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Lighthouse project: Developmental care – from theory to practice

A guest article by Dr Susanne Rücker, paediatrician , Hospital “Dritter Orden”, Munich, Germany

Observing the little patient’s needs: NIDCAP in practice © Klinikum Dritter Orden, München

Developmental care is a paramount aspect in the care of preterm babies. Being a neonatal unit providing maximum medical care, this approach has always been an important factor in the provision of care for our patients. However, there has not been a comprehensive concept in operating developmental care that has been applied uniformly.
It was hence our wish to implement a programme for developmental care that includes family-centred care from the start. EFCNI made us aware of the FINE (Family and Infant Neurodevelopmental Education) programme – a structured training for family-centred developmental care based on NIDCAP (Newborn Individualized Developmental Care and Assessment Program). Due to a donation by EFCNI in 2016, we were able to host a NIDCAP training with a team of NIDCAP coaches from Rotterdam and Tübingen, in our clinic. The two-day-workshop imparted scientific principles, strategies in care provision while observing the babies’ reactions to it, as well as the role of the family in the spectrum of care. Another training module enabled our staff, within the scope of Bed-Side-Observation under supervision, to gain extensive knowledge in observation of behaviour which is essential if one aims at providing individualised care.

After the workshops were finished, we were facing the task to implement what we had learned into our daily clinical routines.The first initial steps in early 2017 were to set up a task force that was in charge of coordinating the activities and projects related to NIDCAP. Moreover, they developed a concept for internal coachings, to train more staff according to the new concept. It is our goal to establish the optimal environment for our small patients, so they have both calm surroundings and adequate stimulation for the best developmental outcome possible.  Procedures are being questioned critically and continuously adapted. We did, for instance, introduce a stress-and pain-management as well as measures to reduce noise in the unit and advanced the possibilities to provide Kangaroo Care. All these steps have already shown to have a positive impact on our patients.  The family is in the focus because it is our aim to empower the parents as they know their child’s needs best and intuitively react in the right manner given that we have included them from the very beginning in the care for their baby. We want to enable mothers to be the primary care givers for their child(ren) as early as possible and the early and successful discharge rates proof us right in doing so. Furthermore, we introduced 24/7 access for siblings to the unit, so they can be part of their brother’s or sister’s care.

Graphic: © efcni

Implementing NIDCAP into our daily NICU procedures is facing two main challenges: one is staff shortage the other is raising awareness for the benefits of this care procedure: NIDCAP and its individual approach as well as the shift of responsibilities from the clinical staff to the parents, demands a change of thinking.  Implementing such a programme does require persistence and a lot of patience. We are however convinced to be on the right track. We already realised changes that have become irrevocable practice: We wish to optimise the care in labour and delivery unit as well as in our neonatal nurseries  in the future and want to offer a NIDCAP training to some of our staff.

Please click here for the German original article.

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Developmental care for little patients – FINE trainings in Romania

A guest article by Corina Croitoru, President of the Association Unu și Unu

Preterm babies, and ill newborns are properly treated from the medical point of view, but, the human dimension is often neglected. They are ‘just’ patients and the parents are ‘just’ visitors. By supporting FINE training in Romanian hospitals, Unu si Unu Association aims to change this situation. 

The aim: “Through this project we want to support the babies and their parents. At birth, both the baby and the mother are very vulnerable and they need each other. The experience of the countries who applied the concept of infant- and family-centred developmental care showed us that this is the way to change the neonatal units. Because the units following the family-centred care concept have a huge impact on the neurological development level of the child, it could prevent disabilities and raise the bond and attachment between mother and child”, says Corina Croitoru, the president of the Association Unu și Unu. She initiated the project and her goal is to introduce these kind of centres where parents can take care of their babies in all neonatal units in Romania within the next five to ten years.

The project “Little human in therapy” offers the chance that the little patient can be taken care by his or her own family. This approach respects one of the fundamental rights that every newborn has the right to not be separated from his parents (United Nations Convention, Children Rights, 1989). In this way, the parents will not only be accepted in neonatal intensive care units, but they also will be able to practice Kangaroo care, to take care of their babies, to feed them, taking them into their arms during the painful procedures. All this will take place, of course, after the children are stabilised and while respecting babies’ needs.

