Experience of neonatal intensive care unit nurses in providing developmentally‐supportive care: A qualitative study

Many challenges have been noted in the implementation of developmentally‐supportive care principles in neonatal intensive care units, despite evidence that adhering to such care principles achieves positive results for the neonate. The aim of this study was to explore and describe compliance in adhering to developmentally‐supportive care principles implemented in one neonatal intensive care unit in South Africa. An exploratory design was used in this qualitative study with purposive sampling to select eligible neonatal intensive care registered nurses (n = 14) as participants. Participants all worked in a 10 bed neonatal intensive care unit at a large tertiary care public hospital. Six audio‐recorded interviews were conducted, with recordings subsequently transcribed and analyzed. Three main themes were identified: value of developmentally‐supportive care, nature of developmentally‐supportive care, and barriers to developmentally‐supportive care. One of the main themes had subthemes, which substantiated the findings, and included parent involvement, nurse engagement, and holistic care. Study outcomes offer insight into the development or revision of policies and practices, which are crucial when implementing developmentally‐supportive care, particularly in resource‐poor settings where challenges are magnified.     

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.     

Learning how we learn: an ethnographic study in a neonatal intensive care unit

Title.  Learning how we learn: an ethnographic study in a neonatal intensive care unit.
Aim.  This paper is a report of a study to identify how nurse clinicians learn with and from each other in the workplace.
Background.  Clinicians' everyday practices and interactions with each other have recently been targeted as areas of research, because it is there that quality of care and patient safety are achieved. Orientation of new nurses and doctors into a specialty unit often results in stress.
Method.  An ethnographic approach was used, including a 12-month period of fieldwork observations involving participation and in-depth interviews with nurse, doctor and allied health clinicians in their workplace. The data were collected in 2005–2006 in a paediatric teaching hospital in Australia.
Findings.  The findings were grouped into four dimensions: orientation of nurses, orientation of medical registrars, preceptoring and decision-making. The orientation of new staff (nursing and medical) is a complex and multi-layered process which accommodates multiple kinds of learning, in addition to formal learning. Workplace learning also can be informal, incidental, interpersonal and interactive. Interactive and interpersonal learning and the transfer of knowledge include codified and tacit knowledge as well as intuitive understandings of 'how we do things here'.
Conclusion.  Research into how nurses learn is crucial for illuminating learning that is non-formal and less recognized than more formal kinds. To provide a safe practice environment built on a foundation of knowledge and best practice, there needs to be an allocation of time in the busy workday for learning and reflection.     

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.     

新生儿监护病区患儿安全护理的效果评价

目的探讨新生儿监护病区患儿安全护理的效果。方法入住新生儿监护病区的646例患儿按无陪护全程护理,与未入住新生儿监护病区的509例患儿护理效果进行比较。结果入住与未入住新生儿病区患儿的臀红、鹅口疮、脐炎比较,P<0.01,有显著性差异。抢救成功率、死亡率、窒息率均有不同程度的改善。结论新生儿监护病区现有的安全护理是行之有效的,规范了护理管理;增强了护士的工作责任心;强化了安全意识和法制观念,提高了护理质量,确保了患儿安全。