Neonatal outcomes and quality of care in level II perinatal centers supported by a children's hospital-medical school level III program.

OBJECTIVE: Eight Level II perinatal centers developed contracts with the children's hospital to provide consultative neonatal patient care, education, and administrative support. The purpose of the present study was to evaluate infant outcomes and quality of care during a 3-year period of the program, 1994 to 1996. STUDY DESIGN: Neonatal mortality rates were determined for the 18,703 live births. Quality of care was assessed for 30 infants who died at the Level II centers and 315 infants transferred to the children's hospital. RESULTS: The neonatal mortality rate was 2.2/1000 live births. Quality-of-care issues primarily involved 80 "drop-in" deliveries

Baby boomer nurses bearing the burden of care: A four-site study of stress, strain, and coping for inpatient registered nurses.

OBJECTIVE: Because today's nursing workforce faces a multitude of stressors, the objective of this study was to describe stress, strain, and coping across institution types for inpatient registered nurses (n = 694), and to identify the influence of age on these findings. METHODS: This study, using a multi-site, mixed methods approach, provides data to support more focused interventions that address the challenges of specific types of stressors and age cohort needs. RESULTS: The worst scores for sub-scales addressing stress and strain for this sample of inpatient nurses were problems associated with physical environment and responsibility. Consistency was found across the four institutions for the sub scale of responsibility. Baby Boomer nurses (born between 1946 and 1964) had significantly worse scores than other age cohorts, specifically with the stress and strain sub-scales of role overload, role insufficiency, role ambiguity, role boundary, and interpersonal strain. CONCLUSION: The authors outline specific ways to support registered nurses by using staffing metrics that factor in unit activity as well as supporting the Baby Boomer nurse, both physically and psychosocially.

Analysis of the nursing workforce crisis: a call to action.

In our integrative review of reports on the health care workforce shortage, we examined 15 reports that focused primarily on nursing and were conducted by various stakeholders. We studied these reports objectively, identifying problems and solutions as described by the authors, which we then categorized by theme. We found problems at both the national and institutional levels and noted that the reports contained similar problem and solution "themes." Yet we also found gaps between these-some problems had no solutions and some solutions didn't address any of the suggested problems. Gaps occurred among problems and solutions listed in the following theme categories: demand, health care economics, workforce planning, research and data support, and technology. Despite the urgent need, we still lack a national strategy designed to avert the nursing shortage. This review may provide a foundation for such a plan.We present the results of our analysis and our recommendations to the federal government and national organizations, to institutions, and to nurses. These recommendations don't provide a comprehensive strategy for averting the nursing shortage, but they do offer a basis upon which one may be created.

Perinatal outcomes in a school-based program for pregnant teen-agers.

Teen-age pregnancy constitutes a high-risk factor for prematurity, low birth weight, intrauterine growth retardation, infant mortality, and later health, behavioral, developmental, and educational disadvantages. A case-controlled study was performed to evaluate the influence of the Teen-age Parent Center on pregnancy outcomes. Improved outcomes were identified for low-birth-weight rate, high school graduation rate, smoking during pregnancy, and prenatal care. These results indicate that a comprehensive, school-based program can enhance perinatal outcomes.

A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age.

OBJECTIVES: To develop a succinct and comprehensive breast-feeding assessment score (BAS) to accurately identify infants at risk for early cessation of breast-feeding before initial hospital discharge. STUDY DESIGN: Mothers who intended to breast-feed their infants were solicited from 9 suburban hospitals. Two detailed data forms covering 107 items were completed before hospital discharge. A third form was completed at 7 to 10 days of age after telephone contact with the mother. RESULTS: Cessation of breast-feeding occurred in 113 of 1075 infants (10.5%). A multiple logistic regression analysis revealed 8 variables that were significant (P <.05) in predicting breast feeding cessation. A BAS was developed based on the odds ratios and relative risks of breast-feeding cessation for these 8 variables. CONCLUSIONS: The BAS was easily and quickly performed before hospital discharge for near term and term infants, which accurately predicted the risk of breast-feeding cessation within 7 to 10 days of age in the population studied.

Using standard desk-top tools to monitor medical error rates.

Many experts believe it is time to do something about the high number of medical errors and adverse events highlighted in the recent IOM report. This article examines how front line managers can use a valuable quality improvement/assurance tool--the statistical process control chart--to track and analyze medical error rates. It includes a step-by-step guide to the creation and interpretation of a demonstration chart, discusses potential barriers to the use of statistical process control charts, and suggests ways to overcome those barriers.