entral 0ospital& )-+a cit.& 5ingdo/ of Saudi )ra-ia. @+e stud. in7ol7ed 5% nurses and 12 doctors. ) pre - post assess/ent Duestionnaire was de7eloped after eAtensi7e literature re7iew and 7alidated -. t+e researc+ in7estigators to /easure t+e >nowledge and practice of nurses and doctors -efore and after t+e instructional sessions. @+e stud. concluded t+at t+ere was c+ange in nurses and doctorsC >nowledge a-out de7elop/ental care post instructional sessionCs i/ple/entation. 4urt+er/ore& nursesC practice regarding de7elop/ental care was i/pro7ed post instructional sessionCs i/ple/entation w+ic+ /eans t+at t+e instructional sessions +ad an effecti7e role in en+ancing -ot+ t+eir >nowledge and t+eir practice. @+e stud. reco//ended t+at w+en designing a new neonatal intensi7e care unit or refitting an older one wit+ /ore /odern eDuip/ent& t+e infrastructure and design of it /ust -e suita-le to facilitate t+e application of de7elop/ental care. 1oreo7er& t+e econo/ic i/pact of t+e i/ple/entation and /aintenance of de7elop/ental care practices s+ould -e considered -. indi7idual institutions. Ke! "ards# 3e7elop/ental care& pre/ature and low -irt+ weig+t infants& neonatal intensi7e care unit. Abbreviations# 389 3e7elop/ental 8are ,1P9 ,ast 1enstrual Period ,<=9 ,ow <irt+ =eig+t NI869 Neonatal Intensi7e 8are 6nit 589 5angaroo 8are $% Introduction Pre/aturit. is a /aEor +ealt+ pro-le/ -ecause it is a leading cause of infant /ortalit.. Preter/ -irt+& defined as c+ild-irt+ occurring at less t+an 37 co/pleted wee>s or 25( da.s of gestation& is a /aEor deter/inant of neonatal /ortalit. and /or-idit. and +as long-ter/ ad7erse conseDuences for +ealt+ (Stac. Fet al& 2'1' .It represents t+e +ig+est percentage of +ig+ ris> group and accounts for t+e largest nu/-er of ad/issions to neonatal intensi7e care unit (NI86 .@+e true incidence of preter/ -irt+ a/ong t+e de7eloping countries 7aries fro/ countr. to anot+er and fro/ one geograp+ic region to anot+er wit+in a countr.. 0owe7er& a-out 7G12 H of deli7eries in de7eloping countries are preter/ (*ra. et al.& 2''7 . Preter/ infants are at great ris> for /edical co/plications and future de7elop/ental disa-ilities. @+e. can de7elop a range of pro-le/s -ecause t+eir organs are not /ature and an unfa7ora-le en7iron/ent in t+e neonatal intensi7e care unit /a. co/pound t+is /or-idit.. It +as -een recogni?ed for /an. .ears t+at t+e en7iron/ent of neonatal intensi7e care unit can +a7e an i/portant influence on t+e de7elop/ent of pre/ature infants ()ita F Sinder& 2''3 .

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Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2'& 2'13

