Medical staff's sentiments on the establishment of quiet time in the NICU

Nurses' perspectives on implementing sleep protection for premature infants in the neonatal intensive care unit: a qualitative study

BACKGROUND

The normal development of sleep-wake cycles is crucial for the long-term neurological health of preterm infants, yet sleep protection practices remain suboptimal. Given China's large population of preterm infants and its distinct cultural background and healthcare policies compared to Western countries, NICU nurses in China may face unique challenges. However, our understanding of the barriers and facilitators encountered by nurses in implementing sleep protection for preterm infants is limited.

METHODS

From November 2023 to February 2024, we conducted semi-structured interviews with 15 nurses at a tertiary children's hospital in China. The interview guide was based on the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Data analysis employed inductive thematic analysis, aligning the findings with the COM-B model and the Theoretical Domains Framework (TDF) to identify key barriers to effective management and potential interventions.

RESULTS

Three major themes emerged: (1) Capability: Lack of knowledge among practitioners; Limited communication with parents; Inability to understand the cues of the baby; and Developing guidelines to support decision-making; (2) Opportunity: Time constraints; Poor interdisciplinary collaboration; Lower priority for sleep; and Additional medical expenses; (3) Motivation: Positive management attitude; Organizational expectations and support; Professional sense of responsibility; and Being an example to peers.

CONCLUSION

To improve sleep protection for preterm infants in NICU settings, it is imperative to address several key barriers. Firstly, elevating the priority of sleep protection is essential. Specifically, a comprehensive strategy focusing on enhancing healthcare professionals' knowledge and skills, promoting multidisciplinary collaboration, strengthening communication with parents, and optimizing human resource allocation is crucial for effectively implementing sleep protection measures.

TRIAL REGISTRATION

Not required.

Pain management in hospitalized infants: recommendations for achieving the Sustainable Development Goals

OBJECTIVE

to assess pain management in infants in a Neonatal Intensive Care Unit (NICU) and discuss its articulation with the Sustainable Development Goals, with a focus on promoting neonatal well-being.

METHOD

a documentary study, retrospective in nature and quantitative approach, conducted in a NICU of a public hospital in Paraná, Brazil, between January and July 2022, with 386 medical records of infants, hospitalized for more than 24 hours, between 2019 and 2021. Data were subjected to descriptive and inferential analysis, considering p-value<0.05 as a statistical difference. National ethical guidelines were respected.

RESULTS

all infants underwent at least one painful procedure, but only 13.7% had documented pain. Pharmacological interventions, such as fentanyl (25.9%), and non-pharmacological interventions, such as breastfeeding encouragement (86%) were used. Only 2.8% were reassessed.

CONCLUSION

there was a devaluation of neonatal pain management that may perpetuate neonatal well-being and sustainable development.

Reducing Noise in the NICU

BACKGROUND

In the neonatal intensive care unit (NICU), elevated noise negatively impacts the neurodevelopmental environment, interrupts sleep, and can affect brain development in neonates. The American Academy of Pediatrics recommends that noise levels in the NICU should not exceed 45 dB.

PURPOSE

The project aims were to: (1) decrease average noise level by 10% from baseline and (2) decrease exposure to severe noise (>65 dB) to <5% of the time.

METHODS

This quality improvement project was conducted during 2021-2022 as a pre/post observational design in a Level IV NICU in New York City. We monitored sound levels for 20-24 h, 5 d/wk. Quality improvement interventions included: novel approaches to staff education, visual cues for when noise thresholds were exceeded, parent education, including access to personal decibel meters, technical improvements to vital sign monitors and entry doors, and defined quiet times (HUSH) for 2 h each 12-hour shift.

RESULTS

Education efforts and technical improvements successfully reduced median noise levels within the stepdown unit ( P < .001), though not in the acute care NICU. In contrast, the implementation of 2-hour periods of enforced "quiet time" every 12 h effectively reduced both median noise levels and the incidence of severe noise (>65 dB) in both locations.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The HUSH strategy may be a sustainable way to decrease noise in the NICU. Future projects should prioritize education and dedicated quiet times to align with recommended standards, while research should explore the long-term developmental impacts of excessive noise levels on neonatal growth.

Impact of Quiet Time on Psychological Outcomes of Neonatal Intensive Care Unit Nurses in Jeddah, Saudi Arabia: A Cross-Sectional Study

BACKGROUND AND OBJECTIVE

Although quiet time is implemented in neonatal intensive care units (NICUs) for the benefit of infants, it may also positively impact the psychological outcomes of healthcare professionals. Several studies have examined the impact of quiet-time implementation on patients; however, there is a paucity of research assessing its impact on the psychological outcomes of NICU nurses, particularly in Saudi Arabia.

OBJECTIVE AND METHODS

This study aimed to assess the impact of quiet time on the psychological outcomes (stress, anxiety, and depression) of NICU nurses in Jeddah, Saudi Arabia. A cross-sectional design was used for this study. A total of 87 NICU nurses from two hospitals participated in this study. One group did not practice quiet time, while the second group did. A questionnaire survey assessed participants' demographic characteristics, and their depression, anxiety, and stress were assessed using the depression, anxiety, and stress scale-21 (DASS-21). The data were analyzed for frequency, percentage, mean, and standard deviation (SD). Bivariate analysis, independent t-tests, and one-way analysis of variance were used to test the differences between variables and groups. Pearson's correlation coefficient (r) was used to analyze the relationships between continuous variables and perceived stress, anxiety, and depression.

RESULTS

A substantial number of NICU nurses perceived stress, anxiety, and depression; however, there were no significant differences in perceived stress, anxiety, and depression between the nurses who worked in NICUs that applied quiet time and NICUs that did not (P ≤ 0.05).

CONCLUSION

This study found no statistically significant relationship between quiet-time implementation and perceived stress, anxiety, or depression among NICU nurses. Further research with a larger sample size or increased quiet-time implementation may be required.