Stress and burnout influence NICU healthcare professionals’ decision-making on family-centered care delivery: An international survey

The Neonatal Intensive Care Unit (NICU) environment is complex with competing demands. Health care professionals (HCP) caring behaviors and sensitivity to emotional, role and practical demands of infants and families contribute to family satisfaction and improves infant health outcomes. This research examined NICU HCP's beliefs about providing family-centered care (FCC) and factors that influence decision-making to implement FCC. The sample included 263 multidisciplinary HCP working in NICUs around the world. Participants reported low/moderate levels of family caring beliefs (M = 83.81, SD = 6.49), high levels of perceived stress (M = 27.81, SD = 3.21), and moderate levels of burnout (M = 32.62, SD = 2.71). A significant negative correlation (r = ?0.489, p < .001) exists between participant perceived stress and caring beliefs. A significant correlation (r = 0.473, p < .001) exists between participant perceived stress and level of burnout. Results suggest stress and burnout are critical factors foundational to HCPs' caring beliefs and FCC delivery.     

Family satisfaction with care in the intensive care unit: A regional Australian perspective

ObjectiveMany patients admitted to an intensive care unit (ICU) are unable to make ongoing decisions of care for themselves during their ICU stay. The perspectives of families and other nominated decision makers are particularly important in forming a partnership with clinicians to provide effective person-centred care. The aim of this study is to evaluate family satisfaction with care in the ICU in regional NSW, Australia, and explore the relationship between the level of satisfaction and family characteristics.MethodsA cross-sectional survey design was conducted in two ICUs in regional NSW, Australia, using a validated family satisfaction questionnaire. The Family Satisfaction in the Intensive Care Unit survey calculates an overall family satisfaction score (FS-Total) and two subscales, measuring family satisfaction with care (FS-Care) and family satisfaction with decision-making (FS-DM).ResultsA total of 104 family members were surveyed, with a 53% response rate. The mean FS-Total score was high (85.58, standard deviation [SD] = 14.6), with FS-Care (92.94, SD = 15.71) ranked higher than FS-DM (81.84, SD = 19.16). Significant differences in mean FS-Total and FS-DM scores were reported by the partners/spouses (p = 0.009 and p = 0.003, respectively) and those who lived with the patient (p = 0.039 and p = 0.011, respectively). Levels of satisfaction were also impacted by communication, waiting room facilities, and visiting times.ConclusionsOpportunities exist to further explore and improve family satisfaction with care in ICUs in regional NSW, Australia, particularly for spouses and partners and those who co-reside with the patient. Developing family-friendly clinical spaces and waiting rooms that allow family privacy along with amenities that support comfort and rest throughout their ICU experience may improve satisfaction levels.     

Psychometric properties of the Persian version of the parental stress scale: NICU

AimThe aim was to translate the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) into the Persian language and to evaluate the psychometric properties of the Persian version.MethodThe PSS: NICU was translated into Persian using the process of forward–backward translation. Thereafter, an internal panel of neonatal nurses (n = 10) assessed face and content validity and a panel of parents (n = 20) assessed content validity. A sample of 260 parents recruited from two different neonatal units completed the PSS: NICU and answered some open-ended questions in which they could comment on language and wording. Psychometric properties including internal consistency, Cronbach's alpha (if item deleted) and corrected item total were evaluated.ResultThe result indicates that the Persian version of PSS: NICU, has acceptable psychometric properties and can be considered in clinical practice in NICUs in Iran.ConclusionIn order to support parents, healthcare providers need to diagnose their sources of stress in the Neonatal Intensive Care Unit. The Persian version of the PSS: NICU can be used for this purpose.     

