ROOM FOR IMPROVEMENT: NURSES' PERCEPTIONS OF PROVIDING CARE IN A SINGLE-ROOM NEWBORN INTENSIVE CARE UNIT
A retrospective, cross-sectional survey design was used to examine nurses' perceptions of benefits, risks, and clinical outcomes of those in single-patient rooms in a newborn intensive care unit. Walsh WF, McCullough KL, White RD. Adv Neonatal Care. 2006;6:261-270.
Single-patient rooms (SPRs) for critically ill newborns have been suggested as optimal environments for newborns, because of noise reduction and decreased overstimulation. In 2004, a level III-C newborn intensive care unit of Vanderbilt Children's Hospital moved into a new building. Contained in the design are 44 intensive care beds in 40 rooms, with 4 of the rooms for twins. These 40 rooms are divided into 7 pods consisting of 6 to 7 infants. Also, there are 16 intermediate beds in 13 rooms, with 3 rooms for twins. These are arranged in pods as well.
Individual patient monitors are in each room and are connected to a central station and the screens on the wall of each pod. A code system is in place to activate a pager system when assistance is needed for a specific room. Most communication to the central nursing station is done by nurses via telephone. Walkie-talkies are used to contact the charge nurse or respiratory therapy personnel for nonemergency situations.
After being on the new unit for 9 months, a 9-item survey was given to 197 full- and part-time newborn intensive care unit nurses. There were 127 nurses (65%) who completed the survey. The authors note that the questions were purposely written to reflect the concerns and biases of members of the interdisciplinary neonatology team. Objective data were also collected on sound levels and infection rates.
The survey included items about preferences, safety, staff assistance and stress, communication, and impact on workload and staffing. Each question had a 5-point response option, from strongly disagree to strongly agree. Significance levels were given in comparison to percentages of nurses who agreed with items and those who disagreed. However, the statistical procedure used to estimate the significance levels is not given. Notably, nurses preferred SPRs to open-room design (63% vs 34%, P < .05). They felt that SPRs were safe (83% vs 17%, P < .01). Nurses indicated that handwashing was improved in SPRs (81% vs 19%, P < .01). Authors note the limitations of self-report and survey items.
Catheter-related bloodstream infection was significantly improved with SPRs as opposed to open-room design (3.3/1,000 vs 10.1/1,000 device days, P < .05). Noise levels in SPRs were significantly less than those in open rooms (63.3 +/- 2.1 vs 56 +/- 3.1 dB). The authors note that the noise reduction resulted in less stress for patients and unit staff.
EFFECT OF A SPECIALIZED PEDIATRIC INSTITUTIONAL SETTING ON ORGAN RECOVERY FROM POTENTIAL DONORS
A retrospective, descriptive study was undertaken to determine whether there was a difference in pediatric organ recovery between freestanding children's hospitals in comparison to all other hospitals. Donkin M, Kolovos N, Checchia PA. Am J Crit Care. 2006:15:497-501.
Organ donor data from a transplant service covering hospitals in parts of Missouri, Illinois, and Arkansas from 2000 to 2003 were reviewed. All donors younger than 18 years were included in the analysis. Differences in organ recovery rates were estimated using [chi]2 test and the Fisher exact test.
Patients were divided into 4 age groups: younger than 1, 1-5, 6-10, and 11-17 years. Organ categories were listed as follows: heart, lungs, liver, kidneys, and all. The only statistically significant difference found in organ recovery was that there was more liver recovery in other hospitals as compared to freestanding children's hospitals (100% vs 82%, P = .02). The authors concluded that the type of institution did not affect organ recovery rate, except for liver recovery.
The study highlighted the low successful organ recovery rate (210/318, 66%) from potential pediatric donors, despite identification of donors, appropriate referrals, and family consent. The authors suggest that research regarding child-specific strategies for donor management may improve pediatric organ recovery rate, so that more recipients in need of organs will be able to receive them.