Details of the project: Unu si Unu Association started the project “Little human in therapy” in 2 maternities: Polizu, National Institute for Health of Mother and child Bucharest and Maternity Dominic Stanca, Emergency Hospital Cluj-Napoca. 110 participants (20% doctors and 80% nurses) from both maternities attended the FINE LEVEL 1 training (3 sessions of 2 days each) by Inga Warren, Senior Trainer NIDCAP, UK NIDCAP from the University College London Hospital. Additional 12 guests from other maternities from Romania joined the course, in preparation of a future expansion of the project. 

The feedback received from the medical staff was very positive: “The approach according to FINE principles will enhance the quality of medical care procedures with impact on neuro-development on short and long term for this category of newborns. The change of experience with the founder team from Great Britain, helped us with the implementation of the project in Polizu maternity. Our goal is to apply as many of the methods that we have learned as the position of the new born, building “nests” adequate for the needs of the preterm baby and create a special environment for the sensory development by respecting the epidemiological rules.” said Corina Datu neonatologist doctor in I.N.S.M.C. – maternity Polizu.

“It was an amazing experience, and the presentation was very good. Things about all of us knew are good, both for the baby’s and their parents. It is good to remember them and to try to apply as many as possible. I think is very good for the nurses to see these things and to apply them together after. Thank you so much for this experience.” Doctor Bogdana Todea, Dominic Stanca Maternity, Cluj.

The FINE Level 2 training focused on practical skills and on baby’s individual needs. This involves studying the way preterm and newborn babies behave. The baby may not speak but the way he/she reacts gives us an idea about how he/she is feeling and what kind of help he/she may need. It is important for staff and parents to understand these reactions so that they can care for the baby in the safest, most sensible and sensitive way. 6 healthcare professionals joined this level 2 training course, two doctors and two nurses from Bucharest and one doctor and one nurse from Cluj accepted the challenge of further training with the aim of introducing the family-centred care approach in their hospitals.

Images (c) COPAC

Outcome: Soon, the results of the course became apparent. Inga Warren declared that when she visited the intensive care neonatal unit from Polizu Maternity after finishing the course, she observed that some of the techniques from the course were already used.

After six months since the FINE Level 1 training, Kangaroo care has been practiced almost daily in Stanca Maternity. The smallest children who received Kangaroo Care weighed 800 grams, and we started to also involve fathers. In order to involve even more parents in the care of their hospitalised baby in the NICU, Association Unu si Unu supports, with the help of its voluntary team, weekly, practical workshops for parents and hand hygiene seminars, in the Maternity in Cluj.

Another result is the donation of products for the implementation: nests for a good positioning, gel positioning pillows, incubator covers, Kangaroo Care blouses and Kangaroo Care chairs, chairs for parents, baby feeding pillows, mini pacifiers, lamps with dimmer, weighing, blankets, storage boxes.

In 2018, Unu și Unu received an award by the Coalition of Patient Associations in Romania (COPAC) for the project. 

Timing: The project needed a 6 months fundraising period, 3 months for signing contracts with hospitals, 3 months for FINE Level 1 training, 1 month for donation of necessary materials for the implementation, 6 months for organizing FINE Level 2 training + seminars for parents + parents inclusion, step by step, in the NICUs.

 

 

Contact details for further information: Corina Croitoru, corina.croitoru(at)unusiunu.com

Special thanks to
Corina Croitoru
President of the Association Unu și Unu
https://unusiunu.com

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Lighthouse project: Family and Infant Neurodevelopmental Education

The Family and Infant Neurodevelopmental Education (FINE) programme is an educational pathway in infant and family-centred developmental care for all healthcare professionals working in neonatal care. The overall goal is to improve the outcomes for babies and families in neonatal care. The curriculum includes themes such as neurodevelopment of the newborn, the relationship between parents and their baby, management of stress and pain, and observing and understanding the baby’s behaviour. The concept has spread to many parts of the world and thousands of healthcare professionals have completed at least the first level of the FINE curriculum. Due to the sustainable impact on the implementation of family-centred care, FINE is one of our lighthouse projects in the field of education and training of the multidisciplinary neonatal team.

