Since premature infants are born before the due date, they need special medical care and support. Although advanced medical care is vital to the infant’s survival, supportive care also affects brain function and structure of the brain. Besides, the infant’s nervous system is developed normally by performing certain types of sensory stimuli appropriate for the infant. The absence of suitable stimuli negatively affects the physiological function and neurobehavioral development of premature infants, increasing the risk of physical injury, mental retardation, and abnormal development . These infants are sensitive to new conditions after birth, and prematurity exposes them to problems adapting to extraterrestrial life. Performing medical interventions in many situations saves the lives of premature infants, but these interventions are not without complications and may cause acute or chronic problems in premature infants in the long run. Moreover, pain, stress, and separation from parents together with environmental stimuli (ventilators, monitors, incubators, telephone ringtones, and the sound of taps, shelves, and cupboard doors), and multiple cares in the neonatal intensive care unit (NICU) can also negatively affect the infant’s health, leading to changes in heart rate and oxygen saturation levels, expanding fluctuations in blood pressure, increasing restlessness in the short run, and delaying the development of the central nervous system and brain in the long run [1, 3]. These conditions are very difficult for the newborn to tolerate and the infant may develop complications such as hypoxemia and unstable blood pressure, apnea, bradycardia, changes in cerebral blood flow, and intraventricular bleeding .To reduce the complications of neonatal admission to the NICU, quality care by the nurse is essential, and effective nursing practices are one of the most important steps for neonatal development and survival .
Developmental care refers to the care provided in the neonatal intensive care unit to reduce environmental stress and improve the infant’s adaptation to extra uterine life by the care and treatment team with the parents’ cooperation and empowerment. Implementation of developmental care improves the condition of each infant and reduces treatment and care costs and is one of the criteria for the implementation of quality care in neonatal intensive care units. This type of care is the implementation of supportive techniques such as reducing environmental stimuli (light, noise, etc.), flutter sucking, music and touch, kangaroo care, and infant pain control techniques . Developmental care aims to reduce the infant’s stress, store the infant’s energy, enhance the infant’s natural growth, and improve quality sleep conditions for the infant. In addition, emotional and behavioral support of the immature infant is very important. Pena (2016) showed that developmental care interventions include support for the infant with the infant’s reading behavior, measures to promote the infant’s physiological stabilization, and inducing the infants’ normal growth and maturity . Razavi Nejad (2017) also emphasized that implementation of new care techniques, including symptom-based care and clustering care as necessary strategies to implement interventions for the normal development of the infant in line with implementing developmental care .
Implementing developmental care has both short-term and long-term consequences. Positive outcomes of developmental care include early breastfeeding and weight gain, shortening of infants’ hospital stay, increasing parental satisfaction, and improving the child’s development in later life as one of its long-term consequences . Chou et al. (2015) found that music therapy intervention in the infant environment during development leads to better oxygenation of the infant and possibly increases brain development . Yusuf Nova et al. (2017) also highlighted the effectiveness of a combination of kangaroo care and music interventions in the neonatal intensive care unit and even after discharge . Rahimi et al. (2017) reported that educating nurses and physicians about non-pharmacological control of pain in infants by sucrose and swaddling and limiting painful processes can prevent stress to the infant . Sabaghi et al. (2016) found that the implementation of developmental care has no effect on the duration of hospitalization of infants under mechanical ventilation . Momeni et al. (2015) showed that the mixed kangaroo care and music therapy had a positive effect on the vital signs of the infant, and also had a significant positive relationship with neonatal behavioral development and their weight gain .
Since nursing premature infants admitted to the neonatal intensive care unit requires sensitivity, accuracy, skill, and experience, and given that nurses are the primary caregivers of hospitalized infants, their slightest malpractice can cause irreparable harm to the infant. Therefore, standard care training can improve the quality of nursing services and minimize infants’ physical, psychological, and developmental complications.
Currently, it is possible to use distance education techniques to increase learners’ knowledge and skills by using appropriate technology and facilitating the learning process at any time and place [12, 13].To make nurses familiar with the latest developments in providing care to patients, the use of technology in education is necessary [14, 15]. The advantages of e-learning include lower cost, more flexibility, ease of access, inclusiveness, and the ability to self-control in learning and adapting to individual learning goals. Other advantages of e-learning are paying attention to learners’ needs, ease of access to various resources, continuous monitoring of academic achievement, and presentation and preparation of various educational models . Increasing nursing knowledge and care skills improve nurses’ job satisfaction and the quality of services provided by them .
Kadivar et al. (2017) stated that e-learning programs are effective in increasing the motivation of health care staff in providing neonatal care .
Issues such as understanding and awareness of the type of care are likely to affect its implementation. Education is one of the ways that can affect nurses’ awareness. Since very limited studies have addressed distance education for developmental care in Iran, this study aims to examine the effect of a developmental-care-based distance education program on the perception and knowledge of nurses working in the neonatal intensive care units of Afzalipour Hospital in Kerman in 2020.