PURPOSE: To understand staff nurses' experiences when implementing developmental care in their nursing practice.
PARTICIPANTS: Purposeful sampling of 22 registered nurses in 2 neonatal intensive care units (NICUs). The units were selected because of their verbalized commitment to developmental care. The nurses worked day and night shifts, and their NICU experience ranged from 1 to 40 years.
DESIGN: A qualitative descriptive study with an emergent design.
METHODS: Tape-recorded, nonstructured interviews with staff nurses until saturation of data where no new data were provided, and there was a complete description of experiences. Observed routine nursing care of 88 hours over 18 weeks, which was recorded in field notes. Data were coded and emergent themes identified.
RESULTS: Findings revealed variations in nurses' delivery of developmental care, which metaphorically resembled a bell-shaped curve. The left tail of the curve represented nurses resistant to developmental care. Most nurses were in the middle of the curve and implemented developmental care as the standard of care in the units. Their delivery of care demonstrated wide variations in their practice and knowledge of developmental care. The right tail of the curve represented a few nurses whose developmental care had evolved into a reflective practice, which was integrated into all aspects of their caregiving. Implementation evolved in nurses' individual practice as well as on the unit level. Nine phases were identified for the implementation of developmental care in the units. Organizational strengths and weaknesses were identified to support developmental care as the standard of practice on the units. These supports maintained basic interventions for developmental care but did not advance care to a reflective level of practice.
CONCLUSION: Many nurses did not demonstrate the knowledge of reflective practice. Variations in practice could be due to basing caregiving decisions on other models such as infants' physiologic needs and peer relationships instead of the developmental care model. Recommendations are given for advancing developmental care practice to a reflective level. Educational activities to encourage a reflective practice include using exemplars and role modeling.