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Shahintab S, Nourian M, Rassouli M, Pourhoseingholi MA. Palliative care nurse: A quantitative study of caring for neonates at end-of-life stage. JOURNAL OF NEONATAL NURSING 2024. [DOI: 10.1016/j.jnn.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
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Hanna M, Shah R, Marquez L, Barzegar R, Gordon A, Pammi M. Infant isolation and cohorting for preventing or reducing transmission of healthcare-associated infections in neonatal units. Cochrane Database Syst Rev 2023; 6:CD012458. [PMID: 37368649 PMCID: PMC10297826 DOI: 10.1002/14651858.cd012458.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Neonatal healthcare-associated infections (HAIs) result in increased morbidity and mortality, as well as increased healthcare costs. Patient isolation measures, i.e. single-room isolation or the cohorting of patients with similar infections, remain a recommended and commonly used practice for preventing horizontal spread of infections in the neonatal intensive care unit (NICU). OBJECTIVES: Our primary objective was to assess the effect of single-room isolation or cohorting, or both for preventing transmission of HAIs or colonization with HAI-causing pathogens in newborn infants less than six months of age admitted to the neonatal intensive care unit (NICU). Our secondary objective was to assess the effect of single-room isolation or cohorting, or both on neonatal mortality and perceived or documented adverse effects in newborn infants admitted to the NICU. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, the WHO ICTRP and ClinicalTrials.gov trials registries. There were no restrictions to date, language or publication type. We also checked the reference lists of studies identified for full-text review. SELECTION CRITERIA: Types of studies: cluster-randomized or quasi-randomized trials at the level of the cluster (where clusters may be defined by NICU, hospital, ward, or other subunits of the hospital). We also included cross-over trials with a washout period of more than four months (arbitrarily defined). TYPES OF PARTICIPANTS newborn infants less than six months of age in neonatal units that implemented patient isolation or cohorting as infection control measures to prevent HAIs. Types of interventions: patient isolation measures (single-room isolation or cohorting, or both of infants with similar colonization or infections) compared to routine isolation measures. TYPES OF OUTCOME MEASURES the primary outcome was the rate of transmission of HAIs as estimated by the infection and colonization rates in the NICU. Secondary outcomes included all-cause mortality during hospital stay at 28 days of age, length of hospital stay, as well as potential adverse effects of isolation or cohorting measures, or both. DATA COLLECTION AND ANALYSIS The standard methods of Cochrane Neonatal were used to identify studies and assess the methodological quality of eligible cluster-randomized trials. The certainty of the evidence was to be assessed by the GRADE method as evidence of high, moderate, low, or very low certainty. Infection and colonization rates were to be expressed as rate ratios for each trial and if appropriate for meta-analysis, the generic inverse variance method in RevMan was to be used. MAIN RESULTS We did not identify any published or ongoing trials to include in the review. AUTHORS' CONCLUSIONS The review found no evidence from randomized trials to either support or refute the use of patient isolation measures (single-room isolation or cohorting) in neonates with HAIs. Risks secondary to infection control measures need to be balanced against the benefits of decreasing horizontal transmission in the neonatal unit for optimal neonatal outcomes. There is an urgent need to research the effectiveness of patient isolation measures for preventing the transmission of HAIs in neonatal units. Well-designed trials randomizing clusters of units or hospitals to a type of patient isolation method intervention are warranted.
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Affiliation(s)
- Morcos Hanna
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
| | - Rita Shah
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
| | - Lucila Marquez
- Department of Pediatric Infectious Diseases, Baylor College of Medicine, Houston, USA
| | - Rebecca Barzegar
- RPA Newborn Care, Sydney Local Health District, Sydney, Australia
| | - Adrienne Gordon
- RPA Newborn Care, Sydney Local Health District, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
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Bertuzzi A, Martin A, Clarke N, Springate C, Ashton R, Smith W, Orlowski A, McPherson D. Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis. BMJ Open 2023; 13:e068932. [PMID: 37147093 PMCID: PMC10163491 DOI: 10.1136/bmjopen-2022-068932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes. DESIGN Systematic review and narrative synthesis. DATA SOURCES Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022. ELIGIBILITY CRITERIA Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesised narratively, according to the methods of Campbell et al. RESULTS: Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies. CONCLUSIONS The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness. PROSPERO REGISTRATION NUMBER CRD42022311689.
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Affiliation(s)
| | | | | | | | - Rachel Ashton
- Ashton Editorial Consulting, London, UK
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Wayne Smith
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Andi Orlowski
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Gill FJ, Nelson H, Bear N, Tallon M, Pienaar C, Ferullo J, Baker S. A new children's hospital with a larger floor space, single rooms, and V-shaped ward design: A pre-post evaluation of nurse time providing patient care and nurse, patient, and family experiences. J Health Serv Res Policy 2023; 28:89-99. [PMID: 36617492 DOI: 10.1177/13558196221146658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The impact of hospital building design on patients, families and nurses related to nursing care interactions is not well understood. This study reports a pre-post intervention study to understand the effects of the move to a new children's hospital in Perth, Australia, on nurse workflow activities and on patient, family, and nurse experiences. METHODS We used a pre-post explanatory sequential design involving observation of nurse work tasks; measurement of the Practice Environment Scale and Nurse Work Index; weekly surveys of nurse, patient and family experiences; and nurse focus groups and interviews with patients and families. Survey data were analysed using linear regression; qualitative data analysis used a thematic approach. RESULTS Nurse time spent walking almost doubled (p < 0.001), from an estimated 10 min at T1 (pre-move) to around 20 min at T4 (12 months post-move), but there was no difference in nurse time providing patient care (p = 0.114). The Practice Environment Scale and Nurse Work Index showed significantly reduced scores for nursing foundations for quality of care (adjusted mean difference -0.08, p = 0.016) and staffing and resource adequacy (adjusted mean difference -0.19, p < 0.001).This fall was mirrored in nurse experience surveys with a reduction in mean scores from T1 to T3 (3 months post-move) of -0.7 (p < 0.001) and from T1 to T4 of -0.4 (p = 0.002). Thematic analysis of qualitative data found that initial challenges appeared to reduce over time. Nurses reported difficulties managing workflow in the new wards and feelings of exhaustion at T3, but this changed to more positive accounts at T4. For patients and families there was a tension between leaving the old and familiar, enjoying the light and space of the new and shared observations that nurses appeared to be busier at T3. At T4, these experiences had changed to 'being a family in hospital' and confidence that a nurse was always close by. CONCLUSIONS Both benefits and challenges of the new hospital design were encountered from the perspective of nurses, patients, and families. Nurses spent double the time walking in the new environment, but time spent providing patient care was unchanged. Over time, the initial practice challenges reduced as nurses adapted to working in the new environment. TRIAL REGISTRATION ACTRN12618000775213.