An interview of Inga Warren and Monique Oude Reimer-van Kilsdonk

We had the opportunity to ask Inga Warren, Primary author and Co-director of FINE, and Monique Oude Reimer-van Kilsdonk, Co-director of FINE, some questions about their programme:

What was the idea behind FINE and what was the starting point?
FINE began as in-service training at St. Mary’s Hospital in London, then home to the UK’s NIDCAP Training Centre, but we soon realised the need to make good quality education accessible beyond our own unit on a scale that would not be possible for NIDCAP.

How did you put your idea into practice?
Start-up funding from parents allowed Inga time to develop training materials. Nikk Connemann (project consultant) as well as Monique and Esther van der Heijden (Co-author) in Rotterdam shared the vision of creating a universal programme that would support NIDCAP in practice and we started working together in 2012; by 2013 the FINE curriculum had taken shape and the current training pathway was formalised with Level 1: Foundations and Level 2: Practical Skills, and we began to recruit experienced and talented faculty.

When did you start to hold advanced trainings across Europe?
The first centre outside to try FINE Level 2 was the Institute of Neonatology in Belgrade, Serbia in 2014.  NIDCAP training had been introduced but as in many other low-income countries a more affordable option was needed. Six nurses completed the level 2 course, translated into Serbo-Croat.

The EFCNI gave us platforms for spreading information with invitations to speak at the jENS conference in Budapest 2015 and the annual Parent Organisations meeting in 2016. With this support awareness of FINE has grown and grown. EFCNI facilitated translations into German and enabled training at both levels to start in Germany in 2016. They encouraged and supported parent organisations in Greece (2016), Cyprus (2017), Romania, and Hungary (2018) to set up FINE training. These are brave moves in countries where parents often do not have opportunities to care for their babies during neonatal care.

Enquiries are coming from more countries in the Eastern side of Europe and many other countries around the world. NIDCAP Training Centres in eight countries are now licensed to run FINE, with three more preparing. The UK – Rotterdam partnership has delivered FINE to many other countries that are not eligible for a license. The NIDCAP Federation International has endorsed the programme.

Where do you think, the most notable changes were achieved?
Staff surveys in the UK show a strong conviction that FINE improves practice. In France and Belgium, it has been so well received that it has attracted state funding. In the absence of data by which to compare before and after practice it is difficult to measure precise outcomes but we have encouraging feedback from units such as Helena Venizelou in Athens, Greece, and in Cluj in Romania where new practices such as kangaroo care were introduced rapidly, parental access was opened up and staff were enthusiastic about the dramatic changes they made in spite of previous forebodings. More centres in these countries are now asking for FINE and we are very proud to be supporting the work of parent organisations in this way. Countries with well-developed infant and family centred developmental care, such as Sweden, are reporting that FINE has revitalised interest in NIDCAP based care and we are seeing a growing number of people enquiring about further training, which will be important for developing faculty to make FINE sustainable.  

Lighthouse Education & training

Outlook:
From October 2018 to the end of 2019, FINE 1 and FINE trainings are planned in the following countries (as of September 2018):

  • Austria (FINE 2)
  • Belgium (FINE 1+2)
  • France (FINE 2)
  • Germany (FINE 1+2)
  • Greece (FINE 1)
  • Hungary (FINE 1)
  • Ireland (FINE 1+2)
  • Italy FINE (1+ 2)
  • Lithuania (FINE 1)
  • Netherlands (FINE 1+2)
  • New Zealand (FINE 1)
  • Portugal (FINE 1)
  • Qatar (FINE 1+2)
  • Romania (FINE 1+2)
  • Saudi Arabia (FINE 1+2)
  • Sweden, (FINE 2)
  • UK (FINE 1+2)

 

Special thanks to
Inga Warren, Co-director of FINE
Monique Oude Reimer-van Kilsdonk, Co-director of FINE

 

Map of FINE trainings

Map of participants of FINE trainings. Figures by Inga Warren and Monique Oude Reimer-van Kilsdonk. Graphic by EFCNI

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