www.iiste.org

3e7elop/ental care (38 was introduced in t+e /id-1(!'s1 to /ini/i?e t+e stress eAperienced -. preter/ infants t+roug+ /odification of t+e en7iron/ent using suc+ strategies as noise and lig+t reduction and /ini/al +andling% I/portant de7elop/ent occurs in t+e fetus t+roug+out t+e final wee>s of pregnanc.. 4or infants -orn -efore 35 wee>s gestation& t+is de7elop/ent occurs in t+e new-orn intensi7e care unit (NI86 w+ere t+e. are +andled freDuentl. and endure in7asi7e& stressful procedures. 3e7elop/ental care reduces stressful sti/uli -. atte/pting to i/itate t+e intrauterine en7iron/ent (S./ington F Pinelli& 2''% . It was /entioned -. <renda F 1o-olaEi &(2''( F *ouc+on& F et al& (2'1' t+at& de7elop/ental care is a non-traditional >ind of care and it represents a fra/ewor> for practice in NI86 w+ic+ opti/i?es t+is en7iron/ent t+roug+ reducing its stresses& +elp preter/ infants cope -etter wit+ t+is en7iron/ent and +as -een proposed to ensure +ealt+. outco/es for pre/ature -a-ies. @+ese inter7entions include reducing noise and lig+t& control of eAternal sti/uli (7esti-ular& auditor.& 7isual& tactile & /ini/al +andling& >angaroo care (58B is s>in-tos>in contact -etween an infant and parent & co--edding& positioning or swaddling& clustering of nurser. care acti7ities& and gi7ing longer rest periods. @+is approac+ reDuires nurses in t+e NI86 to -e trained to read t+e -e+a7ioral cues of preter/ infants and custo/i?e a plan of care for eac+ one so t+at t+e inter7entions will -e /ost effecti7e in pro/oting eac+ infantCs de7elop/ent @+e t+eor. -e+ind de7elop/ental care is t+at it opti/i?es e7er. aspect of t+e infantsI de7elop/ent and /ini/i?es t+e deleterious effects of -eing -orn pre/aturel. (Prentice F Stainton& 2''3 . @+e re7iew of t+e literature proposes t+at infants w+o recei7e de7elop/ental care de/onstrate i/pro7ed neurode7elop/ent outco/es until t+e age of two and see/ less li>el. to de7elop long-ter/ disa-ilities and -e+a7ioral pro-le/s -. 5J .ears of age. Parents report lower le7els of stress and see/ to de7elop /ore /utuall. understanding relations+ips wit+ t+eir infants if t+e. recei7ed de7elop/ental care and nurses o-ser7e an i/pro7e/ent in t+e well--eing of t+ese infants (Na.lor F et al& 2'11 . In general& results of nu/erous studies on de7elop/ental care +a7e s+own t+at& it +as +ad a positi7e influence on a 7ariet. of outco/es suc+ as infantCs weig+t& nu/-er of /ec+anical 7entilation da.s& lengt+ of +ospitali?ation& incidence of intracranial +e/orr+age and an i/pro7e/ent in neonatal neuro-e+a7ioral organi?ation as well as long-ter/ i/pro7e/ent of -e+a7ior and cogniti7e de7elop/ent. 1oreo7er& parents report lower le7els of stress and see/ to de7elop /ore /utuall. understanding relations+ips wit+ t+eir infants (=ong F 0oc>en-err.& 2''! . )ll +ealt+ care professionals in t+e NI86 need to -e gentle& considerate and co/passionate in t+e care of preter/ infants. Nurses& p+.sicians& parents& and ot+ers in7ol7ed in t+e care of preter/ infants /ust rel. in part on infantsC -e+a7ior to identif. c+anges in /edical condition and responses to care (,e7in F et al.& 2''7 . 1oreo7er& @+o/as F 4ors.& (2''7 stated t+at t+e nurse acts as a coordinator -. co/-ining eApertise and pro7iding co/pre+ensi7e care during t+e infantCs sta. in t+e intensi7e care nurser.. @+e. are responsi-le for teac+ing re+a-ilitati7e s>ills and pro7iding counseling for parents .1oreo7er& neonatal nurses need to -e trained to pro7ide indi7iduali?ed de7elop/ental supporti7e care for preter/ infant& need to plan and pro7ide care t+at /eets not onl. t+e preter/Cs illness needs -ut also +is;+er de7elop/ental needs. &% 'esearc Problem and Significance# @+e pre7alence of pre/aturit. in 5ingdo/ of Saudi )ra-ia is a-out 7-12 H fro/ t+e total -irt+s w+ic+ account 57%''' per .ear (1inistr. of +ealt+ of 5S)& 2'11 .@+is is a serious and -ig pro-le/ w+ic+ leads to increase in /ortalit. and /or-idit. rate a/ong t+is group of new-orn. So we need a new trends and approac+es in caring wit+ pre/ature -a-ies to reduce t+is /ortalit. rate and i/pro7e t+eir outco/es. Since its inception& t+e de7elop/ental care approac+ +as generated nu/erous studies& focusing /ainl. on t+e i/pact of t+is approac+ on pre/ature infants. In general& results +a7e s+own t+at de7elop/ental care +as +ad a positi7e influence on a 7ariet. of outco/es suc+ as weig+t& nu/-er da.s on /ec+anical 7entilation& lengt+ of +ospitali?ation& incidence of intracranial +e/orr+age and an i/pro7e/ent in neonatal neuro-e+a7ioral organi?ation as well as long-ter/ i/pro7e/ent of -e+a7ior and cogniti7e de7elop/ent (S./ington F Pinelli& 2''( . <ecause t+e i/ple/entation of a de7elop/ental care approac+ de/ands t+at NI86 staff acDuire new >nowledge and s>ills& it is surprising to note t+at 7er. little +as -een pu-lis+ed on training progra//es and t+eir e7aluation. So t+e /ain ai/ of t+e current stud. is to e7aluate t+e effect of instructional sessions on nursesC and doctorsC >nowledge& practice and attitude regarding de7elop/ental care in NI86 in )-+a cit.. (% 'esearc )b*ectives# 1. @o assess t+e le7el of doctors and nursesC >nowledge regarding de7elop/ental care. 2. @o e7aluate doctors and nursesC practice regarding de7elop/ental care. 3. 3esign& i/ple/ent and e7aluate an instructional sessions regarding de7elop/ental care.

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Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2'& 2'13

