core measures nursing examples
These measures may or may not relate to specific diseases, but they always link the patient as an individualized person to the specific surface (body/environment) where care is rendered and care is received. Developmental care for high-risk infants in neonatal intensive care units (NICUs) is practised throughout the industrialized world. National Academy of Sciences To err is human: building a safer health System. Gibbins S, Hoath S, Coughlin M, Gibbins A, Franck L. The universe of developmental care: a new conceptual model for application in the neonatal intensive care unit. Core measures quantify otherwise invisible nursing actions in NICUs with measurable and tangible constructs that are essential for improvement and standardization. To define and standardize developmental care in the context of the UDC and Joint Commissions core measures concept, a comprehensive electronic search was conducted in MEDLINE, CINAHL, EMBASE and PsycINFO using the terms developmental care, developmentally supportive care, caring, and infant between 1978 and 2008. Lund CH, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA. Based on the premise that infant behaviours are a means of communication, healthcare professionals were encouraged to examine infant responses to the environment systematically and adjust their caregiving activities when signs of stress were observed. Kfoury AG, French TK, Horne BD, Rasmusson KD, Lappe DL, Rimmasch HL, Roberts CA, Evans RS, Muhlestein JB, Anderson JL, Renlund DG. It is the context as well as the actual location where care occurs. 2004, Chizawsky & Scott-Findlay 2005). and transmitted securely. The family is placed intentionally as proximal as possible to the infant-patient. 
No conflict of interest has been declared by the authors. Groce JB. Nibert L, Ondrejka D. Family presence during pediatric resuscitation: an integrative review for evidence-based practice. The proposed five core measures represent the first step in operationalizing evidence-based developmental care (Figure 2). Holditch-Davis D, Brandon DH, Schwartz T. Development of behaviors in preterms: relation to sleeping and waking.
With a focus on quality care delivery through the application of standardized medical treatment strategies, evidence-based medical interventions were organized into disease-specific core measure sets across several life-threatening medical conditions. Subsequent researchers have tested the general hypothesis that the provision of a developmentally appropriate sensory milieu, coupled with minimal disruptions and care contingent on patient cues, improves medical and developmental outcomes. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. The staff is depicted in a protective orbit around the infant-family dyad. Developmental care is a professional practice, education and research opportunity that nurses need to explore, evaluate and refine continuously within the rapidly changing technological environment of the NICU. Evaluation and development of potentially better practices to improve pain management in neonates. Archives of Disease in Childhood, Fetal and Neonatal Edition. The patient-centeredness of the UDC model aligns seamlessly with the Joint Commission core measures concept. Focused attention on quality healthcare delivery is relatively new, beginning in the mid-1980s. The corresponding criteria include specific interventions that promote sleep (Feldman et al. Nursing, medicine, and other healthcare professionals are invited to embrace this practical framework, integrate these care actions into their professional practice and evaluate clinical, economic and psychosocial outcomes as a consequence of this standardized model for developmental care. The https:// ensures that you are connecting to the 2006), and (3) access to resources and supports that assist them in their short and long term parenting needs (Doucette & Pinelli 2004) (Table 4). This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Assessment & management of stress and pain core measure. coughlin m., gibbins s. & hoath s. (2009), core measures, developmentally supportive care, neonatal intensive care unit, nursing. It is a disturbance within the physiological orbit which necessitates medical intervention and nursing care. The core measures concept for developmental care should standardize care experiences for patients, families and staff during neonatal intensive care unit stays. Attributes and corresponding criteria specific to pain and/or stress assessment and management are: (1) routine assessment and documentation of pain and stress with an established pain/stress tool (Stevens & Gibbins 2002, Anand et al. Periano PD, Algarin CR. 2007). The attributes specific to the healing environment encompass the physical, human and organizational elements requisite for a safe and healing hospital experience. will also be available for a limited time. The core measures are protected sleep, pain and stress assessment and management, activities of daily living (positioning, feeding and skin care), family-centred care and the healing environment. This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Anand KJS, Aranda JV, Berde CB, Buckman S, Capparelli EV, Carlo W, Hummel P, Johnston CC, Lantos J, Tutag-Lahr V, Lynn AM, Maxwell LG, Oberlander TF, Raju TNK, Soriano SG, Taddio A, Walco GA. Summary proceedings from the neonatal pain-control group. Nurse clinicians, educators and scholars are increasingly committed to advancing the science of developmental care in relation to nursing practice. In care interactions, there are not two separate surfaces bumping against each other or two separate surfaces with an intervening space, but a single, continuous, looped structure which is both organism and environment. Skin-to-skin contact (kangaroo care) promotes self regulation in premature infants: sleep-wake cyclicity, arousal modulation, and sustained exploration. 