Laptop on a desk with the DandleLION Positioning Competency Toolkit webpage on it

Utilizing The Positioning Competency Toolkit

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Learn about our latest educational tool for NICU clinicians— The Positioning Competency Toolkit. The Toolkit is grounded in the 5 Tenets of Neurodevelopmentally Supportive Positioning™ and explains how to use each part to achieve better outcomes for premature infants.

What’s Included

The Positioning Competency Toolkit, created by the interdisciplinary Dandle•LION Clinical Education team, is a multimedia resource designed to enhance positioning practice that can be used with any positioning system or device.

The Toolkit was developed to support the standardization of best practices and includes:

  • The Positioning Pearls video series, featuring an introductory video that sets the 5 Tenets™ as the foundation for NICU positioning
  • A visual overview of the 5 Tenets
  • Positioning Competency Tool for clinicians
  • Neonatal Neurodevelopmental Assessment of Posture and Positioning (NeoNAPP) tool to evaluate baby’s positioning against our 5 Tenets

Applications of the Positioning Competency Toolkit may include, but are not limited to:

  1. Unit based clinical orientation
  2. Clinical skills competency training
  3. Quality improvement projects designed to improve positioning practices

How To Use The Toolkit

The Positioning Pearls Video Series

There are seven scenario-based positioning videos in the series.  Start with Neurodevelopmentally Supportive Positioning, the first video of our Positioning Pearls series, that gives clinicians:

  • Familiarity with the 5 Tenets in less than 10 minutes
  • Real-world examples of each tenet in the clinical setting
  • Just-in-time inservice training prior to using the NeoNAPP

The 5 Key Tenets Overview Document

This overview document outlines the 5 Tenets and explains why they promote the healthy development of the brain and body.  By mimicking the womb as much as possible, this approach not only has a substantial impact on the neurodevelopment of preterm infants but also positively impacts the development of future motor milestones.

Positioning Competency Tool

This tool is a pre-and/or post-educational assessment of a caregiver’s skill. It promotes and encourages the proper flow of care and neurodevelopmental integrity by examining the positioning techniques of the assessed clinicians.

The Positioning Competency Tool provides clinicians with:

  • 16 care parameters that relate to proper caregiving and positioning before, within, and after the 5 Tenets
  • A quantifiable assessment that reflects novice to expert-level proficiency in Neurodevelopmentally Supportive Positioning
  • An indication of successful competency in providing the 5 Key Tenets of Neurodevelopmentally Supportive Positioning

NeoNAPP

The Neonatal Neurodevelopmental Assessment of Posture and Positioning (NeoNAPP) is a tool with pictorial examples that are used to assess a baby’s positioning based on the 5 Tenets. Scores on each tenet can range from 0 (absence of the tenet) to 2 (successful attainment of the tenet).

Clinical implications for the total score are listed at the bottom of the tool:

  • < 7 points – Needs Improvement: Increase positional support
  • 7–9 points – Good: Ensure midline alignment, flexion and containment
  • 10 points – Optimal: Maintain and document position

Why Is The Toolkit Important?

Neurodevelopmentally supportive positioning promotes both neuroprotective age-appropriate developmental care and trauma-informed care. It positively influences physiologic function and stability, sensory development, neurobehavioral organization, skin integrity, thermoregulation, bone density, and sleep, optimizing growth, brain development, and neonatal developmental outcomes. In alignment with work by the National Association of Neonatal Therapists and National Association of Neonatal Nurses, DandleLION Medical has created the 5 Key Tenets of Neurodevelopmentally Supportive Positioning.  The 5 Tenets can be viewed as the gold standard for positioning – flexion, midline alignment, containment, 360 degrees of proprioception, and free movement with recoil.

Educational & Consultation Resources

Laptop sitting on desk, with "Introducing: Dandle Lion Positioning Pearls" and four preview images of positioning pearl videos on the screen.

Everything You Need To Know: Dandle•LION Positioning Pearls

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The Positioning Pearls Series

The Positioning Pearls video series was born out of a need for clinically-focused positioning education that speaks to the nuances of positioning babies in various stages of hospitalization.  