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+% 'esearc ,et odolog!# 4.1. Research Design @+e design of t+is stud. was a Duasi-eAperi/ental one group pre-test;post-test design. 4.2. Aim of the study: @+e ai/ of t+e current stud. was to e7aluate t+e effect of instructional sessions on nursesC and doctorsC >nowledge and practice regarding de7elop/ental care in NI86 in )-+a cit.. 4.3. Setting @+e stud. was conducted at Neonatal Intensi7e 8are 6nit in -ot+ )-+a *eneral 0ospital and )sser 8entral 0ospital& )-a+ cit.& 5ingdo/ of Saudi )ra-ia. 4.4. Sample @+e stud. in7ol7ed 5% nurses and 12 doctors fro/ t+e a-o7e /entioned settings. 4.5. Hypotheses: @+ere will -e an i/pro7e/ent in t+e su-EectsC >nowledge regarding de7elop/ental care as a result of i/ple/entation of t+e instructional sessions. Instructional sessions will +a7e an effecti7e role in i/pro7e/ent of su-EectsI practice regarding de7elop/ental care due to increase t+eir le7el of >nowledge. 4. . !ools of Data "ollection: ) pre - post assess/ent Duestionnaire was de7eloped -. t+e researc+ in7estigators after eAtensi7e literature re7iew. @+e data was collected using t+e following tools9I- A structured .uestionnaire S eet /pre0 post format1# @+e structured Duestionnaire s+eet was de7eloped -. t+e researc+ers. @+e Duestionnaire was concerned wit+ gat+ering data related to9 1 8+aracteristics of stud. su-Eects including age& educational Dualifications& .ears of eAperience in neonatal intensi7e care unit& e/plo./ent status& and if t+e. attended an. training courses regarding de7elop/ental care. ) self-report Duestionnaire was used. 2 @+e >nowledge of stud. su-Eects a-out t+e de7elop/ental care t+at s+ould -e pro7ided for a pre/ature ; low -irt+ weig+t -a-ies (closed- ended Duestions . Scoring s!stem# Knowledge# ) correct response was scored I and t+e incorrect ?ero. 4or eac+ area of >nowledge& t+e scores of t+e ite/s was su//ed- up and t+e total di7ided -. t+e nu/-er of t+e ite/s& gi7ing a /ean score for t+e part. @+ese scores were con7erted into a percent score& and /eans and standard de7iations were co/puted. 5nowledge was considered satisfactor. if t+e percent score was K'H or /ore and unsatisfactor. if less t+an K'H. - )bservation S eet# It was de7eloped -. t+e researc+ers and used to o-ser7e su-EectsC practice as regards de7elop/ental care /easures w+en caring for a pre/ature -a-. in NI86s and in case of not doing it identif. causes fro/ t+e gi7en list. Scoring s!stem# Practice9 @+e ite/s reported to -e done correctl. were scored LIL and t+e ite/s not done or incorrectl. done were scored L'L. 4or eac+ area& t+e scores of t+e ite/s were su//ed-up and t+e total di7ided -. t+e nu/-er of t+e ite/s& gi7ing a /ean score for t+e part. @+ese scores were con7erted into a percent score& and /eans and standard de7iations were co/puted. @+e practice was considered done if t+e percent score was K'H or /ore and not done if less t+an K'H. 4.#. $rocedures: +%2%$ Preparator! P ase# ) re7iew of t+e past and current local and international related literature on t+e 7arious aspects of t+e pro-le/ using& articles& periodicals& /aga?ines and -oo>s was done. @+is re7iew was +elping t+e researc+ in7estigators to -e acDuainted wit+ t+e actual di/ension and /agnitude of t+e stud. and guide also in de7eloping t+e stud. tools. @+e content 7alidit. of t+e Duestionnaire was esta-lis+ed -. an eApert panel of four neonatal doctors and nurses. @+e instru/ent was t+en pre-tested on a s/all sa/ple of neonatal doctors and nurses (nM5 not included in t+e stud. to ensure clarit. of instructions and t+at ite/s were understanda-le and worded appropriatel.. ) consent for/ and a co7er letter detailing t+e stud. were attac+ed to eac+ Duestionnaire. ) written per/ission (infor/ed consent to conduct t+is stud. was o-tained fro/ 1edical and Nursing directors in -ot+ )sser 8entral 0ospital and )-+a *eneral 0ospital after clear eAplanation a-out t+e ai/s and eApected outco/es of t+e stud..

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Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2'& 2'13

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@+e first session& t+e stud. was started -. inter7iewing t+e su-Eects at t+e a-o7e /entioned settings and gi7ing t+e/ a -rief idea a-out t+e ai/ of t+e stud.& its co/ponents and eApected outco/es. )lso t+e su-Eects were inter7iewed for socio-de/ograp+ic c+aracteristics and pre test. )ccording to t+e actual assess/ent for needs of t+e stud. su-Eects& instructional sessions were designed wit+ t+e following o-Eecti7es9 a1 3eneral ob*ectives of t e instructional sessions# I/pro7e >nowledge and en+ancing practice of nurses and doctors regarding de7elop/ental care in NI86. b1 Specific# @o t+is end& t+e instructional sessions e/p+asi?ed t+e acDuisition of >nowledge a-out t+e following issues9 3efine t+e concept of pre/aturit. (definition& classification& co//on pro-le/s of pre/aturit. . EAplain t+e NI86 ecolog. and its i/pact on t+e pre/ature. 3iscuss t+e i/pacts of traditional care on pre/ature infants in t+e NI86. ,ist t+e sources of en7iron/ental sti/ulation (7isual& auditor.& tactile& and inappropriate positioning and t+eir i/pact on pre/ature infantsB EAplain t+e essential role of t+e nurse and p+.sician in de7elop/ental care. 3e/onstrate t+e different /easures of de7elop/ental care. +%2%&% Implementation p ase# @+e progra/ consisted of K sessions including t+eor. and practiceB eac+ session was a-out one +our and using different teac+ing strategies as (lecture& group discussion& de/onstration and real o-Eects . @+e sessions consisted of for/al presentations on t+e a-o7e topics. #t+er ele/ents of t+e sessions included infor/ational /aterials& 7ideos& p+otograp+& Dui??es and practice periods super7ised -. t+e researc+ in7estigators. @+e researc+ers were a7aila-le two da.s; wee> fro/ ( a/ to 2 p/. at t+e a-o7e /entioned settings to super7ise t+e practice of stud. su-Eects. @+e consultant of neonatolog. was a7aila-le one da. ; wee> to gi7e t+e for/al presentation on t+e a-o7e topics. @+e progra/ was i/ple/ented according to stud. su-EectsC p+.sical& /ental readiness and t+eir wor> load. @+e su-Eects were /oti7ated and rewarded for t+eir acti7e participation in t+e sessions t+roug+out stud. period -. pro/ised to gi7e t+e/ a certificate for t+eir attendance. +%2%(% Evaluation p ase @+e instructional sessions were e7aluated after t+e i/ple/entation p+ase (at t+e end of siA session using t+e sa/e pre- for/at Duestionnaire. 4% Statistical anal!sis @+e data was re7ised& coded& ta-ulated& and presented using descripti7e statistics in t+e for/ of freDuencies and percentage for Dualitati7e 7aria-les& and /eans and standard de7iations for Duantitati7e 7aria-les. Nualitati7e 7aria-les for nurses were co/pared using 2-tailed test. In addition& after collecting data fro/ 15 doctors& we eAa/ined our data using nonpara/etric statistics (=ilcoAon Signed-Oan> @est to co/pare doctorsC >nowledge and practice related to de7elop/ental care Pre; Post Instructional Sessions I/ple/entation. 8orrelation is significant at t+e '.'5 and '.'1 le7el. Statistical anal.ses were perfor/ed using t+e SPSS ($ersion 17.' software. 5% 'esults 4reDuencies and percentages of t+e de/ograp+ic 7aria-les will -e presented. Percentage distri-ution of doctors and nursesC >nowledge and practice related to de7elop/ental care pre; post instructional sessions i/ple/entation. In addition& t+is section will also discuss an. significance found -etween nursesC >nowledge and practice score as regard to t+eir c+aracteristics.

