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"It's being integrated into nursing practice pretty
widespread," said Ann Stadtler, MSN, CPNP, director
of the nonprofit Brazelton Touchpoints Center at Children's
Hospital in Boston. "In 1995, this was a pilot
program for nurse practitioners. Since then, we've found
[all] nurses have really taken to this approach."
The namesake of the program, Brazelton, is an author
and professor emeritus at Harvard Medical School. Thirty
years ago, he helped establish the pediatric training
and research center at Children's Hospital in Boston.
Brazelton, who some credit as the country's most influential
pediatrician since Benjamin Spock, MD, is best known
in research circles for his development of the Brazelton
Neonatal Behavioral Assessment Scale in the 1970s. The
"Brazelton" is used worldwide to test physical,
neurological and emotional responses in newborns.
Brazelton's Touchpoints model theorizes a series of
milestones that describe the development process of
children from newborn to age 3, before language skills
develop. Touchpoints also focuses on changes in parents.
For instance, the "newborn touchpoint" is
a stage when new babies begin their initial attachment
to parents, while the emotions of the mother and father
simultaneously depart from the "idealized children
of their imaginations" as they grasp the child's
gender, size and temperament, according to Brazelton.
At the three-week Touchpoint interval, babies are establishing
how they react to parents' caregiving. At the six- to
eight-week period, parental self-confidence grows as
infant feeding and sleeping habits are stabilizing and
the baby begins to engage with its environment.
Touchpoints follows the child through the third year,
when talking begins to dominate the child's mode of
expression. Instructing parents in Touchpoints ideas
provides them with a basis of understanding the fits
and spurts of changes they'll experience with their
child's early development, according to the program.
Brazelton's reputation is what attracted Smith to the
Touchpoints program. She went to Boston for the individual
training session offered by the Touchpoints Center,
and later returned to be trained as a Touchpoints instructor
herself.
Harris Methodist's Education Center formally implemented
the Touchpoints model in its mother/baby nursing unit,
training 17 nurses in the program. The hospital eventually
plans to train all 450 nurses who work in its center
for obstetrical, perinatal and neonatal care.
Smith held a training session for nurses and child
care professionals in June, teaching not only nurses
from Harris, but also nurses from Cook Children's Health
Care System of Fort Worth. For two days at a church
recreation building in nearby Arlington, Smith walked
her class of 30 to 40 students through the 13 Touchpoint
milestones designated in Brazelton's course. In addition
to videos, lectures and question-and-answer sessions,
the attendees also enjoyed personal visits from parents
and their children for live demonstrations.
Twenty-month-old Julian arrived apprehensively in the
play area of the center, overwhelmed by the sight of
so many strangers around him. They watched Julian interact
with his father and a Touchpoints program coordinator
before slowly enthralling himself with books, balls
and stuffed animals. The students noted his diminishing
shyness, though still needing to stay within a zone
of comfort near his father.
"We point out the little things the child is doing,
and why," Smith said. "And we not only look
at the development of the child, but the development
of the parent."
Improving the relationship between parents and children
is the base goal of Touchpoints, but the first step
in achieving that goal is improving the relationship
between the nurse or doctor and the parents. Nurses
said Touchpoints teaches them how to defer to parents,
who sometimes feel excluded or powerless in deciding
the direction of care for their child.
"It makes really good sense in building relationships
with people you're caring for," Smith said. "These
people are going to come back for more appointments,
be more satisfied with their care [and] they're going
to tune in to their babies more."
Kathleen Stuckly, RN, a neonatal nurse for Harris Methodist
trained in Touchpoints, said parents are understandably
reticent to interfere with a health care provider's
treatment of their children, but sometimes that caution
ushers in a guarded, psychological barrier especially
evident with premature and sick babies.
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