الفهرس 
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Abstract
Based on the findings of the current study, it was concluded that, the deficit of knowledge, practice and lack of neonatal physical set up facilities lead to non-compliance of nurses’ practice which considered factors contribute to non-applicability of developmental supportive care.
In the light findings of the present study, the following recommendations are suggested:
1) Enhancement of neonatal nurse’s developmental supportive care through in services –training programs about developmental supportive care.
2) Proper pre-service training for newly recruited nurses and in-service training program for nurses about the most recent developmental supportive care interventions for preterm neonates’ guidelines are mandatory to update their knowledge and improve their performance about developmental supportive care.
3) Future researches must be strategically targeted to provide more concrete information related to developmental supportive care in NICU.
Developmental care practice for neonates have shown positive outcomes, including enhanced weight gain, shorter hospitalization duration, enhancement of neuro-development, effective pain control, less stress for neonates and parents feel more involved in the care of their neonates and relationships between hospital staff and parents are strengthened (Moody et al., 2018).
Barriers for performing developmental supportive care for neonates in NICU, included lack of knowledge or training about developmental supportive care, staff resistance, lack of time, lack of administrative support, lack of equipment and supplies, inadequate number of staff, NICU environment (Elarousy et al., 2020).
The aim of the study
The aim of this study was to assess the factors contribute to non-applicability of the developmental supportive care by neonatal nurses at neonatal intensive care unit.
Research questions:
1- What are the factors contribute to non-applicability of the developmental supportive care?
2- Are nurses knowledge deficit about the developmental supportive care factors lead to non-applicability?
3- Deos the neonatal intensive care unit physical set up facilities contribute to non-applicability of the developmental supportive care?
4- Are nurses practices policy contributes to non-applicability of the developmental supportive care?
Subjects and methods
The subjects and methods of this study discuss under the following four main designs:
I. Technical design
II. Operative design
III. Administrative design
IV. Statistical design
The technical design of this study includes four main categories: research design, setting, sample and tools of data collection.
Research Design:
A descriptive design was utilized in this study to assess factors affecting non applicability of developmental supportive care in neonatal intensive care unit.
Research Setting:
The study was conducted at the selected Neonatal Intensive Care Unit (NICU) at Tanta Educational Hospital at Gharbia Governorate which considered the biggest hospital in Gharbia Governorate providing care to neonates.
Research Subjects:
Purposive sample of nurses who providing direct car to neonates in the previously mentioned setting, The total number of nurses was (60 nurses) regardless their age, educational level, years of experiences and attending of previous courses.
Study Tool
Data were collected through using the following tools:
1- Questionnaire sheet:
Part I:concerning characteristics of nurses
Characteristics of the nurses include (age, sex, educational level, years of experience, previous attending of training courses).
Part II: Concerning nurse’s Knowledge regarding the developmental supportive care.
It was used to assess nurse’s knowledge and reported practices regarding developmental supportive care
Part III: concerning factors affecting non –applicability of developmental supportive care
This part was concerned with an assessment of the factors that affect non applicability of developmental supportive care.
Scoring System:
The scoring system for the studied nurse’s knowledge was designed as follows a score was assigned for each question concerning specific items. According to the nurse’s answers, the scores were summed up and converted into percentages. The total score was (90) marks, each complete correct answer was given (2) mark, incomplete correct answer was given (1) mark and incorrect answer was given (0) mark, these scores were summed-up and converted into a percent score. The total score of the questionnaire was 100%and three score level accordingly as:
Score more than 90%was considered good knowledge.
Score from 80% < 90% was considered average level of knowledge.
Score less than <80% was considered poor knowledge.
2-Observational checklists
Observational checklists were used to assess the actual nurses’ practices regarding developmental supportive care.
Observational checklist:
The observational checklists were designed from related studies, Used by the researcher to assess nurses’ practice toward applicability of developmental supportive care it included the flowing items:
1. Postures support/positioning (12 items).
2. Reducing noise (6 items).
3. Reducing light (4 items).
4. Containment (2 items).
5. Kangaroo care (7 items).
6. Non-nutritive sucking (4 items).
Scoring System:
The scoring system for the practice of the studied nurses regarding application of developmental supportive care was designed as follows 6 procedure each procedure consist of different number of steps, each step scored (1) if competently done and (0) if not competently done. The total score level was (35),, according to nurses practice they will be classified into competent level of practice more than (99) and incompetent level less than (99) practices.
These scores were summed up and converted into percent score. According to the practice for each study subject. It was be categorized into:
• Incompetent less than 99%.
• Competent 99% or more.
Results:
The current study revealed the following results:
Regarding characteristics of the studied sample, 40% of studied nurses aged from 25-30 years old, 66.7% of them had nursing bachelor degree, 51.6% of them had from 5-10 years of experiences and all of nurses 100% did not receive developmental supportive care courses.
According to nurses’ total knowledge score about developmental supportive care, 61.7% had poor knowledge regarding developmental supportive care while 25% of them had good level of knowledge regarding developmental supportive care and 13.3% of nurses had average level of knowledge.
According to nurses’ total knowledge score about physical set up facilities as a factor affecting non applicability of developmental supportive care the majority 95% of studied nurses reported that physical set up of the neonatal unit affecting non applicability of developmental supportive care while 5% of them reported that the physical set up not affecting application of developmental supportive care.
Regarding nurses’ total actual practices score regarding developmental care, more than half 63.3% of the studied nurses had incompetent level of performance regarding developmental supportive care, only 36.7% of them had competent level of performance.
Regarding relation between total knowledge score of the studied nurses and their characteristics, there were statistically significance relations between the total knowledge score of nurses and their age, educational level, years of experience and attending of pervious courses.
Regarding relation between total actual practices score of the studied sample and their characteristics, there was highly statistically significant between practice with age, Job description, Education level and Years of experience where χ2 = (20.193, 21.994, 13.316, 19.403) when p-value was <0.001.
Regarding correlation between studied sample total knowledge score, their total practices score there were highly statistically positive significant correlation between total knowledge score of studied nurses and their total reported practices score. When p-value was <0.001there were positive significance correlation between total knowledge score.
The current study suggests the following recommendations:
1-Enhancement of neonatal nurse’s developmental supportive care through in services –training programs about developmental supportive care.
2-Proper pre-service training for newly recruited nurses and in-service training program for nurses about the most recent developmental supportive care interventions for preterm neonates’ guidelines are mandatory to update their knowledge and improve their performance about developmental supportive care.
3-Future researches must be strategically targeted to provide more concrete information related to developmental supportive care in NICU