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Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2'& 2'13

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6able /$1# Percentage 3istri-ution of Nurses according to t+eir 8+aracteristics. No% 7 4+ /$88%891 Items Age 4ro/ 2' .ears to less t+an 25 .ears 4ro/ 25 .ears to less 3' .ears 4ro/ 3' .ears and /ore " P S3 Education <ac+elor of nursing Nursing 3iplo/a <ears of e=perience ,ess t+an one .ear 4ro/ one .ear to less t+an 5 .ears 4ro/ 5 .ears to less t+an 1' .ears 4ro/1' .ears and /ore " P S3 >ave !ou received previous training courses about developmental care? .es

:re;uenc! 13 21 2' 3.'% P .7(1 33 21 5 27 1( 3 2.33 P.73%

9 2%.1 3!.( 37.'

K1.1 3!.( (.3 5'.' 35.2 5.5

15 27.! No 3( 72.2 @+e age of (3!.(H of nurses was ranged fro/ 25 .ears to less t+an 3' .ears& two t+ird of t+e/ (K1.1H +ad -ac+elor degree of nursing. 0alf of t+e studied nurses (5'.'H +ad one to less t+an fi7e .ears of eAperience in t+e NI86 and t+e /aEorit. of t+e/ (72.2H +ad not recei7ed pre7ious training courses a-out de7elop/ental care for preter/ infants in NI86. 6able /&1# Percentage 3istri-ution of NursesC 5nowledge and Practice related to 3e7elop/ental 8are Pre; Post Instructional Sessions I/ple/entation. No% 7 4+ /$88%891 pre post @& test P- value Items 9 9 Knowledge of nurses regarding developmental 21.' 3(.' care Satisfactor. $&%$4 8%888 6nsatisfactor. 33.' 15.' Nurses' practice of developmental care 3one 1%.' %'.' +%A45 8%8( Not done 25.' 2(.' Statisticall! significant at pB8%84 )nal.sis of data s+owed a +ig+l. statistical significant difference -etween nursesI >nowledge related to de7elop/ental care pre and post instructional sessions i/ple/entation as re7ealed -. P.Q'.'''. )lso& t+is ta-le indicates t+at t+ere was a statistical significant difference -etween nursesI practice regarding de7elop/ental care pre and post instructional sessions i/ple/entation as re7ealed -. P.Q'.'3. 6able /(1# Oelations+ip -etween NursesC 5nowledge and Practice score as regard to t+eir c+aracteristics. Items Age Education <ears of Nurses' practice e=perience of developmental care / Practice Score1 NurseC >nowledge regarding -.1(5-2 .'%3 .1!3 .'57 -.1!5.'55 -.2!%-22 .''3 de7elop/ental care NursesC practice of .'33 .732 -.151- .11! .2'%2 .'3% 1 -----de7elop/ental care (Practice Score 2 8orrelation is significant at t+e '.'5 le7el (2-tailed . 228orrelation is significant at t+e '.'1 le7el (2-tailed . It is o-ser7ed fro/ t+is ta-le t+at& t+ere was significant difference in t+e relations+ip -etween nurseC >nowledge regarding de7elop/ental care and -ot+ t+eir age and nursesC practice of de7elop/ental care. 1oreo7er& t+ere was

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Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2'& 2'13

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significant difference in t+e relations+ip -etween nurseC .ears of eAperience and t+eir practice of de7elop/ental care. 6able /+1# Percentage 3istri-ution of 3octors according to t+eir 8+aracteristics. No% 7 $& /$88%891 Items :re;uenc! 9 Age ,ess t+an 3' .ears 1 !.3 4ro/ 3' .ears to less t+an 35 .ears % 33.3 4ro/ 35 .ears to less t+an %' .ears 5 %1.7 4ro/ %' .ears and /ore 2 1K.7 " P S3 2.K7 P.!!7 Education <ac+elor of /edicine 3 25.' 1aster % 33.3 P+3 5 %1.7 Position Oesident % 33.3 Specialist K 5'.' 8onsultant 2 1K.7 <ears of e=perience ,ess t+an one .ear 1 !.3 4ro/ .ear to less t+an 5 .ears K 5'.' 4ro/ 5 .ears to less t+an 1' .ears 5 %1.7 " P S3 2.33 P.K51 >ave !ou received previous training courses about developmental care? .es % 33.3 No ! KK.7 @+e age of (%1.7H of doctors was ranged fro/ 35 .ears to less t+an 35 .ears and t+e. +ad P+3. @+e +alf of t+e sa/ple was specialist and t+eir .ears of eAperience ranged fro/ one .ear to less t+an 5 .ears. In addition& t+e /aEorit. (KK.7H of t+e studied sa/ple +ad not recei7ed pre7ious training courses a-out de7elop/ental care for preter/ infants in NI86. 6able /41# Percentage 3istri-ution of 3octorsC 5nowledge and Practice related to 3e7elop/ental 8are Pre; Post Instructional Sessions I/ple/entation. No% 7 4+ /$88%891 pre post C-6est P- value Items 9 9 Knowledge of doctors regarding developmental 5.' 1'.' care Satisfactor. -$%AD2 8%84 6nsatisfactor. 7.' 2.' Doctors' practice of developmental care 3one 2.' %.' -8%2&A 8%+2 Not done 1'.' !.' "ilco=on Signed 'anE -6est /C-6est1 Statisticall! significant at pB8%84 )nal.sis of data s+owed a statistical significant difference -etween doctorsI >nowledge related to de7elop/ental care pre and post instructional sessions i/ple/entation as re7ealed -. P. Q'.'5. 1eanw+ile t+ere was no statistical significant difference -etween doctorsI practice regarding de7elop/ental care pre and post instructional sessions i/ple/entation as re7ealed -. P. Q'.%7. 2% Discussion Preter/ ; low -irt+ weig+t (,<= infant is a li7e -orn infant deli7ered -efore 37 wee>s fro/ t+e first da. of last /enstrual period (,1P .@+e preter/ infant in t+e neonatal intensi7e care unit (NI86 is cared for wit+ +ig+l. ad7anced /edical tec+nolog. w+ic+ resulted in increased sur7i7al rates for preter/ infants -ut not in /aEor i/pro7e/ents in /or-idit. rates or decreased ris>s of de7elop/ental dela.s& p+.sical disa-ilities& and -e+a7ioral 5%

Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2'& 2'13

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disorders. Preter/ infants can eAperience a range of pro-le/s related to i//aturit. and to t+e unfa7ora-le setting of t+e neonatal intensi7e care unit (NI86 . @+e infantCs sensor. eAperience in t+e NI86 en7iron/ent& wit+ its eAposure to -rig+t lig+ts and +ig+ sound le7els& and freDuent stressful inter7entions eAert +ar/ful effects on t+e i//ature -rain t+at alters its su-seDuent de7elop/ent (,issauer et al.& 2''K . In an atte/pt to address t+is& de7elop/ental care is a safe practice /odel and it ad7ocates a -road range of inter7entions designed to /ini/i?e t+e negati7e i/pact of suc+ an en7iron/ent& t+ere-. i/pro7ing neurode7elop/ental outco/es. @+is includes controlling eAternal sti/uli suc+ as sound& lig+t& and acti7it.B encouraging fa/il. in7ol7e/entB and considering appropriate co/forting /easures. It also ad7ocates an indi7idual approac+ to care t+at is dictated -. cues fro/ t+e infant ()lti/ier& 2'11 . Oo-ert F =+ite& (2''7 stated t+at& t+oug+ t+e neonatal intensi7e care unit (NI86 pro7ides t+e +ig+l. speciali?ed care capa-le of increasing t+e c+ances of sur7i7al& it does not necessaril. offer t+e ideal en7iron/ent for t+e de7elop/ent of t+e infant. 1uc+ +as -een said a-out t+e potentiall. +ar/ful effects of t+e NI86 en7iron/ent on t+e neurode7elop/ent of t+e pre/ature. @+e ai/ of neonatal intensi7e care is essentiall. to preser7e life -. eAtending t+e appropriate /edical care in an en7iron/ent t+at /i/ics t+e wo/-& pro7iding as /uc+ as possi-le an eAperience t+at +as -een pre/aturel. interrupted. 1ore recent care procedures see> to reduce t+e discrepanc. -etween wo/- and NI86 en7iron/ent. Oeducing noise and lig+t eAposure& restraining unnecessar. +andling and adopting /ore restful positioning constitute a series of initiati7es ai/ed at reducing stress for t+e neonate and i/pro7ing neurode7elop/ental outco/e. 3e7elop/ental care +as garnered /uc+ interest a/ong clinicians and researc+ers in recent .ears. ) re7iew of t+e literature s+ows t+at /ost researc+ efforts +a7e -een concerned wit+ t+e i/pact of suc+ care on t+e +ealt+ and de7elop/ent of pre/ature infants. <.ers F et al&(2''K w+o studied a con7enience sa/ple of 11% pre/ature infants and t+eir parents to e7aluate t+e i/pact of indi7iduali?ed& de7elop/entall. supporti7e fa/il.centered care on infant p+.siological 7aria-les& growt+& -e+a7ioral stress cues& return to sleep state& /edical and de7elop/ental progress& co/plications& resource utili?ation& parental perception of t+e neonatal intensi7e-care unit eAperience& and o7erall parental satisfaction& found t+at Preter/ infants w+o recei7ed de7elop/entall. supporti7e fa/il.-centered care de/onstrated fewer -e+a7ioral stress cues and co/para-le s+ort-ter/ outco/es and resource utili?ation t+an infants w+o recei7ed routine care. )not+er clinical trial stud. is (-efore-after inter7ention on a single group& 31 +ospitali?ed pre/ature new-orns in NI86 of )l-Ra+ra 0ospital in Isfa+an& Iran. @+e researc+ers found t+at appl.ing dail. silence periods can greatl. +elp to increase oA.gen saturation and can i/pro7e t+e growt+ of pre/ature infants. @+erefore& -. pro7iding /ore facilities in clinical en7iron/ents of NI86& conducting progra/s to reduce lig+t and noise in t+ese wards would -e possi-le (@a+eri F et al& 2'1' . @o our >nowledge& t+e issue of professional de7elop/ent and training in de7elop/ental care +as -een studied 7er. little. <ecause professional practices are suc+ a >e. co/ponent of de7elop/ental care& it is crucial to design and offer attracti7e and effecti7e training progra//es. @+e present stud. is i/portant in +ow it /a. +elp to fill t+is gap in >nowledge and de/onstrate t+e potential -enefits of instructional sessions on nursesC and doctorsC >nowledge and practice regarding de7elop/ental care in NI86. @+is stud. ai/ed at e7aluates t+e i/pact of instructional sessions on nursesC and doctorsC >nowledge and practice regarding de7elop/ental care in NI86 in )-+a cit.. @+is part discusses t+e results of t+e current stud. co/paring wit+ recent literature and ot+er related studies. It also eAplained to w+at eAtent t+e results of t+e current stud. supported or reEected t+e researc+ +.pot+eses. )s regard nursesC c+aracteristics& t+e present stud. re7ealed t+at t+e age of (3!.(H of nurses was ranged fro/ 25 .ears to less t+an 3' .ears and +alf of t+e studied nurses (5'.'H +ad one to less t+an fi7e .ears of eAperience in t+e NI86. @+is result is agree wit+ @anir& )>+anF ErgSl (2'11 w+o conducted a stud. on1'' nurses wor>ing in neonatal intensi7e care units of four +ospitals in Istan-ul& @ur>e.& to define t+e practices of nurses in an atte/pt to reduce t+e stress in neonates caused -. en7iron/ental factors& found t+at 5'H of t+e nurses wor>ing in NI86 are -etween t+e ages of 1! and 3'& and 51H of t+e nurses +ad .ears of eAperience in t+e NI86 ranged -etween 1 to 5 .ears. @+is is confir/ed -. <oAwell& (2''' w+o /entioned t+at& nurses wor>ing in t+e NI86 s+ould -e eAperienced to -e s>illful in pro7iding care for t+ose preter/ infants. In relation to t+e pre7ious training courses a-out de7elop/ental care& /ore t+an two t+ird of total sa/ple (nurses and doctors +ad not recei7ed an. training courses a-out de7elop/ental care. @+is eAplains w+. t+eir le7el of >nowledge and practice regarding de7elop/ental care was poor -efore t+e i/ple/entation of t+e instructional sessions. @+is supported -. $ali?ade+ F et al.& (2'13 w+o conducted a stud. on 7' nurses wor>ing in neonatal intensi7e care units in @a-ri?& Iran to deter/ine t+e congruence of nursesI acti7it. in four areas of de7elop/ental care in order to o-tain -asic infor/ation for aut+orities to pro7ide a progra/ to ac+ie7e related standards in t+e future& t+e stud. re7ealed t+at t+e congruence of nursesI perfor/ance wit+ standards of de7elop/ental care still reDuires /ore efforts. @+erefore& it is necessar. to train t+e staff in t+is regard and prepare t+e/ for structural and functional facilities. @+e researc+ers added colla-oration and continuing education of t+e supporti7e staff in t+e NI86 are 7ital

