In the Practice Improvements in Neonatal Care section of Advances in Neonatal Care (ANC), we encourage authors, novice as well as experienced, to share manuscripts that are fundamental to neonatal nursing practice. Let's start with what is fundamental. What you do daily is fundamental to the care you provide to your patients?
Practice improvement and quality improvement are the "combined and unceasing efforts of everyone in the caregiving setting to make changes that will lead to better patient outcomes, better system performance, and better professional learning.1,2 This is the responsibility of all healthcare providers. One of which is you, each one of you.
Quality improvement can be related to new caregiving protocols you have learned or experienced. Questions you can ask your team are as follows: "What evidence has shaped the way you provide care?" "Have you made a recent change to your policies?" "What is your unit implementing that has benefited patients?" "What is your unit implementing that is unique, or not so unique, but has had a positive impact or unpredicted outcome?" "What is a concept or disease process that you have difficulty grasping?" "What better way to gain further understanding of that disease process than to write about it?" Educating each other is a fantastic way to learn ourselves, actually one of the best. This means content within this section is not limited to what is defined as solely a quality improvement initiative. Any topic that is fundamental to neonatal intensive caregiving is suitable for this section of the journal.
As nurses we are constantly mindful of safety risks, how to minimize these risks, and prevent errors or events from occurring. Nurses are uniquely positioned to anticipate potential events1 (you know that gut feeling). Who better to provide information to our profession than the nursing providers at the bedside? We need to ask whether this is the best we can do? Is this practice or caregiving protocol in the context of person-centered care and are the experiences of the neonates and their parents used to guide how the practice is implemented. It is important to remember that real outcome measures in healthcare are not what immediately happens but what the neonates and their family experiences over the course of their life because of their time spent in the neonatal intensive care unit (NICU).1
Numerous quality improvement initiatives have been developed in the NICU setting. Some of these topics are as follows:
* Pain assessment
* Reduction of central line-associated bloodstream infections (CLABSIs)
* Prevention of sepsis
* Prevention of necrotizing enterocolitis (NEC)
* Hand hygiene
* Mother-infant interactions
* Human milk nutrition
* Prevention of unplanned extubations
* Management of bronchopulmonary dysplasia (BPD)
* Prevention and management of hypothermia
* Magnetic resonance imaging without sedation
* Use of music therapy3
In addition, there are many processes that take place on an hourly, daily, and weekly basis that require standardization, care bundles, checklists, or even pathophysiological explanations relating to their use and development.1 There are diverse topics that you can share your learned experiences on:
* Improving our practice, by providing general information updates, reviews of the pathophysiology of a disease process, pharmacology principles of a specific medication, or pathophysiology of a certain disease process.
* Concept analysis of ideas central to neonatal nursing. You may have written one of these during your educational endeavors. To be publishable, you need to make sure the concept analysis is applicable in the real world.
* Clinical excellence related to specific problems. What has your unit been doing well that had had a positive effect on patient outcomes or that has positively affected parental satisfaction or participation.
* Descriptions of essential nursing care strategies for specific diagnosis.
* Neonatal concepts that pertain to all levels of nursing from the novice to the expert or targeted to a specific audience such as the new staff nurse or the advanced practice nurse.
* Quality improvement projects that promote practice and process improvement.
* Neonatal assessment processes.
Consider your own units. What is occurring that concerns you? What has been helpful? Look at the effects of the implementation of new care bundles, new equipment, new staffing models, or environmental issues. Work with the unit leadership when something new is implemented in your unit, equipment, practice bundle, or medication. Have you initiated a new task force? Document the effects of this practice. As NICU care provider, you are uniquely positioned to have a positive and lasting effect on the care provided in your institution. Share this with your colleagues. Pat yourselves on the back for the outstanding work you do and care you provide to our tiny patients and their families.
We want to use this section of ANC to capture the excellence of neonatal care that you are providing. Your unique educational and experiential viewpoints and your lived experiences are valuable. We look forward to reading your manuscripts. Many resources are available to assist you on this quest. These are in your units, hospitals, national associations, and this editorial board. Share your knowledge with our readers so that they may gain new knowledge that will enrich and expand their clinical knowledge and continue to improve the care we provide for our tiny precious patients.
Pamela Harris-Haman, DNP, APRN, NNP-BC
Section Editor, Practice Improvements in
Neonatal Care
[email protected]
References