2006) (Table 1). White RD. Shabot MM. The UDC model portrays a patient-centric care environment, graphically representing the patient at the center of the healthcare universe (Figure 1). These principles, in conjunction with the early work of pioneer neonatal nurses and paediatricians, laid the theoretical foundation for the work of Als and colleagues (Als 1982, Als et al. Distilling the evidence on developmental care a systematic review. Brown MS, Ohlinger J, Rusk C, Delmore P, Ittmann P. Implementing potentially better practices for multidisciplinary team building: creating a neonatal intensive care unit culture of collaboration. The universe as a whole is situated within an educational medium which pervades and connects individual constituents. Core measures for developmental care should validate and quantify the impact of nursing care activities in neonatal intensive care units, allowing cross-institutional comparisons. Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation. Access to these internal body systems occurs across the shared care surface. Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes. Developmental care has been a recognized practice strategy in neonatal intensive care units for over two decades. There is inconsistency in the definition and operationalization of developmental care. Didactic teaching sessions or interactive learning opportunities in which caregivers experience the contrast of standard (such as experiencing loud noises, frequent handling or bright lights) vs. developmental care practices (as defined by the core measures) may be used to increase understanding of developmental care. Despite the availability of effective evidence-based medical interventions for common life-threatening medical conditions, there was a high degree of variability in use of these proven therapies in the patient care setting. Although the practice and philosophical interpretation of developmental care may vary across units, the goal is to provide a structured care environment which supports, encourages and guides the developmental organization of the premature and/or critically ill infant. official website and that any information you provide is encrypted Task Force on Sudden Infant Death Syndrome 2005, http://www.NAP.EDU/books/0309068371/HTML/, Infant sleep-wake states will be assessed, documented, and guides all infant interactions (, 1.All non-emergent caregiving is provided during wakeful states, 2.Sleep-wake states are assessed and documented, 3.Scheduled caregiving is contingent on the infants sleep-wake states and adapted accordingly, Care strategies that support sleep are individualized for each infant and documented (, 1.Caregiving activities that promote sleep (i.e. MC, SG and SH made critical revisions to the paper for important intellectual content. Presenting care strategies in this format creates a reflective opportunity for care providers, taking the focus off the care task and placing it on the care experience at the shared care surface. Vaivre-Douret L, Ennouri K, Jrad I, Garrec C, Papiernik E. Effect of positioning on the incidence of abnormalities of muscle tone in low-risk, preterm infants. 2001, 2004) (Table 2). These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. Unlike the criteria employed by the Joint Commission to manage discrete medical conditions, core measures for developmental care are focused on care actions which are disease-independent but nonetheless essential to promote healthy growth and development of the infant and family. Sharek PJ, Powers R, Koehn A, Anand KJS. Distinct attributes and criteria for feeding focus on the appropriate use of non-nutritive sucking, employing infant feeding cues as a measure of infant feeding readiness and parental education and support of breastfeeding and the use of breastmilk (McCain 2003, Pinelli & Symington 2005, Ludwig & Waitzman 2007). Before Although these core measures have improved patient and system outcomes within disease-specific areas (Jha et al. Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. Braun BI, Koss RG, Loeb JM. Beyond the staff is the environment, comprised of the physical, human and organizational elements that represent the healthcare setting. Similar to existing adult studies examining the safety, efficacy and cost effectiveness of core measures (Kfoury et al. The UDC model is an extension to existing nursing knowledge and is proposed as a means to critically examine individual or collective components of developmental care in order to evaluate practice, identify research questions and/or identify learning opportunities related to care practices. Sweeney JK, Gutierrez T. Musculoskeletal implications of preterm infant positioning in the NICU. Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. Each core measure set represents an organized constellation of caring activities that acknowledges the holistic needs of the infant-family dyad within the context of the UDC model and the hospital experience. 2006), and (3) involvement in and sharing of a pain and stress management care plan with parents (Franck et al. Developmental care has its roots in the principles of nursing science as outlined by Florence Nightingale (1860) indicating the nurses responsibility in creating and maintaining an environment conducive to the healing process. Automated data acquisition and scoring for JCAHO ICU core measures. The Journal of Advanced Nursing (JAN) is an international, peer-reviewed, scientific journal. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Sleep in brain development. 2003, Schmidt 2004), and documentation of evidence-based policies, procedures and resources to sustain the healing environment over time (Lafferty 2004, Schmidt 2004) (Table 5). The core measures for developmental care create a framework for the comparative analysis of developmental care practices and associated clinical outcomes across multiple healthcare systems.
