Content Validity for the NICU Caregiver Behavior Checklist

Objective: To update and establish content validity for the Checklist of NICU Caregiver Behaviors. Design: Structured literature review and Delphi analysis. Setting/Local Problem: Neonates born prematurely or who are sick in the NICU are frequently exposed to harmful stimuli that can affect brain development and result in adverse neurodevelopmental outcomes. In response to this risk, NICU caregiving now encompasses protecting and promoting neurodevelopment to affect long-term outcomes for neonates and their families. Developmentally supportive care (DSC) includes internationally recognized best practices for the care of neonates in the NICU. Implementation and operationalization of DSC is a priority for neonatology. Although evidence-supported guidelines exist for effective DSC strategies in the NICU, no validated tool exists to support implementation at the point of care. Participants: Nine expert reviewers from the United States and India including four occupational therapists, one nurse practitioner, one clinical nurse specialist, and three neonatal medicine specialists. Intervention/Measurements: The Checklist of NICU Caregiver Behaviors had been updated based on a structured review of the evidence. The updated checklist was then shared with a group of professionals with DSC expertise who provided further recommendations using a modified Delphi survey process. Results: The project yielded the current NICU Caregiver Behavior Checklist. Expert reviewers provided 53 actionable recommendations in Round 1 and 18 actionable recommendations in Round 2 to support clarity and use of the tool. In response, the NICU Caregiver Behavior Checklist was reformatted as a collection of five checklists, each representing a core measure of DSC; the introduction section was expanded; language was broadened; and clarifications were provided to promote observations of target behaviors and allow for more site- specific recommendations and assessments. Conclusion: This evidence-based tool can be used as part of DSC education, as a self-assessment tool, and as a measure of NICU caregivers'use and quality of DSC.