The S.T.A.B.L.E.® Program: the evidence behind the 2012 update

Effect Analysis of In-Hospital Transfer Care Based on STABLE Technology in Critically Ill Newborns

Purpose

Analysis of the effectiveness of in-hospital transfer care based on the STABLE (sugar and safe care, temperature, airway, blood pressure, lab work, emotional support) technique in critically ill neonates.

Methods

Retrospective analysis of the case data of 180 critically ill neonates transferred to the NICU (neonatal intensive care unit) via the delivery room (operating room) in our hospital from April 2020 to December 2021. Of which, 88 newborns from April 2020 to February 2021 were resuscitated by conventional resuscitation and then transferred to the NICU by the nurses in the delivery room (operating room) through the green channel, and they were recorded as the control group; and 92 newborns from March to December 2021 were transferred to the NICU by the NICU transfer nurses who arrived at the delivery room (operating room) earlier and used the in-hospital transfer care based on STABLE technology, and they were recorded as the intervention group. The indicators to be assessed were the execution pass rate in the simulated assessment of the transfer emergency procedure for both groups of transporters, execution times of the various subprocesses during the transfer procedure for both groups of transporters, accidents in transit, and blood glucose, blood pressure, body temperature, respiration, blood gas indicators, and family satisfaction of children in both groups after transfer.

Results

The total execution pass rate for transporters was higher in the intervention group than in the control group (P < 0.05). The execution times of the various subprocesses during the transfer procedure of transporters were shorter in the intervention group than in the control group (P < 0.05). The incidence of accidents in transit was lower in the intervention group than in the control group (P < 0.05). After transfer, the blood glucose, blood pressure, body temperature, respiratory, and blood gas indicators of the children in the intervention group were all more stable than those in the control group (P < 0.05). The satisfaction of the families of the children in the intervention group was higher than that of the control group (P < 0.05).

Conclusion

The implementation of transfer care based on STABLE technology for newborns in urgent need of in-hospital transfer can effectively improve the comprehensive quality and emergency response ability of transfer nurses and shorten the in-hospital transfer time, and the incidence of adverse reactions during the transfer of children is less, the vital signs are stable, and the satisfaction of family members is high, which is of promotion value.

Critical care nursing role in low and lower middle-income settings: a scoping review

OBJECTIVES

A scoping review was conducted to answer the question: How is critical care nursing (CCN) performed in low-income countries and lower middle-income countries (LICs/LMICs)?

DESIGN

Scoping review guided by the JBI Manual for Evidence Synthesis.

DATA SOURCES

Six electronic databases and five web-based resources were systematically searched to identify relevant literature published between 2010 and April 2021.

REVIEW METHODS

The search results received two-stage screening: (1) title and abstract (2) full-text screening. For sources of evidence to progress, agreement needed to be reached by two reviewers. Data were extracted and cross-checked. Data were analysed, sorted by themes and mapped to region and country.

RESULTS

Literature was reported across five georegions. Nurses with a range formal and informal training were identified as providing critical care. Availability of staff was frequently reported as a problem. No reports provided a comprehensive description of CCN in LICs/LMICs. However, a variety of nursing practices and non-clinical responsibilities were highlighted. Availability of equipment to fulfil the nursing role was widely discussed. Perceptions of inadequate resourcing were common. Undergraduate and postgraduate-level preparation was poorly described but frequently reported. The delivery of short format critical care courses was more fully described. There were reports of educational evaluation, especially regarding internationally supported initiatives.

CONCLUSIONS

Despite commonalities, CCN is unique to regional and socioeconomic contexts. Nurses work within a complex team, yet the structure and skill levels of such teams will vary according to patient population, resources and treatments available. Therefore, a universal definition of the CCN role in LIC/LMIC health systems is likely unhelpful. Research to elucidate current assets, capacity and needs of nurses providing critical care in specific LIC/LMIC contexts is needed. Outputs from such research would be invaluable in supporting contextually appropriate capacity development programmes.

Periviability: A Review of Key Concepts and Management for Perinatal Nursing

One of the most complex clinical problems in obstetrics and neonatology is caring for pregnant women at the threshold of viability. Births near viability boundaries are grave events that carry a high prevalence of neonatal death or an increased potential for severe lifelong complications and disabilities among those who survive. Compared with several decades ago, premature infants receiving neonatal care by today's standards have better outcomes than those born in other eras. However, preterm labor at periviability represents a more complex counseling and management challenge. Although preterm birth incidence between 20/7 and 25/7 weeks has remained unchanged, survival rates at earlier gestational ages have increased as perinatal and neonatal specialties have become more adept at caring for this at-risk population. Women face difficult choices about obstetric and neonatal interventions in light of uncertainties around survival and outcomes. This article reviews current neonatal statistics in reference to short- and long-term outcomes, key concepts in obstetric clinical management of an anticipated periviable birth, and counseling guidance to ensure shared-decision making.

Paediatric inter-hospital transportation: a clinical governance project

This article discusses a quality improvement project in the context of paediatric inter-hospital transportation. The project was set in a large university teaching hospital in Ireland. Risk assessment on the clinical site revealed a gap in the application of best national and international standards in inter-hospital transportation practice. A project was undertaken to explore current paediatric transport services and respond to a clinical service deficit. Consequently, the proposed quality improvement initiative proposes a universal Paediatric Advanced Life Support Programme (PALS) to upskill and enhance the required clinical standards and competencies of neonatal nurses. This intervention was underpinned by attention to change management principles and organisational culture in health care. As a clinical practice development, it demonstrates how benchmarking against best practice can advance the quality and safety agenda in paediatric practice. Education initiatives are recommended to ensure that clinical standards in paediatric transportation are monitored and reviewed with the potential to improve clinical outcomes.

Preparing community Level II neonatal intensive care unit nurses to deliver Level IIIA care

The purpose of this quality initiative was to increase NICU nurse competency to meet the care needs of higher acuity infants. A multifaceted educational approach with individual bedside education, a clinical practicum, inservices, and case presentations was based on results from a needs assessment, observational feedback, and chart audits. Results of this educational intervention included increased nurse competency and a change in admission criteria to care for higher acuity infants without transporting them to another hospital miles away. As the admission criteria changed, the volume of higher acuity infants increased, and the nurses were able to maintain their competency in caring for these infants.