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in t+e success of t+e unit. Infants and t+eir fa/ilies rel. on t+ese professionals for education& +elp wit+ decision /a>ing& and /ost i/portantl.& Dualit. care. )lt+oug+ t+ere are li>el. /an. NI86 units wit+ supporti7e staff t+at possess t+ese Dualities& t+ere is alwa.s roo/ for i/pro7e/ent. Staff in t+e NI86 /ust -e o-ser7ant of an. signs t+at caregi7ers /a. de/onstrate t+at indicate t+e. need Duestions answered or assistance pertaining to t+eir +ealt+ or t+e +ealt+ of t+eir infant. ,i>ewise& it is >e. t+at staff /e/-ers not onl. support anot+erIs decisions& -ut wor> toget+er cooperati7el. to create a first class en7iron/ent for all w+o are a part of t+e NI86. ) neonatal intensi7e care nurse also /ust >eep records of o-ser7ations and practices in order to pro7ide /edical doctors wit+ infor/ation to +elp t+e/ decide on clinic decisions a-out -a-.Is care. @+e. /ust defense -a-iesC rig+ts and coordinate t+eir practices. @+e. /ust -e a-le to ta>e decisions a-out independent nurser. and put t+eir decisions into practices and also t+e. /ust participate in s>ill i/pro7e/ent practices. @+e results indicated t+at t+ere was a +ig+l. statistical significant difference -etween nursesI >nowledge related to de7elop/ental care pre and post instructional sessions i/ple/entation. @+is could -e attri-uted to feeling of interest fro/ nurses toward de7elop/ental care and fa7ora-le attention t+at nurses ga7e to t+e instructional sessions. )ll nurses 7olunteered to participate and eApressed t+eir satisfaction wit+ t+e acti7ities. NursesC acceptance to t+e sessions a-out t+e de7elop/ental care as an i/portant nursing care /a. -e t+e >e. factor to i/pro7e t+eir >nowledge. In support to current findings& )ita F Sinder& (2''3 w+o studied t+e art of de7elop/ental care in NI86 and Oo-inson& (2''3 w+o studied t+e c.cled lig+t and growt+ in NI86& -ot+ researc+ers found t+at de7elop/ental care elicits a +ig+ le7el of interest a/ong +ealt+ care professionals in t+e NI86. I addition t+is finding is concurrent wit+ t+e results of 1ilette F et al& (2''5 w+o conducted a DuasieAperi/ental one group pre-test;post-test design. Participants were nurses wor>ing in a neonatal intensi7e care unit and t+e ai/ of t+e was to e7aluate t+e i/pact of a de7elop/ental care training progra//e on nursesI -e+a7iors and cogniti7e attri-utes wit+ regard to t+e pre7ention of o7ersti/ulation of pre/ature infants and t+e results of t+is stud. s+owed t+e potential of suc+ training progra//es to +elp nurses i/ple/ent de7elop/ental care. 1oreo7er& t+e results of t+e present stud. go wit+ t+e results o-tained -. E,-Sa.ed& (2''( w+o conducted a stud. to assess t+e effect of training progra/ for nurses wor>ing in t+e Neonatal Intensi7e 8are 6nit a-out 3e7elop/ental Supporti7e 8are of Preter/ Infants& found t+at& t+e /aEorit. of nurses +ad increased t+eir >nowledge a-out de7elop/ental care significantl. post-progra/. #f t+e current stud.& t+ere was statistical significant difference in t+e relations+ip -etween nursesC .ears of eAperience and practice score& w+ereas .ears of eAperience increased t+eir practice score increased. In addition& t+ere was a statistical significant difference in t+e relations+ip -etween nursesC >nowledge and t+eir ageB t+is /eans t+at& -. increasing t+e nursesI age& t+e. +ad satisfactor. le7el of >nowledge. In t+eir literature re7iew& <reeding F @urner& (2''% /entioned t+at wit+ increasing .ears of eAperience -. wor>ing in critical units& t+e nurse -eca/e /ore s>illful -ased on t+e >nowledge de7elop/ent t+roug+out +er wor>. 4indings of t+e current stud. +ig+lig+ted a statistical significant difference in t+e relations+ip -etween nursesC practice and t+eir le7el of >nowledge pre and post instructional sessions i/ple/entation. @+is /eans t+at increase le7el of nursesI >nowledge a-out de7elop/ental care is associated wit+ i/pro7e/ent in t+eir practice. @+is finding is in contrast wit+ t+e 7iew of Jones and S+erida& (1((( w+o /entioned t+at increases >nowledge le7el does not /ean usuall. increase in perfor/ance le7el. 1eanw+ile& Oo-eldo& =ilson and *ra.& (1((( stated t+at -ad practice and negati7e -e+a7ior usuall. /ore co//on a/ong t+ose w+o +ad poor >nowledge. <ut t+e researc+ers suggested t+at practice is t+oug+t to -e +ea7il. influenced -. t+e >nowledge and attitudes of t+e studied sa/ple. 1eanw+ile& increasing concordance -. correcting /isconceptions a-out de7elop/ental care /ig+t increase /oti7ation to practice it and i/pro7e s>ills. @+e result of t+e present stud. s+own t+at& t+ere was a statistical significant difference -etween doctorsI >nowledge related to de7elop/ental care pre and post instructional sessions i/ple/entation. @+is /eans t+at t+ere is i/pro7e/ent in doctorsI >nowledge post instructional sessions i/ple/entation co/pared wit+ pre instructional sessions. In addition& t+ere was no statistical significant difference -etween doctorsI practice regarding de7elop/ental care pre and post instructional sessions i/ple/entation. @+is finding can -e interpreted -. t+e doctors spend little ti/e wit+ t+e preter/ infants and t+e /ain responsi-ilities of t+e/ Eust fall or end w+en t+e. eAa/ine t+e preter/ and descri-e t+e /edications and gi7e t+e instructions w+ic+ t+e nurses perfor/ it. A% Conclusion @+ere was c+ange in nurses and doctorsC >nowledge a-out de7elop/ental care post instructional sessionCs i/ple/entation. 4urt+er/ore& nursesC practice regarding de7elop/ental care was i/pro7ed post instructional sessionCs i/ple/entation w+ic+ /eans t+at t+e instructional sessions +ad an effecti7e role in en+ancing -ot+ t+eir >nowledge and t+eir practice.

