NIDCAP Federation International

Transcription

1 NIDCAP Federation International Changing the future for infants in intensive care Outline of NIDCAP Training Process Joint Guide for Trainers and Site Organizers Heidelise Als, PhD, 1995, 1997, 1998 NIDCAP Federation International, 2001, 2006 NIDCAP is a registered trademark of the NFI, Inc.

2 Outline of NIDCAP Training Process: Joint Guide for Trainers and Site Organizers 2 I. Initial Intake Process A. Trainer receives telephone call from prospective trainee(s) and discussion ensues on the NIDCAP training needs with relation to site development; trainer offers brief overview of training. B. Trainer sends Program Guide (emphasizing Level I and II) and Fee Structure to trainee/site organizer. C. If trainee(s)/site wishes to pursue training, trainer discusses mutually agreeable time frame. D. Trainer sends the following materials to site organizer: a) Joint Guide for Trainers and Site Organizers; b) NIDCAP Training Binder (one for the site organizer and one for each trainee) E. The site organizer sends the preliminary training visit schedule as well as the completed site and trainee self assessments and registration forms to the trainer by the deadline determined by the trainer (well before training target date). F. Telephone conference call or correspondence with site organizer to negotiate modifications of schedule as indicated. G. Trainer receives finalized training plan from site organizer (including number and names of trainees, room and audio-visual arrangements, travel arrangements, hotel accommodations including contact names and phone numbers). II. Introductory Lecture (~ 8:30 AM 1:00 PM) A. Audience: All prospective trainees (front row), others from site (others from area, depending on goals of organizer) B. Length of presentation: hours C. Location: Auditorium or conference room with audiovisual means D. Content Outline 1. Fetal brain development 2. Fetal behavioral development 3. Synactive theory of development 4. Behavioral assessment of individual newborn functioning 5. VIDA Health Communication, Inc. Film series: Focus on the Brain, Part 1: The Science of Preterm Infant Development; Part 2: Clinical Practices for Special Care Nurseries, Assessment of Preterm Infant Behavior 7. Longitudinal perspective on preterm infant neurodevelopmental competence and issues (research from newborn period to 8 years of age: neurobehavioral and neurophysiological aspects) 8. Implications for NICU care 9. The parenting process: Fullterm and preterm 10. VIDA Health Communication, Inc. Film series: No Matter How Small: A parent s Guide to Preterm Infant Development, 2006.

3 Outline of NIDCAP Training Process: Joint Guide for Trainers and Site Organizers Relationship-based co-regulatory care and specifics of NIDCAP methodology 12. Examples of the path to the infant, care delivery and temporal structuring of regulation and support of infant and family development in the NICU 13. Research on the effectiveness of developmental care a) Als et al., Pediatrics, 1986 b) Parker et al., Journal of Pediatrics, 1992 c) Becker et al., Nursing Research, 1993 d) Als et al., JAMA, 1994 e) Fleisher et al., Clinical Pediatrics, 1995 f) Buehler et al., Pediatrics, 1995 g) Westrup et al., Pediatrics, 2000 h) Kleberg et al., Early Human Development, 2000 i) Kleberg et al., Early Human Development, 2002 j) Als et al., Journal of Developmental and Behavioral Pediatrics, 2003 k) Als et al., Pediatrics, Developmental team model: Co-regulation and synaction in the NICU E. Materials needed 1. Audiovisual Aids a) VIDA Health Communication, Inc. Film series: Focus on the Brain, Part 1: The Science of Preterm Infant Development; Part 2: Clinical Practices for Special Care Nurseries; No Matter How Small: A parent s Guide to Preterm Infant Development, b) PowerPoint Presentation c) LCD projector (with high resolution and sound capability) and screen d) DVD player e) Remote control advancing device f) Laser pointer g) Lapel microphone, desirable in all circumstances 2. NIDCAP Reading Packet and NIDCAP Training Binder 3. NIDCAP Lecture Evaluation Form for each lecture attendee F. Continuing Education Credits: This is left up to the organizers G. Method of Evaluation: Lecture Evaluation Form III. Introductory Workshop (2:00 5:00 P.M.) A. Audience: Trainees, typically 4 (max 6); and organizer(s) of site; key facilitators of training B. Length of Session: 3 hours C. Location: Conference room with AV facility and table surface large enough to accommodate all participants

