NICU Nurses' Stress and Work Environment in an Open Ward Compared to a Combined Pod and Single-Family Room Design

Relationships of nursing stress and trait emotional intelligence with mental health in neonatal intensive care unit nurses: A cross-sectional correlational study

BACKGROUND

The neonatal intensive care unit (NICU) is a stressful and emotionally laden environment, but the relationships between nursing stress, emotional intelligence, and mental health have not been studied in NICU nurses.

OBJECTIVES

The study aimed to determine (i) whether nursing stress and trait emotional intelligence controlled for the five-factor model of personality predict mental health in NICU nurses and (ii) whether trait emotional intelligence buffers the effect of nursing stress on mental health.

METHODS

A cross-sectional correlational study in 123 (28%) of 440 eligible NICU nurses using self-report questionnaire measures of nursing stress (Nursing Stress Scale), trait emotional intelligence (Assessing Emotions Scale), and psychological distress and emotional well-being (Mental Health Inventory). The data were analysed using hierarchical multiple regression and moderation analyses.

RESULTS

The hierarchical multiple regressions showed nursing stress predicted psychological distress (ΔR2 = .11) and emotional well-being (ΔR2 = .10) at Step 1. The five-factor model of personality explained further variance in psychological distress (ΔR2 = .27) and emotional well-being (ΔR2 = .26) at Step 2. Finally, trait emotional intelligence predicted further increments in psychological distress (ΔR2 = .05) and emotional well-being (ΔR2 = .08) at Step 3. The optimism (expecting good things to occur in one's life) and mood regulation (dampening, repairing and maintaining emotions) subdimension of trait emotional intelligence predicted psychological distress (β = -.29) and emotional well-being (β = .41) in the final models of the hierarchical multiple regressions. Trait emotional intelligence did not moderate the effect of nursing stress on psychological distress or emotional well-being.

CONCLUSIONS

NICU managers and educators should seek to remedy controllable work-related stressors and support NICU nurses' emotional competence because these respective environmental and personal factors predict mental health in these nurses.

A unit's experience with hybrid NICU design: description of care model and implications for patients, families, and professionals

As the first extra-uterine setting for hospitalized infants, the neonatal intensive care unit (NICU) environment can make a lasting impact on their long-term neurodevelopment. This impact is likely mediated through both specific characteristics of the physical design of the care environment, as well as the experiences that occur within this environment. Recent studies document many established benefits of single-family rooms (SFRs). However, there is concern that infants who spend a prolonged time in SFRs without their parents being intimately involved in their care have reduced opportunities for meaningful experiences, with possible adverse consequences. The purpose of this report is to share an example of an application of the family-centered developmental care model through a hybrid NICU design, inclusive of both SFRs and semi-private bays. In this paper, we empirically describe the physical and operational considerations of a hybrid model, outline the strengths and challenges of this approach, and discuss implications for patients, families, and professionals.

Integrating Neonatal Intensive Care Into a Family Birth Center: Describing the Integrated NICU (I-NIC)

BACKGROUND

Parent-infant separation resulting from admission to a neonatal intensive care unit (NICU) is often reported as the most challenging and distressing experience for parents. Aiming to mitigate the stress of parent-infant separation, a new neonatal care model was designed to integrate NIC with delivery and postpartum care. Yet, little is known about the model and its implementation.

METHODS

Using a qualitative descriptive design with field observations, we describe the characteristics of an integrated-neonatal intensive care (I-NIC) model and examined perceptions of clinical staff (n = 8) and parents (n = 3).

RESULTS

The physical layout of the I-NIC rooms required additional oxygen and suction columns and new signage to specify them as NICU-equipped. Other NICU-related equipment was mobile, thus moved into rooms when necessary. Nurses were cross-trained in labor/delivery, postpartum, neonatal care; however, nurses primarily worked within their specific area of expertise. Clinician and parent perceptions of the model were notably positive, reporting decreased anxiety related to separation, increased ability for chest feeding and skin-to-skin care, and improved interdisciplinary care.

CONCLUSION

Future work is needed to understand implementation of the model in other settings, with specific attention to unit architecture, level of NICU care services, patient census, and staff and patient outcomes.

Fewer Patients per Nurse Does Not Offset Increased Nurse Stress Related to Treatment Uncertainty and Mortality in the Neonatal Intensive Care Unit

BACKGROUND

Many inpatient healthcare institutions' nurse staffing plans systematically assign fewer patients to nurses when patient acuity is high, but the impact of this strategy on components of nurse stress has not been thoroughly investigated.

