Including parents in the evaluation of clinical microsystems in the neonatal intensive care unit

Examining Efficiency in Open-Bay and Single-Family Room NICU Designs

BACKGROUND

There is growing awareness of the relationship between physical work environments and efficiency. Two conflicting factors shape efficiency in the neonatal intensive care unit (NICU) environment: the move to single-family rooms (SFRs) and increased demand for care, requiring growth in unit size.

PURPOSE

The goal of this research was to understand the impact of SFR NICUs on efficiency factors such as unit design, visibility and proximity, staff time, and workspace usage by various health professionals.

METHODS

A pre-/postoccupancy evaluation assessed a NICU moving from an open-bay to an SFR unit composed of 6 neighborhoods. A NICU patient care manager and researchers in design and communication implemented a multimethodological design using staff surveys, observations, and focus groups.

RESULTS

Outcomes revealed SFR NICUs contribute to increased efficiency and overall satisfaction with design. Outside of staff time spent in patient rooms, decentralized nurse stations were the most frequented location for staff work, followed by huddle stations, medication and supply rooms, and corridors. Work at the observed locations was largely performed independently. Survey outcomes reported increased feelings of isolation, but focus groups revealed mixed opinions regarding these concerns.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Design solutions found to enhance efficiency include a neighborhood unit design, standardized access to medications and supplies, and proximity of supplies, patient rooms, and nurse workstations. Although feelings of isolation were reported and most staff work was done independently in the patient room, the SFR unit might not be the culprit when considered alongside staff's desire to be closer to the patient room.

Data-Driven Nurse Staffing in the Neonatal Intensive Care Unit

ABSTRACT

The challenge of nurse staffing is amplified in the acute care neonatal intensive care unit (NICU) setting, where a wide range of highly variable factors affect staffing. A comprehensive overview of infant factors (severity, intensity), nurse factors (education, experience, preferences, team dynamics), and unit factors (structure, layout, shift length, care model) influencing pre-shift NICU staffing is presented, along with how intra-shift variability of these and other factors must be accounted for to maintain effective and efficient assignments. There is opportunity to improve workload estimations and acuity measures for pre-shift staffing using technology and predictive analytics. Nurse staffing decisions affected by intra-shift factor variability can be enhanced using novel care models that decentralize decision-making. Improving NICU staffing requires a deliberate, systematic, data-driven approach, with commitment from nurses, resources from the management team, and an institutional culture prioritizing patient safety.

Introduction of microsystems in a level 3 neonatal intensive care unit-an interprofessional approach

Background

Growth of neonatal intensive care units in number and size has raised questions towards ability to maintain continuity and quality of care. Structural organization of intensive care units is known as a key element for maintaining the quality of care of these fragile patients. The reconstruction of megaunits of intensive care to smaller care units within a single operational service might help with provision of safe and effective care.

Methods/Design

The clinical team and patient distribution lay out, admission and discharge criteria and interdisciplinary round model was reorganized to follow the microstructure philosophy. A working group met weekly to formulate the implementation planning, to review the adaptation and adjustment process and to ascertain the quality of implementation following the initiation of the microsystem model.

Discussion

In depth examination of microsystem model of care in this study, provides systematic evaluation of this model on variable aspects of health care. The individual projects of this trial can be source of solid evidence for guidance of future decisions on optimized model of care for the critically ill newborns.

Trial registration

ClinicalTrial.gov, NCT02912780. Retrospectively registered on 22 September 2016.

Who is Billy Reuben? Health literacy and patient education

The issue of health literacy is focused on whether health consumers understand and are able to apply the information provided to them. In the neonatal setting, limited parent and caregiver health literacy can result in increased stress and poor compliance with instructions. Health literacy and patient education go hand in hand. This article includes an overview of health literacy and how it applies to the neonatal setting. Information is provided to assist with assessing for health literacy. Hints and resources are also provided for improving patient and family education.

The gas cylinder, the motorcycle and the village health team member: a proof-of-concept study for the use of the Microsystems Quality Improvement Approach to strengthen the routine immunization system in Uganda

Background

Although global efforts to support routine immunization (RI) system strengthening have resulted in higher immunization rates, the World Health Organization (WHO) estimates that the proportion of children receiving recommended DPT3 vaccines has stagnated at 80% for the past 3 years (WHO Fact sheet—Immunization coverage 2014, WHO, 2014). Meeting the WHO goal of 90% national DPT3 coverage may require locally based strategies to support conventional approaches. The Africa Routine Immunization Systems Essentials-System Innovation (ARISE-SI) initiative is a proof-of-concept study to assess the application of the Microsystems Quality Improvement Approach for generating local solutions to strengthen RI systems and reach those unreached by current efforts in Masaka District, Uganda.

