Facilitation of developmental care for high-risk neonates : an intervention study

Abstract

English: The implementation of developmental care in South Africa seems problematic. As an effective care approach, developmental care (DC) reduces short- and long-term sequelae for pre-term and sick infants. This study therefore investigates and documents how DC can be implemented successfully in a South African context. The research design chosen, intervention design and development, has six phases: problem analysis and project planning, information gathering and synthesis, design, implementation, evaluation and advanced development, and dissemination. The sixth phase fell outside this study’s scope. Phase One, problem analysis and project planning, involved analysing and describing the level of DC practiced at the research site before implementation, and planning the implementation of DC in a South African public NICU. Planning involved consulting relevant literature and the multidisciplinary team of the NICU. Phase Two, information gathering and synthesis, consisted of identifying the factors involved in DC implementation from national and international examples of such implementation in neonatal intensive care. These factors were derived from available literature and other resources, including institutions where DC and kangaroo-mother care have been implemented, to provide a contextual framework for the intervention plan. The intervention plan for DC implementation at the research site was designed in Phase Three, based on the information gathered in Phase Two. The plan consisted of descriptive representations of the realities of clinical practice combined with applicable theoretical perspectives on the practice of DC. Guidelines for implementing DC were established as part of the plan. Phase Four involved the execution of the intervention plan in a South African public NICU, with participation from members of the multidisciplinary team. The intervention plan was refined and developed further in Phase Five, through monitoring and evaluating DC principles in the NICU. The guidelines were validated by an expert group. The study used Lincoln and Guba’s model (1985: 305) to ensure trustworthiness. No experimental and control groups were used as DC was implemented uniformly in the NICU, with all infants receiving this care. Harm or damage to research participants were not expected, as DC implementation benefits them and improves their working environment. Confidentiality was ensured for all participants and institutions involved. Informed consent for participation was obtained from individual members of the multidisciplinary team. Clearance was obtained from the ethics committee of the University of Pretoria, and institutional consent was obtained from the necessary organisations. This intervention study targeted the multidisciplinary team where medical, nursing, allied health profession and non-medical support personnel were involved in implementing DC. Phase One’s targets and goals included improving the quality of care rendered at the research setting, reducing developmental delays for preterm and sick infants and improved the working environment for the multidisciplinary team. Personnel targets were increasing the staffs’ knowledge and skills, and improving staff morale and job satisfaction. These targets and goals were achieved.