In this model, education extends across all orbital planes. A randomized controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth. 2002, Symington & Pinelli 2002,Symington & Pinelli 2006). This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model. Developmentally supportive activities of daily living core measure. Chizawsky LLK, Scott-Findlay S. Tummy time! 1999) developmental care core measures need to be further developed and explored. facilitative tuck, swaddled bathing and skin-to-skin care) are integrated into the patients daily care plan, 2.All caregiving activities are modified according to the infants state, 3.Light and sound levels are maintained within the recommended range; implement cycled lighting to support nocturnal sleep, Families are educated on the importance of sleep safety in the hospital and the home; this education is documented (, 1.Family education on caregiving activities that promote safe sleep is provided, 2.Parenting opportunities are provided to promote infant sleep, 3.Staff role model Back to Sleep practices for families once the infant has demonstrated physiologic flexion of the upper body in supine, Assessments of pain and/or stress are performed routinely and documented (, 1.Each infant is assessed for pain and/or stress at a minimum every 4 hours or with each infant interaction, 2.Each infant is assessed for pain and/or stress during all procedures and caregiving activities, 3.A valid pain assessment tool is utilized, Pain and/or stress is managed before, during and after all procedures until the infant reaches their baseline; interventions and infant responses are documented (, 1.Non-pharmacologic and/or pharmacologic measures are utilized prior to all stressful and/or painful procedures, 2.Caregiving activities are adapted to minimize pain and stress, 3.Infant response to pain and/or stress relieving interventions is documented, Family is involved and informed of the pain and stress management plan of care for their infant(s); involvement and information sharing is documented (, 1.Parents are involved and informed of the pain and stress management plan of care for their hospitalized infant(s), 2.Family education regarding infant pain and stress cues is provided, 3.Family is encouraged to provide comfort to their infant, Positioning: Infant positioning is documented to provide comfort, safety, physiologic stability and support optimal neuromotor development (, 1.Each infant is positioned and handled in flexion, containment and alignment during all caregiving activities, 2.Infant position is evaluated with every infant interaction and modified to support symmetric development, 3.Positioning aides are gradually removed and Back to Sleep and Tummy to Play practices are implemented as the infant demonstrates physiologic flexion of the upper body in supine, Feeding: Feeding will be infant-driven, individualized, nurturing, functional and developmentally appropriate to ensure safety (, 1.Non-nutritive sucking is offered with each non-oral feeding contingent on the infants state, 2.Assessment of feeding readiness cues and the quality of the oral feeding is documented with each oral feeding encounter, 3.Education regarding the benefits of breastmilk is provided and family choice is supported, Skin-care: Infant skin integrity is assessed, protected and care is documented (, 1.Infants are bathed no more frequently than every 3 days, 2.Skin integrity is assessed using a reliable assessment tool at least once per shift and documented. The key concept guiding data organization in this paper is the United States of Americas Joint Commissions concept of core measures for evaluating and accrediting healthcare organizations. Systematic reviews and randomized control trials were considered the strongest level of evidence. Nurses can use the UDC and its core measures to guide and evaluate clinical practice. 2003,Grigg-Damberger et al. The effects of family resources, coping, and strains on family adjustment 1824 months after the NICU experience. Franck LS, Scurr K, Couture S. Parent views of infant pain and pain management in the neonatal intensive care unit. At the turn of the 21st century, two landmark reports drew global attention to the quality healthcare crisis in the United States of America To Err is Human (1999) and Crossing the Quality Chasm (2001). Developmental care has been linked to a variety of favourable clinical outcomes. Johnson BH, Abraham MR, Parrish RN. 2006), (2) management of pain and stress before, during, and following all painful procedures with subsequent documentation of interventions and a return of the infants pain scores to pre-procedural baseline (Anand et al. The family-centred care core measure incorporates the tenets of the Institute for Family-centred Care and recognizes that families must have (1) unrestricted access to their infant (Johnson et al. The attributes pertaining to protected sleep encompass assessment, documentation and utilization of infant state to guide care delivery (Holditch-Davis et al. FOIA 2007). Learn more Corresponding, measurable criteria articulate the specific actions needed to achieve the designated attribute.
