Nursing Diagnosis: Application to Clinical Practice
11th Edition

Readiness for Enhanced Organized Infant Behavior
DEFINITION
Readiness for Enhanced Organized Infant Behavior: A pattern of modulation of the physiologic and behavioral systems of functioning of an infant (ie, autonomic, motor, state, organizational, self-regulatory, and attentional–interactional) that is satisfactory but that can be improved, resulting in higher levels of integration in response to environmental stimuli
DEFINING CHARACTERISTICS (BLACKBURN & VANDENBERG, 1993)
Autonomic System
  • Regulated color and respiration
  • Reduced visceral signals (eg, smooth)
  • Reduced tremors, twitches
  • Digestive functioning, feeding tolerance
Motor System
Smooth, well-modulated posture and tone
Synchronous smooth movements with:
  • Hand/foot clasping
  • Grasping
  • Hand-to-mouth activity
  • Suck/suck searching
  • Hand holding
  • Tucking
State System
  • Well-differentiated range of states
  • Active self-quieting/consoling “Ooh” face
  • Cooing
  • Clear, robust sleep states
  • Focused, shiny-eyed alertness with intent or animated facial expressions
  • Attentional smiling
RELATED FACTORS
Because this is a diagnosis of effective functioning, the use of related factors is not warranted.
P.410

Focus Assessment Criteria
Objective Data
Assess for Defining Characteristics.
Ability to regulate
  • Respiratory rate
  • Color
  • Cardiac rate
Autonomic/visceral stability
  • Smooth digestive functioning
  • Reduced twitches, tremors
Posture/tone
  • Smooth
  • Midline oriented
  • Well modulated
  • Balanced flexion/extension
Synchronous, smooth movements
  • Hand/foot clasping
  • Suck/suck searching
  • Symmetric movements
  • Grasping
  • Hand holding
  • Hand-to-mouth activity
  • Tucking
Sleep–wake states
  • Well-differentiated range
  • Robust cry
  • Organized alertness
  • Clear states from deep sleep
Self-regulatory ability
Balance of engaging and withdrawal
Ability to orient and arouse to visual or auditory stimuli
Reciprocal interactions
  • Eye contact
  • Easy consolation
  • Exploratory behavior
  • Reaching toward
  • Mutual gazing
  • Attending to social stimuli
Goals
The infant will continue age-appropriate growth and development and not experience excessive environmental stimuli.
The parent(s) will demonstrate handling that promotes stability.
Indicators
  • Describe developmental needs of infant.
  • Describe signs of stress or exhaustion.
  • Demonstrate:
    • Gentle, soothing touch
    • Melodic tone of voice, coos
    • Mutual gazing
    • Rhythmic movements
    • Acknowledgment of all baby’s vocalizations
    • Recognition of soothing qualities of actions
General Interventions
P.411

Explain to Parents the Effects of Excess Environmental Stress on the Infant.
Provide a list of signs of stress for their infant.
Teach them to terminate stimulation if infant shows signs of stress.
Instruct parents to, when providing developmental intervention(s):
  • Offer only when the infant is alert (if possible, show parents examples of alert and not alert).
  • Begin with one stimulus at a time (touch, voice).
  • Provide intervention for a short time.
  • Increase interventions according to infant’s cues.
  • Provide frequent, short interventions instead of infrequent, long-term ones.
Explain to Parents the Developmental Needs of Infants.
Stimulation (visual, auditory, vestibular, tactile, olfactory, gustatory)
Periods of alertness
Sleep requirements
Explain, Role-Model, and Observe Parents Engaging in Developmental Interventions.
Visual
Eye-to-eye contact
Face-to-face experiences
High-contrast colors, geometric shapes (eg, black and white shapes on paper mobile); up to 4 weeks, simple mobiles of four dessert-size paper plates with stripes, four-square checkerboards, a black dot, and a simple bull’s eye, hung 10 to 13 inches from baby’s eyes.
Auditory
Use high-pitched vocalizations.
Play classical music softly.
Use a variety of voice inflections.
Avoid loud talking.
Call infant by name.
Avoid monotone speech patterns.
Vestibular (Movement)
Rock baby in chair.
Place infant in sling and rock.
Close infant’s fist around a soft toy.
Slowly change position during handling.
Provide head support.
Tactile
Use firm, gentle touch as initial approach.
Use skin-to-skin contact in a warm room.
Provide alternative textures (eg, sheepskin, velvet, satin).
Avoid stroking if responses are disorganized.
Olfactory
Wear a light perfume.
Gustatory
Allow non-nutritive sucking (eg, pacifier, hand in mouth).
Promote Adjustment and Stability to Caregiving Activities (Blackburn & Vandenberg, 1993; Merenstein & Gardner, 1998).
Waking
Enter room slowly.
Turn on light and open curtains slowly.
Avoid waking baby if he or she is asleep.
Changing
Keep room warm.
Gently change position: contain limbs during movement.
Stop changing if infant is irritable.
Feeding
Time feedings with alert states.
Eliminate unnecessary noise.
Hold infant close and, if needed, swaddle in blanket.
Bathing
Ventral openness may be stressful. Cover body parts not being bathed.
Proceed slowly; allow for rest.
Offer a pacifier or hand to suck.
Eliminate unnecessary noise.
Use a soft, soothing voice.
P.412

Explain Need to Reduce Environmental Stimuli When Taking Infant Outside
Shelter eyes from light.
Swaddle the infant so his or her hands can reach the mouth.
Protect from loud noises.
Praise Parent(s) on Interaction Patterns; Point Out Infant’s Engaging Responses
Initiate Health Teaching and Referrals if Needed
Explain that developmental interventions will change with maturity. Refer to Delayed Growth and Development for specific age-related developmental needs.
Provide parent(s) with resources for assistance at home (eg, community resources).
Rationales
Refer to Rationales under Disorganized Infant Behavior.