Sepedi: Phethagatšo ya tlhokomelo ya tlhabollo ka Afrika Borwa e bonagala e na le mathata. Bjalo ka mokgwa wa tlhokomelo wo o šomago gabotse, tlhokomelo ya tlhabollo (DC) e fokotša ditlamorago tša nako ye kopana le ye telele go masea a pele ga nako le ao a lwalago. Ka gona dinyakišišo di nyakišiša le go ngwala ka moo DC e ka phethagatšwago ka katlego ka gona maemong a Afrika Borwa. Tlhamo ya dinyakišišo ye e kgethilwego, tlhamo le tlhabollo ya tsenogare, o na le dikgato tše tshela: tshekatsheko ya mathata le peakanyo ya protšeke, kgoboketšo le tswako ya tshedimošo, tlhamo, phethagatšo, kelo le tlhabollo ya maemo a godimo, le phatlalatšo. Kgato ya botshelela e ile ya wela ka ntle ga sebaka sa dinyakišišo tše. Kgato ya Pele, tshekatsheko ya mathata le peakanyo ya diprotšeke, e be e akaretša go sekaseka le go hlaloša maemo a DC ao a dirilwego lefelong la nyakišišo pele ga phethagatšo, le go rulaganya phethagatšo ya DC ka NICU ya setšhaba ya Afrika Borwa. Peakanyo e be e akaretša go bala dingwalo tše di amanago le sehlopha sa dikarolo tše dintši tša NICU. Kgato ya Bobedi, kgoboketšo ya tshedimošo le tswako, e akaretša go laetša mabaka ao a amegago phethagatšong ya DC go tšwa mehlaleng ya bosetšhaba le ya boditšhabatšhaba ya phethagatšo ye bjalo ka tlhokomelong ye e tseneletšego ya masea ao a sa tšwago go belegwa. Mabaka a a tšerwe go tšwa go dingwalo tše di lego gona le methopong ye mengwe, go akaretšwa dihlongwa tšeo go tšona tlhokomelo ya DC le kgomano ka letlalo ya mma le lesea di phethagaditšwego, go fa tlhako ya diteng ya leano la tsenogare. Leano la tsenogare la phethagatšo ya DC lefelong la nyakišišo le hlamilwe ka go Kgato ya Boraro, go ya ka tshedimošo yeo e kgobokeditšwego ka go Kgato ya Bobedi. Leano le be le na le dikemedi tše di hlalošago tša dilo tša kgonthe tša mokgwa wa kliniki tšeo di kopantšwego le dipono tša teori tše di šomago ka ga mokgwa wa DC. Ditlhahli tša go phethagatša DC di hlomilwe bjalo ka karolo ya leano. Kgato ya Bone e be e akaretša phethagatšo ya leano la tsenogare ka NICU ya setšhaba ya Afrika Borwa, ka go kgatha tema go tšwa go maloko a sehlopha sa dikarolo tše dintši. Leano la tsenogare le ile la hlwekišwa le go hlabollwa go ya pele mo Kgatong ya Bohlano, ka go hlokomela le go sekaseka melawana ya DC ka NICU. Ditlhahli di ile tša tiišetšwa ke sehlopha sa ditsebi. Dinyakišišo di šomišitše motlolo wa Lincoln le Guba (1985: 305) go netefatša botshepegi. Ga go dihlopha tša diteko le tša taolo tšeo di šomišitšwego ka ge DC e ile ya phethagatšwa ka go swana ka NICU, ka masea ka moka a hwetša tlhokomelo ye. Kotsi goba tshenyo go bakgathaema ba dinyakišišo e be e sa letelwa, ka ge phethagatšo ya DC e ba hola le go kaonafatša tikologo ya bona ya mošomo. Sephiri se ile sa netefatšwa go bakgathatema ka moka le dihlongwa tšeo di amegago. Tumelelo ye e nago le tsebo ya go kgatha tema e hweditšwe go tšwa go maloko ka o tee ka o tee a sehlopha sa dikarolo tše ntši. Go hweditšwe tumelelo go tšwa go komiti ya maitshwaro ya Yunibesithi ya Pretoria, gomme tumelelo ya setheo e hweditšwe go tšwa mekgatlong ye e hlokagalago. Dinyakišišo tše tša tsenogare di be di nepišitše sehlopha sa dikarolo tše ntši moo bašomi ba tša kalafo, booki, profešene ya maphelo yeo e dirišanago le bašomi ba thekgo bao e sego ba tša kalafo ba bego ba amega go phethagatšeng DC. Dinepišo le maikemišetšo a Kgato ya Pele di be di akaretša go kaonafatša boleng bja tlhokomelo yeo e filwego lefelong la nyakišišo, go fokotša go diega ga tlhabollo ya masea a pele ga nako le ao a babjago le go kaonafatša tikologo ya mošomo ya sehlopha sa dikarolo tše ntši. Dinepišo tša bašomi e be e le go oketša tsebo le bokgoni bja bašomi, le go kaonafatša maikutlo a bašomi le kgotsofalo ya mošomo. Dinepišo tše le maikemišetšo di ile tša fihlelelwa.

