Developmentally Supportive Care in the Cardiac Intensive Care Unit: A Concept Analysis

Introduction: Literature provides strong support for developmentally supportive care in the Neonatal Intensive Care Unit (NICU) as a care model associated with reduced length of stay, improved enteral feeding, and improved neurodevelopmental outcomes. Many infants who undergo surgery for congenital heart disease are neonates, but developmentally supportive care is not the usual care model in a Cardiovascular Intensive Care Unit (CVICU). Following congenital heart surgery, the infant requires multiple monitors of vital functions, chest tubes, endotracheal intubation and mechanical ventilation, central venous and arterial lines, urinary catheter, and may require high technology support such as extracorporeal life support or delayed sternal closure. The invasive nature of this level of support may initially preclude a developmental care model. However, as the infant recovers, the nursing and medical care needs become less intense, which may be an appropriate time to change the focus of care from lifesaving high technology to developmental support. The neonate with heart disease is typically a term infant, unlike the focus on premature infants in the NICU. However, some recent literature suggests that the brains of infants with heart disease developmentally resemble that of a premature infant. The CVICU patient population also includes children with heart disease of all ages, from neonates to young adults. Neurodevelopmental delay is common in children with heart disease, and risk factors for delays include neonatal surgical repair, preoperative medical and neurological co-morbidities, length of cardiopulmonary bypass and deep hypothermic circulatory arrest, birth weight less than 2.5 kg, and hospital length of stay. Neonates and young infants with the most complex heart defects are at highest risk for developmental delay, and may benefit greatly from developmental support.  

Purpose/Aim: It is not known whether the components of NICU developmentally supportive care are applicable to the care of infants and children with cardiac disease. The purpose of this concept analysis is to better understand how developmentally supportive care is applicable to the care of infants and children with heart disease, and their families, in the CVICU.

Methods: Using the Walker and Avant method of concept analysis, definitions and uses of the concept of developmental care in the CVICU will be identified and the attributes will be described. A model case of developmentally supportive care for infants and children with heart disease will be developed, as will examples of a contrary case, related case, and borderline case. Antecedents of the concept and consequences of the application of developmentally supportive care for infants and children with heart disease will be discussed.

Conclusion/Implications: This concept analysis will provide guidelines and operational structure for CVICU nurses to implement developmentally supportive care measures in a population of infants and children with severe heart disease who are at risk for developmental delay, at an appropriate time in their recovery. Establishing a more developmentally supportive care environment will facilitate holistic care of the infant or child and their family, and support excellence in nursing practice.