Methods

The ARISE-SI intervention had three components: health unit (HU) advance preparations, an action learning collaborative, and coaching of improvement teams. The intervention was informed and assessed using qualitative and quantitative methods. Data collection focused on changes and outcomes of improvement efforts among five HUs and one district-level team during the intervention (June 2011–February 2012) and five follow-up months.

Results

Workshops and team meetings had a 95% attendance rate. All teams gained RI system knowledge and implemented changes to address locally identified problems. Specific changes included: RI register implementation and expanded use, Child Health Card provision and monitoring, staff cross-training, staffing pattern changes, predictable outreach schedules, and health system leader—community leader meetings. Several RI system barriers prevalent across Masaka District (e.g., lack of backup HU gas cylinders, inadequate outreach transportation, and village health team underutilization) were successfully addressed. Three of five HUs significantly increased the vaccines administered. All improvements were sustained 5 months post-intervention. External evaluation validated the findings of high levels of participant engagement, empowerment to make change, and willingness to sustain improvements.

Conclusions

The Microsystems Quality Improvement Approach is a comprehensive approach, grounded in systems thinking, and coupled with intensive coaching. It provides a robust framework for engaging teams in the development of unique local solutions that strengthen RI systems in resource poor settings. The sustained improvements in local RI systems from this study provide evidence that this approach may be an effective framework for enhancing the WHO’s Reaching Every District (RED) immunization strategy.

Effect of Family-centered Care on Improving Parental Satisfaction and Reducing Readmission among Premature Infants: A Randomized Controlled Trial

INTRODUCTION

Healthcare quality is usually evaluated through analysing medical outcomes including neonatal readmission and patient and family satisfaction. Parental involvement in neonatal care is considered as one of the most important factors, which directly affects these outcomes. The aim of the present study was to determine the effect of family-centered care including maternal participation, presence, and information about neonatal care, on maternal satisfaction and neonatal readmission; the care services were provided by the primiparous mothers of preterm infants.

MATERIALS AND METHODS

One hundred and ten primiparous mothers with preterm infants participated in this clinical trial. All samples were randomly divided into family-centered care (FCC) and control groups, through simple random sampling. The FCC program, which consisted of information about neonatal care, maternal presence, and participation in the care process, was implemented in the FCC group, while the control group was provided with routine care. Data were obtained using demographic and satisfaction questionnaires and readmission checklist.

RESULTS

In the FCC group, the mean score of satisfaction increased after the implementation of the program (22.36 and 59.28 before and after the program, respectively) (p<0.001); however, this increase in the control group was not significant. The obtained results regarding the different aspects of satisfaction indicated that mothers in the FCC group were more satisfied with maternal presence in the neonatal intensive care unit (NICU), compared with aspects of information and participation. In addition, the number of neonatal readmission was less in the FCC group compared with the control group, and the mean duration of hospitalization was 6.96 and 12.96 days in the FCC and control groups, respectively (p<0.001).

CONCLUSION

FCC program seems to be effective in increasing maternal satisfaction and decreasing neonatal readmission. Therefore, it seems necessary that healthcare authorities of the departments of obstetrics and gynecology in Iran provide the opportunity for the implementation of such programs in clinical environments, which follow the policy of parental absence and participation in the intensive care units.

Maternal and neonatal nurse perceived value of kangaroo mother care and maternal care partnership in the neonatal intensive care unit

BACKGROUND

Kangaroo Mother Care (KMC) enhances infant and maternal well-being and requires maternal-care partnerships (MCP) for implementation.

OBJECTIVE

To examine maternal and neonatal nurse provider perspectives on the value of KMC and MCP.

STUDY DESIGN

Prospective cohort design of neonatal nurses and mothers of preterm infants self-report anonymous questionnaire. Analyses of categorical independent variables and continuous variables were calculated.

RESULTS

In all, 82.3% of nurses (42) and 100% (143) of mothers participated in the survey. compared with 18% of nurses, 63% of mothers believed "KMC should be provided daily" and 90% of mothers compared with 40% of nurses strongly believed "mothers should be partners in care." In addition, 61% of nonwhite mothers identified that "KMC was not something they were told they could do for their infant" compared with 39% of white mothers. Nonwhite and foreign-born nurses were 2.8 and 3.1 times more likely to encourage MCP and KMC.

CONCLUSION

Mothers held strong positive perceptions of KMC and MCP value compared with nurses. Nonwhite mothers perceived they received less education and access to KMC. Barriers to KMC and MCP exist among nurses, though less in nonwhite, foreign-born, and/or nurses with their own children, identifying important provider educational opportunities to improve maternal KMC access in the NICU.

