The implementation of a multidisciplinary neurodevelopmental supportive care training programme related to preterm infants in the South African public health sector

Abstract

Background: Preterm infants are at great risk for a variety of health and developmental problems. The Neurodevelopmental Supportive Care (NDSC) Approach aims to minimise the stress of the neonatal intensive care unit (NICU) environment. Neurodevelopmental supportive care is a well-studied area internationally but despite the evidence, this approach is not currently applied in South African public sector NICUs, as standard practice. The training of the multidisciplinary team (MDT), on NDSC, seems too limited to equip them for their work in the NICU environment. Aims: 1) To assess the current state of the neonatal intensive care unit with regard to neurodevelopmental supportive care in the two public sector hospitals, 2) To develop a structure for implementation and prepare for implementation, and 3) To implement the training programme intervention and evaluate the process of implementation. The aims were aligned with three phases and each aim had a number of objectives. Methods: This was an implementation study using a multiphase design and the Quality Implementation Framework (QIF) to guide the implementation process. The intervention which was implemented was a multidisciplinary, NDSC training programme related to preterm infants in the NICU. The study was based on the four phases of the QIF and consisted of nine distinct steps. Total population sampling was used and participants included the MDTs who provide services in two public sector academic hospital NICUs in South Africa. Results: In Phase 1 of the study, the training needs of the MDT and the operationalisation of the NDSC approach confirmed the MDTs did not adhere to the NDSC approach and all nine NDSC categories needed to be included in the training programme. During Phase 2 the implementation plan was developed. The implementation and evaluation of the NDSC training programme in Phase 3 revealed implementation facilitators and barriers. Small changes in practice were identified and participants were positive about the training.Conclusion: The training programme was perceived as positive and small changes in individual NDSC practice were noticed. Changing practice is a complex and lengthy process and the implementation of the NDSC training programme was only the beginning of this process. Recommendations from this study were made and can guide future implementation of training on NDSC in the public sector NICUs.