2003, Ohlinger et al. Protected sleep is the most important core measure because it highlights the importance of behavioural state; which is the foundation for all human activities. 1988a, 1988b), who described the complex relationship between the developing brain of preterm infants and the increasingly technological NICU environment. Doucette J, Pinelli J. The new PMC design is here! The site is secure. Developmental care recognizes the physical, psychological and emotional vulnerabilities of premature and/or critically ill infants and their families and is focused on minimizing potential short and long-term complications associated with the hospital experience. Thus, observations about comfort, safety, tolerance, health, wellness and satisfaction within this complex dynamic system of the patient care experience can be made relative to this confluence. Five core measure sets for evidence-based developmental care were identified: protected sleep, pain and stress assessment and management, developmental activities of daily living, family-centred care and the healing environment. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2005), processes to standardize complex care practices, such as those involved in developmental care, have not been explored. Neither the developing infant nor the environment exist in isolation, but rather intersect at this shared surface. Designing the neonatal intensive care unit for optimal family involvement. Notes on Nursing: What it is, and what it is Not. Symington A, Pinelli JM. This placement acknowledges the crucial role of family in the patients hospital experience and creates a visual reminder of this relationship to the clinician. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. The patient is illustrated as a dynamic organism consisting of internal physiological systems influenced by a requisite sleep-wake cycle and an outer care surface (the planetary ring). Once it is determined that the infant is in a state of optimal readiness to engage in a caring exchange, as measured by their sleep-wake cycle and ability to sustain a mutual relationship, the developmentally supportive care provider (parent/nurse) can begin their caring exchange with the infant-patient. Kaaresen PI, Ronning JA, Ulvund SE, Dahl LB. 2002, Schmidt 2004, Ludington-Hoe et al. Care in U.S. hospitals the hospital quality alliance program. Als H, Duffy FH, McAnulty G. Behavioral differences between preterm and fullterm newborns as measured with the APIB system scores: I. Als H, Duffy FH, McAnulty G. The APIB, an assessment of functional competence in preterm and fullterm newborns regardless of gestational age at birth: II.
Transient sounds or Lmax (the single highest sound level) shall not exceed 65 dB, 2.Ambient light levels ranging between 10600 lux and 160 foot candles shall be adjustable and measured at each infant bed space, 3.Physical and auditory privacy is afforded at each patient bed space, A collaborative healthcare team that emanates teamwork, mindfulness and caring (, 1.Interdisciplinary care rounds occur at least weekly, 2.Direct care providers demonstrate caring behaviors which include adherence to hand hygiene protocols, cultural sensitivity, open listening skills and a sensitive relationship orientation, 3.Nurse-physician collaboration is defined, practiced, and reinforced on a daily basis, Evidence-based policies, procedures and resources are available to sustain the healing environment over time (, 1.Core measures of developmental care provide the standard of care for all patient care providers, 2.Resources to support the implementation of developmental care as defined by the core measures are always available, 3.A system for staff accountability in the practice of developmental care as outlined by the core measures is operational. Franck LS, Cox S, Allen A, Winter I. Parental concern and distress about infant pain. Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. Translating evidence-based guidelines into performance measures for venous thromboembolism and acute coronary syndrome. MC, SG and SH provided administrative, technical or material support. Around the globe, industrialized countries began to scrutinize the quality of their healthcare delivery and identify deficiencies and opportunities for improvement. Nurses can also use core measures as a framework for clarifying and enriching parental and staff knowledge of developmental care. Ohlinger J, Brown MS, Laudert S, Swanson S, Fofah O.
Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Although tremendous advances in neonatal care and the developmental support offered to high risk infants have been made over the past three decades, variability in practice remains a constant concern that precludes systematic comparisons.
