Pilot Survey of Nurses' Attitudes and Practice of Developmentally Supportive Care in NICUs inTaiwan

Purpose: to examine both neonatal nurses' attitudes in applying developmentally supportive care (DSC) and their perceptions of practice of DSC in NICUs in Taiwan.

Methods: The Chinese version of Neonatal Nursing Care Survey (NNCS) was a self-administered paper survey and distributed to NICU nurses from six regional medical institutions (two each located in the northern, central, and southern Taiwan). This tool designed on a five-Likert scale ranging from 1 to 5 assesses nurses' attitudes (including 38 items) toward and perceptions of their practice (including 61 items) of DSC for preterm infants in NICU. The context of NNCS reflects overall DSC strategies classified into five components: individualized care, appropriate sensory input, promote comfort, appropriate positioning, and parental involvement.  Higher scores indicate that the nurse has a more positive attitude about applying DSC knowledge, and/or that she provides DSC to preterm infants more frequently.

Results: Of 267 questionnaires, 221 were returned, gathering an 82.8 % response rate that varied between 62.5 and 96.8% among hospitals. Neonatal nurses generally showed a positive attitude about applying DSC knowledge (M=3.50, SD=.38). Their highest attitude score was "promote comfort component", while as the lowest one was "individualized care".  The top 5 of 16 practice strategies of DSC provided by nurses in order to frequency were: "nesting", "supportive positioning aids", "covering the incubator", "holding in tucked position", and "midline positioning". The average practice scores (ranging from 3.44-4.08, SD= .54-.74) were higher than the score in attitudes. In this study, the correlations of five DSC components between attitudes and practice were weak. "Individual care" attitudes and practice had no significant correlation with any component of other DSC attitudes or practices. Nurses' attitudes towards "appropriate sensory inputs" and "promote comfort" consistently correlated with their practice of these two components, whereas "appropriate positioning" and "parent involvement" show no such consistency. 

Conclusion: Findings of this study may help nursing educators and administrators at both unit and hospital levels to provide educational programs and supports in order to promote nurses' knowledge and attitudes, and consequently facilitate nurses' DSC practice. Further studies to understand nurses' attitudes and practice experience are recommended, especially for those items with low values.