Development and validation of a neonatal intensive care parent satisfaction instrument

OBJECTIVE

To develop and test the psychometric properties of the EMPATHIC-N (EMpowerment of PArents in THe Intensive Care-Neonatology) questionnaire measuring parent satisfaction.

DESIGN

A psychometric study testing the reliability and validity of a parent satisfaction questionnaire by applying confirmatory factor analysis including standardized factor loadings and subsequently Cronbach's α reliability estimates across time, congruent validity, and nondifferential validity testing.

SETTING

A 30-bed neonatal intensive care unit in a university hospital.

PATIENTS

Two cohorts with a total of 441 parents whose child was admitted to the neonatal intensive care unit, January to December 2009.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

In the first cohort, 220 of 339 (65%) parents responded; in the second cohort, 59 of 102 (58%) parents responded. Structural equation modeling and confirmatory factor analysis resulted in a sufficient model fit of 57 statements within five domains: Information, Care & Treatment, Organization, Parental Participation, and Professional Attitude. Standardized factor loading of these statements were between 0.58 and 0.91. Reliability measures, Cronbach's α, of the domains ranged from 0.82 to 0.95. Reliability across time showed no evidence of statistically significant differences between the domains. Congruent validity was confirmed by a good correlation (p = .01) between the domains and four general satisfaction questions. Nondifferential validity showed no significant effect sizes between the infants' characteristics and the domains, except between ventilated infants and parent participation statements and infants ≥30 wks gestational age and organizational statements.

CONCLUSIONS

The EMPATHIC-N questionnaire is a valid quality performance indicator to measure the delivered care as perceived by parents.

The assessment of satisfaction with care in the perinatal period

Patient satisfaction is frequently used to evaluate the quality of medical care and to guide the development of health care services. Improved satisfaction is a goal recommended by the Institute of Medicine and the government of the United Kingdom for health care reform. During the perinatal period, dynamic changes in physical and psychological state impose unique challenges in the assessment of satisfaction. This article reviews the measurement of satisfaction with care, together with factors that may influence satisfaction and its measurement during the perinatal period. Recommendations are also provided for further research and development of satisfaction instruments and potential interventions to improve satisfaction with perinatal care.

A Comparison of Parent Satisfaction in an Open-Bay and Single-Family Room Neonatal Intensive Care Unit

Objective:

The purpose of this research was to test the hypothesis that parental satisfaction with neonatal intensive care is greater in a single-family room facility as compared with a conventional open-bay neonatal intensive care unit (NICU).

Methods:

This investigation was a prospective cohort study comparing satisfaction survey results for parents who responded to a commercially available parent NICU satisfaction survey following the provision of NICU care in open-bay and single-family room facilities. A subset of 16 items indicative of family-centered care was also computed and compared for these two NICU facilities.

Results:

Parents whose babies received care in the single-family room facility expressed significantly improved survey responses in regard to the NICU environment, overall assessment of care, and total survey score than did parents of neonates in the open-bay facility. With the exception of the section on nursing in which scores in both facilities were high, nonsignificant improvement in median scores for the sections on delivery, physicians, discharge planning, and personal issues were noted. The total median item score for family-centered care was significantly greater in the single-family room than the open-bay facility.

Conclusions:

Parental satisfaction with care in the single-family room NICU was improved in comparison with the traditional open-bay NICU. The single-family room environment appears more conducive to the provision of family-centered care. Improved parental satisfaction with care and the potential for enhanced family-centered care need to be considered in decisions made regarding the configuration of NICU facilities in the future.

Developing nurse/parent relationships in the NICU through negotiated partnership

OBJECTIVE

To explore parents' experience and satisfaction with care in the Neonatal Intensive Care Unit (NICU).

DESIGN

Qualitative design using an interpretive description method.

SETTING

A tertiary-level care 69-bed NICU.

PARTICIPANTS

Ten parents (nine mothers and one father) were interviewed.

METHOD

Parents were interviewed in person or via telephone, either following or close to discharge. Interviews were recorded, transcribed, and then analyzed using an evolving coding guide.

RESULTS

All parents indicated that the relationship they developed with the bedside nurse was the most significant factor affecting their satisfaction with their NICU experience. All parents described nursing actions of perceptive engagement, cautious guidance, and subtle presence, which facilitated the development of this relationship. Further analysis of the data revealed that parents portrayed nurses in ideal nurse/parent interactions as fulfilling the roles of teacher, guardian, and facilitator.

CONCLUSION

Developing a collaborative and effective nurse/parent relationship is the most significant factor affecting parents' satisfaction with their NICU experience. Providing nursing care in a manner that optimizes consistency and continuity of care facilitates the ability of both parties to develop this relationship.