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Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
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Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU

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INTRODUCTION …

INTRODUCTION

A major limitation in improving patient care has been the shortage of staff nurses. In the control phase

staff patient ratio was 1:3 , 1:4 which affected the delivery of quality care nursing, affecting the patient
outcome in terms of infection and mortality rate.

It is hypothesized that sudden influx of inexperienced nurses may be detrimental for patient care in the
short term especially in absence of structured training & mentorship program in place.

AIMS AND OBJECTIVES

To assess the effect of new joinees as staff nurses on patient care in neurosurgery ICU using infection
rate and mortality rate as the surrogate markers for nursing care.

MATERIALS AND METHODS

In this retro-prospective study in neurosurgery ICU over 6 months( Oct 2010- Mar 2011), the infection
rates (using blood, tracheal & urine culture reports) were calculated for a group of patients.

RESULT

Hospital Mortality Rate and Gross Infection Rates in terms of tracheal, urine and blood cultures were
assessed . severity of head injury was also assessed as it can act as a ditermental factor affecting

Hospital mortality rate in control phase 18%, in training phase 16.4 % and final phase 15.3%

Gross infection rates: tracheal culture incidence in control phase 62.3%, traning phase 59.3%, final phase
22.3% . in terms of urine culture incidence control phase 48.9%, training phase 34.2%, final phase 12.6%
and for blood culture it was 24.9% in control phase, 14.5% in training phase and 4.2 in final phase.

CONCLUSION



There is significant decrease in mortality following introduction of 1:1 nursing in neurosurgery
ICU.



The severity of head injury was approximately in the same range of all the phases hence it has
no significant role to play in the reduction of mortality rate.



Blood infection rate (4.25), tracheal infection rate (22.3%) & urine infection rate (12.6%) in the
final phase were significantly lower (p<0.001) than the preceding two phases

Structured programs and mentorship plays a vital role in improving the nursing practices .

Published in: Health & Medicine
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Transcript

  • 1. S/N SHINY VARGHESE Neurosurgery ICU, JPNATC Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU
  • 2. BACKGROUND
    • A major limitation in improving patient care has been the shortage of staff nurses.
    • In the control phase staff patient ratio was 1:3 , 1:4 which affected the delivery of quality care nursing, affecting the patient outcome in terms of infection and mortality rate.
    • Sudden increase in nursing strength by inexperienced nurses brings with it its own set of difficulties in patient care.
  • 3. BACKGROUND (cont…….)
    • It is hypothesized that sudden influx of inexperienced nurses may be detrimental for patient care in the short term especially in absence of structured training & mentorship program in place.
  • 4. AIMS & OBJECTIVES To assess the effect of new joinees as staff nurses on patient care in neurosurgery ICU using infection rate and mortality rate as the surrogate markers for nursing care.
  • 5. MATERIAL & METHODS
    • In this retro-prospective study in neurosurgery ICU over 6 months( Oct 2010- Mar 2011), the infection rates (using blood, tracheal & urine culture reports) were calculated for a group of patients.
    • There was sudden increase in new joinees by 100% in Decmeber 2010
  • 6. Different phases
    • Control phase (Oct 2010-Nov 2010)
    • When the nurse:patient ratio was 1:4
    • 2) Training phase (Dec 2010-Jan 2010)
    • When the nurse: patient ration was 1:1 but new nurses were inexperienced
    • 3) Final phase (Feb 2011-march 2011)
    • When the nurse: patient ration was 1:1 and all nurses had been trained in neuro-ICU care.
  • 7. EVALUATION PARAMETERS
    • GROSS INFECTION RATE
    • This is defined as no. of patients getting infected(tracheal, urine and blood ) in respect of total no. of patients getting admitted in neurosurgery, ICU in a particular phase.
    • HOSPITAL MORTALITY RATE
    • This is defined as no. of deaths in respect of total no. of patients in a particular phase.
    • NURSE PATIENT RATIO IN EACH PHASE
    • The average no. of patients a nurse is assigned with
    • in a particular phase.
  • 8. SEVERITY OF HEAD INJURY This is judged on the basis of G.C.S (Glassgow Coma Scale) Head injury Average G.C.S Severe head injury 3-6 Moderate head injury 7-11 Minor head injury 12-15
  • 9.  
  • 10. RESULT HOSPITAL MORTALITY RATE S No. Phases Nurse Patient ratio Total no. of patients No. of deaths % 1. CONTROL PHASE 1:4 ( evening and night shift) 1:3 ( morning shift) 266 48 18 % 2. TRAINING PHASE 1:1 (inexperienced and untrained ) 255 42 16.4 % 3. FINAL PHASE 1:1 (fully trained) 216 33 15.3 %
  • 11.  
  • 12. GROSS INFECTION RATE INFECTION IN TRACHEAL CULTURE S No. Phases Nurse Patient ratio Total no. of patients No. of culture positive patients % 1. CONTROL PHASE 1:4 ( evening and night shift) 1:3 ( morning shift) 266 166 62.3 % 2. TRAINING PHASE 1:1 (inexperienced and untrained ) 255 151 59.3 % 3. FINAL PHASE 1:1 (fully trained) 216 48 22.3 %
  • 13. INFECTION IN URINE CULTURE S No. Phases Nurse Patient ratio Total no. of patients No. of culture positive patients % 1. CONTROL PHASE 1:4 ( evening and night shift) 1:3 ( morning shift) 266 130 48.9 % 2. TRAINING PHASE 1:1 (inexperienced and untrained ) 255 87 34.2 % 3. FINAL PHASE 1:1 (fully trained) 216 27 12.6 %
  • 14. INFECTION IN BLOOD CULTURE S No. Phases Nurse Patient ratio Total no. of patients No. of culture positive patients % 1. CONTROL PHASE 1:4 ( evening and night shift) 1:3 ( morning shift) 266 66 24.9 % 2. TRAINING PHASE 1:1 (inexperienced and untrained ) 255 37 14.5 % 3. FINAL PHASE 1:1 (fully trained) 216 9 4.2 %
  • 15.  
  • 16. CONCLUSIONS
    • There is significant decrease in mortality following introduction of 1:1 nursing in neurosurgery ICU.
    • The severity of head injury was approximately in the same range of all the phases hence it has no significant role to play in the reduction of mortality rate.
    • This mortality further decreased significantly following in house training to new recruits.
  • 17. CONCLUSIONS
    • There is a significant role of nurse patient ratio in the improvement of nursing care standards as it is obvious from the study that by making nurse patient ratio 1:1 there is a huge decrease in infection rate.
    • Blood infection rate (4.25), tracheal infection rate (22.3%) & urine infection rate (12.6%) in the final phase were significantly lower (p<0.001) than the preceding two phases.
  • 18.
    • There was no significant difference between the control & training phases in the incidence of blood, tracheal & urine infection. However, Trend towards improvement in all parameters of patient outcome is seen following the induction of fresh staff nurses in the system which became significant later.
    • Structured programs and mentorship plays a vital role in improving the nursing practices .
    CONCLUSION
  • 19.  

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