Who’s in the NICU: Implications for Physical Therapist Education
Purpose/Hypothesis: The purpose of this qualitative study was to understand the experience of becoming and being a physical therapist in the special care nursery (SCN) or neonatal intensive care unit (NICU). This study was designed based on existing concerns that not all physical therapists who practice in the SCN and NICU follow the published guidelines regarding preparation and expertise to work in these settings. Currently, PTs have a wide range of experience, training, and mentoring prior to assuming an independent neonatal caseload. Number of Subjects: 12 Materials and Methods: A phenomenological research approach was utilized. The design of the study included procedures to ensure rigor and trustworthiness of findings by establishing transferability, credibility, dependability, and confirmability. Physical therapists working in the SCN/NICU for at least 2 years participated in the study. Data were collected through one-on-one in-depth interviews to elicit the experiences, opinions, feelings, and knowledge of these therapists. All participants were asked the same questions from the interview guide, with follow-up probing questions as needed to gain deeper understanding. All interviews, ranging from 25 to 50 minutes, were recorded and transcribed and the transcripts were carefully analyzed line-by-line. Meaningful units were identified, coded and categorized used the constant comparison method for data analysis. Data collection and analysis continued until no new themes emerged and data saturation was assured. Results: Qualitative analysis of the interview transcripts yielded four themes: 1) Never Alone, which reflects the unique collaborative culture of the NICU; 2) Families First, which speaks to the need to focus on the family, avoid judgment, and facilitate their involvement in the care of their child; 3) Take a Deep Breath, which reflects the need to be mindful and cautious because of the potential to do harm while caring for fragile infants; 4) Know What You Don't Know, which reflects the depth and breadth of knowledge necessary to work in the NICU/SCN. Conclusions: This project was the first to systematically research practicing therapists’ beliefs and perspectives regarding PT practice in the SCN and NICU. Current practice does not align with the adopted statements from APTA and APPT establishing NICU as an advanced practice setting. Much evidence draws attention to the fragility of premature neonates, yet our PT practice and education do not appropriately address these concerns. This study has implications for physical therapists, hospital administrators, physical therapy educators, and policy makers. Clinical Relevance: The most important implications for PT Education and continuing education include: 1) Not all therapists who enter the NICU are following published guidelines for preparation for working in the SCN or NICU; 2) Therapists who entered the NICU without prerequisite knowledge acknowledge that they were unaware of their limitations; 3) Documents that drive DPT education address the lifespan, but are often mute on the issue of the infant and premature infant; 4) New graduates may graduate from a PT program never touching an infant and having perhaps a short NICU lecture, yet then be assigned to cover the NICU as needed as the adult acute care therapist; and 5) There is significant incongruence between the published guidelines and current practice.