The Development of a Holistic Nursing Model for Preterm Infants to Promote Growth and Reduce Complications in the Neonatal Intensive Care Unit

Abstract

Introduction Preterm infants admitted to neonatal intensive care units often present with immature organ systems, particularly the respiratory, neurological, and immune systems. This immaturity contributes to delayed growth, low birth weight, increased risk of severe complications, and long-term developmental abnormalities. Therefore, a holistic nursing approach is essential to promote optimal growth and minimize complications. 

Objectives The objectives of this study were: 1) To examine the current situation and problems in providing nursing care for preterm infants admitted to the neonatal intensive care unit at Phrae Hospital, 2) To develop a holistic nursing model for the care of preterm infants, and 3) To evaluate the outcomes of implementing the holistic nursing model for preterm infants in the neonatal intensive care unit at Phrae Hospital.

Design This study employed a research and development with historical controlled design, guided by Donabedian’s service quality framework, which includes structure, process, and outcomes.

Methodology The study participants consisted of registered nurses, mothers, and preterm infants admitted to the neonatal intensive care unit at Phrae Hospital between March and July 2025. A purposive sample of 15 professional nurses was selected, while 48 preterm infants were recruited through simple random sampling and divided equally into experimental and control groups (24 infants per group). The research instruments included 1) a data collection form for the development of a holistic nursing model for preterm infants, 2) a semi-structured focus group discussion guide, 3) the holistic nursing practice guidelines for preterm infants developed in this study, 4) a compliance record for adherence to the holistic nursing practice guidelines (content validity index = .98), 5) a patient-assigned primary nursing system, 6) a satisfaction questionnaire for primary nurses, and 7) a satisfaction questionnaire for mothers regarding holistic nursing care. All instruments except for item 4 demonstrated a content validity index of 1.00. Qualitative data were analyzed using content analysis, while quantitative data were analyzed using Descriptive statistics (frequency, percentage, mean, and standard deviation) and Inferential statistics (Chi-square test and t-test).

Results 1) Situation analysis revealed that challenges in the care of preterm infants were identified, with an emphasis on crisis management through the critical phase while psychosocial care was insufficient. Family and maternal involvement in care planning was limited. In terms of care processes, continuity and integration of care plans were lacking, resulting in inconsistent practices. A unified, evidence-based approach centered on the infant and family, from admission through discharge, was therefore needed. 2) The Holistic Nursing Model for Preterm Infants comprised 2.1) Holistic Nursing Practice Guidelines: These guidelines included seven nursing activities that influenced the quality of care across three stages, initial admission care, post-crisis care, and discharge care. Each stage applied the five steps of the nursing process to ensure systematic and comprehensive care, 2.2 Primary Nursing Assignment System: Implementation of a patient-assigned primary nursing system, along with monitoring adherence to the holistic nursing practice guidelines, 2.3 Nurse Training and Competency Development: Provision of education and competency-building programs to strengthen nurses’ knowledge and skills in delivering holistic care for preterm infants. 3) Outcomes of Model Implementation: The development and application of the holistic nursing model resulted in a statistically significant increase in infant weight gain, averaging more than 20 grams per day (p = .036). Major complications, including bronchopulmonary dysplasia and ventilator-associated pneumonia, were significantly reduced compared with the conventional care group (p < .05). Furthermore, the length of hospital stay was significantly shortened (p < .001). Satisfaction with the holistic nursing model was rated at the highest level by primary nurses and at a high level by mothers of preterm infants.

Recommendation Neonatal intensive care units can apply the holistic nursing model for preterm infants to align with their specific contexts. The implementation of this model has resulted in positive outcomes, including improved weight gain and enhanced safety through a reduction in complications. These benefits are attributed to the continuity of care, the individual accountability of primary nurses, and the collaborative efforts of the multidisciplinary team. Consequently, the model has contributed to high levels of satisfaction among both mothers and healthcare personnel.