Defense Date


Graduation Date

Summer 2006


Immediate Access

Submission Type


Degree Name



Instructional Leadership Excellence (ILEAD)


School of Education

Committee Chair

Barbara M. Manner

Committee Member

Dena Hofkosh

Committee Member

Joseph T. Brennan

Committee Member

Thelma Patrick


best practice, best practices, change, Checklist for Observing Developmentally Supportive, developmentally supportive care, DSC, environmental support, environmentally supportive care, family-centered care, individualized care, individualized developmentally supportive care, learning organization, neonatal intensive care unit, newborn intensive care unit, NICU, nurse clinicians, nurse leaders, nursing education


This study assessed the effect of a learning organization of clinical nurse leaders on an increase in levels of developmentally supportive, family-centered care (DSC). The intervention occurred in the Newborn Intensive Care Unit (NICU) at Magee-Womens Hospital, Pittsburgh, PA. Clinical nurse leaders (N = 9) were encouraged to model research-based, developmentally supportive techniques. The "Checklist for Observing Developmentally Supportive Care in the NICU" was developed to assess the levels of DSC in 17 measurable techniques in three conceptual areas: environmental support, individualized support, and family-centered care. The checklist includes adaptations for infants with medical or familial issues. Infants and caregivers remained anonymous. Blinded to the purpose of the study, two trained raters collected data. Using Cohen's Kappa (unweighted), rater observations were compared to the Principal Investigator's. Reliabilities per criteria were estimated at 0.74-1.00, with 10 of 17 criteria above 0.92, 14 above 0.85. Summary measures of observations in conceptual areas were compared pre- and post intervention using the Mann-Whitney U non-parametric test. Results showed significant increase (p < .01) in the use of optimal levels of environmentally supportive care, no significant differences in optimal levels of support in individualized care, and significant decrease (p < .001) in optimal levels of family-centered care techniques. Pre- post intervention ratings for each criterion were analyzed using exact chi-square statistics. There were significant positive changes in 4 of 5 criteria in environmentally supportive care, significant negative changes in 2 of 7 criteria in individualized support and in 1 of 3 criteria in family-centered care. Dialogue revealed philosophical/experiential biases in promotion of family-centered care. Although the clinical nurses deemed individualized/family-centered care valuable, they insisted that ancillary support was needed for consistent caregiving in these areas. Environmental support was more easily provided. Strategies generated by the learning organization to overcome obstacles to DSC included: interventions in environment and parent support, increase in facilitation of individualized/family-centered techniques by specialists, and endorsement of the checklist to measure levels of DSC, with the possibility of tracking individual infant care. Findings of this study encourage use of learning organizations to promote DSC as the standard of best practices in NICUs.