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Affiliation(s)
- Fenella J Gill
- Perth Children's Hospital, Child and Adolescent Health Service and School of Nursing, Faculty of Health Sciences, 168274Curtin University and Curtin Enable Institute, Perth, Australia
| | - Helen Nelson
- Perth Children's Hospital, 60081Child and Adolescent Health Service, Perth, Australia
| | - Natasha Bear
- Perth Children's Hospital, 60081Child and Adolescent Health Service, Perth, Australia
| | - Mary Tallon
- Perth Children's Hospital, Child and Adolescent Health Service and School of Nursing, Faculty of Health Sciences, 168274Curtin University, Perth, Australia
| | - Catherine Pienaar
- Perth Children's Hospital, Child and Adolescent Health Service and Vaccine Safety, West Australian Department of Health, Perth, Australia
| | - Jade Ferullo
- Perth Children's Hospital, 60081Child and Adolescent Health Service, Perth, Australia
| | - Sue Baker
- Perth Children's Hospital, 60081Child and Adolescent Health Service, Perth, Australia
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Jansen S, Berkhout RJM, Te Pas AB, Steggerda SJ, de Vries LS, Schalij-Delfos N, van der Hoeven A, Lopriore E, Bekker V. Comparison of neonatal morbidity and mortality between single-room and open-bay care: a retrospective cohort study. Arch Dis Child Fetal Neonatal Ed 2022; 107:611-616. [PMID: 35444004 DOI: 10.1136/archdischild-2021-323310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In response to the increasing focus on family-centred care, neonatal intensive care unit (NICU) environments have gradually shifted towards the single-room design. However, the assumed benefits of this emerging design remain a subject of debate. Our goal was to evaluate the impact of single-room versus open-bay care on the risk of neonatal morbidity and mortality in preterm neonates. DESIGN Retrospective cohort study. SETTING Level III NICU. PATIENTS Neonates born <32 weeks' gestation between 15 May 2015 and 15 May 2019. MAIN OUTCOME MEASURES Mortality and morbidities of a cohort of neonates admitted to a new, single-room unit (SRU) were compared with a historical cohort of neonates admitted to an open-bay unit (OBU). Group differences were evaluated and multivariable logistic regression analyses were performed. RESULTS Three-hundred and fifty-six and 343 neonates were admitted to the SRU and OBU, respectively. No difference in neonatal morbidities and mortality were observed between cohorts (bronchopulmonary dysplasia: OR 1.08, 95% CI 0.73 to 1.58, p=0.44; retinopathy of the prematurity stage ≥2: OR 1.36, 95% CI 0.84 to 2.22, p=0.10; intraventricular haemorrhage: OR 0.89, 95% CI 0.59 to 1.34, p=0.86; mortality: OR 1.55, 95% CI 0.75 to 3.20, p=0.28). In adjusted regression models, single-room care was independently associated with a decreased risk of symptomatic patent ductus arteriosus (adjusted OR 0.54, 95% CI 0.31 to 0.95). No independent association between single-room care and any of the other investigated outcomes was observed. CONCLUSIONS Implementation of single-rooms in our NICU did not lead to a significant reduction in neonatal morbidity and mortality outcomes.
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Affiliation(s)
- Sophie Jansen
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Romy J M Berkhout
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Linda S de Vries
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | | | - Alieke van der Hoeven
- Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
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Shahintab S, Nourian M, Rassouli M, Pourhoseingholi MA. Palliative care nurse: A quantitative study of caring for neonates at end-of-life stage. Ann Med Surg (Lond) 2022; 82:104729. [PMID: 36268399 PMCID: PMC9577836 DOI: 10.1016/j.amsu.2022.104729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the quality of the care provided to newborns at End-of-Life (EOL) stages and compare the care which is already being given to the infants admitted to the NICUs of the selected hospital in (XXX) with the existing standards. Knowing how End-of-Life nursing care is provided, compared with the standard in the terminal stage of neonates' life can provide accurate information for policies, research, and educational practices. METHODS In this descriptive study, 100 nursing care services, provided to neonates at the EOL stages and their parents, were observed and compared to the standard checklist which had been developed based on the literature review and existing standards in 2015. The study setting included the NICUs of the four hospitals affiliated to (XXX) The Content and Face Validity of the checklist were determined based on specialists' comments. The Content Validity Index was 94.85%, and its reliability was evaluated too through the inter-rater correlation coefficient (ICC = 0.715). RESULTS Only 11.49% of EOL nursing care services were given properly and 77.92% were not given at all. Results showed that 10.59% of EOL nursing care services were performed improperly. CONCLUSION The overall rate of accordance with the EOL nursing care standards was poor (16.78%). Nursing care given to infants and their parents at EOL stages is far from the standards. This can be due to various reasons, such as inadequate training and the lack of comprehensive guidelines.
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Affiliation(s)
- Sepideh Shahintab
- Neonatal Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Manijeh Nourian
- Department of Pediatric and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Department of Pediatric and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Director General of Health Promotion and Nursing Service Office, MOHME, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Amin Pourhoseingholi
- Research Associate Professor of Biostatistics, Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Comparison of Psychological and Physiological Stress in NICU Nurses: Effects of Unit Design and Shift. Adv Neonatal Care 2021; 21:E93-E100. [PMID: 33427752 DOI: 10.1097/anc.0000000000000837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied. PURPOSE To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift. METHODS Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models. RESULTS NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001). IMPLICATIONS FOR PRACTICE Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress. IMPLICATIONS FOR RESEARCH Strategies are needed for reducing stress in NICU nurses who work night shift.
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Dadiz R, Riccio J, Brown K, Emrich P, Robin B, Bender J. Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit. J Perinatol 2020; 40:29-35. [PMID: 32859962 PMCID: PMC7453859 DOI: 10.1038/s41372-020-0749-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aimed to identify: (a) latent safety threats (LSTs) in a new neonatal intensive care unit (NICU) through simulation-based pre-occupancy operations testing, and (b) LSTs that remained unresolved 1-year post-occupancy. STUDY DESIGN In this qualitative study, 111 healthcare professionals participated in patient care simulations and debriefings in a new NICU. Debriefing transcripts were inductively analyzed to characterize LSTs. Unresolved LSTs were identified 1 year after NICU occupancy. RESULTS Thematic saturation was attained after analysis of nine debriefings. Four major themes affecting staff function and patient safety emerged from 305 threats: relay of information, workplace design, patient care processes, and patient family and staff focus. One-year post occupancy, 29 (9%) LSTs remained unresolved. CONCLUSION Team debriefings of simulated patient events uncover LSTs that can largely be resolved before transitioning patient care into a new NICU. Understanding how LSTs interact provides a platform to develop viable strategies to mitigate patient safety risks.
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Affiliation(s)
- Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.
| | - Julie Riccio
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Kristen Brown
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Paula Emrich
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Beverley Robin
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | - Jesse Bender
- Department of Pediatrics, Mission Hospital, Asheville, NC, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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Frechette J, Bitzas V, Kilpatrick K, Aubry M, Lavoie-Tremblay M. A hermeneutic-phenomenological study of paediatric intensive care unit nurses' professional identity following hospital redesign: Lessons learned for managers. J Nurs Manag 2020; 28:872-880. [PMID: 32219900 DOI: 10.1111/jonm.13012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 11/27/2022]
Abstract
AIM To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change. BACKGROUND While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity. METHOD The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n = 15) in a large Canadian paediatric hospital. RESULTS Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions. CONCLUSION Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes. IMPLICATIONS FOR NURSING MANAGEMENT The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated; 2) the physical environment needs to be considered when determining staffing requirements; and 3) identity transitions need to be managed.
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Affiliation(s)
- Julie Frechette
- McGill University Ingram School of Nursing, Montreal, QC, Canada
| | - Vasiliki Bitzas
- McGill University Ingram School of Nursing, Montreal, QC, Canada.,Quebec Integrated University Centre for Health and Social Services of Western Central Montreal Island, Montreal, QC, Canada
| | | | - Monique Aubry
- School of Business and Management, Université du Québec à Montréal, Montreal, QC, Canada
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NICU Nurses' Stress and Work Environment in an Open Ward Compared to a Combined Pod and Single-Family Room Design. Adv Neonatal Care 2019; 19:416-424. [PMID: 31651473 DOI: 10.1097/anc.0000000000000603] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The architectural design of a neonatal intensive care unit may affect the quality of the work environment for nurses, yet few studies have been conducted using reliable and valid measures. Recent studies have suggested some drawbacks of single-family rooms (SFRs) for both infants and parents. Research is needed to explore nurses' work environment in units combining pods and SFRs. PURPOSE To compare neonatal intensive care unit nurses' work stress, satisfaction, obstacles, support, team effectiveness, ability to provide family-centered care, and satisfaction with noise, light, and sightlines in an open ward with a new unit of pods and SFRs. METHODS A pre-post occupancy study was conducted in a level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. RESULTS There were no significant differences in nurse stress, satisfaction, support from colleagues, perceptions of team effectiveness, and ability to provide family-centered care between the open ward and the pod/SFR unit. Organizational obstacles, such as difficulties obtaining information from colleagues, were significantly lower in the pod/SFR. In contrast, environmental and technology obstacles were greater in the new pod/SFR unit. IMPLICATIONS FOR PRACTICE Some specific aspects of the pod/SFR unit are optimal for neonatal intensive care unit nurses, while other aspects of the open ward are perceived more favorably. IMPLICATIONS FOR RESEARCH Studies are needed to examine the isolation the nurses may experience in SFR units, as well as strategies to reduce isolation.
