Enhancing Nursing Care Reliability in Neonatal Intensive Care Units

项目总结 新生儿质量改善的努力被正确地归功于改善了患者的安全结局，而婴儿 新生儿重症监护病房(NICU)继续遭受可预防的伤害。主要机制 对改善结果负责的是常规护理过程的高度可靠性- 尤其是护士的工作--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局有关的基本护理，这是导致护士低血压的主要原因 护理可靠性是高工作量。护士工作量经常作为护理的客观措施而被操作 使用病人与护士的人员配置比率和/或病人敏锐度指标的资源强度。然而，客观的 衡量标准没有包括护士工作量的重要经验方面，这些方面可能会影响可靠性 认知需求和时间压力。我们前期的研究发现，NICU护士的主观工作量 与人员配置比例或婴儿敏锐度相比，与护理可靠性的相关性更强、更一致， 这表明比率对护理可靠性的直接影响可能被高估了。此外，对 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的IV级NICU中进行的，与基准比较，该NICU具有更高的护理资源 单位，限制了泛化能力。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招收多达210名护士，以报告大约 在1120个轮班的过程中有820个婴儿。我们的目标是：1)评估客观和客观的不同效果 护士主观工作量对NICU护理可靠性的影响；2)检验轮班水平情景之间的关系 因素与护士主观工作量评分；3)评价护士主观工作量综合评价的有效性 一个班次内的工作负荷评级，为实时测量策略提供信息。建议的研究直接 对NICHD PA-18-790的回答是：“研究医生和护士的工作量对工作表现和 新生儿环境中的“患者安全”。具体地说，我们关注的是工作量和安全之间的关系- 相关性能，以及对结果的影响，我们将在后续研究中进行测试。这个项目将 通过扩大当前对护士工作量及其对护理可靠性的影响的理解来提高患者的安全性 超越人员比例和婴幼儿视力测量，确定影响护士主观感受的可修改因素 工作量，并为NICU中主观工作量监测的测量策略提供信息。

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.