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A Narrative Review of NICU Implementation of Evidence-Based Early Relational Health Interventions
Umber Darilek1, Erin Finley, Jacqueline McGrath
1Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Dr Darilek); Departments of Medicine and Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Dr Finley); Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Finley); and School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Dr McGrath).
Background:
Early relational health (ERH) interventions in the neonatal intensive care unit (NICU) buffer infants from toxic stress effects. Implementation science (IS) can guide successful uptake of evidence-based practice (EBP) ERH interventions. It is unknown if implementors of ERH interventions currently use the resources of IS to improve implementation.
Purpose:
A narrative review of recent literature on implementation of ERH EBPs was completed to understand (a) which ERH interventions are currently being implemented in NICUs globally, (b) whether clinical implementors of ERH interventions have adopted the resources of IS, (c) existence of implementation gaps, and (d) implementation outcomes of ERH interventions in contemporary literature.
Data Sources:
Scopus, PubMed, and CINHAL were searched for original research regarding implementation of dyadic ERH interventions using key words related to IS and ERH.
Study Selection:
For inclusion, ERH EBPs had to have been implemented exclusively in NICU settings, contained data addressing an IS domain, printed in English within the last 5 years. Twenty-four studies met inclusion criteria.
Data Extraction:
Studies were distilled for intervention, IS domains addressed, location, aims, design, sample, and outcomes.
Results:
Eleven ERH interventions were described in the literature. Few studies utilized the resources of IS, indicating variable degrees of success in implementation. Discussions of implementation cost were notably missing.
Implications For Practice And Research:
Implementors of ERH interventions appear to be largely unfamiliar with IS resources. More work is needed to reach clinicians with the tools and resources of IS to improve implementation outcomes.
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