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Tobiano G, Murphy N, Grealish L, Hervey L, Aitken LM, Marshall AP. Effectiveness of nursing rounds in the Intensive Care Unit on workplace learning. Intensive Crit Care Nurs 2019; 53:92-99. [DOI: 10.1016/j.iccn.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/20/2018] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
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VanHeuvelen JS. Isolation or interaction: healthcare provider experience of design change. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:692-708. [PMID: 30737809 DOI: 10.1111/1467-9566.12850] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Recent studies have drawn attention to the relationship between healthcare environments and patient outcomes. Yet, it remains unclear how changes in the design of healthcare facilities are experienced by providers. To understand this relationship, this study employs an inhabited institutionalist theoretical frame to assess longitudinal ethnographic and interview data collected at a neonatal intensive care unit (NICU) as it transformed from an open-bay unit, to one with single-patient rooms. Findings show that changing the structure of the NICU interfered with the original local organisational culture of collaboration. While providers actively worked to maintain the original culture, their success in doing so was mediated by the built environment. Responding to the new space, practitioners developed new practices. Some of the practices (such as doorway discussions and increased individual assessments) directly undermined the original organisational culture, whereas others (hallway hangouts and calling out) worked to transpose the original culture into the new space. These findings call for greater attention to the effect of physical space on organisational culture.
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The Choreography Involved in a NICU Expansion to Ensure Emergency Preparedness. J Perinat Neonatal Nurs 2019; 33:211-212. [PMID: 31335846 DOI: 10.1097/jpn.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION Simulation has become an integral tool in healthcare facility redesign. Immersing clinical experts into their future environment has demonstrated benefits for transition planning. This study evaluates translation of a proven macrosystems testing protocol, TESTPILOT, to an organization with limited simulation experience. METHODS An experienced TESTPILOT team guided Woman's Hospital Baton Rouge's simulation preparation for their new neonatal intensive care unit. Metrics included participant evaluations, latent safety threats (LST), and clinician surveys. Latent safety threats recorded during debriefings were addressed by workflow committees. Clinicians were surveyed at four time points for readiness and preparedness on 24 key processes. RESULTS The local team invested nearly 750 hours into learning and implementing seven simulations that participants rated positively. Most of the 305 LST were minor issues. Surveys at baseline (42% of staff), postsim (18%), pretransition (26%), and postmove (29%) demonstrated strong internal consistency. System readiness lagged behind staff preparedness (P < 0.007); both were higher after simulations (P ≤ 0.001) but at no other interval. Critical laboratory notification, rounding structure, team coverage, and feedback were still evolving as of move day (P < 0.02). DISCUSSION Macrosystems testing using simulation identifies LST, improves process, and prepares staff. The methodology is implementable in organizations with limited prior exposure. Woman's Hospital Baton Rouge accrued essential skills to model and orchestrate an immersive neonatal intensive care unit and then drive effective multidisciplinary debriefings. Staff immersed in the new environment began to articulate their jobs before moving in. The trajectory of system readiness improvement corroborated LST correction. Future research is needed to determine the extent of simulation required for different organizational structures.
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Nassery W, Landgren K. Parents' Experience of Their Sleep and Rest When Admitted to Hospital with Their Ill Child: A Qualitative Study. Compr Child Adolesc Nurs 2018; 42:265-279. [PMID: 30388907 DOI: 10.1080/24694193.2018.1528310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to explore parents' experiences of sleep and rest while admitted to hospital together with their ill child. When a child is hospitalized, it can be a traumatic experience for the entire family. Adaptation to the new situation and new parental responsibilities is necessary. Hospitalized children demand more supervision and care, making sleep disturbance a common challenge among these parents. A qualitative exploratory interview study was conducted using semi-structured individual or couple interviews with 17 parents (12 mothers and five fathers) admitted together with their ill child for shorter or longer periods at pediatric wards at a university hospital in Sweden. Interviews were analyzed with content analysis. Sufficient amount of sleep and rest was described as vital for parental functioning. The main theme Factors influencing sleep and rest emerged with three subthemes. Environmental factors describe experiences such as disturbing sounds and uncomfortable beds. Interpersonal factors describe how supportive relations with spouses, relatives, nurses, and doctors were experienced as strengthening the parental confidence and helping parents to relax. Parents wanted to participate in the care but appreciated help from the nurses when they needed rest or support. The last subtheme, Organizational factors, describe how continuous information about the child's care and prognosis was experienced as the most important factor to feel secure and calm. Parents expressed that a possibility to buy lunch and dinner at the ward would greatly relieve parents' stress and help them rest. Parents in this study were grateful that they were allowed to stay by their child's side, but pointed out improvement opportunities. Single rooms with comfortable beds for the parents were in high demand to promote relaxation and sleep. Continuous, adjusted, information was seen as important. All hospitalized children have the right to partake in their own treatment and care, and they need a parent at their side. By optimizing parents' sleep and rest in the hospital, a more positive experience of the hospitalization can be achieved for the entire family.
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Affiliation(s)
| | - Kajsa Landgren
- Department of Health Sciences, Faculty of Medicine, Lund University , Lund , Sweden
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Kuhn P, Sizun J, Casper C. Recommendations on the environment for hospitalised newborn infants from the French neonatal society: rationale, methods and first recommendation on neonatal intensive care unit design. Acta Paediatr 2018; 107:1860-1866. [PMID: 30025190 DOI: 10.1111/apa.14501] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 11/30/2022]
Abstract
AIM Hospitalised newborn infants may be stressed due to inappropriate sensory stimuli and early separation from their families, that can negatively impact their neurodevelopment. The French Group of Reflection and Evaluation of the Environment of Newborns (GREEN) issues guidelines based on environmental neonatology and family-centred care. The first recommendation focuses on private family rooms versus large shared rooms. METHODS These guidelines are based on a systematic evaluation of the literature providing different grades of evidence. Internal and external reviews by multidisciplinary experts examined the scientific evidence of all recommendations. The literature search was performed for the period January 1, 2000 to January 1, 2016 with the keywords 'single room' or 'private room' and 'neonatal intensive care unit'. RESULTS A total of 25 studies were retained. Most studies reported a positive impact of private rooms on the health of newborn infants and satisfaction of families. Private rooms could lead to sensory deprivation if there is low parental involvement with limited presence and to reduced interaction among caregivers. CONCLUSION We recommend that neonatal units should mostly have private rooms. With this architectural design, we recommend supporting the staff's needs for changes in the organisation and philosophy of care and to provide improved family support.
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Affiliation(s)
- Pierre Kuhn
- Service de Médecine et de Réanimation du nouveau-né; Hôpital Hautepierre; Strasbourg France
| | - Jacques Sizun
- Pôle de la Femme, de la Mère et de l'Enfant; CHRU de Brest; Brest France
| | - Charlotte Casper
- Unité de Néonatologie; Hôpital des Enfants; CHU Toulouse; Toulouse France
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Abstract
BACKGROUND Working in a neonatal intensive care unit (NICU) can be both rewarding and stressful. Stressors can outweigh satisfiers, leading to job dissatisfaction and turnover. Nurse retention remains a problem, particularly for nurses within the first year of employment. PURPOSE The purpose of this study was to examine current nurse stressors, satisfiers, and coping processes in the NICU. METHODS Seventy-two neonatal nurses from 3 Magnet facilities in North Carolina completed the ICU Stressors Survey, the Ways of Coping Scale, demographic data questions, and free-text questions in Qualtrics, a secure online survey system. Questionnaires were analyzed using protocols developed and validated by instrument developers, and quantitative data were analyzed using SPSS statistical software. Free-text responses were analyzed using iterative coding and thematic grouping. RESULTS Most nurses thought that NICU nursing was stressful, but they coped well with work stress. Nurses felt confident in their knowledge and patient care abilities and were not stressed by the NICU environment. Inadequate staffing was the most common stressor. Coping strategies were aimed at task completion. Nurses wanted better teamwork on their units. Nurses felt more respected by their peers and families than by their immediate supervisors and physicians. IMPLICATIONS Attention to staffing patterns is paramount. Team-building activities may help foster mutual respect and collegiality among the nursing staff and between disciplines. Research investigating creative staffing patterns would be helpful. Interprofessional research may also reduce stressors and enhance team performance.