PURPOSE

To examine the relationship between nurse-to-patient ratio assigned based on NICU patient acuity with the Nurse Stress Scale (NSS) subscales Death and Dying, Conflict with Physicians, Inadequate Preparation, Lack of Support, Conflict with Other Nurses, Work Load, and Uncertainty Concerning Treatment.

METHODS

A survey including the NSS tool items, demographic questions, and a question about nurse-to-patient ratio during the shift was administered. Cronbach's α, linear regression, and Spearman's correlation were used for data analysis.

RESULTS

Analysis of the 72 participating NICU nurses' survey responses showed fewer patients per nurse during the shift was negatively correlated with stress related to Death and Dying ( P < .001) and Uncertainty Concerning Treatment ( P = .002) subscale scores. This inverse relationship remained significant after controlling for education and years of experience.

IMPLICATIONS FOR PRACTICE

The observed higher stress can be inferred to be due to high patient acuity since fewer patients are assigned to nurses caring for high-acuity patients. Improvements in communication to nurses about patients' medical condition, treatment rationale, and information that should be conveyed to the family could reduce nurse stress from treatment uncertainty. Targeted education and counseling could help nurses cope with stress due to patient deaths.

IMPLICATIONS FOR RESEARCH

Interventions to reduce stress related to treatment uncertainty and death of patients among NICU nurses caring for high-acuity infants should be developed and evaluated.

Staff perceptions and challenges of the single-family room design- experience of a greenfield level 4 neonatal intensive care unit in the Middle East

AIM

This study was undertaken to specifically identify challenges associated with the popular single-family room (SFR) design in our new neonatal intensive care unit (NICU), so as to reap the full benefits of this architectural model.

METHODS

A survey was sent to all 223, newly recruited staff on our NICU. Questions explored staff perceptions of family experience, safety, and staffs' experience of the SFR in comparison to the open bay model.

RESULTS

We obtained a response rate of 66%. Most staff perceived SFR as having a positive impact on communication with families, privacy, feasibility for skin-to-skin contact, reduction in noise levels, and family access to their baby. There were however concerns raised about patient safety and isolation of staff and families in the SFR architecture. Lack of opportunities to leave the patient room for breaks, and increased physical demands were highlighted. Staff also felt physically and emotionally less well supported.

CONCLUSION

Whilst the SFR configuration was felt to be beneficial for infants and families, staff shared their perceived concerns regarding infant safety and isolation and staff satisfaction, and implied modifications to workflows. The survey findings resulted in re-organization of our staff numbers and communication systems and further facilitation of parent interactions in order to optimize benefits of SFR design.

Unintended Consequences of the Neonatal Intensive Care Unit Environment: Integrative Review of Single-Family Room Unit Design

BACKGROUND

Recent trends in neonatal intensive care unit design have been directed toward reducing negative stimuli and creating a more developmentally appropriate environment for infants who require intensive care. These efforts have included reconfiguring units to provide private rooms for infants.

PURPOSE

The purpose of this integrative review was to synthesize and critically analyze negative outcomes for patients, families, and staff who have been identified in the literature related to single-family room (SFR) care in the neonatal intensive care unit.

METHODS/SEARCH STRATEGY

The electronic databases of CINAHL, ProQuest Nursing & Allied Health, and PubMed databases were utilized. Inclusion criteria were research studies in English, conducted from 2011 to 2021, in which the focus of the study was related to unit design (SFRs). Based on the inclusion criteria, our search yielded 202 articles, with an additional 2 articles found through reference list searches. After screening, 44 articles met our full inclusion/exclusion criteria. These studies were examined for outcomes related to SFR unit design.

FINDINGS/RESULTS

Our findings revealed both positive and negative outcomes related to SFR unit design when compared with traditional open bay units. These outcomes were grouped into 4 domains: Environmental Outcomes, Infant Outcomes, Parent Outcomes, and Staff Outcomes.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Although SFR neonatal intensive care unit design improves some outcomes for infants, families, and staff, some unexpected outcomes have been identified. Although these do not negate the positive outcomes, they should be recognized so that steps can be taken to address potential issues and prevent undesired outcomes.

