A Narrative Review of NICU Implementation of Evidence-Based Early Relational Health Interventions

Background: 

Because neonatal resuscitation is an uncommon occurrence within neonatal intensive care units (NICUs), nurses’ responses to emergency events and resuscitation skills may be inadequate. Regular resuscitation education via simulated events can improve nursing skills and confidence during a resuscitation event. A local level IV NICU recently moved into a new building and adopted a private patient room model from the open bay model. With this operational change, there was an increased need for new nursing team members to accommodate the expanding NICU population. Also, there was a growing nursing turnover rate that contributed to this project’s need.

Purpose: 

The overall objective was to increase nursing confidence through simulated neonatal resuscitation events. The specific aims of the project were to assess nursing staff confidence on resuscitation, compliance, and attendance at simulated resuscitation events and to achieve an increase in follow-up scores from baseline scores to indicate nursing confidence and competence in relation to specific resuscitation tasks and skills.

Methods: 

A level IV NICU in Northeast Florida was utilized as the project site. Simulated resuscitation events were provided to nursing team members that were 1hour in length and reviewed general neonatal resuscitation practices, including chest compressions, airway management, and medication administration that were offered for neonatal nursing staff during a 3-month period. The Pediatric Resuscitation Self Efficacy Scale was used to measure nursing confidence performing neonatal resuscitation at baseline and following each simulation training event. The survey scores were utilized as primary data, with a high total possible score of 40. Each question was eligible for up to 4 points, depending on which Likert type was selected. During analysis, average scores were determined for both baseline and follow-up, with ad hoc analysis of each individual question following total score, using inferential statistics.

Results: 

Of 186 eligible nurses, 101 nurses participated in the simulated events, with 76 completing a baseline survey and 55 completing a follow-up survey. Statistical analysis indicated a significant increase in the posttest survey scores from all nurses, with the largest increase in those with less than 2 years of nursing experience. Baseline mean scores were 33.42, with follow-up mean scores of 35.07. In addition, those with increased experience in nursing showed a higher average pre score to those with fewer years of experience. Individual question analysis showed statistical significance on 2 questions relating to recognition of events and medication administration. No significance was noted between pre- and posttest scores and educational level.

Implications for Practice and Research: 

Nursing experience may influence confidence in responding to resuscitation and emergency events. Thus, reinforcement of skills and knowledge through simulated resuscitation events may increase nursing confidence for the clinical nursing team. Simulated events could be offered through annual training for emergency events.

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