4 Outline of NIDCAP Training Process: Joint Guide for Trainers and Site Organizers 4 D. Content Outline 1. Training packet and preparation for bedside day 2. Path to the infant (sensitization to own site) 3. Bedside environment 4. Contact ecology (ventilators, IVs, etc.) 5. Direct care observation (NIDCAP sheet discussion) 6. Process of interpretation of the infant s behavior as observed 7. The infant s goals 8. Formulation and language of recommendations 9. Videotape/DVD of caregiving with discussion 10. The change process in the NICU 11. The privilege to observe; team building 12. Opportunities towards developmental care implementation (e.g., orientation; developmental committee; physician tutorial; etc.) 13. Reflective process work in the NICU 14. Support to staff E. Materials Needed 1. Audiovisual a) PowerPoint Presentation b) Videotape/DVD of caregiving segment 2. NIDCAP Training Binder F. Teaching Method: Workshop (presentation and guided discussion) G. Method of Evaluation: Workshop Evaluation Form IV. Bedside Introduction (~8:00 AM - ~5:00 PM; & ~2 hours on day following bedside days) A. Number of Trainees: 2 trainees per day per trainer B. Location: Conference room and NICU bedside C. Length of Session: 8-9 hours D. Content Outline 1. Path to the infant from hospital entrance (parking lot) 2. Orientation to the NICU 3. Orientation to care room 4. Orientation to bed space 5. Orientation to infant 6. Direct observation guided by trainer (emphasis on pattern of infant s behavior) 7. Brief feedback to caregiver (and evaluation form) 8. If at trainer s own site, brief summary entered in chart 9. Discussion of observation and creation of complete write-up in conference room a) Environment b) Length of observation components c) Journal Page d) Joint formulation of observation (see example write-ups as models)

5 Outline of NIDCAP Training Process: Joint Guide for Trainers and Site Organizers 5 e) Study of medical record (using growth charts, ponderal index charts) f) Formulation of medical and behavioral summary g) Formulation of goals h) Formulation of recommendations i) Template ratings 10. During two hour reflection session on following day: a) Homework discussion b) Reflective guidance of trainees c) Time line development d) Reflection on trainee s work within site context E. Logistical & Material Needs 1. Meeting Room a) Must be available for training session throughout the day b) Must be large enough to accommodate trainees comfortably c) Must be equipped with table surface spacious enough for each trainee s materials d) Must have indirect lighting e) Must be comfortable and supportive of trainers and trainees energies (e.g. flowers; water; snacks) f) Must be close to NICU 2. Materials (one each per trainee) a) Legal sized clip board b) Quiet pen(s) c) Accurate timepiece with a second hand d) Trainees must bring their complete NIDCAP Training Binder to this session 3. Infant s Medical Chart The medical chart of the infant being observed must be available at approximate midpoint of discussion when the infant s medical summary is formulated. Therefore the conference room should be as close to the NICU as possible and permission to remove the chart for approximately 30 to 45 minutes must be obtained in advance. 4. Path to the Infant The teaching technique of role playing will have to be cleared with the NICU administrative staff to assure appropriate support for the NICU staff involved. If this is not feasible the experience is structured accordingly. 5. Observation a) An infant for observation (any infant who is receiving caregiving is suitable for observation, with exception of an infant receiving pavulon). Ideal is an infant whose care is considered to be challenging. b) A nurse or other professional caregiver agreeing to observation of him or herself and the infant in his or her care during a caregiving interaction (more than vital signs taking is necessary for observation). 6. Schedule Pre-observation session with path to the infant should start at least 1 hour and 15 minutes prior to anticipated bedside caregiving interaction to be observed (e.g. observation of an infant who will be cared for at about 9AM requires the start of the session at 7:45AM at the latest). Move to bedside for a minimum of 10 minute baseline observation, before caregiving interaction begins; once caregiving interaction is completed, a minimum of 10 minutes of additional observation is recorded, or until the infant appears settled; return to conference room for