Afrikaans: Die implementering van ontwikkelingsorg in Suid-Afrika lyk problematies. Omdat dit 'n doeltreffende sorgbenadering is, verminder ontwikkelingsorg (OS) kort- en langtermyngevolge onder premature en siek babas. Hierdie studie ondersoek en dokumenteer dus hoe OS suksesvol in 'n Suid-Afrikaanse konteks geïmplementeer kan word. Die gekose navorsingsontwerp, intervensie-ontwerp en -ontwikkeling het ses fases: probleemontleding en projekbeplanning; inligtinginsameling en -sintese; ontwerp; implementering; evaluering en gevorderde ontwikkeling; en verspreiding. Die sesde fase het buite die bestek van hierdie studie geval. In Fase Een, probleemanalise en projekbeplanning, is die vlak van OS wat voor implementering op die navorsingsterrein toegepas is, ontleed en beskryf; en vervolgens is daar beplan aan die implementering van OS in 'n Suid-Afrikaanse openbare neonatale intensiewesorgeenheid (NISE). Tydens die beplanning is sowel relevante literatuur as die multidissiplinêre span van die NISE geraadpleeg. In Fase Twee, inligtinginsameling en -sintese, is die faktore wat gepaardgaan met die implementering van OS geïdentifiseer op grond van nasionale en internasionale voorbeelde van sodanige implementering in neonatale intensiewe sorg. Hierdie faktore is afgelei uit beskikbare literatuur en ander bronne, insluitend instellings waar OS en kangaroe-moedersorg geïmplementeer is, om 'n kontekstuele raamwerk vir die intervensieplan te bied. Die intervensieplan vir die implementering van OS op die navorsingsterrein is in Fase Drie ontwerp, gebaseer op die inligting wat in Fase Twee ingesamel is. Die plan het bestaan ​​uit beskrywende voorstellings van die realiteite van kliniese praktyk gekombineer met toepaslike teoretiese perspektiewe rakende die praktyk van OS. Riglyne vir die implementering van OS is as deel van die plan opgestel. Fase Vier het behels dat die intervensieplan in 'n Suid-Afrikaanse openbare NISE in werking gestel is met deelname deur lede van die multidissiplinêre span. Die intervensieplan is in Fase Vyf verfyn en verder ontwikkel by wyse van monitering en evaluering van OS-beginsels in die NISE. Die riglyne is deur 'n groep kundiges gevalideer. Die studie het Lincoln en Guba se model (1985: 305) gebruik om geloofwaardigheid te verseker. Daar is geen eksperimentele of kontrolegroepe gebruik nie, aangesien OS eenvormig in die NISE geïmplementeer is, waardeur alle babas hierdie sorg ontvang het. Geen nadeel of skade vir navorsingsdeelnemers is verwag nie, aangesien die implementering van OS hulle bevoordeel en hul werksomgewing verbeter. Vertroulikheid is verseker vir alle deelnemers en betrokke instellings. Ingeligte toestemming vir deelname is van individuele lede van die multidissiplinêre span verkry. Goedkeuring is van die etiekkomitee van die Universiteit van Pretoria verkry, en institusionele toestemming is van die nodige organisasies verkry. Hierdie intervensiestudie was gerig op die multidissiplinêre span, waar mediese personeel, verpleegkundige personeel, personeel uit verwante gesondheidsberoepe, en niemediese ondersteuningspersoneel by die implementering van OS betrokke was. Fase Een se doelwitte en oogmerke was onder meer die verbetering van die gehalte van sorg wat in die navorsingsomgewing gelewer word, die vermindering van ontwikkelingsvertragings by premature en siek babas, en verbetering van die werksomgewing vir die multidissiplinêre span. Oogmerke ten opsigte van personeel was om personeel se kennis en vaardighede uit te brei, en om personeel se moraal en werkstevredenheid te verhoog. Hierdie doelwitte en oogmerke is bereik.