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Joshi R, Straaten HV, Mortel HVD, Long X, Andriessen P, Pul CV. Does the architectural layout of a NICU affect alarm pressure? A comparative clinical audit of a single-family room and an open bay area NICU using a retrospective study design. BMJ Open 2018; 8:e022813. [PMID: 29961040 PMCID: PMC6045752 DOI: 10.1136/bmjopen-2018-022813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To determine differences in alarm pressure between two otherwise comparable neonatal intensive care units (NICUs) differing in architectural layout-one of a single-family room (SFR) design and the other of an open bay area (OBA) design. DESIGN Retrospective audit of more than 2000 patient days from each NICU cataloguing the differences in the number and duration of alarms for critical and alerting alarms, as well as the interaction of clinicians with the patient monitor. SETTING Two level 3 NICUs. RESULTS A total of more than 150 000 critical and 1.2 million alerting alarms were acquired from the two NICUs. The number of audible alarms and the associated noise pollution varied considerably with the OBA NICU generating 44% more alarms per infant per day even though the SFR NICU generated 2.5 as many critical desaturation alarms per infant per day. CONCLUSION Differences in the architectural layout of NICUs and the consequent differences in delays, thresholds and distribution systems for alarms are associated with differences in alarm pressure.
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Affiliation(s)
- Rohan Joshi
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Clinical Physics, Maxima Medisch Centrum locatie Veldhoven, Veldhoven, Noord-Brabant, The Netherlands
| | | | - Heidi van de Mortel
- Department of Neonatology, Maxima Medisch Centrum locatie Veldhoven, Veldhoven, The Netherlands
| | - Xi Long
- Department of Fertility, Pregnancy, and Parenting Solutions, Philips Research Eindhoven, Eindhoven, The Netherlands
- Department of Electrical Engineering, Technische Universiteit Eindhoven, Eindhoven, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Maxima Medisch Centrum locatie Veldhoven, Veldhoven, The Netherlands
| | - Carola van Pul
- Department of Clinical Physics, Maxima Medisch Centrum locatie Veldhoven, Veldhoven, Noord-Brabant, The Netherlands
- Department of Applied Physics, Technische Universiteit Eindhoven, Eindhoven, The Netherlands
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Hourigan SK, Subramanian P, Hasan NA, Ta A, Klein E, Chettout N, Huddleston K, Deopujari V, Levy S, Baveja R, Clemency NC, Baker RL, Niederhuber JE, Colwell RR. Comparison of Infant Gut and Skin Microbiota, Resistome and Virulome Between Neonatal Intensive Care Unit (NICU) Environments. Front Microbiol 2018; 9:1361. [PMID: 29988506 PMCID: PMC6026636 DOI: 10.3389/fmicb.2018.01361] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 06/05/2018] [Indexed: 01/08/2023] Open
Abstract
Background: There is a growing move to provide care for premature infants in a single family, private room neonatal intensive care unit (NICU) in place of the traditional shared space, open bay NICU. The resultant effect on the developing neonatal microbiota is unknown. Study Design: Stool and groin skin swabs were collected from infants in a shared-space NICU (old NICU) and a single-family room NICU (new NICU) on the same hospital campus. Metagenomic sequencing was performed and data analyzed by CosmosID bioinformatics software package. Results: There were no significant differences between the cohorts in gestational age, length of stay, and delivery mode; infants in the old NICU received significantly more antibiotics (p = 0.03). Differentially abundant antimicrobial resistance genes and virulence associated genes were found between the cohorts in stool and skin, with more differentially abundant antimicrobial resistance genes in the new NICU. The entire bacterial microbiota analyzed to the genus level significantly differed between cohorts in skin (p = 0.0001) but not in stool samples. There was no difference in alpha diversity between the two cohorts. DNA viruses and fungi were detected but did not differ between cohorts. Conclusion: Differences were seen in the resistome and virulome between the two cohorts with more differentially abundant antimicrobial resistance genes in the new NICU. This highlights the influence that different NICU environments can have on the neonatal microbiota. Whether the differences were due to the new NICU being a single-family NICU or located in a newly constructed building warrants exploration. Long term health outcomes from the differences observed must be followed longitudinally.
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Affiliation(s)
- Suchitra K Hourigan
- Department of Pediatrics, Inova Children's Hospital, Falls Church, VA, United States.,Inova Translational Medicine Institute, Falls Church, VA, United States.,Department of Pediatric Gastroenterology, Pediatric Specialists of Virginia, Fairfax, VA, United States
| | | | | | - Allison Ta
- Department of Pediatrics, Inova Children's Hospital, Falls Church, VA, United States
| | - Elisabeth Klein
- Inova Translational Medicine Institute, Falls Church, VA, United States
| | - Nassim Chettout
- Inova Translational Medicine Institute, Falls Church, VA, United States
| | - Kathi Huddleston
- Inova Translational Medicine Institute, Falls Church, VA, United States
| | - Varsha Deopujari
- Inova Translational Medicine Institute, Falls Church, VA, United States
| | - Shira Levy
- Inova Translational Medicine Institute, Falls Church, VA, United States
| | - Rajiv Baveja
- Fairfax Neonatal Associates PC, Falls Church, VA, United States
| | - Nicole C Clemency
- Inova Translational Medicine Institute, Falls Church, VA, United States
| | - Robin L Baker
- Fairfax Neonatal Associates PC, Falls Church, VA, United States
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Broom M, Kecskes Z, Kildea S, Gardner A. Exploring the Impact of a Dual Occupancy Neonatal Intensive Care Unit on Staff Workflow, Activity, and Their Perceptions. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 12:44-54. [PMID: 29925276 DOI: 10.1177/1937586718779360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2012, a tertiary neonatal intensive care unit (NICU) transitioned from an open plan (OP) to a dual occupancy (DO) NICU. The DO design aimed to provide a developmental appropriate, family-centered environment for neonates and their families. During planning, staff questioned the impact DO would have on staff workflow and activity. To explore the impact of changing from an OP to a DO NICU, a prospective longitudinal study was undertaken from 2011 to 2014, using observational, time and motion, and surveys methods. Main outcome measures included distance walked by staff, minutes of staff activity, and staff perceptions of the DO design. Results highlighted no significant difference in the distances clinical nurses walked nor time spent providing direct clinical care, whereas technical support staff walked further than other staff in both designs. Staff perceived the DO design created a developmentally appropriate, family-centered environment that facilitated communication and collaboration between staff and families. Staff described the main challenges of the DO design such as effective staff communication, gaining educational opportunities, and the isolation of staff and families compared to the OP design. Our study provides new evidence that DO provides an improved developmentally environment and has similar positive benefits to single-family room for neonates and families. Such design may reduce the larger floor plan's impact on staff walking distance and work practices. Challenges of staff transition can be minimized by planning and leadership throughout the development and move to a new design.
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Affiliation(s)
| | | | - Sue Kildea
- 3 University of Queensland (UQ) School of Nursing and Midwifery and Mater Health Service, Brisbane, Australia
| | - Anne Gardner
- 1 Australian Catholic University, Barton, Australia
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Staff Nurse Perceptions of Open-Pod and Single Family Room NICU Designs on Work Environment and Patient Care. Adv Neonatal Care 2018; 18:189-198. [PMID: 29794838 DOI: 10.1097/anc.0000000000000493] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neonatal intensive care units have historically been constructed as open units or multiple-bed bays, but since the 1990s, the trend has been toward single family room (SFR) units. The SFR design has been found to promote family-centered care and to improve patient outcomes and safety. The impact of the SFR design NICU on staff, however, has been mixed. PURPOSE The purposes of this study were to compare staff nurse perceptions of their work environments in an open-pod versus an SFR NICU and to compare staff nurse perceptions of the impact of 2 NICU designs on the care they provide for patients/families. METHODS/SEARCH STRATEGY A prospective cohort study was conducted. Questionnaires were completed at 6 months premove and again at 3, 9, and 15 months postmove. A series of 1-way analyses of variance were conducted to compare each group in each of the 8 domains. Open-ended questions were evaluated using thematic analysis. FINDINGS/RESULTS The SFR design is favorable in relation to environmental quality and control of primary workspace, privacy and interruption, unit features supporting individual work, and unit features supporting teamwork; the open-pod design is preferable in relation to walking. IMPLICATIONS FOR PRACTICE Incorporating design features that decrease staff isolation and walking and ensuring both patient and staff safety and security are important considerations. IMPLICATIONS FOR RESEARCH Further study is needed on unit design at a microlevel including headwall design and human milk mixing areas, as well as on workflow processes.