The relationship between person-centred care and the intensive care unit experience of critically ill patients: A multicentre cross-sectional survey

BackgroundPerson-centred care has the potential to improve the patient experience in the intensive care unit (ICU). However, the relationship between person-centred care perceived by critically ill patients and their ICU experience has yet to be determined.ObjectivesThe aim of this study was to investigate the relationship between person-centred care and the ICU experience of critically ill patients.MethodsThis study was a multicentre, cross-sectional survey involving 19 ICUs of four university hospitals in Busan, Korea. The survey was conducted from June 2019 to July 2020, and 787 patients who had been admitted to the ICU for more than 24 hours participated. We measured person-centred care using the Person-Centered Critical Care Nursing perceived by Patient Questionnaire. Participants' ICU experience was measured by the Korean version of the Intensive Care Experience Questionnaire that consists of four subscales. We analysed the relationship between person-centred care and each area of the ICU experience using multivariate linear regression.ResultsPerson-centred care was associated with ‘awareness of surroundings’ (β = 0.29, p < .001), ‘frightening experiences’ (β = ?0.31, p < .001), and ‘satisfaction with care’ (β = 0.54, p < .001). However, there was no significant association between person-centred care and ‘recall of experience’.ConclusionsWe observed that person-centred care was positively related to most of the ICU experiences of critically ill patients except for recall of experience. Further studies on developing person-centred nursing interventions are needed.     

Healthcare professionals’ values about and experience with facilitating end-of-life care in the adult intensive care unit

ObjectivesTo evaluate values and experience with facilitating end-of-life care among intensive care professionals (registered nurses, medical practitioners and social workers) to determine perceived education and support needs.Research designUsing a cross-sectional study design, 96 professionals completed a survey on knowledge, preparedness, patient and family preferences, organisational culture, resources, palliative values, emotional support, and care planning in providing end-of-life care.SettingGeneral adult intensive care unit at a tertiary referral hospital.ResultsCompared to registered nurses, medical practitioners reported lower emotional and instrumental support after a death, including colleagues asking if OK (p = 0.02), lower availability of counselling services (p = 0.01), perceived insufficient time to spend with families (p = 0.01), less in-service education for end-of-life topics (p = 0.002) and symptom management (p = 0.02). Registered nurses reported lower scores related to knowing what to say to the family in end-of-life care scenarios (p = 0.01).ConclusionFindings inform strategies for practice development to prepare and support healthcare professionals to provide end-of-life care in the intensive care setting. Professionals reporting similar palliative care values and inclusion of patient and family preferences in care planning is an important foundation for planning interprofessional education and support with opportunities for professionals to share experiences and strengths.     

A survey of inotrope and vasopressor line change practices in Australian and New Zealand Neonatal Intensive Care Units

IntroductionSick and or preterm neonates who are admitted to the Neonatal Intensive Care Unit (NICU) frequently require inotropes and vasopressors which support the cardiovascular system to function adequately. There are many different clinical practices that nurses can adopt to perform inotrope and vasopressor infusion line and syringe changes, some of which have the theoretical potential to cause fluctuations in blood pressure. The purpose of this study was to identify current inotrope infusion line change practices in the neonatal intensive care population of Australia and New Zealand and examine what drives these current clinical practices.MethodologyAn observational, exploratory quantitative study was carried out in all 28 Australian and NICUs. An electronic survey tool was distributed to one member of each unit who responded on behalf of their clinical setting.ResultsThe results showed that variation exists in the practice of inotrope and vasopressor line change practices across the 22 participating NICUs. The most popular method was the quick change method with 54.5% of Neonatal Intensive Care Units implementing this practice in their unit. The most frequently reported basis for current practice was literature (54.5%) followed by expert opinion (40.9%), previous clinical practices (36.4%) and multidisciplinary consensus (22.7%).ConclusionThis study has identified areas requiring further research in order for a standard, safe and efficient practice to be implemented in the Neonatal Intensive Care Unit for these critically sick neonates.     

