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 . •

1. S/N SHINY VARGHESE Neurosurgery ICU, JPNATC Effect of New Joinees as Staff Nurses on patient care in Neurosurgery ICU

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.

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

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 %

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 %