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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
19:15

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Published on: August 25, 2014

Nursing workload in UK tertiary neonatal units.

D W A Milligan1, P Carruthers, B Mackley

  • 1Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. d.w.a.milligan@ncl.ac.uk

Archives of Disease in Childhood
|July 2, 2008
PubMed
Summary

Neonatal nurse staffing needs were reassessed using updated dependency categories. Current nursing workload demands more time per infant than a decade ago, necessitating revised care models.

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Area of Science:

  • Neonatal intensive care nursing
  • Healthcare workload assessment
  • Nursing resource management

Background:

  • Existing research on neonatal nurse staffing and infant care needs is over 10 years old.
  • Significant changes in the preterm population and treatment practices necessitate updated assessments.
  • Neonatal intensive care requires adequate numbers of trained neonatal nurses for safe and effective care.

Purpose of the Study:

  • To validate the British Association of Perinatal Medicine (BAPM) dependency categories.
  • To revalidate the Northern Region (NR) dependency categories.
  • To assess contemporary nursing workload in neonatal intensive care units.

Main Methods:

  • Direct observation of nursing activities around infants in three English tertiary neonatal intensive care services.
  • Data collection occurred every 10 minutes by trained observers.
  • Analysis related time spent on nursing activities to infant dependency category and nurse grade.

Main Results:

  • Both BAPM and NR scales identified differences between dependency categories.
  • Distinguishing nasal continuous positive airway pressure (nCPAP) from ventilation improved category discrimination when combined with BAPM2/NRA.
  • The revised four-point scale showed varying nursing time requirements per hour: BAPM1/NRA (56 min), nCPAP/BAPM2/NRB (36 min), BAPM3/NRC (20-22 min), BAPM4/NRD (31-32 min).
  • The NR scale was easier to apply and demonstrated higher interobserver agreement (98.5%) than the BAPM scale (93%).
  • All dependency categories required more nursing time compared to 1993.

Conclusions:

  • Both validated scales effectively predict average nursing workload.
  • A revised categorization, separating nCPAP from ventilation, offers a more robust and practical approach.
  • Overall nursing time required for all infant categories has increased since 1993.