Compliance With Best Practice Guidelines for Neurodevelopmental Supportive Care in South Africa: A Situational Analysis.

Neurodevelopmental supportive care provides preterm infants with evidence-based care to ensure the best possible neurological outcomes. The study aimed to determine the compliance of current nursing care practices with best practice guidelines by means of a situational analysis. The situational analysis was done in 2 cycles in the neonatal intensive care units (n = 25) of a private healthcare provider in South Africa. Structured observations were done in cycle 1 using the Implementation of Neurodevelopmental Supportive Care checklist. Cycle 2 comprised focus group discussions to verify findings from cycle 1. Seventeen conclusion statements were formulated, which were thematically combined to be presented as 9 categories: neonatal intensive care unit design, individualized care, family-centered care, infant positioning, handling techniques, environmental manipulation, pain management, knowledge of infant behavior, and feeding. The conclusion statements identified improvement opportunities in current practice and offer suggestions, which can be used to guide an implementation strategy for best practice guidelines of neurodevelopmental supportive care in the neonatal intensive care units of the private healthcare group in future. Addressing improvement opportunities in all the categories will ensure that all aspects of the guideline requirements are met, resulting in a comprehensive strategy improving practice and patient outcomes.

Improving healthcare: a guide to roll-out best practices.

BACKGROUND: Best practices comprise recent, relevant, and helpful nursing practices, methods, interventions, procedures or techniques based on high-quality evidence. Best practices should be implemented to improve individual patients' health outcomes the overall quality of health care, and to strengthen the health system at large. Four facilitators (benefit levers) to effectively roll-out best practices in healthcare organizations were identified: alignment, permeation plans, leadership for change, as well as supporting and reinforcing structures. PURPOSE OF THE RESEARCH: To develop and review a guide for an operational plan to facilitate the roll-out of best practices in healthcare organizations. METHODOLOGY: The content of the guide was based on findings of an integrative literature review and interviews. This article discusses the development of the guide using the logic model as format (phase One) as well as its review including five key informants using the Delphi method (phase Two). RESULTS: The Logic Model provided a feasible format for the guide. Two Delphi rounds were required to review the guide's design and content. This guide addresses pre-roll-out resources; pre-roll-out activities, best practices (outcomes) during and after roll-outs; and impact. CONCLUSION: The guide should be tested in different healthcare organizations and adapted accordingly to have an impact on improved patient and health outcomes. The guide can be used by managers wishing to roll-out best practices in their healthcare organizations to achieve improved health outcomes for individual patients.

Quality Improvement Initiative for Family-Centered Care in the Neonatal Intensive Care Unit of a Tertiary Hospital in South Africa.

The introduction of family-centered care in the neonatal intensive care unit was identified as a high priority to facilitate bonding and attachment with potential positive outcomes for the parents and infants. The aim of the study was, therefore, to develop and implement a quality improvement initiative to foster family-centered care in a tertiary neonatal intensive care unit from birth onward. A pretest posttest intervention design was used using mixed methods over 3 phases to determine the perceived level of family-centered care according to healthcare professionals and parents using self-administered questionnaires; to develop and implement a quality improvement initiative to enhance family-centered care in a neonatal intensive care unit using a nominal group technique, followed by the quality improvement process; and to evaluate the outcomes of the initiative by repeating the self-administered questionnaires to parents and staff. Various activities were introduced as part of the initiative such as early breastfeeding, early introduction of parents to their infant, open visitation policy, and involvement in caring activities. The perceived level of care according to staff and parents increased. It is expected to enhance bonding and attachment between the infants and their parents, with consequential long-term positive outcomes.

Integrative review of benefit levers' characteristics for system-wide spread of best healthcare practices.

AIM: To critically analyse the characteristics of the benefit levers that are required for effective system-wide spread of evidence-based practice. BACKGROUND: Evidence-based nursing practice is the cornerstone of quality patient care and merits system-wide implementation. Achieving system-wide spread of evidence-based innovations requires adoption of four benefit levers (the facilitators for spreading innovations), conceptualized by Edwards and Grinspun: alignment, leadership for change, permeation plans and supporting and reinforcing structures. Although these concepts have been explored and described in primary studies, they were only recently identified as benefit levers and their characteristics have not been reviewed in the context of health care using an integrative literature review. DESIGN: An integrative literature review using an adapted Whittemore and Knafl design. DATA SOURCES: A comprehensive search using multiple sites such as Scopus, EBSCOhost, ProQuest, ScienceDirect, Cochrane Library, Nexus, SAePublications, Sabinet, Google Scholar and grey literature was conducted (January-March 2012) and updated (December 2014). After reading the abstracts, titles and full-text articles, forty (N = 40) research and non-research documents met the inclusion criteria. REVIEW METHODS: Thirty-five documents remained after critical appraisal. A systematic approach was used to analyse and synthesize the data and formulate concluding statements. RESULTS: Data revealed characteristics about alignment (personal, organizational and contextual attributes), permeation plans (phases), leadership for change (types, strategies, position, attitude and support) and supporting and reinforcing structures (types and requirements). CONCLUSION: Benefit levers should be used to promote the spread of evidence-based practices. However, more studies concerning benefit levers, specifically regarding 'alignment' and 'permeation plans', are required to promote system-wide spread of best healthcare practices.

Integrative literature review defining evidence-based neurodevelopmental supportive care of the preterm infant.

Neurodevelopmental supportive care (NDSC) is a well-researched topic and extensive evidence is available on its benefits in terms of the outcome for preterm infants. The programs, strategies, and individual elements of NDSC have been evaluated; however, knowledge and implementation of the developmental care approach is fragmented and the evidence base for elements of NDSC that make up the holistic model is not explicitly documented. The aim of this study was to identify and critically appraise the methodologic quality of relevant research studies and synthesize the current best available evidence of NDSC. A comprehensive investigation of NDSC including studies using research methods other than clinical trials may provide a combination of results from several primary studies, therefore an integrative literature review was utilized as the method of choice. Sixteen research articles were found to be of good methodologic quality and level and strength of evidence after critical appraisal. They described or defined the elements of NDSC explicitly. Extraction of data from these articles contributed to the formulation of 25 conclusion statements. Each of these statements could be grouped under 9 categories that resulted from a process of synthesis, and each of these categories could be substantiated from its literature support, clinical impact, and supporting evidence, including the specific literature references and volume and level of evidence associated with that element of NDSC, providing the evidence base for defining NDSC.