The WISER Study

 描述(由申请人提供)：本提案服务于NICHD的使命，以确保所有儿童都有机会充分发挥其健康和多产的潜力 活着。优化提供者的幸福感对于向最脆弱的患者：早产儿提供安全和高质量的护理至关重要。这项提案的主要创新目标包括测试增强复原力科学(WISER)计划基于网络的实施在提高新生儿重症监护病房(NICU)卫生工作者复原力方面的有效性，评估其对病房安全文化的影响，以及检查其对早产儿临床结局的影响。WISER计划是一种既定的低强度但引人入胜的干预措施，它整合了教育和行为矫正，以提高提供者的幸福感和弹性，从而创造一个防止患者受到伤害的组织环境。在美国，每年有50,000多名极低出生体重儿(VLBW；&lt；1500 gm)出生，照顾这些婴儿既具有挑战性，又成本高昂。护理质量和结果差异很大。不断增长的技术要求和耐心的敏锐性已经将卫生工作者的职业倦怠推向了崩溃的边缘。少数经过测试的提高照顾者韧性的干预措施缺乏广泛采用的可行性。我们必须提高卫生工作者应对工作场所压力的能力，以便创造一个支持更安全、更好护理的环境。本研究旨在达到以下目的：1.测试WISER在提高NICU健康专业人员复原力方面的有效性；2.测试WISER在改善患者安全和组织结果方面的有效性；3.测试WISER的可持续性；以及4.描述WISER计划的障碍和促进者。我们建议在六个三级护理NICU中使用阶梯式楔形混合方法随机对照试验(SwRCT)来测试WISER计划在NICU环境中的有效性。这项试验的结果也将为卫生工作者韧性、组织环境和出生的极低出生体重儿的临床结果之间的因果关系提供洞察力。这项建议建立并扩大了专家跨学科研究小组之间现有的协作关系。如果成功，这项提案将代表着新生儿患者安全运动的突破，并为全国范围内的推广提供了一个模式。

 DESCRIPTION (provided by applicant): This proposal serves the mission of the NICHD to ensure that all children have the chance to achieve their full potential for healthy and productive lives. Optimizing provider well-being is critical to the delivery of safe and high quality care to he most vulnerable of patients: very preterm babies. Major innovative objectives of this proposal include testing the Web-based Implementation for the Science of Enhancing Resilience (WISER) program's effectiveness in enhancing resilience among Neonatal Intensive Care Unit (NICU) health workers, evaluating its effect on unit safety culture, and examining its effect on clinical outcomes in preterm infants. The WISER program is an established but low-intensity yet engaging intervention, which integrates education and behavior modification to boost provider well-being and resilience in order to create an organizational environment which prevents patient harm. Care for the more than 50,000 very low birth weight (VLBW; < 1500 gm) infants born annually in the United States is challenging and expensive. Quality of care and outcomes vary widely. Increasing technical demands and patient acuity have pushed burnout among health workers to the breaking point. The few tested interventions that improve caregiver resilience lack feasibility for widespread adoption. We must improve health workers' ability to cope with the stress at the workplace in order to create an environment that supports safer, better care. This study is designed to achieve the following aims: 1. Test the effectiveness of WISER in improving NICU health professional resilience; 2. Test the effectiveness of WISER in improving patient safety and organizational outcomes; 3. Test the sustainability of WISER; and 4. Describe the barriers and facilitators of the WISER program. We propose to test the effectiveness of the WISER Program in the NICU setting using a stepped-wedge mixed-methods randomized controlled trial (swRCT) at six tertiary care NICUs. The results of this trial will also provide insights into the causal relations between health worker resilience, the organizational environment, and clinical outcomes among infants born VLBW. This proposal builds on and expands the existing collaborative relationships among the expert interdisciplinary research team. If successful, this proposal will represent a breakthrough for the neonatal patient safety movement and provide a model for scaling up nationally.