TABLE 1.

Survey Respondent Comments Regarding Best Practices and Barriers Related to Developmental Care

Survey Domain	Best Practices	Barriers/Challenges
Developmental education/rounding What tools/methods are used to help staff embrace DC? What have been some barriers to implementing DC?	Formal training Developmental education for new nurses; “Lunch and Learns” on DC; nursing education on typical development/early intervention services; education from OT/PT to nurses; education from former NICU nurses Informal/bedside education Bedside education on developmental practices for parents and nursing; guided practice with Child Life; one-on-one case discussions for nurses; posted education and recommendations at bedside; education in CICU newsletter on DC; active involvement of parents Committees/interdisciplinary teams DC committee; Forming multidisciplinary teams; developmental rounds	Limited time/resources Many competing demands on team; time and resources to educate and train; limited funding, staff resources, space/equipment; lack of OT/PT resources Patient/family factors Critical nature of illness, acute patients, physical restrictions; varying patient ages and needs; families with varying viewpoints; limited caregiver availability Culture/environment Lack of understanding of DC; staff resistant to change; environment not conducive to DC; patient oversedation
Environmental adaptations How does CICU provide darkness for sleep? How does CICU provide indirect lighting during alertness? How does CICU provide low levels of sound? How are TVs regulated for younger children? How does CICU control TV time and quiet time?	Regulation of light and sound Lower lighting, decrease noise, and minimize conversations; unit lights turned off overnight for sleep/wake cycle; quiet time with dim lighting during day; quiet time with no touch midnight to 2 AM; individual rooms, doors that close, phones that vibrate; alarms are attended to right away Regulation of television Child appropriate stations and hospital network; nursing has begun to discuss regulation of TV with parents; Child Life supplies appropriate DVDs; no TV for quiet hours	Environment Open bay rooms do not provide darkness; lighting not good, too bright/too dim; overhead paging is a standard practice; unit is very loud Inconsistent practices Sicker patients get bright overhead lights; sometimes too much dimming of lights-–need to promote appropriate stimulation during the day Lack of television regulation TVs on, even for newborns; recommendations not regulated or challenging to regulate
Implementation of care and restraint/sedation use How does CICU provide support for self-soothing during difficult procedures? How does CICU promote nonrestraint use?	Support for self-soothing Sweet Ease, pacifier, bundling, holding by parents, music; utilization of Child Life, positioning; parents work with Child Life, OT for comfort positioning; parents remain at bedside during procedures Promoting nonrestraint use Positioning, comfort care; integration of parents into plan of care; decreased stimulation, clustered care, appropriate pain medication/sedation, nonnutritive sucking; education on swaddling/nonrestraints to safely position; appropriate positioning devices; mitts over hands to avoid pulling lines	Inconsistent practices Clustered care but not regulated; try to cluster care, but care is interrupted by tests and physician consults; Sweet Ease though inconsistent; some patients, clustering contraindicated; Child Life sometimes able to help but inconsistent Overuse of restraints Sometimes restrained when not needed; goal not to restrain but newer staff scared of self-extubation, lean toward more sedation and restraint use
Infant holding Are parents able to hold infants? If CICU experienced negative events with holding, how overcome?	Preventing/overcoming negative events We have bundles to help prevent negative events; lines have securement devices, tubing additionally secured; team education of techniques and “airway guardian”; quality improvement project to determine best practices; unplanned extubations and line dislodgements are tracked	Inconsistent practices Depends on stability of patient; chronic stable patients with close provider supervision; if nursing comfortable with holding and safety

Abbreviations: CICU, cardiac intensive care unit; DC, developmental care; NICU, neonatal intensive care unit; OT, occupational therapy; PT, physical therapy.