READINESS FOR NEONATAL RESUSCITATION: MEASURING KNOWLEDGE, EXPERIENCE, AND COMFORT LEVEL
Jukkala AM, Henly SJ. Appl Nurs Res. 2007;20:78-85.
Researchers employed a descriptive, cross-sectional survey design to meet the following objectives: (1) describe the development of the Neonatal Resuscitation Index (NRI) and Neonatal Resuscitation Experience Index (NREI); (2) report findings on initial testing of the NRI and NREI; (3) examine relationships between knowledge of neonatal resuscitation, skill performance frequency, and level of comfort performing skills; and (4) examine differences in knowledge, experience, and comfort level in nurses with and without neonatal resuscitation program provider status.
The NRI and NREI are both paper-and-pencil questionnaires. Development of the instruments included content review by a panel of experts. Initial testing of the instruments was conducted at 5 rural and 2 urban hospitals, with a sample of 70 nurses.
Test reliability of the instruments was estimated using Cronbach [alpha]. The NRI reliability was .73. The NREI experience subscale reliability was .94, whereas the comfort subscale was .94.
It was discovered that nurses were most comfortable when they performed skills more frequently (r = 0.88, P < .01). It was found that knowledge was related to frequency of skill performance (r = 0.40, P < .01) as well as comfort level (r = 0.44, P < .01). Urban nurses reported performing neonatal resuscitation more frequently and had higher levels of comfort compared to rural nurses. Those with current neonatal resuscitation program provider status had significantly higher scores on the NRI (t = -3.15, P = .002).
The researchers recommend continued development and testing of the instruments, particularly with larger, more diverse groups of providers. They plan further testing using factor analytical models. The researchers note that the NRI and NREI can be used for staff assessment and educational purposes.
LEVEL AND VOLUME OF NEONATAL INTENSIVE CARE AND MORTALITY IN VERY-LOW-BIRTH-WEIGHT INFANTS
Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH. N Engl J Med. 2007;356:2165-2175.
Researchers examined the medical records of 48,237 very-low-birth-weight infants (less than 1,500 g) born in California hospitals in 1991 to 2000 to determine differences in neonatal mortality among neonatal intensive care units with various levels of care and different volumes of neonates. Records used were birth certificates, hospital discharge abstracts, and fetal and infant death certificates.
Infants who had major congenital anomalies or weighed less than 500 g were excluded from the study. Logistic regression was used to estimate odds of death of infants. Lower levels of care and lower volumes were associated with increased odds of death, ranging from 1.19 (95% confidence interval, 1.04-1.37) to 2.72 (95% confidence interval, 2.37-3.12).
The researchers suggest that increasing the use of facilities that have a high level of care and a high volume may reduce mortality rates for very-low-birth-weight infants. They recommend the consideration of regionalization of perinatal care to reduce mortality of these infants.