Related Experiment Video
Updated: May 29, 2026
Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit
Published on: January 7, 2020
Challenges in conducting prospective research of developmentally directed care in surgical neonates: a case study
Sharon Laing1, Kaye Spence, Catherine McMahon
1Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Insights
Implementing the Newborn Individualized Care and Assessment Program (NIDCAP) in surgical neonates faced challenges due to clinical demands. Successful integration of complex interventions requires careful methodological appraisal in critical care settings.
Area of Science:
- Neonatal care research
- Evidence-based practice in critical care
- Clinical intervention studies
Background:
- Rigorous evaluation of clinical innovations is often hindered by real-world practical constraints.
- This study aimed to assess the effectiveness of developmentally directed care in surgical neonates via a randomized controlled trial.
- The intervention utilized was the Newborn Individualized Care and Assessment Program (NIDCAP).
Purpose of the Study:
- To share lessons learned from conducting prospective research on a practice-intervention within a critical care environment.
- To inform future research endeavors in similar settings.
- To identify barriers and facilitators for implementing complex interventions in neonatal critical care.
Main Methods:
- The study assessed three intervention components: NIDCAP observation frequency, infant assignment to specialized nurses, and care consistency.
- Implementation barriers were identified through qualitative discussions with key nursing staff.
- A randomized controlled trial design was employed to evaluate the NIDCAP intervention.
Main Results:
- The NIDCAP intervention was not successfully implemented, evidenced by insufficient observations and inconsistent care allocation.
- Key barriers included high patient turnover, unpredictable medical status changes, and staff shortages.
- Competing demands between clinical service provision and research activities in a busy critical care unit impeded implementation.
Conclusions:
- Barriers encountered in implementing NIDCAP are pertinent to other critical care settings considering complex interventions.
- Similar challenges are likely across diverse clinical contexts.
- A methodologically informed approach is crucial for appraising the implementation and evaluating complex interventions.
Background:
Evaluation is fundamental to evidence-based practice. Due to practical constraints inherent in real-world clinical environments, however, innovations in clinical practice are often implemented without rigorous research. We set out to evaluate the effectiveness of developmentally directed care in surgical neonates using a randomised controlled trial with a Newborn Individualized Care and Assessment Program (NIDCAP) intervention.
Aim:
The aim of this paper is to inform future studies by sharing lessons learnt in conducting prospective research of a practice-intervention in a critical care setting.
Method:
Three intervention components were used to assess implementation: number of NIDCAP observations; infant allocation to project nurses, and consistency of care. Barriers to implementation were identified through discussions with nurses who had key roles.
Results:
Insufficient episodes of NIDCAP observation and infant allocation to project nurses, and lack of consistency of care indicated that the intervention had not been successfully implemented. Barriers to implementation (fast 'turnover' of patients, unpredictable changes in medical status, staff/skill shortages, and inconsistent care) were attributed to the competing demands between service provision and research in a busy critical care context.
Conclusions:
The findings regarding barriers to successful implementation of NIDCAP in this case study are relevant to any critical care setting where complex interventions are under consideration, as similar challenges are plausible across a range of clinical contexts. Adopting a critical methodologically-informed approach to appraise implementation and evaluate complex interventions is essential.