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Enhancing Nursing Care Reliability in Neonatal Intensive Care Units

提高新生儿重症监护室护理的可靠性

基本信息

批准号：
10569147
负责人：
Heather Lynn Tubbs Cooley
金额：
$ 12.02万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-03-12 至 2025-02-28
项目状态：
未结题

项目摘要

PROJECT SUMMARY Neonatal quality improvement efforts are rightly credited with improving patient safety outcomes yet infants in neonatal intensive care units (NICUs) continue to experience preventable harm. A primary mechanism responsible for improved outcomes is the high degree of process reliability with which routine care processes – especially those of nurses – must be completed. Studies from our team and others show that NICU nurses regularly miss essential care linked to neonatal safety outcomes and that a primary contributor to nurses’ low care reliability is high workload. Nurse workload is often operationalized as objective measures of nursing resource intensity using patient-to-nurse staffing ratios and/or patient acuity metrics. However, objective measures do not capture important experiential aspects of nurse workload that likely influence reliability such as cognitive demands and time pressure. Our prior research found that NICU nurses’ subjective workload was more strongly and consistently associated with care reliability than either staffing ratio or infant acuity, suggesting that direct effects of ratios on care reliability may be overestimated. Further, routine monitoring of subjective workload in NICUs may be an important new strategy for addressing variation in care reliability. Our prior research was conducted in a single level IV NICU with high nursing resources compared to benchmarking units, limiting generalizability. We propose to evaluate relationships between nurse workload and care reliability in a larger, more diverse sample of NICUs, nurses, and infants. Using an intensive longitudinal design, we will enroll up to 210 nurses in 5 NICUs to report on workload and care reliability for approximately 820 infants over the course of 1,120 shifts. We aim to: 1) evaluate differential effects of objective and subjective nurse workload on care reliability in NICUs; 2) examine relationships between shift-level situational factors and nurses’ subjective workload ratings; and 3) evaluate the validity of aggregating nurses’ subjective workload ratings within a shift to inform real-time measurement strategies. The proposed study directly responds to NICHD PA-18-790 to “study the effects of physician and nurse workload on performance and patient safety” in neonatal environments. Specifically, we focus on relationships between workload and safety- related performance, with implications for outcomes that we will test in a subsequent study. This project will advance patient safety by broadening current understanding of nurse workload and its effects on care reliability beyond staffing ratios and infant acuity measures, determining modifiable factors influencing nurses’ subjective workload, and informing measurement strategies for subjective workload monitoring in NICUs.

项目概要新生儿质量改进工作被正确地认为可以改善患者安全结果，但婴儿新生儿重症监护病房 (NICU) 继续遭受可预防的伤害。主要机制改善结果的原因在于日常护理流程的高度可靠性 – 尤其是护士的——必须完成。我们团队和其他人的研究表明 NICU 护士经常错过与新生儿安全结果相关的基本护理，这也是护士素质低的主要原因护理可靠性是高工作量。护士工作量通常被作为护理的客观衡量标准使用患者与护士人员配置比率和/或患者敏锐度指标来确定资源强度。然而，客观措施没有捕捉到护士工作量的重要经验方面，这些方面可能会影响可靠性，例如作为认知需求和时间压力。我们之前的研究发现，NICU 护士的主观工作量是与护理可靠性的相关性比人员配置比例或婴儿敏锐度更强烈且一致，这表明比率对护理可靠性的直接影响可能被高估了。此外，日常监测 NICU 的主观工作量可能是解决护理可靠性差异的重要新策略。我们的先前的研究是在单一 IV 级 NICU 中进行的，与基准相比，该研究具有较高的护理资源单位，限制了普遍性。我们建议评估护士工作量和护理之间的关系在更大、更多样化的 NICU、护士和婴儿样本中的可靠性。使用密集的纵向根据设计，我们将在 5 个新生儿重症监护病房 (NICU) 中招募多达 210 名护士，以报告大约 1,120 个轮班期间有 820 名婴儿。我们的目标是：1）评估客观和新生儿重症监护室护理可靠性的主观护士工作量； 2）检查轮班情境之间的关系因素和护士的主观工作量评级； 3）评估汇总护士主观评价的有效性轮班内的工作负载评级以告知实时测量策略。直接提出的研究回应 NICHD PA-18-790“研究医生和护士的工作量对绩效和新生儿环境中的“患者安全”。具体来说，我们关注工作量和安全之间的关系 - 相关的表现，以及对我们将在后续研究中测试的结果的影响。该项目将通过扩大目前对护士工作量及其对护理可靠性影响的理解来提高患者安全除了人员配置比例和婴儿敏锐度测量之外，确定影响护士主观的可修改因素工作量，并为 NICU 主观工作量监测的测量策略提供信息。