Discussion
Through the process of enhancing nursing
practice in developmental care for preterm infants,
the nurses were empowered to maintain control
over their practice. A key element that empowered
the staff nurses was providing knowledge and
skills. In this study, the nurse participants learned
much of their developmental care knowledge from
conferences, workshops, articles, poster presentations,
and role models. The increase in developmental
care knowledge served to enhance the power of the
nurses in relation to developmental care practice.
The increased knowledge that the nurse gained
about developmental care means that the nurses have
gained the power of practice or exerted greater power
(ie. responsibility) that hitherto. Mrayyan21 pointed
out that implementing changes requires improving
the efficiency of nurses. Having a good level
of knowledge and skills will enhance nurses
confidence in making decisions about their practices.
In regard to the activities of the group meetings,
the nurses were encouraged to become involved
in decision making regarding their patient care,
improving the quality of their nursing care, and
enhancing their autonomy. Autonomy is an essential
element of the nursing profession22-23 and is often
addressed in the context of accountability, authority
and responsibility.24-25 The freedom to make
independent decisions about ones practice is an
essential aspect of autonomy.21 The nurse participants
in this study were encouraged to participate in
decision making in group meetings, which was a
part of their autonomy and thus, enhanced their
power.26-27 Enhancing the nurses autonomous
decision making is viewed as a strategy to strengthen
their overall autonomy, and in turn, improve
patient care.
Developmental care was considered by the NICU
team to be a specialized nursing care in the field of
neonatal nursing. Implementing developmental
care in the NICU challenges the successful
implementation of the roles of the advanced
practice nurse (APN). The process of enhancing
the nursing practice in developmental care using
the PAR model in this study helped the staff
nurses to develop the skills that would allow them
to practice at an advanced level. Pickler and Reyna28
asserted that implementing developmental care in
the NICU provides opportunities for advanced
practice nursing in the care of high-risk infants.
Delametter29 also mentions that advanced practice
nursing encompasses the respective components of
specialization and autonomy. As a result of the study,
the nurses became richer in knowledge, skills,
experience, and confidence in their developmental
care practice. This knowledge will help them to
strengthen advanced practice nursing in terms of
achieving sustainability in developmental care
practice.
In the process of enhancing nursing practice,
the nurse participants had opportunities for
creative innovation. From this, new materials
were created by the nurse participants to make
their practice more effective and easier to
implement. Specifically, the developmental care
protocol was developed and the supporting
pillow was invented. The nurses had opportunities
to use their competence to develop work routines
and this demonstrated the current health care
environment requirement of creative changes
necessary to improve nursing practices. Hence, it
would be advantageous if, where it would be
appropriate; administrators provided all staff nurses
opportunities to use their potential for creative
innovation in order to enhance nursing practices
over a wider sphere of care.