The management of infant developmental needs by community nurses

Abstract

The aim of this study was: to describe what the responsibilities of community nurses are, according to the scope of practice of registered nurses, with regard to the management of development needs of infants in primary health care clinics in South Africa; and to develop guidelines for the support of community nurses to address the developmental needs of infants 0-2 years. There is an increased awareness that the early years of life are a period of considerable opportunity for growth as well as vulnerability to harm. It is imperative that community nurses take actively part in promotion of normal development of infants as well as being involved in the early identification of developmental delays and disabilities. While evidence confirms that developmental surveillance should be incorporated into the ongoing health care of the infant, such services are not consistently provided in health care settings and, if provided, the delivery thereof suffers from significant inadequacies. In the first phase of the study, a case study strategy was used to investigate the phenomenon. People outside the case (the context) were included to elucidate the case, namely health service management concerned with nursing issues; personnel involved in the training of community nurses at the clinic; families with infants 0-2 years who displayed typical development; families with infants 0-2 years with an identified developmental delay or disability; other health care professionals (e.g. speech/language therapist, occupational therapists and physiotherapists). Multiple sources of evidence (interviews, perusal of official documentation and field notes) were used to collect data. Content analysis was used to analyze the data. In the second phase, ten main guidelines aimed at community nurses working in a primary health care clinic in South Africa, were developed. A focus group was utilized to assist with finalizing and validation of the recommended guidelines. All professional groups represented in the case study were included. The main findings of the research imply that infant developmental care is not included to its fullest potential, in the health care delivered to infants and their families. Community nurses, according to the scope of practice of registered nurses, do not fulfil their responsibilities with regard to the management of development needs of infants. They need a greater understanding of what infant developmental care comprises and therefore need additional training to equip them to deliver holistic infant developmental care. Management need to review their commitment and type of support to community nurses if infant developmental care as part of community nurses’ responsibilities, is to be effective and of high quality. Community nurses and other health care professionals must recognize the nature and potential of inter-professional collaboration to ensure positive outcomes for infants with developmental delays and disabilities. Furthermore, other health care professionals can be an invaluable source of support and learning for community nurses in the management of infant developmental needs. The study demonstrated the importance for community nurses, as well as management concerned with nursing issues, personnel concerned with cntinuous professional development of nurses at the clinic, and other health care professionals, e.g. speech/language therapists, occupational therapists and physiotherapists; of being aware of the importance of addressing developmental needs of infants and their families in a holistic way, and to identify developmental delays and disabilities timely to ensure positive outcomes for infants and their families.