Practice of family-centred care in intensive care units before the COVID-19-pandemic: A cross-sectional analysis in German-speaking countries

ObjectivesTo provide insights into visiting policies and family-centred care practices with a focus on children as visitors in Intensive Care Units in German-speaking countries.Methods/DesignOnline-survey with a mixed methods approach. Leading clinicians (n = 1943) from German-speaking countries were invited to participate. Outcomes included the percentage of intensive care units with open visiting policies, age restrictions, family-centred care activities and barriers.SettingPaediatric, mixed and adult unitsResultsIn total, 19.8% (n = 385) of the clinicians responded. Open visiting times were reported by 36.3% (n = 117), with significant differences between paediatric (79.2%), adult (21.3%) and mixed-age (41.2%) units (p < 0.01). Two-thirds of clinicians stated that their units had no age restrictions for children as visitors (n = 221, 68.4%). The family-centred care activities most frequently implemented were open visiting times and dissemination of information. Significantly more German units have open visiting policies and more Swiss units allow children as visitors, compared to the other countries (both p < 0.001). Barriers to family-centred care were concerns about children being traumatized, infection and workload.ConclusionThe majority reported that family-centred care policies had been implemented in their units, including open visiting policies, allowing children as visitors without age restriction and other family-centred care activities.     

Nurses' improved provision of infants’ procedural pain assessment and management with non-pharmacological interventions following a training program in Jordan

This study aims to compare the frequency of nurses’ documented assessment and performance of non-pharmacologic interventions to relieve procedural pain in neonates before and after a training intervention. Forty neonatal nurses received knowledge and clinical training about procedural pain assessment and non-pharmacological management related to neonates.The charts of 70–80 Neonatal Intensive Care Units admissions were compared at three-time points: once before and twice after the training intervention. Nurses’ documentation of pain assessment and non-pharmacological pain management techniques demonstrated significantly higher frequencies one month after the training than baseline (p = .00) and three months after the training than after the first month (p = .00). The training positively affected the pain management practices of nurses and clinical practice showed progressive improvement over time; all of which emphasize the importance of nurses' in-service training in improving the application of pain assessment and non-pharmacologic pain reduction strategies in NICUs.     

Feasibility of pilates for pregnant women: A randomised trial

ObjectiveTo investigate the feasibility and preliminary effects of Pilates exercises in primigravida women.DesignSingle-blind randomized controlled feasibility trial.SettingCommunity Pilates classes.ParticipantsLow-risk pregnant women.InterventionsPregnant women were randomly assigned to Pilates exercises (experimental) group for 6 consecutive weeks or usual antenatal care, the control group.Main outcomesThe primary outcome was feasibility of Pilates classes. Secondary outcomes included quality of life, pain, and mobility.Results21 women were recruited to the trial. Eleven were randomly allocated to the experimental group and 10 to the control group. Retention of participants was excellent for the Pilates group (100%) compared to 70% in the control group. There were no adverse events. The Pilates group showed greater gains in quality of life on the SF-12 from the pre-test (M = 81.0, SD = 11.8) to the post-test (M = 83.3, SD = 8.52) compared to the control group (pre-test M = 69.78, SD = 15.9) (post-test M = 68.1, SD = 16.05) (Wald Chi-Square = 5.597, p = 0.018). Although the duration of labour was shorter in the Pilates group (Mdn = 215, IQR: 279 min) than usual care (Mdn = 458.5, IQR: 305 min), the difference was not statistically significant. There were no significant differences between groups for pain, mobility, abdominal separation, urinary continence, analgesia, or the mode of birth.ConclusionsModified Pilates appears feasible and safe for low-risk pregnant women. Further research is needed in on this topic.     

Staff nurse turnover in neonatal intensive care units

The turnover rate and patterns in Neonatal Intensive Care Units (NICUs) were assessed and compared with adult Intensive Care Units (ICUs) and General Infant Care Units at the same hospitals for the year 1976. Thirty-five hospitals with NICUs participated in the study. The findings of this study disagree with the previous literature in three major ways: 1 The turnover rate of staff nurses was less than half that estimated by The National Commission on Nursing for 1970. 2 The turnover rates in ICUs and NICUs were not significantly higher than that for staff nurses in Non-Intensive Care Units. In addition, the pattern of turnover among leavers is identical for all three major types of unit. The variability pattern for neonatal units, however, is statistically significant; this is not so with the other units studied. 3 There is no evidence for a stabilization of turnover following the usual 'induction crisis period' (the first 3 to 6 months).     