IsiZulu: Ukusetshenziswa kokunakekelwa ngokuphathelene nokuthuthuka kubonakala kuyinkinga eNingizimu Afrika. Njengendlela yokunakekela ephumelelayo, ukunakekelwa ngokuphathelene nokuthuthuka (DC) kunciphisa ukulandelana kwezigaba zokuthuthuka kwezinsana ezizalwe ngaphambi kwesikhathi kanye nabantwana abagulayo kwesikhathi eside. Ngakho-ke lolu cwaningo lucwaninga futhi lubhale ukuthi i-DC ingasetshenziswa kanjani ngokuphumelelayo esimweni saseNingizimu Afrika. Idizayini yocwaningo ekhethiwe, idizayini yokungenelela kanye nentuthuko, inezigaba eziyisithupha: ukuhlaziywa kwenkinga nokuhlelwa kwephrojekthi, ukuqoqwa kwemininingwane nokuhlanganiswa, idizayini, ukuqaliswa, ukuhlolwa kanye nentuthuko esezingeni eliphakeme, nokusatshalaliswa. Isigaba sesithupha sikhishiwe kulokho obekuzowenziwa kulolu cwaningo. Isigaba Sokuqala, ukuhlaziywa kwenkinga nokuhlelwa kwephrojekthi, kwakuhilela ukuhlaziya nokuchaza izinga le-DC elenziwa endaweni yocwaningo ngaphambi kokusetshenziswa, nokuhlela ukusetshenziswa kwe-DC ku-NICU yomphakathi waseNingizimu Afrika. Ukuhlela kwakuhlanganisa ukubonisana ngokubhaliwe okufanele kanye neqembu lezinhlobonhlobo zamathimba ase-NICU. Isigaba Sesibili, ukuqoqwa kwemininingwane nokuhlanganiswa, kwakuhlanganisa ukukhomba izici ezibandakanyekile ekusetshenzisweni kwe-DC ezibonelweni zikazwelonke nezamazwe omhlaba zokusetshenziswa okunjalo ekunakekelweni okubucayi kwabantwana abasanda kuzalwa abasengcupheni. Lezi zici zithathwe kokubhaliwe okutholakalayo nakwezinye izinsiza, kuhlanganise nezikhungo lapho kusetshenziswe khona ukunakekelwa kwe-DC kanye nokokubeka kukamama usana esifubeni (kangaroo), ukuhlinzeka ngohlaka oluqondene nohlelo lokungenelela. Uhlelo lokungenelela lokuqaliswa kwe-DC endaweni yocwaningo yadizayinwa eSigabeni Sesithathu, ngokusekelwe emininingwaneni eqoqwe eSigabeni Sesibili. Uhlelo lwaluqukethe ukubonakaliswa okuchazayo kwamaqiniso omkhuba wokwelapha kuhlangene nemibono esebenzayo yenkolelo-mbono ngokwenziwa ku-DC. Imihlahlandlela yokuqalisa i-DC yasungulwa njengengxenye yohlelo. Isigaba Sesine sihilela ukuqaliswa kohlelo lokungenelela ku-NICU yomphakathi waseNingizimu Afrika, ngokubamba iqhaza okuvela emalungwini ethimba lemikhakha eminingi. Uhlelo lokungenelela lwalungiswa futhi lwasungulwa ngokuqhubekayo eSigabeni Sesihlanu, ngokuqapha nokuhlola izimiso ze-DC ku-NICU. Imihlahlandlela iqinisekiswe yiqembu lochwepheshe. Ucwaningo lusebenzise imodeli ka-Lincoln no-Guba (1985: 305) ukuqinisekisa ukwethembeka. Awekho amaqembu okuhlola nawokulawula asetshenzisiwe njengoba i-DC isetshenziswe ngokufanayo e-NICU, lapho zonke izinsana zithola khona lokhu kunakekelwa. Bekungalindelekile ukulimala noma umonakalo kubabambiqhaza bocwaningo, njengoba ukuqaliswa kwe-DC kuzuzisa bona futhi kuthuthukisa indawo yabo yokusebenzela. Imfihlo yaqinisekiswa kubo bonke ababambiqhaza kanye nezikhungo ezibandakanyekayo. Imvume enolwazi yokubamba iqhaza itholwe kumalungu ngamanye amathimba anhlobonhlobo. Imvume itholakale ekomitini lezimilo laseNyuvesi yasePitoli, futhi imvume yesikhungo itholakale ezinhlanganweni ezidingekayo. Lolu cwaningo lokungenelela lwaluhloselwe ithimba lezemikhakha eminingi lapho umsebenzi wezempilo wezokwelapha, wobuhlengikazi, womfelandawonye kanye nabasebenzi bosizo olungelona elezokwelapha babebandakanyeka khona ekusebenziseni i-DC. Isigaba kanye nemigomo Yesigaba Sokuqala kuhlanganisa ukuthuthukisa iqophelo lokunakekelwa okunikezwa esimisweni socwaningo, ukunciphisa ukubambezeleka kokukhula kwezinsana ezizalwe ngaphambi kwesikhathi kanye nezigulayo kanye nokuthuthukisa isimo sokusebenza sethimba lemikhakha enhlobonhlobo. Imigomo yabasebenzi yayikhulisa ulwazi kanye namakhono abasebenzi, futhi ithuthukisa indlela abazizwa ngayo abasebenzi ngokuphathelene nokweneliseka emsebenzini. Izuziwe imigomo kanye nalokho obekuphokophelwe.