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D% 'ecommendations In the light of findings of the current study, the following recommendations are suggested: =+en designing a new neonatal intensi7e care unit or refitting an older one wit+ /ore /odern eDuip/ent& t+e infrastructure and design of it /ust -e suita-le to facilitate t+e application of de7elop/ental care. Neonatal intensi7e-care unit pro7iders s+ould educate staff and parents a-out t+e potential -enefits of de7elop/ental care /easures and consider de7eloping policies and procedures for t+ese /easures. 1ost of t+e researc+ +as focused on de7elop/ental care as a w+ole& so future researc+ s+ould focused on t+e strong scientific e7idence for specific co/ponents of de7elop/ental care. )ll ot+er +ospital wor>ers (=ard 8ler>& Engineers or 7isitors (fa/il. 7isitors or professional in t+e nurseries s+ould assist in t+e pro7ision and /aintenance of a de7elop/entall. supporti7e en7iron/ent. @+e econo/ic i/pact of t+e i/ple/entation and /aintenance of de7elop/ental care practices s+ould -e considered -. indi7idual institutions. $8% Et ical considerations @+e researc+ protocol was appro7ed -. researc+ et+ics co//ittee of 5ing 5+alid 6ni7ersit. -. t+e date (OE8 T 2'13-'2-1K . $$% AcEnowledgements @+is researc+ was funded -. 5ing 5+alid 6ni7ersit. wit+in t+e acti7ities of Second Oesearc+ ProEect of 5ing 5+alid 6ni7ersit.& 5ingdo/ of Saudi )ra-ia under grant nu/-er 556US 171U33. )ppreciation goes to aut+orities and all t+e participating doctors and nurses. $&% 'eferences )ita&1. F Sinder&,.(2''3 9 @+e art of de7elop/ental care in t+e NI869 a concept anal.sis. Journal of )d7anced Nursing& %1(3 9223-232. )lti/ier&,.(2'11 9 1ot+er and 8+ild Integrati7e 3e7elop/ental 8are 1odel9 ) Si/ple )pproac+ to a 8o/pleA Population. New-orn F Infants Nursing Oe7iewsB 11(3 9 1'5-1'!. <oAwell& *. (2''' 9 Neonatal Intensi7e 8are Nursing& (1st ed. . ,ondon& New Vor>9 @a.lor and 4rancis 8o/pan.& pp. 25&1K5-177. <reeding&J. F @urner&3.(2''% 9 Oegistered nurses and li7ed eAperience of ad7ocac. wit+in a critical care unit9 ) p+eno/enological stud. . )ustralian 8ritical 8are& 15(3 9 1(2-1((. <renda& 0.*. F 1o-olaEi&4. (2''( 9 3e7elop/ental Inter7entions in t+e NI86 =+at are t+e 3e7elop/ental <enefitsW %eo Re&ie's. 1( )3* +arch 1: e113 ,e12(. <.ers& J.4.& ,ow/an& ,.<.& 4rancis& J.& 5aigle ,.& ,ut?& N.0.& =addell& @.& F 3ia?& ).,.(2''K 9 ) DuasieAperi/ental trial on indi7iduali?ed& de7elop/entall. supporti7e fa/il.-centered care. J #-stet *.necol Neonatal Nurs. Jan-4e-B 35(1 91'5-15. E,-Sa.ed& 0.E. (2''( 9 3e7elop/ental Supporti7e 8are of Preter/ Infants9 @raining progra/ for Nurses wor>ing in t+e Neonatal Intensi7e 8are 6nit. @+esis Su-/itted for partial fulfill/ent of 3octorate 3egree .Pediatric Nursing. 4acult. of Nursing. )in S+a/s 6ni7ersit.. Eg.pt. *ouc+on& S.& *regori& 3.& Picotto& ).& Patrucco& *.&Nangeroni& 1.F 3i *iulio& P.(2'1' 9 S>in-to-S>in 8ontact after 8esarean 3eli7er.9 )n EAperi/ental Stud.. Nursing Oesearc+& 5((2 9 7!-!%. *ra.& ,.& =att&,. F <lass& E (2''7 9 )7aila-le at www.pediatrics.org;cgi;content;full;1'5;1;e1%. Jones& 3 F S+eridan& 1. (1((( 9 ) case stud. approac+9 de7elop/ent critical t+in>ing s>ills in no7ice pediatric nurses. Journal 8ontin-Educ- Nurse& Oussia& 3' (2' 9 75-7!. ,e7in& 1.& @ude+ope&3. F @+earl&J. (2''7 9 Essentials of neonatal /edicine9 t+e low -irt+ weig+t infant& (3rd ed . P+iladelp+ia9 ,ippincott 8o/pan.& pp. 12'-1%'. ,issauer& @.& 4anaroff& ).& Oodrigue?& O.& F =eindling& 1. (2''K . Neonatolog. at glance. (1st ed. Pp. 2'& K'& 1%K-1%! . <lac>well Pu-lis+ing. 1ilette&0.I.& Oic+ard&,. F 1artel&1.(2''5 9 E7aluation of a de7elop/ental care training progra//e for neonatal nurses .doi9 1'.1177;13K7%(35'5'51%'' - "hild Health "are -une . / ) 2 *: /4,1(/. Na.lor& 5.@.& 5ingsnort+& S.& ,a/ont& ).& 1c5ee7er& P. F 1acart+ur& 8. (2'11 9 @+e effecti7eness of /usic in pediatric +ealt+care9 a s.ste/atic re7iew of rando/i?ed control trials. E7id <ased 8o/ple/ent )ltern 1ed. ()rticle I3 %K%75( 91! pages. Prentice& 1. F Stainton& 8. (2''3 9 #utco/es of de7elop/ental care in an )ustralian neonatal intensi7e care nurser. Neonatal Networ>& 22 (K & 17G23. Oo-ledo& ,B =ilson& )B F *ra.& P. (1((( 9 0ispanic /ot+erIs >nowledge and care of t+eir c+ildren wit+ respirator. illnesses. Journal Pediatric Nursing& England. 1% (% 9 23(-2%7.