Expert consensus to weight an adherence score for audit and feedback of practices that prevent necrotizing enterocolitis in very low birth weight infants

ObjectiveNecrotizing enterocolitis (NEC) is a catastrophic abdominal complication threatening the life of premature infants, but adoption of prevention and early recognition practices differs as do NEC rates in Neonatal Intensive Care Units (NICUs). The purpose of this research was to validate and weight an evidence-based adherence score (aka NEC-Zero Adherence Score) to prevent and foster timely recognition of NEC.Study designAn electronic Delphi (e-Delphi) approach was used to identify consensus. NEC experts were recruited via the NEC Society and surveyed until consensus and stability criteria for the Delphi were met (≥ 70% consensus and mean responses changed < 15% between rounds).ResultsExpert panelists (n = 22) were experienced (M = 17.6, SD 11 years) and predominately physicians (68%) or neonatal nurse practitioners (18%). Consensus (> 70% by item) supported a 10 point score. Points were distributed across 1) an exclusive human milk diet (5 points), 2) standardized feeding protocols (3 points), 3) antibiotic stewardship (1 point), and 4) a unit-specified approach to early recognition (1 point). Withholding feeding during transfusion was controversial (M = 0.50, SD 0.73) and met consensus criteria to drop from the score.ConclusionsHolding feeding during transfusion was dropped from the score. Relationships between the score and unit NEC rates as well as its utility for use in audit and feedback should be studied in the future.     

Effect of bundle set interventions on physiologic alarms and alarm fatigue in an intensive care unit: A quality improvement project

ObjectiveTo determine if the implementation of an evidence-based bundle designed to reduce the number of physiologic monitor alarms reduces alarm fatigue in intensive care nurses.DesignThis quality improvement project retrospectively reviewed alarm data rates, types, and frequency to identify the top three problematic physiologic alarms in an intensive care unit. An alarm management bundle was implemented to reduce the number of alarms. The Nurses’ Alarm Fatigue Questionnaire was used to measure nurses’ alarms fatigue pre- and post-implementation of the bundle.SettingA combined medical surgical intensive care unit at an accredited hospital in the United States.ResultsThe top three problematic alarms identified during the pre-implementation phase were arrhythmia, invasive blood pressure, and respiration alarms. All three identified problematic physiologic alarms had a reduction in frequency with arrhythmia alarms demonstrating the largest decrease in frequency (46.82%). When measuring alarm fatigue, the overall total scores increased from pre- (M = 30.59, SD = 5.56) to post-implementation (M = 32.60, SD = 4.84) indicating no significant difference between the two periods.ConclusionAfter implementing an alarm management bundle, all three identified problematic physiologic alarms decreased in frequency. Despite the reduction in these alarms, there was not a reduction in nurses’ alarm fatigue.     

Effectiveness of mHealth application in improving knowledge of mothers on preterm home care

mHealth intervention can be an important tool for health education. The study aimed to determine the effectiveness of a mHealth application in improving mothers' knowledge of preterm home care. One hundred sixty mothers of preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU) of a tertiary care teaching hospital in Karnataka, India participated in a randomized controlled trial. The mothers in the intervention group showed a statistically significant increase in knowledge scores (pre = 17, post = 27, (p < .001) compared to mothers in the control group (pre = 18, post = 20). Knowledge scores didn't differ across age (U = 2629.00, p .051), employment status (χ² = 3.060, p = .80), parity (χ2 = 0.025, p = .874) and socio-economic status (χ2 = 6.702, p = .57). Only education was significantly associated with baseline knowledge score (χ2 = 6.163, p = .013). The mHealth educational app effectively improved the knowledge of mothers on preterm home care.