Nurses' Perception of Preterm Infants' Pain and the Factors of Their Pain Assessment and Management

In the neonatal intensive care unit, preterm infants undergo many painful procedures. Although these can impair their neurodevelopment if not properly managed, only half of the painful procedures are optimally handled. This cross-sectional study aimed to evaluate nurses' perceptions of preterm infants' pain, to evaluate nurses' pain assessment and management practices, as well as to identify the individual and contextual factors that influence nurses' assessments and interventions for pain management. Secondary analyses, including a mixed-model analysis, were performed with data from a larger study (n = 202 nurses). Nurses were found to have attitudes and perceptions in favor of preterm infants' pain management, although they reported using few standardized instruments to assess pain. Nurses stated that they widely used sucrose, non-nutritive sucking, and positioning as pain management interventions, while skin-to-skin contact was rarely practiced. Nurses' attitudes and perceptions influenced their pain assessment practices, which predicted their implementation of interventions. Several contextual (country, level of care, and work shift) and individual factors (age, level of education, had a preterm infant, perceptions of family-centered care, and skin-to-skin contact) also predicted nurses' pain assessment and management practices.

The prevalence and influencing factors for compassion fatigue among nurses in Fangcang shelter hospitals: A cross-sectional study

AIM

We aim to investigate the prevalence and associated factors for compassion fatigue among nurses in Fangcang Shelter Hospitals in Wuhan. Studies have shown that compassion fatigue was more common among nurses than other health-care providers, and its predictors were also different. In recent years, most studies have investigated compassion fatigue in emergency and oncology nurses, whereas there is little information on compassion fatigue among nurses from the frontline of Fangcang Shelter Hospitals during the COVID-19 pandemic.

METHODS

A descriptive, cross-sectional design was used in this study. An online survey was conducted among nurses (n = 972) of five Fangcang Shelter Hospitals in Wuhan, Hubei province, China, from 6 March to 10 March 2020. A self-administered questionnaire including demographic information, work-related information, General Health Questionnaire, Perceived Stress Scale and Compassion Fatigue Scale was used.

RESULTS

The prevalence of compassion fatigue among nurses in Fangcang Shelter Hospitals was moderate, and most cases were mild. There was a significant relationship between compassion fatigue and work-related factors, mental health and perceived stress among nurses working in Fangcang Shelter Hospitals.

CONCLUSIONS

Various factors contribute to compassion fatigue, including lower job satisfaction and job adaptability, less praise from patients, more fear of infection and more perceived stress. A good working atmosphere, organizational support and psychological consultation are essential to alleviate nurses' compassion fatigue during the anti-epidemic period.

Emotional Intelligence and Perceived Health Related to Expressed Compassion Fatigue: A Study in Health Sector at Regional Level

Background: The work of health professionals often involves physical as well as psychological strain. They constantly deal with traumatic situations of pain and suffering, which destabilize the sense of well-being. Compassion fatigue is a feeling that appears in these cases and is related to other variables such as burnout or emotional drain.

Aims: The principal aim of this project was to deepen the analysis of compassion fatigue and how it could be explained through the relationship with other constructs such as emotional intelligence and perceived health.

Methods: This work followed the STROBE checklist for cross-sectional studies. In this study 1,521 nurses (M_age = 47.32; SD = 8.44) participated. The responses reported by the nurses were analyzed by classifying them as high or low compassion fatigue and the differences of both groups were analyzed for the variables of emotional intelligence, perceived health and quality of professional life.

Results: It was obtained significant differences for all factors except for emotional intelligence factor. A linear regression analysis showed both emotional intelligence and perceived health helped to explain (12%) compassion fatigue.

Conclusion: This study provides light on comprehending the conception of compassion fatigue. It highlights the importance of intervention programs that improve the quality of professional life.

Caregiver Presence and Involvement in a Canadian Neonatal Intensive Care Unit: An Observational Cohort Study

BACKGROUND

Presence in the neonatal intensive care unit (NICU) is a vital step for caregivers initiating involvement, such as skin-to-skin contact, holding or singing/reading to their newborn. Little is known about caregiver presence and involvement in Canadian NICU's context by caregiver type (mother, father, other), and the association between maternal presence and key maternal and newborn characteristics.

PURPOSE

The primary objective was to examine the presence and involvement of family caregivers in the NICU. The secondary objective was to examine the relationship between maternal presence and maternal and newborn characteristics.

DESIGN AND METHODS

A prospective observational cohort study in an open bay setting of an Eastern Canadian NICU. Presence (physically present at the newborn's bedside) and involvement (e.g., skin-to-skin, singing/reading) were tracked daily by families in the NICU until discharge. Demographic information was also collected.

