Measuring nursing workload in neonatal intensive care

AIM: To determine if a suitable method of measuring nursing workload could be developed in neonatal intensive care units (NICUs). BACKGROUND: Nursing is a multifunctioning activity and previous methods measuring the demand for nurses do not put enough emphasis on the individual capabilities. The reporting of NICU activity has traditionally been related to bed occupancy and the number of infants requiring ventilator support. A classification system based on activity, hours of care and nursing staff ratios has been used; however, it does not consider the clinical ability of the individual nurses. METHODS: A 5-month prospective study was undertaken in which nurses in two NICUs scored their patients' level of dependency and professional assessment of the level of intensity of care required by the infants in each shift. In addition, serial measures of severity of illness scores for each patient were collected. KEY ISSUES: The study identified methods of measuring workload that consider the individual nurse's ability and contributing organizational factors. We found that the estimates of nursing hours using the two traditional dependency measures did not match the current practice or take into account the skill of the nurses. A method in which the nurses indicated the intensity of nursing care required by their patients was suitable one for capturing their individual capabilities. System factors were also found to contribute to the nursing workload. CONCLUSIONS: It is not sufficient to use patient acuity or severity of illness alone. Other factors such as the nurse's assessment of the intensity of care required and the organizational factors are important components of workload estimates.     

Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice

Title. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. Aim. This paper is a discussion of evidence‐based core measures for developmental care in neonatal intensive care units. Background. Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America’s Joint Commission’s concept of ‘core measures’ for evaluating and accrediting healthcare organizations. This concept is applied to five disease‐ and procedure‐independent measures based on the Universe of Developmental Care model. Data sources. Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Discussion. Five core measure sets for evidence‐based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family‐centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant‐family dyads. Conclusion. Standardized disease‐independent core measures for developmental care establish minimum evidence‐based practice expectations and offer an objective basis for cross‐institutional comparison of developmental care programmes.     

Magnitude and factors associated with neonatal hypothermia among neonates admitted in neonatal intensive care units: Multicenter cross-sectional study

BackgroundNeonatal hypothermia leads to adverse clinical effects ranging from mild metabolic stress to death.ObjectivesTo assess the magnitude of neonatal hypothermia and associated factors among neonates admitted in the neonatal intensive care unit at Northwest Amhara referral hospitals.MethodsInstitution based cross-sectional study, 356 sample, systematic random sampling method were used. The data were by Epi-Info 7.2 and analyzed by SPSS 22. Multivariable logistic regression were used to predictor variables using odds ratio with a confidence interval of 95% and a p-value of 0.05.ResultsThe magnitude of Neonatal hypothermia was 61.5%. Age< 24 h, delayed initiation of breast feeding within one hour of birth, no skin to skin contact with mother immediately after delivery, resuscitation at birth, low birth weight, and bathing within 24 h were all factors significantly associated with neonatal hypothermia.ConclusionThe magnitude of Neonatal hypothermia was high.     

Parental experiences in neonatal intensive care unit in Ethiopia: a phenomenological study

IntroductionNeonatal intensive care unit is important to save the lives of a sick neonate; however, parents are challenged by several stressful conditions during their stay. Therefore, this study aimed to explore the lived experiences of parents in neonatal intensive care units in Ethiopia.MethodsWe used a phenomenological study design. The data were collected using an in-depth interview method from purposively selected parents. In addition, we followed a thematic analysis approach and used Open Code Software Version 4.02 to process the data.ResultsIn this study, 18 parents were interviewed. The researchers have identified six themes. Parents complained of psychological problems like anxiety, stress, worries, hopelessness, and a state of confusion. In addition, anger, crying, sadness, frustration, dissatisfaction, regret, disappointment, feeling bad, self-blaming, nervousness, disturbance, and lack of self-control were major emotional problems raised by the parents. Parents expressed that health care providers showed indiscipline, lack of commitment, and uncooperative behaviour. Likewise, shortage of medicines, money, and limited time to visit their neonates were the other concerns of many parents. At the same time, parents were provided minimal information and limited cooperation from health care providers.ConclusionParents whose infants admitted to the NICU were suffered from various psychological and emotional problems. Researchers recommend that health care providers should be supported parents with psycho-emotional problems, strengthen parents–healthcare workers'' interaction, and scale up neonatal intensive care unit services to the primary health care centres.

KEY MESSAGES

• Parents whose infants admitted to the NICU were suffered from psychological and emotional problems.
• Poor NICU environment, shortage of equipment, long hospital stay, the presence of pandemic COVID-19, and lack of parental involvement in the care were identified barriers that affected parents'' stay.

     

儿童重症监护室非计划性拔管现状调查及分析

目的描述非计划性拔管在儿童重症监护室的现状及原因。方法2008年1—12月上海某三级甲等儿科医院中3个重症监护室发生非计划性拔管的患儿共21例,根据意外事件报告单,对发生非计划性拔管的原因进行系统分析。结果患儿的年龄、患儿身体约束不当、镇静不足、胶布固定无效和护理人力不足是造成患儿非计划性拔管的高危因素。结论非计划性拔管率是重症监护质量的重要指标,建立一套有效的预防非计划性拔管标准包括有效约束、有效胶布固定、有效的镇静,合理护理人力配置以及提高护士的评估能力将有助于降低非计划性拔管发生率,提升重症监护室的护理品质。