Enhancing Nursing Care Reliability in Neonatal Intensive Care Units

项目摘要 新生儿质量改善的努力被正确地归功于改善患者安全结果， 新生儿重症监护室（NICU）继续经历可预防的伤害。主要机制之一 负责改善的结果是高度的过程可靠性，与常规护理过程- 尤其是护士，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，这是护士低血糖的主要原因。 护理可靠性是高工作量。护士工作量往往是可操作的客观措施的护理 使用患者与护士的人员配备比率和/或患者紧急度度量来确定资源强度。然而，客观 措施不捕捉重要的经验方面的护士工作量，可能会影响可靠性， 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员工比例或婴儿敏锐度更强且更一致， 这表明比率对护理可靠性的直接影响可能被高估。此外，日常监测 NICU的主观工作负荷可能是解决护理可靠性变化的重要新策略。我们 先前的研究是在一个单一的四级新生儿重症监护室进行的，与基准相比， 单位，限制概括性。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 设计，我们将在5个NICU招募多达210名护士，以报告大约 820名婴儿在1,120次轮班中。我们的目标是：1）评估客观和 主观护理工作量对新生儿重症监护病房护理可靠性影响 评价综合护士主观工作负荷的有效性 在一个班次内的工作量评级，以通知实时测量策略。研究建议直接 响应NICHD PA-18 - 790 "研究医生和护士工作量对绩效的影响， 新生儿环境中的患者安全。具体来说，我们专注于工作量和安全之间的关系- 相关的性能，与结果的影响，我们将在随后的研究测试。该项目将 通过扩大目前对护士工作量及其对护理可靠性的影响的理解，提高患者安全性 除了人员比例和婴儿急性措施，确定可修改的因素影响护士的主观 工作负荷，并告知测量策略，主观工作负荷监测在NICU。

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.