Behavior Profile: Nurturing Care
Goal has not been set
Provider delivers nurturing, respectful care throughout the continuum of antenatal care, delivery, and post-natal care

Behavior Analysis

Strategy

BEHAVIOR AND STEPS

What steps are needed to practice this behavior?

Provider delivers nurturing, respectful care throughout the continuum of antenatal care, delivery, and post-natal care

  1. Providers share all medical information with clients
  2. Providers offer clients opportunities to ask questions
  3. Providers treat clients and families with dignity and respect
  4. Providers establish a healing environment in facilities, including prioritizing sleep for newborn and mother, minimizing stress and pain of newborn and mother, and engaging the parents in feeding, bathing, practicing KMC, and nesting the newborn
  5. Families actively participate in newborn care while in facility to support a healing environment including prioritizing sleep, minimizing stress and pain of newborn, feeding (breastfeeding or cup-feeding), bathing, practicing Kangaroo Mother Care (KMC), and nesting the newborns

FACTORS

What factors may prevent or support practice of this behavior?
Structural
Accessibility: A discharged mother might live far from the facility where her baby remains an in-patient, making regular engagement very difficult
Service Provider Competencies: Lack of clear policies and guidelines on these aspects of care, and policies that exist are still in development or not widely shared
Service Provider Competencies: Provider Capacity and Commitment: Lack of training on newborn neurodevelopmental concerns: providers are well-trained on pathology and physiology, but not on psychological aspects
Service Provider Competencies: Provider Capacity and Commitment: Providers feel engaging parents in care is a risk to efficient or effective care, rather than a benefit in them
Service Provider Competencies: Provider Capacity and Commitment: Lack of understanding of the importance of creating a quiet, low-light, or other soothing environment
Service Provider Competencies: Provider Capacity and Commitment: Capacity of parents to engage in care varies widely, making systematic engagement timely and complicated
Service Experience: Existing policies and guidelines often limit parental involvement in delivery and inpatient special newborn care
Service Experience: Parental role in newborn care, even including consent for care, is not discussed during ANC, making engagement at birth complicated
Service Experience: Clients often have limited medical literacy and do not feel equipped to request anything different from the status quo; often, they are also disempowered or not informed about the important role a healing environment can play in their child’s life
Service Experience: Facilities do not have physical space and accommodations (e.g., comfortable chairs, hand cleansing and toilet facilities, breast pumps) that allow parents to be physically present with the newborn
Social
Family and Community Support: Families do not feel empowered to participate in care while in a facility
Internal
Attitudes and Beliefs: Providers feel nurturing care behaviors at times challenge their authority or compete rather than complement other care actions in terms of time or resources
Attitudes and Beliefs: Nurturing care behaviors are new, and more established providers do not see benefit

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior, and what actions must they take?
Institutional
Policymakers: Adopt, clarify, and enforce policies on family-centered, developmentally appropriate care
Facility Managers : Identify opportunities to create a more healing environment within facilities
Peer Providers : Encourage and support colleagues in adoption of new practices
Household
Family Members: Address traditional gender roles to permit both mothers and fathers to participate in caregiving
Family Members: Engage more meaningfully in preparations for newborn

POSSIBLE PROGRAM STRATEGIES

What strategies will best focus our efforts based on this analysis?

Strategy requires Communication Support

Enabling Environment
Institutional Capacity Building: ● Create and disseminate clear policies on required aspects of family-centered developmental care, emphasizing mother-baby dyad care, family engagement in care, consent, and specific components of a healing environment, including clustering clinical care, minimizing painful procedures, providing pain mitigation when necessary, creating a supportive micro-environment (nesting), and maintaining skin integrity
Institutional Capacity Building: Ensure locations for clinical care in facilities include space and facilities for families to participate
Institutional Capacity Building: Create dedicated newborn care rooms with appropriate lighting and quiet
Systems, Products and Services
Quality Improvement: Create exchange programs with providers from facilities with improved nurturing care practices
Quality Improvement: Incorporate training on newborn neurodevelopment in all provider training
Demand and Use
Communication: Empower families to more actively participate in newborn care, including asking questions of providers
Communication: Facilitate discussion on newborn neurodevelopment with families during ANC
Communication: Orient and educate parents about nurturing care in the facility and after discharge