Each video follows the same cadence: context, positioning goals, and positioning strategies. In under 10 minutes, each video provides NICU, PICU, and CVICU clinicians with practical advice for positioning their patients using Dandle•LION products with a focus on The 5 Key Tenets of Neurodevelopmentally Supportive Positioning™ (NSP).

The first Positioning Pearl, titled Neurodevelopmentally Supportive Positioning, gives an overview of the 5 Tenets™ with real-life examples of how each tenet might look in clinical practice.  The remaining videos build upon that knowledge, focusing on specific clinical situations: 

Why Neurodevelopmentally Supportive Positioning Is Important

NSP benefits patients, caregivers, and families. The foundations of NSP are the positioning and sensations provided by the womb, which are crucial to healthy infant development. When babies are in the NICU, they miss out on the experience of the womb, which can affect structural and functional development of the brain and body – including the muscles, bones, and senses.

To bridge the gap between womb and NICU and protect biomechanical, musculoskeletal, and neurosensory development, clinicians should focus on the 5 Key Tenets of Neurodevelopmentally Supportive Positioning™ regardless of which positioning aids are available at the bedside: 

  • Flexion 
  • Containment
  • Midline Alignment 
  • 360 degrees of proprioception
  • Free movement with recoil

Literature has demonstrated that providing hospitalized babies with NSP results in improved duration and quality of sleep, leading to:

  • Increased caloric preservation and growth
  • Protected brain development 
  • Decreased respiratory support 
  • Increased parent satisfaction 

With more sound sleep in the NICU, there may be other benefits for babies, clinicians, and parents including:

  • Decreased procedural touch time spent repositioning babies to achieve comfort 
  • Decreased nuisance alarms caused by movement, discomfort, or agitation 
  • Improved parental perception of their baby’s comfort 

For more information, see The National Association of Neonatal Therapists (NANT) white paper titled Development Matters that provides clinicians with a clinical reasoning tool to help grade positioning aids against the literature, and the comprehensive literature review published by the National Association of Neonatal Nurses (NANN) in 2017 titled Positioning the Neonate for Best Outcomes.

Suggested Uses for Positioning Pearls

  • Just-in-time training for new clinical staff, or for the first time caring for a particular type of patient 
  • Clinical skills competency teaching and evaluation
  • QI projects to improve positioning in a specific population

Accessing the Positioning Pearls

The Positioning Pearls video series can be found on our Vimeo Channel or on our website.

by Dandle•LION Director of Education Alex Luton MN, BS, RN

Clinician Spotlight: Liz Drake MN, NNP, CNS, RN-NICU, C-ELBW

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Dandle•LION is proud to partner with expert clinicians to provide the best available education and evidence-based care strategies. We are excited to introduce you to Elizabeth Drake, MN, NNP, CNS, RN-NICU, C-ELBW, the current CNS in the NICU at CHOC Children’s of Orange County, Mission Viejo Campus!

Liz is also a published author, nationally recognized national conference presenter, consultant and Co-owner of @EngageGrowThrive, and co-developer of the Small Baby Care Specialist Program.

Liz Drake has been practicing in the NICU for 40 years. She has practiced in different roles throughout her career, but her time spent at the bedside with patients, families, and team members are most meaningful.

Extremely passionate about quality Improvement, caring for extremely low birth weight infants, and neuroprotective care, Drake has a strong desire to teach all members of the healthcare team about the uniqueness and language of the premature infant.

As an active clinician, she focuses on how every touch and relational experience we have with premature infants and their families can have an impact. Drake is actively involved with the California State Collaborative in order to partner with families and lead quality improvement initiatives.

Introducing The Dandy Blog!

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We are really excited about the launch of our Dandy blog because it helps us further our education efforts in the field of neurodevelopmental care.  We will provide information about product and practice innovations in neurodevelopmental care and positioning.  

Some of our upcoming content includes:

  • Innovative tools for positioning
  • Training videos for clinically different medical scenarios
  • Case studies 

Our mission is to partner with NICU caregivers to provide tools and education to support you in creating better outcomes for premature and sick babies and we are going to be talking about exactly this on our blog. 

Subscribe to our blog to stay up-to-date on how you can continue to improve outcomes for your tiniest patients.