The Newborn Individualized Developmental Care and Assessment Program is not supported by meta analyses of the data. government site. Grigg-Damberger M, Gozal D, Marcus CL, Quan SF, Rosen CL, Chervin RD, Wise M, Picchietti DL, Sheldon SH, Iber C. The visual scoring of sleep and arousal in infants and children. Despite these documented benefits, we concluded that confusion about the existing theoretical construct and the inability to identify and measure relevant clinical outcomes reliably has resulted in inconsistent adoption of developmental care and undermined its potential as a revolutionary and transformative healthcare philosophy and practice paradigm. Careers. For further information, please visit the journal web-site: http://www.journalofadvancednursing.com. JAN publishes research reviews, original research reports and methodological and theoretical papers. Through the definition of clear, measurable benchmarks for clinical practice, the Joint Commissions core measure concept has reduced mortality in the area of heart failure, acute myocardial infarction and community acquired pneumonia (Jha et al. (Braden Q Scale or similar tool), 3.The skin surface is protected during application, utilization and removal of adhesive products, The family (defined by the infants parents and/or guardians) has 24-hour unrestricted access to their infant and is provided the opportunity to parent; family definition and participation is documented (, 1.Family is offered the opportunity to be present and/or participate in medical rounds and change of shift report, 2.Family is offered the opportunity to be present during invasive procedures and/or resuscitative interventions, 3.Family is supported in parenting activities to include skin-to-skin care, holding, feeding activities, dressing, bathing, diapering, singing and all infant care interactions, The familys level of emotional well-being and parental confidence and competence is assessed and documented weekly (, 1.Mental health professionals resource families weekly, 2.Family observations and input regarding their infant are sought by the clinical care providers and documented in the patients health records, 3.Health care providers share unbiased infant information weekly with the family, The family has access to resources and supports that assist in short term and long term parenting, decision making and parental well-being (, 1.Families are invited to participate in a neonatal intensive care unit family support group, 2.Culturally sensitive family education on infant safety and infant care is available in various formats, 3.Resources for the social, spiritual and financial needs of families are provided, A quiet, dimly lit, private environment that promotes safety and sleep (, 1.Continuous background sound and transient sound in the neonatal intensive care unit shall not exceed an hourly continuous noise level (Leq) of 45 decibels (dB) and an hourly L10 (the noise level exceeded for 10% of the time) of 50 dB. Bethesda, MD 20894, Web Policies The concept of a shared care surface was advanced as a logical cornerstone for neonatal nursing care. Incremental survival benefit with adherence to standardized heart failure core measures: a performance evaluation study of 2958 patients. Schmidt S. Mindfulness and healing intention: concepts, practice, and research evaluation. Systematic reviews and randomized control trials were considered the strongest level of evidence. 2006, Sharek et al. 1998). Family, staff and healthcare organizations have unique learning needs that cannot be ignored within a healthcare milieu that is dedicated to quality healthcare delivery and outcomes. These five categories reflect the recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in the neonatal population. Integrating performance measure data into the Joint Commission accreditation process. sharing sensitive information, make sure youre on a federal 8600 Rockville Pike 2001) (Table 3). This surface was conceptualized as the place where body and environment meet. The inverse relationship between mortality rates and performance in the hospital quality alliance measures.
Stevens B, Gibbins S. Clinical utility and clinical significance in the assessment and management of pain in vulnerable infants. JAN contributes to the advancement of evidence-based nursing, midwifery and health care by disseminating high quality research and scholarship of contemporary relevance and with potential to advance knowledge for practice, education, management or policy. Federal government websites often end in .gov or .mil. American Journal of Health System Pharmacy. Finally, attributes and corresponding criteria specific to skin care highlight the importance of accurate assessment and documentation of skin integrity and practices which protect the vulnerable skin surface (Lund et al. Translation of developmental care into practice requires language and definitions that clearly articulate expectations through measurable, objective and evidence-based criteria. Preventing unwanted effects of the back to sleep campaign. Accessibility Recommended standards for the newborn ICU. MC, SG and SH were responsible for the study conception and design. 2004, Nibert & Ondrejka 2005), (2) assessment of their emotional and physical well-being and their evolving competence and confidence in parenting their infant (Doucette & Pinelli 2004, Kaaresen et al. The UDC approach seeks to frame evidence-based, developmentally supportive care practices and integrate these practices into a performance measurement system similar to the Joint Commission core measures model. The criteria include the measurement and maintenance of recommended light and sound levels and assurance of physical and auditory privacy for families (Johnson et al. The quality of evidence was based on a structured predetermined format that included three independent reviewers. The Cochrane Database of Systematic Reviews.