6 Outline of NIDCAP Training Process: Joint Guide for Trainers and Site Organizers 6 discussion, write-up and consultation as outlined below. It is important to plan a break for lunch to be taken at a close by, in-hospital site in order to conserve time. F. Method of Evaluation 1. Written evaluation of session by trainee using Bedside Evaluation Form 2. Written evaluation of trainee by trainer using Consultation and Guidance with Individual Trainees 3. Trainer evaluates self using Consultation and Guidance with Individual Trainees 4. Trainer formulates written summary in the form of a letter to each trainee using the information in the Consultation and Guidance with Individual Trainees and provides copies to trainees supervisors/mentors. V. Independent Observational Study and Workday(s) A. As outlined in Program Guide, p. 9, Section 3(b). Independent Observational Study (1)-(5). Then send to trainer for review a write-up which reflects your best effort. It should be sent after editing with feedback by others including a parent and NIDCAP colleague. Review the NIDCAP Writeup Evaluation form for your self-guidance before sending the report. Note, Training Centers vary as to the number of reports required. B. Feedback on write-up from trainer to trainee; once write-up is acceptable a workday is scheduled, before the trainee follows an infant and family from admission to discharge and transition to the home with biweekly or weekly NIDCAP observations (beginning of clinical implementation work) in preparation of reliability. If indicated, a second work day or additional reports for review may be required prior to embarking on the Advanced Practicum. Written evaluation by the trainer of each formally submitted report is sent to the trainee. VI. Guidance Towards Reliability As above, under Independent Observational Study, including work days as indicated. VII. Workday(s) A work day follows the format of the Introductory Bedside Day (see p. 4) and the Reliability Day (see p. 7). A Workday is planned by Trainer and Trainee on the basis of the trainer s guidance regarding the trainee s degree of independence of observation and/or write-up formulation. Work days provide important opportunities for improvement of observation, understanding of the infant s functioning, of the caregiver s effort, of the developmental professional s role, responsibilities and opportunities as well as the next steps in formal documentation and guidance. Depending on the trainee s background and progress, more than one Workday may be indicated. The trainer guides the trainee in an understanding of appropriate next training and preparation steps and the trainer determines when the trainee is sufficiently well prepared to embark on the Advanced Practicum. Maximum number of trainees per Workday is two per trainer.

7 Outline of NIDCAP Training Process: Joint Guide for Trainers and Site Organizers 7 VIII. Advanced Practicum Details regarding guidance for the Advanced Practicum and its evaluation are provided in the document Guidelines for the Advanced NIDCAP Practicum. Be sure to be familiar with these guidelines before embarking on the Advanced Practicum. IX. Reliability (~8:00 4:00 or 5:00 P.M. & ~2 hour session on the following day) A. Number of Trainees: 2 maximum per day per trainer B. Length of Session: 8-9 hours C. Content Outline 1. Path to the infant from hospital entrance (parking lot) 2. Orientation to the NICU 3. Orientation to care room 4. Orientation to bed space 5. Orientation to infant 6. Direct observation guided by trainer (emphasis on pattern of infant s behavior) 7. Brief feedback to caregiver (and evaluation form; appended) 8. If at trainee s own site, brief summary entered in chart 9. Individual write-up up to medical summary 10. Reading by section by each trainee with feedback from trainer to each trainee 11. Joint study of record 12. Writing of medical and behavioral summary goals and recommendations 13. Reading by section of summary, goals, and recommendations with feedback by trainer to each of the two trainees 14. Template ratings 15. During two hour reflection session on following day: a) Overall summary for each trainee and deposition of level of accomplishment (reliability yes, not quite, etc.) b) Guidance towards next steps in discussion with trainee s self evaluation c) Development of timeline D. Logistical and Material Needs 1. Meeting Room a) Must be available for training session throughout the day b) Must be large enough to accommodate trainees comfortably c) Must be equipped with table surface spacious enough for each trainee s materials d) Must have indirect lighting e) Must be comfortable and supportive of trainers and trainees energies (e.g. flowers; water; snacks) f) Must be close to NICU 2. Materials (one each per trainee) a) Legal sized clip board b) Quiet pen(s) c) Accurate timepiece with a second hand d) Trainees must bring their complete NIDCAP Training Binder to this session

