Dataset Information

Use of an internet camera system in the neonatal intensive care unit: parental and nursing perspectives and its effects on stress.

ABSTRACT:

Objective

The objective of this study is to evaluate associations between webcam use in the neonatal intensive care unit (NICU) with parental stress and nursing work-related stress and burnout.

Design

Prospective validated and de novo questionnaires administered to NICU parents and nurses during two observation periods: (1) no webcam access (off webcam) and (2) webcam access (on webcam).

Results

Seventy-nine "off webcam" parents, 80 "on webcam" parents, and 35 nurses were included. Parental stress levels were significantly lower "on webcam" and perceptions of the technology were overwhelmingly positive. There were no significant differences in nursing stress levels and burnout between periods. Only 14% of nurses believed that webcam use improves infant's quality of care. Majority nurses felt that webcams increase parental and nursing stress.

Conclusions

Webcam use in the NICU is associated with lower parental stress levels and has no effect on nursing stress levels or work-related burnout. These findings contradict nurses' beliefs that webcams increase parent and nurse stress.

SUBMITTER: Kubicka Z

PROVIDER: S-EPMC7841755 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Use of an internet camera system in the neonatal intensive care unit: parental and nursing perspectives and its effects on stress.

Kubicka Z Z Zahr E E Clark P P Williams D D Berbert L L Arzuaga B B

Journal of perinatology : official journal of the California Perinatal Association 20210128 8

<h4>Objective</h4>The objective of this study is to evaluate associations between webcam use in the neonatal intensive care unit (NICU) with parental stress and nursing work-related stress and burnout.<h4>Design</h4>Prospective validated and de novo questionnaires administered to NICU parents and nurses during two observation periods: (1) no webcam access (off webcam) and (2) webcam access (on webcam).<h4>Results</h4>Seventy-nine "off webcam" parents, 80 "on webcam" parents, and 35 nurses were i ...[more]

PMID: 33510415

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Project description:ImportanceQuality improvement initiatives demonstrate the contribution of reliable nursing care to gains in clinical and safety outcomes in neonatal intensive care units (NICUs); when core care is missed, outcomes can worsen.ObjectiveTo evaluate the association of NICU nurse workload with missed nursing care.Design, setting, and participantsA prospective design was used to evaluate associations between shift-level workload of individual nurses and missed care for assigned infants from March 1, 2013, through January 31, 2014, at a 52-bed level IV NICU in a Midwestern academic medical center. A convenience sample of registered nurses who provided direct patient care and completed unit orientation were enrolled. Nurses reported care during each shift for individual infants whose clinical data were extracted from the electronic health record. Data were analyzed from January 1, 2015, through August 13, 2018.ExposuresWorkload was assessed each shift with objective measures (infant-to-nurse staffing ratio and infant acuity scores) and a subjective measure (the National Aeronautics and Space Administration Task Load Index [NASA-TLX]).Main outcomes and measuresMissed nursing care was measured by self-report of omission of 11 essential care practices. Cross-classified, multilevel logistic regression models were used to estimate associations of workload with missed care.ResultsA total of 136 nurses provided reports of shift-level workload and missed nursing care for 418 infants during 332 shifts of 12 hours each. When workload variables were modeled independently, 7 of 12 models demonstrated a significant worsening association of increased infant-to-nurse ratio with odds of missed care (eg, nurses caring for ≥3 infants were 2.51 times more likely to report missing any care during the shift [95% credible interval, 1.81-3.47]), and all 12 models demonstrated a significant worsening association of increased NASA-TLX subjective workload ratings with odds of missed care (eg, each 5-point increase in a nurse's NASA-TLX rating during a shift was associated with a 34% increase in the likelihood of missing a nursing assessment for his or her assigned infant[s] during the same shift [95% credible interval, 1.30-1.39]). When modeling all workload variables jointly, only 4 of 12 models demonstrated significant association of staffing ratios with odds of missed care, whereas the association with NASA-TLX ratings remained significant in all models. Few associations of acuity scores were observed across modeling strategies.Conclusions and relevanceThe workload of NICU nurses is significantly associated with missed nursing care, and subjective workload ratings are particularly important. Subjective workload represents an important aspect of nurse workload that remains largely unmeasured despite high potential for intervention.

Project description:ImportanceThere are few population-based studies addressing trends in neonatal intensive care unit (NICU) admission and NICU patient-days, especially in the subpopulation that, by gestational age (GA) and birth weight (BW), might otherwise be able to stay in the room with their mothers.ObjectiveTo describe population-based trends in NICU admissions, NICU patient-days, readmissions, and mortality in the birth population of a large integrated health care system.Design, setting, and participantsThis cohort study was conducted using data extracted from electronic medical records at Kaiser Permanente Southern California (KPSC) health care system. Participants included all women who gave birth at KPSC hospitals and their newborns from January 1, 2010, through December 31, 2018. Data extraction was limited to data entry fields whose contents were either numbers or fixed categorical choices. Rates of NICU admission, NICU patient-days, readmission rates, and mortality rates were measured in the total population, in newborns with GA 35 weeks or greater and BW 2000 g or more (high GA and BW group), and in the remaining newborns (low GA and BW group). Admissions to the NICU and NICU patient-days were risk adjusted with a machine learning model based on demographic and clinical characteristics before NICU admission. Changes in the trends were assessed with 2-sided correlated seasonal Mann-Kendall test. Data analysis was performed in August 2019.ExposuresAdmission to the NICU and NICU patient-days among the birth cohort.Main outcomes and measuresThe primary outcomes were NICU admission and NICU patient-days in the total neonatal population and GA and BW subgroups. The secondary outcomes were readmission and mortality rates.ResultsOver the study period there were 320 340 births (mean [SD] age of mothers, 30.1 [5.7] years; mean [SD] gestational age, 38.6 [1.97] weeks; mean [SD] birth weight, 3302 [573] g). The risk-adjusted NICU admission rate decreased from a mean of 14.5% (95% CI, 14.2%-14.7%) to 10.9% (95% CI, 10.7%-11.7%) (P for trend = .002); 92% of the change was associated with changes in the care of newborns in the high GA and BW group. The number of risk-adjusted NICU patient-days per birth decreased from a mean of 1.50 patient-days (95% CI, 1.43-1.54 patient-days) to 1.40 patient-days (95% CI, 1.36-1.48 patient-days) (P for trend = .03); 70% of the change was associated with newborns in the high GA and BW group. The unadjusted 30-day readmission rates and mortality rates did not change.Conclusions and relevanceAdmission rates to the NICU and numbers of NICU patient-days decreased over the study period without an increase in readmissions or mortality. The observed decrease was associated with the high GA and BW newborn population. How much of this decrease is attributable to intercurrent health care systemwide quality improvement initiatives would require further investigation. The remaining unexplained variation suggests that further changes are also possible.

Dataset Information

Use of an internet camera system in the neonatal intensive care unit: parental and nursing perspectives and its effects on stress.

Objective

Design

Results

Conclusions

Publications

Use of an internet camera system in the neonatal intensive care unit: parental and nursing perspectives and its effects on stress.

Similar Datasets

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