INCOT: Irish Neonatal Care in Occupational Therapy Study: The Development of an Occupational Therapy Intervention for Neonatal Units in Ireland
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2024Author:
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2029-08-20Citation:
Kift, Sara Hope, INCOT: Irish Neonatal Care in Occupational Therapy Study: The Development of an Occupational Therapy Intervention for Neonatal Units in Ireland, Trinity College Dublin, School of Medicine, Occupational Therapy, 2024Download Item:
Abstract:
Background: Occupational therapists (OTs) play an important role in neonatal units
internationally. This is a growing area of practice in Ireland, but it is not yet part of the
standard of care in all neonatal units. Additionally, while there is evidence to support
some individual interventions used within OT practice in neonatal units, no studies were
identified that have examined OT as an intervention in an Irish context. The aim of this
research was to explore the current developmental care practices in neonatal units in
Ireland, and to pilot an occupational therapy intervention in this setting.
Methods: This study followed the first two stages of the Medical Research Council (MRC)
Framework for Complex Interventions. Stage One – Development – had three distinct
phases. Phase I involved an exploration of the current practices of developmentally
supportive and family-centred care in neonatal units in Ireland. A qualitative description
design was used, involving semi-structured interviews with 10 staff members from 3
neonatal units. Phase II was informed by the previous phase and employed a survey
methodology. This gathered perceptions of developmental and family-centred practice
nationally. Participants included 22 neonatal unit staff and 90 veteran neonatal parents.
Phase III involved a review of the literature relevant to the practice of occupational
therapy in the neonatal unit, including the effectiveness of interventions used by
occupational therapists in this setting, and the barriers and enablers to parental
participation in co-occupations.
Guided by the findings of Stage One, Stage Two (Phase IV) – Feasibility/Piloting
– sought to explore the impact of the delivery and implementation of a pilot occupational
therapy intervention in an Irish neonatal unit. A quasi-experimental, mixed methods
design was utilised. Data collection took place over a 6-month period of time, during
which an OT intervention was provided to 34 infants and their families. Infants were
between 23.5- and 35-weeks’ gestation at enrolment to the study and were seen for a
mean of 8 sessions (range 3–35). Self-report measures from parents pre- and post-OT intervention (n = 42 parents) completed were the Parental Stressor Scale: Neonatal
Intensive Care Unit (PSS: NICU), Perceived Maternal Parenting Self-Efficacy (PMP S-
E), the Karitane Parenting Confidence Scale (KPCS), the Edinburgh Postnatal Depression
Scale (EPDS) and the Hospital Anxiety and Depression Rating Scale (HADS). Clinical
assessments of the infants were completed using chart review, the Neonatal Behavioural
Assessment Scale (NBAS) and the Goal Attainment Scale (GAS) created for the project,
as well as infant pre- and post-intervention data, including oxygen saturation and heart
rate. Post-intervention surveys were used with both staff (n = 24) and parents (n = 22) to
gather qualitative data regarding their experiences with neonatal OT.
Results
Findings from the thematic analysis of the qualitative interviews in Phase I
indicated themes related to participants’ attitudes and perceptions of developmental care
for infants and families, including a discrepancy between what was perceived to be ideal
practice and what was carried out in neonatal units on a day-to-day basis. The sources of
developmental care education and the value placed on it were also identified, as was the
impact of the environment on developmental care practice. Phase II identified strengths
and areas for improvement in developmental care practice in Ireland. Barriers to the
delivery of developmental care identified by staff included a need for further training, a
lack of staffing on the unit to support developmental care and a lack of dedicated space
for parents within neonatal units. Veteran parent survey analysis also identified variations
in developmental care practice and challenges with the physical space of the neonatal
unit. Parents described feeling close and connected to their infants in the neonatal unit
through the participation in co-occupation or shared purposeful activities with their infant.
Results from the pilot study in Stage Two (Phase IV) identified a statistically
significant improvement in all parental measures post-intervention, apart from the PSS:
NICU infant appearance subscale and the HADS depression subscale. GAS scores
showed statistically significant changes across all domains. Infant autonomic stability, as
measured by heart rate and blood oxygen, demonstrated statistically significant change
between pre- and immediately post-OT sessions. Staff and parent surveys indicate that the
pilot intervention was feasible and deliverable. Parents perceived the occupational therapy
intervention to be empowering to their participation in co-occupations with their infants and beneficial to their infants. Staff reported that the OT pilot intervention enhanced their
ability to deliver developmentally supportive care in the neonatal unit.
Conclusion
This project has provided a profile of current developmental care practices in
Ireland from the perspectives neonatal staff and parents. It has also provided strong
groundwork for the development of neonatal occupational therapy as a complex
intervention, and the potential benefits to infants and their families that this can provide.
Infants spending time on neonatal units have complex and multifactorial needs, and
parenting in this environment has identified challenges. The neonatal unit itself is a
complex environment, with multiple professionals involved with the infants’ care. Thus,
the findings of the pilot study need to be considered within the context of this. The
findings from all phases of the project can inform the development of practice in the
neonatal unit environment, and further research by occupational therapists in this area is
warranted.
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APPROVED
Author: Kift, Sara Hope
Advisor:
Molloy, EleanorPublisher:
Trinity College Dublin. School of Medicine. Discipline of Occupational TherapyType of material:
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