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Abstract
BACKGROUND In 2014, more than 10% of all births in the United States were preterm (born at <37-weeks' gestation). These high-risk infants will often spend weeks to months within the neonatal intensive care unit (NICU), where noise levels can easily reach 120 decibels adjusted (dBA) on a regular and sometimes consistent basis. The American Academy of Pediatrics recommends that NICU sound levels remain below 45 dBA to promote optimal growth and development. PURPOSE The purpose of this evidence-based brief is to critically appraise the literature concerning preterm infant response to noise within the NICU as well as the use of noise interventions to improve health outcomes for the vulnerable preterm infant population. METHODS/SEARCH STRATEGY Systematic searches of databases included the Cochrane Library, CINAHL, PubMed, and Science Direct. Included studies were appraised and then synthesized into a narrative summary. FINDINGS/RESULTS Twenty studies met inclusion criteria for this review. While there are numerous methods that have been shown to reduce noise levels within the NICU, most NICU noise levels remain consistently above the American Academy of Pediatrics recommendations. Studies that assessed interventions found that staff reeducation was critical to sustaining appropriate noise levels. IMPLICATIONS FOR PRACTICE Implementing interventions with rigorous attention to initial and continued staff education with engagement and ownership is recommended. This review identifies gaps in intervention studies targeting vulnerable NICU populations. IMPLICATIONS FOR RESEARCH While noise interventions show promise in the NICU, additional focused research is needed to further strengthen the evidence and inform clinical practice.
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Doede M, Trinkoff AM, Gurses AP. Neonatal Intensive Care Unit Layout and Nurses’ Work. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2017. [DOI: 10.1177/1937586717713734] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neonatal intensive care units (NICUs) remain one of the few areas in hospitals that still use an open bay (OPBY) design for patient stays greater than 24 hr, housing multiple infants, staff, and families in one large room. This creates high noise levels, contributes to the spread of infection, and affords families little privacy. These problems have given rise to the single-family room NICU. This represents a significant change in the care environment for nurses. This literature review answers the question: When compared to OPBY layout, how does a single family room layout impact neonatal nurses’ work? Thirteen studies published between 2006 and 2015 were located. Many studies reported both positive and negative effects on nurses’ work and were therefore sorted by their cited advantages and disadvantages. Advantages included improved quality of the physical environment; improved quality of patient care; improved parent interaction; and improvements in nurse job satisfaction, stress, and burnout. Disadvantages included decreased interaction among the NICU patient care team, increased nurse workload, decreased visibility on the unit, and difficult interactions with family. This review suggests that single-family room NICUs introduce a complex situation in which trade-offs occur for nurses, most prominently the trade-off between visibility and privacy. Additionally, the literature is clear on what elements of nurses’ work are impacted, but how the built environment influences these elements, and how these elements interact during nurses’ work, is not as well understood. The current level of research and directions for future research are also discussed.
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Affiliation(s)
- Megan Doede
- University of Maryland School of Nursing, Baltimore, MD, USA
| | | | - Ayse P. Gurses
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction. Health Care Manag (Frederick) 2017; 35:205-16. [PMID: 27455363 DOI: 10.1097/hcm.0000000000000122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.
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Broom M, Gardner A, Kecskes Z, Kildea S. Transition from an open-plan to a two-cot neonatal intensive care unit: a participatory action research approach. J Clin Nurs 2017; 26:1939-1948. [PMID: 27533312 DOI: 10.1111/jocn.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. BACKGROUND In 2012, an Australian regional neonatal intensive care unit transitioned from an open-plan to a two-cot neonatal intensive care unit design. Research has reported single- and small-room neonatal intensive care unit design may negatively impact on the distances nurses walk, reducing the time they spend providing direct neonatal care. Studies have also reported nurses feel isolated and need additional support and education in such neonatal intensive care units. Staff highlighted their concerns regarding the impact of the new design on workflow and clinical practice. DESIGN A participatory action research approach. METHODS A participatory action group titled the Change and Networking Group collaborated with staff over a four-year period (2009-2013) to facilitate the transition. The Change and Networking Group used a collaborative, cyclical process of planning, gathering data, taking action and reviewing the results to plan the next action. Data sources included meeting and workshop minutes, newsletters, feedback boards, subgroup reports and a staff satisfaction survey. RESULTS The study findings include a description of (1) how the participatory action research cycles were used by the Change and Networking Group: providing examples of projects and strategies undertaken; and (2) evaluations of participatory action research methodology and Group by neonatal intensive care unit staff and Change and Networking members. CONCLUSION This study has described the benefits of using participatory action research to facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. Participatory action research methodology enabled the inclusion of staff to find solutions to design and clinical practice questions. Future research is required to assess the long-term effect of neonatal intensive care unit design on staff workload, maintaining and supporting a skilled workforce as well as the impact of a new neonatal intensive care unit design on the neonatal intensive care unit culture. RELEVANCE TO CLINICAL PRACTICE A supportive work environment for staff is critical in providing high-quality health care.
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Affiliation(s)
- Margaret Broom
- Neonatal Intensive Care Unit, Department of Neonatology, Centenary Hospital for Women and Children, Australian Catholic University, Canberra, ACT, Australia
| | - Anne Gardner
- School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, Canberra, ACT, Australia
| | - Zsuzsoka Kecskes
- Neonatal Intensive Care Unit, Department of Neonatology, Canberra Hospital, Australian National University, Garran, Canberra, ACT, Australia
| | - Sue Kildea
- Midwifery Research Unit, School of Nursing and Midwifery and Mater Health Service, University of Queensland, Brisbane, Qld, Australia
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Transition to a New Neonatal Intensive Care Unit: Positive Effects on Staff Working Environment and How the Physical Environment Facilitates Family-Centered Care. J Perinat Neonatal Nurs 2017; 31:75-85. [PMID: 28121762 DOI: 10.1097/jpn.0000000000000232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
To optimize family-centered care and the staff working environment, the physical care environment should be designed to meet the needs of the infants, their families, and staff. It is important to evaluate the effects of a purpose-built neonatal ward on staff perceptions of job strain, the psychosocial climate, and the appropriateness of the physical environment. This study collected information from staff at a neonatal intensive care unit (NICU), before and after the ward was relocated to a new NICU. Effects were measured using the following variables: job strain, person-centered climate and appropriateness-of-the-physical-environment questionnaires. Data were analyzed using repeated-measures generalized estimating equations and factor analysis. After staff began to work in the new NICU, their job strain significantly increased. At the 2-year follow-up, staff stress levels had returned to preintervention levels. Participating staff perceived the purpose-built neonatal ward as being a significantly more appropriate physical environment for family-centered care of the infants and their families. The staff also perceived the psychosocial climate of the new NICU as significantly more person-centered in terms of having a more homey, comfortable, and everyday ambience and thus experienced as being more supportive. An NICU built according to recommended standards optimized the physical care environment for family-centered care and increased the staff working climate.
