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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
A Needs Assessment of Labor and Delivery Nurses Performing NRP in the Delivery Room
Michael Zujkowski1, Shelley Ehrlich2, Chunyan Liu2
1Department of Pediatrics, Division of Newborn Medicine, Tufts Medical Center, 800 Washington Street, Box 44, Boston, MA, 02111, USA. michael.zujkowski@tuftsmedicalcenter.org.
Introduction:
Labor and delivery (L&D) nurses are often responsible for initiating the critical first steps of the Neonatal Resuscitation Program (NRP). Identification of knowledge gaps and underlying reasons for NRP non-adherence is crucial for designing educational interventions.
Methods:
A convenience sample of 37 L&D nurses from two delivery hospitals were enrolled. Participants completed a Likert scale survey capturing years of experience and comfort level in performing neonatal resuscitation followed by a video recorded standardized manikin-based simulation of a neonatal resuscitation. NRP adherence was assessed using an Observed Structured Clinical Examination (OSCE) assessment tool with prior validity evidence. Percentage of correctly completed OSCE items, median time to initiation of positive pressure ventilation (PPV), and achievement of effective PPV were analyzed using descriptive statistics.
Results:
Participants reported a median of 2.5 years of L&D experience, and a 4/6 confidence level for performing NRP. Fifty-seven percent of items (12/21) items were correctly completed. Participants took 55 s to initiate PPV with 57% initiating PPV within the target of 60 s. The time to effective PPV was 109 s, with 32% of participants achieving this within 60 s. Years of L&D experience had a strong correlation with percentage of correctly completed OSCE items (r = 0.63).
Discussion:
Despite high self-perceived confidence, initiating and achieving effective PPV within the 60 s time window mandated by NRP remains an area for significant improvement for L&D nurses. Next steps include the design and implementation of targeted training to address performance gaps and longer-term tracking for retention of knowledge.
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