RESULTS

Participants included 142 mothers and their newborns. Mothers were present 8.7 h/day, fathers were present 4.1 h/day, and other caregivers were present 1.8 h/day in the NICU in the first 34 days. Mothers were involved in care activities 50% of the time they were present in the NICU, whereas fathers and other caregivers were spending 20% and 6% of their time respectively. Regression identified maternal age, distance to home, parity, birthweight, and length of stay to be statistically significant variables related to maternal presence.

CONCLUSIONS

There is variation in presence and involvement by caregiver type. Targeted interventions to maintain and increase mothers, fathers and other caregivers' presence and involvement in care throughout their stay in the NICU are recommended.

Comparison of Psychological and Physiological Stress in NICU Nurses: Effects of Unit Design and Shift

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.

The Soundscape of Neonatal Intensive Care: A Mixed-Methods Study of the Parents' Experience

Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a comprehensive instrument to investigate the relationship between sounds in NICUs and parental stress. To address this gap, this report presents the “Soundscape of NICU Questionnaire” (SON-Q), which was developed specifically to capture parents’ perceptions and beliefs about the impact that sound had on them and their infants, from pre-birth throughout the NICU stay and in the first postdischarge period. Parents of children born preterm (n = 386) completed the SON-Q and the Perinatal PTSD Questionnaire (PPQ). Principal Component Analysis identifying underlying dimensions comprising the parental experience of the NICU soundscape was followed by an exploration of the relationships between subscales of the SON-Q and the PPQ. Moderation analysis was carried out to further elucidate relationships between variables. Finally, thematic analysis was employed to analyse one memory of sounds in NICU open question. The results highlight systematic associations between aspects of the NICU soundscape and parental stress/trauma. The findings underscore the importance of developing specific studies in this area and devising interventions to best support parents’ mental health, which could in turn support infants’ developmental outcomes.

Emotional Work of Neonatal Nurses in a Single-Family Room NICU

OBJECTIVE

To describe the emotional work of neonatal nurses in a single-family room NICU.

DESIGN

Qualitative interpretive description.

SETTING

A single-family room NICU in the mid-Atlantic region of the United States.

PARTICIPANTS

Fifteen nurses who worked in the single-family room NICU.

METHODS

Data were collected from 110 hours of direct observation and 11 interviews over a 6-month period. We focused on emotional demands using triangulation between interviews and observations to identify themes. Conceptualization of emotional work informed interpretation.

RESULTS

Four themes emerged: Parents Living on the Unit, Isolation of Infants in Rooms, Nurses' Ability to Form Bonds and Establish Trust With Parents, and Sheltering Nurses and Parents From Stressful Events on the Unit. Parents living on the unit and the isolation of infants in private rooms increased the emotional work of nurses. Forming trust and bonds with parents and sheltering parents and themselves from stressful events on the unit decreased nurses' emotional work.

CONCLUSION

Care should be taken in NICU design because unit layout can affect the emotional work of nurses. Understanding how neonatal nursing practice is affected by unit layout can help nurses and those who design NICUs to create and promote optimal practice environments.

Occupational Factors Associated with Health-Related Quality of Life in Nursing Professionals: A Multi-Centre Study

Background: Nursing professionals are exposed to stressful situations arising from the work context that may affect health-related quality of life (HRQoL). The objective of this study was to analyse the relationship between sociodemographic and work-related variables regarding HRQoL in nursing professionals. Methods: A multi-centre, cross-sectional descriptive design was used. The participants consisted 1521 nurses working in healthcare centres, in both primary care and hospital care, in the eight provinces of the Andalusian Public Health System (APHS), Spain. Sociodemographic and work-related variables were analysed: Compassion fatigue, compassion satisfaction and burnout were measured using the professional quality of life questionnaire (ProQOL), and HRQoL was measured using the SF-12 health questionnaire. Results: Compassion fatigue, burnou, and, to a lesser extent, compassion satisfaction significantly influence the physical and mental components of HRQoL. The simple regression analysis showed that burnout and compassion fatigue were significantly associated with the mental component of HRQoL. Gender influenced the mental component of HRQoL. The rest of the sociodemographic and work-related variables were not significantly related to HRQoL. Conclusion: Work-related stress and repeated contact with situations of suffering influence HRQoL. Health systems must implement programmes to increase the emotional well-being of workers.