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Lester BM, Salisbury AL, Hawes K, Dansereau LM, Bigsby R, Laptook A, Taub M, Lagasse LL, Vohr BR, Padbury JF. 18-Month Follow-Up of Infants Cared for in a Single-Family Room Neonatal Intensive Care Unit. J Pediatr 2016; 177:84-89. [PMID: 27470693 DOI: 10.1016/j.jpeds.2016.06.069] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/02/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine whether the single-family room (SFR)-neonatal intensive care unit (NICU) is associated with improved 18-month neurodevelopmental outcome, especially in infants of mothers with high maternal involvement. STUDY DESIGN An 18-month follow-up was undertaken that compared infants born <30 weeks gestational age; 123 from a SFR-NICU vs 93 from an open-bay NICU. Infants were divided into high vs low maternal involvement based on days/week of kangaroo care, breast/bottle feeding, and maternal care. Infants with high vs low maternal involvement in the SFR and open-bay NICUs were compared on the Bayley Cognitive, Language, and Motor scores and Pervasive Developmental Disorders autism screen. RESULTS There were more mothers in the high maternal involvement SFR than in the high maternal involvement open-bay group (P = .002). Infants with high maternal involvement in both NICUs had greater Cognitive (P = .029) and Language (P < .000) scores than infants with low maternal involvement. Effect sizes within NICU were moderate to large in the SFR-NICU for Language scores and moderate for the Language composite in the open-bay NICU. The number of days of maternal involvement was greater in the SFR than open-bay NICU (P < .000), and length of stay was shorter in the high maternal involvement SFR than high maternal involvement open-bay NICU (P = .024). Kangaroo and maternal care predicted Cognitive (kangaroo, P = .003) and Language scores (P = .015, P = .032, respectively). Infants with ≥1 symptom of autism were more likely to be in the open-bay low maternal involvement group vs the SFR high maternal involvement group (OR = 4.91, 95% CI = 2.2-11.1). CONCLUSIONS High maternal involvement is associated with improved 18-month neurodevelopmental outcome, especially in infants cared for in a SFR-NICU.
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Affiliation(s)
- Barry M Lester
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI; Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Departments of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI.
| | - Amy L Salisbury
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI; Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Katheleen Hawes
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI; Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Lynne M Dansereau
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Rosemarie Bigsby
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI; Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Abbot Laptook
- Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Marybeth Taub
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Linda L Lagasse
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI; Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Betty R Vohr
- Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - James F Padbury
- Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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Les chambres familiales en néonatologie : effets sur le nouveau-né prématuré, ses parents et l’équipe soignante. Revue systématique de la littérature. Arch Pediatr 2016; 23:921-6. [DOI: 10.1016/j.arcped.2016.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/22/2016] [Accepted: 04/09/2016] [Indexed: 11/23/2022]
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Hogan C, Jones L, Saul J. The impact of special care nursery design on neonatal nurses. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jnn.2015.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hall SL, Cross J, Selix NW, Patterson C, Segre L, Chuffo-Siewert R, Geller PA, Martin ML. Recommendations for enhancing psychosocial support of NICU parents through staff education and support. J Perinatol 2015; 35 Suppl 1:S29-36. [PMID: 26597803 PMCID: PMC4660046 DOI: 10.1038/jp.2015.147] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/23/2015] [Indexed: 12/25/2022]
Abstract
Providing psychosocial support to parents whose infants are hospitalized in the neonatal intensive care unit (NICU) can improve parents' functioning as well as their relationships with their babies. Yet, few NICUs offer staff education that teaches optimal methods of communication with parents in distress. Limited staff education in how to best provide psychosocial support to families is one factor that may render those who work in the NICU at risk for burnout, compassion fatigue and secondary traumatic stress syndrome. Staff who develop burnout may have further reduced ability to provide effective support to parents and babies. Recommendations for providing NICU staff with education and support are discussed. The goal is to deliver care that exemplifies the belief that providing psychosocial care and support to the family is equal in importance to providing medical care and developmental support to the baby.
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Affiliation(s)
- S L Hall
- Division of Neonatology, St John's Regional Medical Center, Oxnard, CA, USA
| | - J Cross
- Department of Social Work, Widener University, Chester, PA, USA
| | - N W Selix
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - C Patterson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - L Segre
- College of Nursing and Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - R Chuffo-Siewert
- Department of Nursing, University of Iowa Children's Hospital, Iowa City, IA, USA
| | - P A Geller
- Departments of Psychology, Obstetrics/Gynecology and Public Health, Drexel University, Philadelphia, PA, USA
| | - M L Martin
- Department of Nursing, McLeod Regional Medical Center, Florence, SC, USA
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Walsh MC, Powers E, Fanaroff J. The potential for harm from alarm fatigue in single-room NICUs. Acta Paediatr 2015; 104:436-7. [PMID: 25873407 DOI: 10.1111/apa.12953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Michele C. Walsh
- Case Western Reserve University; Rainbow Babies & Childrens Hospital; Cleveland OH USA
| | - Elizabeth Powers
- Case Western Reserve University; Rainbow Babies & Childrens Hospital; Cleveland OH USA
| | - Jonathan Fanaroff
- Case Western Reserve University; Rainbow Babies & Childrens Hospital; Cleveland OH USA
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Santos J, Pearce SE, Stroustrup A. Impact of hospital-based environmental exposures on neurodevelopmental outcomes of preterm infants. Curr Opin Pediatr 2015; 27:254-60. [PMID: 25635585 PMCID: PMC4410011 DOI: 10.1097/mop.0000000000000190] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Over 300,000 infants are hospitalized in a neonatal intensive care unit (NICU) in the United States annually during a developmental period critical to later neurobehavioral function. Environmental exposures during the fetal period and infancy have been shown to impact long-term neurobehavioral outcomes. This review summarizes evidence linking NICU-based environmental exposures to neurodevelopmental outcomes of children born preterm. RECENT FINDINGS Preterm infants experience multiple exposures important to neurodevelopment during the NICU hospitalization. The physical layout of the NICU, management of light and sound, social interactions with parents and NICU staff, and chemical exposures via medical equipment are important to long-term neurobehavioral outcomes in this highly vulnerable population. SUMMARY Existing research documents NICU-based exposure to neurotoxic chemicals, aberrant light, excess sound, and restricted social interaction. In total, this creates an environment of co-existing excesses (chemicals, light, sound) and deprivation (touch, speech). The full impact of these co-exposures on the long-term neurodevelopment of preterm infants has not been adequately elucidated. Research into the importance of the NICU from an environmental health perspective is in its infancy, but could provide understanding about critical modifiable factors impacting the neurobehavioral health of hundreds of thousands of children each year.
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Affiliation(s)
| | - Sarah E. Pearce
- Icahn School of Medicine at Mount Sinai
- Division of Newborn Medicine, Department of Pediatrics
| | - Annemarie Stroustrup
- Icahn School of Medicine at Mount Sinai
- Division of Newborn Medicine, Department of Pediatrics
- Department of Preventive Medicine
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Shepley MM, Smith JA, Sadler BL, White RD. The business case for building better neonatal intensive care units. J Perinatol 2014; 34:811-815. [PMID: 25359412 DOI: 10.1038/jp.2014.174] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/14/2014] [Accepted: 08/19/2014] [Indexed: 02/08/2023]
Affiliation(s)
- M M Shepley
- Department of Design Environmental Analysis, Cornell University, Ithaca, NY, USA
| | - J A Smith
- Smith Hager Bajo Inc., Ashburn, VA, USA
| | - B L Sadler
- Institute for Healthcare Improvement, La Jolla, CA, USA
| | - R D White
- Pediatrix Medical Group, Memorial Hospital, South Bend, IN, USA
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Lester BM, Hawes K, Abar B, Sullivan M, Miller R, Bigsby R, Laptook A, Salisbury A, Taub M, Lagasse LL, Padbury JF. Single-family room care and neurobehavioral and medical outcomes in preterm infants. Pediatrics 2014; 134:754-60. [PMID: 25246623 DOI: 10.1542/peds.2013-4252] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether a single-family room (SFR) NICU, including factors associated with the change to a SFR NICU, is associated with improved medical and neurobehavioral outcomes. METHODS Longitudinal, prospective, quasi-experimental cohort study conducted between 2008 and 2012 comparing medical and neurobehavioral outcomes at discharge in infants born <1500 g. Participants included 151 infants in an open-bay NICU and 252 infants after transition to a SFR NICU. Structural equation modeling was used to determine the role of mediators of relations between type of NICU and medical and neurobehavioral outcomes. RESULTS Statistically significant results (all Ps ≤.05) showed that infants in the SFR NICU weighed more at discharge, had a greater rate of weight gain, required fewer medical procedures, had a lower gestational age at full enteral feed and less sepsis, showed better attention, less physiologic stress, less hypertonicity, less lethargy, and less pain. NICU differences in weight at discharge, and rate of weight gain were mediated by increased developmental support; differences in number of medical procedures were mediated by increased maternal involvement. NICU differences in attention were mediated by increased developmental support. Differences in stress and pain were mediated by maternal involvement. Nurses reported a more positive work environment and attitudes in the SFR NICU. CONCLUSIONS The SFR is associated with improved neurobehavioral and medical outcomes. These improvements are related to increased developmental support and maternal involvement.
