Factors influencing implementation strategies regarding environmental design in neonatal intensive care units

Abstract

Background Nurses working in neonatal intensive care units (NICUs) in South Africa’s public hospitals might be familiar with the guidelines regarding the optimal environment for preterm infant development. However, a selected NICU in the Free State Province of South Africa did not seem to implement the best practice guidelines. The purpose of this study was to explore factors that influenced the implementation strategies regarding the environmental design in NICUs. The following aspects are discussed as background information: foetal developmental stages to provide a guide as to what happens from conception till the birth of the baby; an ideal NICU design to ensure an intra-uterine nurturing environment for the preterm infant; and to anticipate and understand the challenges that this preterm infant might face in the extra-uterine environment. The researcher explored the factors influencing the implementation of best practice guideline one: ‘environmental design implies creating an environment conducive for preterm infant development, similar to the intra-uterine environment’ in an NICU in South Africa. Objectives  To explore and describe factors influencing the implementation of the neurodevelopmental care of preterm infants in one NICU in South Africa;  To describe suggestions made by registered nurses for the implementation of the best practice guideline regarding the NICU environment in the participating public sector hospital in the Free State. Method The researcher utilised a descriptive qualitative research approach to guide this study to explore and describe the factors that influenced the implementation of environmental design guidelines to facilitate neurodevelopmental supportive care in one NICU. This study was guided by Als’ Model of the Synactive Organisation of Behavioural Development (Als, 1982:229-243). Four focus group interviews were conducted with professional nurses working in a NICU, and data were analysed using Tesch’s approach. Three themes emerged from the data: current practices of the best practice guidelines; reasons for not implementing these best practice guidelines; recommendations to implement best practice guidelines. Results Best practice guidelines and training were available to nurses working in the NICU in a selected public hospital. However, the environmental design guideline was not implemented due to shortages of staff, poor maintenance plans, financial constraints and lack of resources, as stated by the professional nurses during the focus group interviews. Conclusion The environmental design guideline was not implemented, implying that babies in the NICU might not have received optimum care.