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Oo-ert& 3. F =+ite& 1.3. (2''7 9 Oeco//ended Standards for New-orn I86 3esign. Oeport of t+e Se7ent+ 8ensus 8onference on New-orn I86 3esign. 8o//ittee to Esta-lis+ Oeco//ended Standards for New-orn I86 3esign. Oo-inson&J.(2''3 9 )n organi?ational guide for an effecti7e de7elop/ental progra/ in t+e NI86. Journal of #-estetric. *.necologic and Neonatal Nursing& 3293(7-3!K. Stac.& <. (2'11 9 @+e worldwide incidence of preter/ -irt+9 a s.ste/atic re7iew of /aternal /ortalit. and /or-idit.. <ull =orld 0ealt+ #rganB !!931G3!. S./ington& ). F Pinelli J. (2''% 9 3e7elop/ental care for pro/oting de7elop/ent and pre7enting /or-idit. in preter/ infants. @+e 8oc+rane 3ata-ase of S.ste/atic Oe7iews9 @+e 8oc+rane 3ata-ase& (3 . S./ington& ).J. F Pinelli J. (2''( 9 3e7elop/ental care for pro/oting de7elop/ent and pre7enting /or-idit. in preter/ infants. Pu-lis+ed #nline9 Januar. 21& 2''(. @a+eri& P.& )--asi E& )-de.a?dan R. F 4at+i?ade+ N.(2'1' 9 @+e effects of a designed progra/ on oA.gen saturation and +eart rate of pre/ature infants +ospitali?ed in neonatal intensi7e care unit of )l-Ra+ra 0ospital in Isfa+an in 2''!-2''(. Iran J Nurs 1idwifer. Oes.B 15(2 9KK-7'. @anir&1.5.& )>+an&,.6. F ErgSl&S.(2'11 9 Identification of nursing care /et+ods intended for reducing stress caused -. en7iron/ental factors in neonates. Scientific Oesearc+ and Essa.s. K(% 91123 -112!. )7aila-le online at +ttp9;;www.acade/icEournals.org;SOE @+o/as&8. F 4ors.&). (2''7 9 8o/parison of t+e effects of contain/ent and stro>ing of preter/ at 7ar.ing le7els of /aturit.. 8+icago9 ,o.ola 6ni7ersit. of 8+icago& 3issertation. $ali?ade+1& ,.& )sadolla+i1& 1.& *+are-ag+i&1.1. F *+ola/i&4.(2'13 9 @+e 8ongruence of NursesI Perfor/ance wit+ 3e7elop/ental 8are Standards in Neonatal Intensi7e 8are 6nits. Journal of 8aring Sciences& 2(1 9 K1-71. =ong& 3. F 0oc>en-err.&1.(2''! 9 Nursing care of infants and c+ildren&((t+ ed. . P+iladelp+ia& ,ondon9 1os-. 8o/pan.& pp.%12-%13.

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