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Affiliation(s)
- Barry M Lester
- Brown Center for the Study of Children at Risk, Departments of Pediatrics, and Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Katheleen Hawes
- Brown Center for the Study of Children at Risk, Departments of Pediatrics, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Beau Abar
- Brown Center for the Study of Children at Risk, Departments of Pediatrics, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Mary Sullivan
- Brown Center for the Study of Children at Risk, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Robin Miller
- Brown Center for the Study of Children at Risk, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Rosemarie Bigsby
- Brown Center for the Study of Children at Risk, Departments of Pediatrics, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Abbot Laptook
- Departments of Pediatrics, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Amy Salisbury
- Brown Center for the Study of Children at Risk, Departments of Pediatrics, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Marybeth Taub
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Linda L Lagasse
- Brown Center for the Study of Children at Risk, Departments of Pediatrics, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - James F Padbury
- Departments of Pediatrics, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
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Djukic M, Kovner CT, Brewer CS, Fatehi F, Greene WH. Exploring Direct and Indirect Influences of Physical Work Environment on Job Satisfaction for Early-Career Registered Nurses Employed in Hospitals. Res Nurs Health 2014; 37:312-25. [DOI: 10.1002/nur.21606] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Maja Djukic
- Assistant Professor, College of Nursing; New York University; 726 Broadway New York NY 10003
| | | | - Carol S. Brewer
- Professor, School of Nursing; University at Buffalo; Buffalo New York
| | - Farida Fatehi
- Research Analyst, College of Dentistry; New York University
| | - William H. Greene
- Robert Stanksy and Toyota Motor Corp., Professor of Economics, Department of Economics; New York University
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Improvements in staff quality of work life and family satisfaction following the move to single-family room NICU design. Adv Neonatal Care 2014; 14:129-36. [PMID: 24675633 DOI: 10.1097/anc.0000000000000046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether there were differences in staff quality of work life and parent satisfaction when a neonatal intensive care unit moved from an open-bay design to a single-room model of care. DESIGN This descriptive study measured staff quality of work life and family satisfaction before and at 2 time periods after the relocation of a perinatal centre and the introduction of single-family room care. Differences in work life quality and satisfaction were determined using 2-sample t-tests. RESULT There were improvements in staff quality of work life and family satisfaction at both time periods following the move. CONCLUSION Lessons learned may be of value to other units considering such a move. A neonatal intensive care unit designed to contribute to parental and staff well-being is a model to be considered for future neonatal designs.
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Rand K, Lahav A. Impact of the NICU environment on language deprivation in preterm infants. Acta Paediatr 2014; 103:243-8. [PMID: 24164604 DOI: 10.1111/apa.12481] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/03/2013] [Accepted: 10/21/2013] [Indexed: 12/28/2022]
Abstract
UNLABELLED It is unclear whether the atypical language development commonly seen in preterm infants is a consequence of language deficiency experienced during their prolonged NICU stay. This review provides a novel viewpoint, which highlights the potential impact of the NICU design on the developmental origin of language disabilities in preterm infants. CONCLUSION Further research is needed to identify evidence-based design solutions for providing preterm infants with a healthier linguistic hospital environment that aids growth and development.
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Affiliation(s)
- Katherine Rand
- Department of Newborn Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Amir Lahav
- Department of Newborn Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Pediatrics; MassGeneral Hospital for Children; Boston MA USA
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Acuity-adaptable patient room improves length of stay and cost of patients undergoing renal transplant: a pilot study. Crit Care Nurs Q 2014; 36:181-94. [PMID: 23470704 DOI: 10.1097/cnq.0b013e318283d0f3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The acuity-adaptable patient room concept is an emerging care model where patient is cared for in the same room from admission through discharge regardless of the patient level of acuity. After implementation of the care cluster strategy to support the implementation of an acuity-adaptable patient room, a descriptive study was conducted looking at so whether there will be a decreased length of stay and cost on patient cared for in the acuity-adaptable patient room compared to patients cared for in a transitional care process. Result of the study showed decreased length of stay of kidney transplant patients from 9.6 (11.0) days (before acuity-adaptable patient room) to 4.1 (1.3) days (acuity-adaptable patient room). Not only that the acuity-adaptable patient room improves patient outcome and cost but with the nursing competency preparation to support the implementation of the acuity-adaptable patient room, a hybrid nurse was created who possessed both critical care and medical-surgical skills. This can be a potential trend in the professional nurse model to address the health care challenges we face today in terms of nursing shortage, abbreviated plan of care, and facility operation efficiency.
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Pineda R, Neil J, Dierker D, Smyser C, Wallendorf M, Kidokoro H, Reynolds L, Walker S, Rogers C, Mathur A, Van Essen D, Inder T. Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments. J Pediatr 2014; 164:52-60.e2. [PMID: 24139564 PMCID: PMC3872171 DOI: 10.1016/j.jpeds.2013.08.047] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/17/2013] [Accepted: 08/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate associations between neonatal intensive care unit (NICU) room type (open ward and private room) and medical outcomes; neurobehavior, electrophysiology, and brain structure at hospital discharge; and developmental outcomes at 2 years of age. STUDY DESIGN In this prospective longitudinal cohort study, we enrolled 136 preterm infants born <30 weeks gestation from an urban, 75-bed level III NICU from 2007-2010. Upon admission, each participant was assigned to a bedspace in an open ward or private room within the same hospital, based on space and staffing availability, where they remained for the duration of hospitalization. The primary outcome was developmental performance at 2 years of age (n = 86 infants returned for testing, which was 83% of survivors) measured using the Bayley Scales of Infant and Toddler Development, 3rd Edition. Secondary outcomes were: (1) medical factors throughout the hospitalization; (2) neurobehavior; and (3) cerebral injury and maturation (determined by magnetic resonance imaging and electroencephalography). RESULTS At term equivalent age, infants in private rooms were characterized by a diminution of normal hemispheric asymmetry and a trend toward having lower amplitude integrated electroencephalography cerebral maturation scores (P = .02; β = -0.52 [CI -0.95, -0.10]). At age 2 years, infants from private rooms had lower language scores (P = .006; β = -8.3 [CI -14.2, -2.4]) and a trend toward lower motor scores (P = .02; β = -6.3 [CI -11.7, -0.99]), which persisted after adjustment for potential confounders. CONCLUSION These findings raise concerns that highlight the need for further research into the potential adverse effects of different amounts of sensory exposure in the NICU environment.
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Affiliation(s)
- Roberta Pineda
- Department of Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
,Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jeff Neil
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
,Department of Neurology, Washington University School of Medicine, St Louis, Missouri
,Department of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Donna Dierker
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St Louis, Missouri
| | - Chris Smyser
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
,Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Michael Wallendorf
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Lauren Reynolds
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri
| | - Stephanie Walker
- Department of Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
| | - Cynthia Rogers
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Amit Mathur
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - David Van Essen
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St Louis, Missouri
| | - Terrie Inder
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
,Department of Neurology, Washington University School of Medicine, St Louis, Missouri
,Department of Radiology, Washington University School of Medicine, St Louis, Missouri
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Broom M, Brady B, Kecskes Z, Kildea S. World Café Methodology engages stakeholders in designing a Neonatal Intensive Care Unit. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jnn.2012.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The purpose of this chapter on human factors in critical care medical environments is to provide a systematic review of the human factors and ergonomics contributions that led to significant improvements in patient safety over the last five decades. The review will focus on issues that contributed to patient injury and fatalities and how human factors and ergonomics can improve performance of providers in critical care. Given the complexity of critical care delivery, a review needs to cover a wide range of subjects. In this review, I take a sociotechnical systems perspective on critical care and discuss the people, their technical and nontechnical skills, the importance of teamwork, technology, and ergonomics in this complex environment. After a description of the importance of a safety climate, the chapter will conclude with a summary on how human factors and ergonomics can improve quality in critical care delivery.