8 Outline of NIDCAP Training Process: Joint Guide for Trainers and Site Organizers 8 3. Infant s Medical Chart The medical chart of the infant being observed must be available at approximate midpoint of discussion session following observation when the infant s medical summary is formulated. Therefore the conference room should be as close to the NICU as possible and permission to remove the chart for approximately 30 to 45 minutes must be obtained in advance. 4. Path to the Infant The teaching technique of role playing will have to have been cleared with the NICU administrative staff to assure appropriate support for the NICU staff involved. If this is not feasible the experience is structured accordingly. 5. Observation a) An infant for observation (any infant who is receiving caregiving is suitable for observation, with exception of an infant receiving pavulon). Ideal is an infant whose care is considered to be challenging. b) A nurse or other professional caregiver agreeing to observation of him or herself and the infant in his or her care during a caregiving interaction (more than vital signs taking is necessary for observation). 6. Schedule Pre-observation session with path to the infant should start at least 1 hour and 15 minutes prior to anticipated bedside caregiving interaction to be observed (e.g. observation of an infant who will be cared for at about 9AM requires the start of the session at 7:45AM at the latest). Move to bedside for a minimum of 10 minute baseline observation, before caregiving interaction begins; once caregiving interaction is completed, a minimum of 10 minutes of additional observation is recorded, or until the infant appears settled; return to conference room for discussion, write-up and consultation as outlined below. It is important to plan a break for lunch to be taken at a close by, in-hospital site in order to conserve time. 7. Evaluation Forms a) Reliability Evaluation Form b) Consultation and Guidance with Individual Trainees E. Method of Evaluations 1. Written evaluation of session by trainee using Reliability Evaluation Form 2. Written evaluation of trainee by trainer using Consultation and Guidance with Individual Trainees 3. Trainer evaluates self using Consultation and Guidance with Individual Trainees 4. Trainer formulates written summary in the form of a letter to each trainee using the information in the Consultation and Guidance with Individual Trainees and provides copies to trainees supervisors/mentors. X. Site Consultation (The last day of each training visit must be dedicated to site consultation) A. Individual meetings with key organizers, at times with CEO, VP, etc., those who plan for the hospital at large to move in the direction of developmental care; nurse manager, chief medical director, etc. It is useful to have the individual meetings before the group meeting; at times however, the group meeting identifies who the persons are to meet with at next site visit consultation. B. For each on-site visit a 1.5- to 2-hour site consultation group meeting with key discipline leadership and developmental leaders is planned. It includes feedback on environment, core

9 Outline of NIDCAP Training Process: Joint Guide for Trainers and Site Organizers 9 interdisciplinary opportunities and guidance towards resource development; strengths identified; readily (short term), accomplishable next steps, and long term planning next steps. C. Organizer/key trainers complete evaluation. D. Trainer completes site consultation form and formulates feedback summary letter for site. E. Annual written site self assessment is recommended. XI. Written Documents Required (As outlined throughout): A. Initial Site Self Assessment B. Initial Trainee Self Assessments C. Registration sheets for each trainer-in-training and each trainee D. Detailed schedule for training visits, including participants of site consultation meeting, individual meetings, meeting room assignments, etc. E. Evaluation by trainees of lecture, workshop, and bedside introduction F. Evaluation by caregiver(s) observed G. Site consultation evaluation (NIDCAP Trainer Evaluations: I. Preparation of Training Components and Training Days; II. Site Consultation) H. Best write-up, before following an infant and family from admission to discharge (Advanced Practicum) I. Advanced Practicum J. Evaluations of Advanced Practicum K. Evaluation of reliability day L. Annual site assessment XII. Fee Structure Training center s fee structure.