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Maguire DJ, Burger KJ, O'Donnell PA, Parnell L. Clinician perceptions of a changing hospital environment. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2013; 6:69-79. [PMID: 23817907 DOI: 10.1177/193758671300600306] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purposes of this study were to describe how a move into a new hospital influenced the work environment, how long it takes clinicians to adjust to such a significant change, and how much a new hospital work environment helps the practice shift toward patient- and family-centered care (PFCC). BACKGROUND Creating a healthy work environment to keep patients safe and staff engaged in the mission of the organization is perhaps one of the most important roles of hospital administrators and nursing leaders. METHODS A descriptive and comparative design was used to investigate how clinicians perceive, evaluate, and adjust to a new hospital environment, and how much a healthy work environment helps the practice shift toward patient- and family-centered care. RESULTS Perceived stress was significantly higher than baseline 15 months after the move into the new hospital (p < 0.0000), and employees with 3 or more years of service had significantly higher stress than others (p < 0.000). Nurses had the second lowest mean stress score (x = 12.5). The PFCC score increased significantly (p < 0.007). CONCLUSIONS The single-patient room model increased the workload of many clinicians, and their stress increased after 15 months. There were additional burdens not measured that also may have added to the stress of the participants. The new hospital enabled a significant practice shift toward PFCC. KEYWORDS Healing environments, organizational transformation, patient-centered care, pediatric, satisfaction.
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Affiliation(s)
- Denise J Maguire
- CORRESPONDING AUTHOR: Denise Maguire, College of Nursing, University of South Florida, Tampa, Florida; ; (813) 396-9962
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Abstract
OBJECTIVE Assess the attitudes and perceptions of parents and healthcare providers regarding the neonatal intensive care unit (NICU) environment while transitioning from an open ward (OW) to private-room (PR) NICU. STUDY DESIGN Parents and staff were surveyed 6 months before and 1 and 8 months after moving from OW to PR in a Level III NICU in 2009. Questions were scored on a 0 to 10 scale in areas of teamwork, communication, development, facility, safety and privacy. RESULTS In OW, parents and medical staff were satisfied with the teamwork. After 1 month in the PR, advanced practitioners reported higher scores whereas nurses reported declines in teamwork and safety but gains in other areas. Advanced practitioners' scores did not vary between surveys in the PR. Nurses were initially satisfied with the PR, but by 8 months, the scores declined. Parental satisfaction scores were consistently higher than medical staff in both settings. CONCLUSIONS Parental satisfaction is likely due to focus on their infant rather than facilities. In the PR, lower nursing scores are likely due to decreased interaction with peers. Research is needed to ensure that improvements gained from a PR NICU are meaningfully consistent.
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Pickler RH, McGrath JM, Reyna BA, Tubbs-Cooley HL, Best AM, Lewis M, Cone S, Wetzel PA. Effects of the neonatal intensive care unit environment on preterm infant oral feeding. RESEARCH AND REPORTS IN NEONATOLOGY 2013; 2013:15-20. [PMID: 25552910 DOI: 10.2147/rrn.s41280] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the effect of neonatal intensive care unit environmental characteristics (perceived levels of light and sound, and time of day) in open unit wards and single-family rooms (SFRs) on oral feeding outcomes in preterm infants. DESIGN Data were collected at each scheduled oral feeding for 87 preterm infants from the first oral feeding until discharge. Data included the prescribed volume of feeding and the volume consumed, the infant's level of wakefulness before feeding, and the nurse's perception of light and sound. RESULTS Data were collected on 5111 feedings in the ward unit and 5802 in the SFR unit from feedings involving 87 preterm infants. Light and sound were rated significantly lower in the SFR (χ2 = 139 and 1654.8, respectively). Feeding times of 9 am, 12 noon, and 3 pm were associated with the highest perceived levels of light and sound, regardless of unit design (P < 0.0001). Moderate light levels and feeding times of 12, 3, and 6 am were associated with improved feeding outcomes. Infants consumed a greater proportion of their prescribed feeding volume when fed in the open ward and when awake before feeding. CONCLUSION Further study on the clinical effects of unit design is needed, as is study on the effects of environmental stimuli, so that interventions can be appropriately developed and tailored for infants needing the most support for optimal development.
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Affiliation(s)
- Rita H Pickler
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jacqueline M McGrath
- School of Nursing, University of Connecticut and Connecticut Children's Medical Center, Hartford, CT, USA
| | - Barbara A Reyna
- VCU Medical Center, Children's Hospital of Richmond, Richmond, VA, USA
| | - Heather L Tubbs-Cooley
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ai M Best
- School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
| | - Mary Lewis
- VCU Medical Center, Children's Hospital of Richmond, Richmond, VA, USA
| | - Sharon Cone
- VCU Medical Center, Children's Hospital of Richmond, Richmond, VA, USA
| | - Paul A Wetzel
- School of Engineering, Virginia Commonwealth University, Richmond, VA, USA
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Altimier L, Phillips RM. The Neonatal Integrative Developmental Care Model: Seven Neuroprotective Core Measures for Family-Centered Developmental Care. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2012.12.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Stichler J. Designs for the most vulnerable of patients. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2012; 5:60-3. [PMID: 23224806 DOI: 10.1177/193758671200500405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mothers' experiences expressing breast milk for their preterm infants: does NICU design make a difference? Adv Neonatal Care 2012. [PMID: 23187646 DOI: 10.1097/anc.0b013e318265b299] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study examined differences in outcomes of provision of mothers' milk before and after implementation of a single-family room (SFR) neonatal intensive care unit (NICU) and described issues related to long-term milk expression. SAMPLE The sample included 40 mothers (15 in the original NICU and 25 in the SFR NICU). DESIGN Descriptive comparative. METHODS Mothers were recruited 2 months before and 3 months after opening an SFR NICU. Nutritional data were collected throughout hospitalization. Mothers used a milk expression diary during hospitalization and completed a survey, "My Experiences With Milk Expression" immediately before infant discharge. RESULTS Seventy-five percent of mothers planned to express breast milk or breastfeed before delivery. The majority of the mothers (55%) were most comfortable pumping in their own homes because of the increased privacy. There were no statistically significant differences between the 2 groups regarding the place where they were most comfortable pumping or where they usually pumped, although more mothers pumped in their babies' rooms in the SFR NICU. The majority of the mothers reported concern about their milk supply at some time during hospitalization and 47.5% reported having breast problems. At discharge, 71.8% of the total group was providing some breast milk and 44.7% of the total group was providing breast milk exclusively. There were no significant differences between the groups in outcomes concerning the provision of breast milk. CONCLUSIONS Individual mother's needs for privacy need to be determined and interventions to support mothers' feeding plans throughout hospitalization and at discharge need to be developed.
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Impact of the design of neonatal intensive care units on neonates, staff, and families: a systematic literature review. J Perinat Neonatal Nurs 2012; 26:260-6; quiz 267-8. [PMID: 22843008 DOI: 10.1097/jpn.0b013e318261ca1d] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Newborn intensive care is for critically ill newborns requiring constant and continuous care and supervision. The survival rates of critically ill infants and hospitalization in neonatal intensive care units (NICUs) have improved over the past 2 decades because of technological advances in neonatology. The design of NICUs may also have implications for the health of babies, parents, and staff. It is important therefore to articulate the design features of NICU that are associated with improved outcomes. The aim of this study was to explore the main features of the NICU design and to determine the advantages and limitations of the designs in terms of outcomes for babies, parents, and staff, predominately nurses. A systematic review of English-language, peer-reviewed articles was conducted for a period of 10 years, up to January 2011. Four online library databases and a number of relevant professional Web sites were searched using key words. There were 2 main designs of NICUs: open bay and single-family room. The open-bay environment develops communication and interaction with medical staff and nurses and has the ability to monitor multiple infants simultaneously. The single-family rooms were deemed superior for patient care and parent satisfaction. Key factors associated with improved outcomes included increased privacy, increased parental involvement in patient care, assistance with infection control, noise control, improved sleep, decreased length of hospital stay, and reduced rehospitalization. The design of NICUs has implications for babies, parents, and staff. An understanding of the positive design features needs to be considered by health service planners, managers, and those who design such specialized units.
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