The effects of single family rooms in a newborn care unit on the social and care environment for mothers and nurses project

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Jones, Liz
Woodhouse, Sara
Hong, Timothy
Sheeran, Nicola
Scannell, Mary
Rowe, Jen
Jones, Rachelle
Uhlmann, Laura
Saul, Julie
Hogan, Christy
Peters, Kathryn
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When the Gold Coast hospital relocated to the Gold Coast University Hospital in September 2013, the Special Care Nursery (SCN) and Neonatal Intensive Care Unit (NICU) moved from a ward style (i.e., open plan) facility to single family rooms (SFR's) where parents could remain in close proximity to their infant 24 hours each day. SFR's are posited to facilitate family-centred care and provide benefits for both parents and infants. Yet, evidence to support this assumption is limited, with little research on this topic to date. Available research suggests benefits to infants, such as decreased stimulation, noise and exposure to infection, and for parents increased privacy and the opportunity to overnight. At the same time concerns have been raised about possible negative outcomes in SFRs. To promote a healthy start to life for children, making such a major change to care provision should be supported with evidence of improved outcomes for patients and a quality care and support environment for nurses. Such a major change in organisational structure might simultaneously have both positive and negative effects, making it critical to determine such outcomes. The move provided a unique opportunity to compare the impact of two different physical environments on family-centred care and, in turn, nurses and mothers, while providing the best opportunity to control the hospital region and reduce other differences that might account for outcomes (e.g., staffing, family characteristics). This report details the findings for the full study that compared experiences for mothers and nurses in the OW to experiences in the SFRs. The report documents the findings from surveys and interviews conducted with both nurses and mothers in both nursery designs. Method 109 mothers (Time 1 N=61 and Time 2 N=48) across the two nurseries completed at least one of the surveys and 23 mothers (Time 1 N=12 and Time 2 N=11) participated in an interview. Mothers were asked in the survey about their psychological wellbeing, parental self-efficacy, perceptions of the physical and social aspects of the nursery environment and their satisfaction with the nursing care. 51 nurses (Time 1 N=22 and Time 2 N=29) across the two nurseries completed a survey and 28 (Time 1 N=17 and Time 2 N=11) participated in an interview. Nurses were asked in the survey about their job attitudes and psychological wellbeing, their level of social support at work and their perceptions of the physical and social aspects of the nursery and interactions with mothers. Nurses were asked in the interviews about their perceptions of family centred care and the factors that facilitated or inhibited family centred care in the nursery. Key findings for mothers Overall, mothers were very positive in both environments about the care provided to their infant and their relationship with hospital staff. Mothers valued nurses who provided information and emotional support using an appropriate interpersonal style. There are a number of benefits for mothers of SFRs: - Mothers (but not fathers) are present more in the SFR nursery - There are higher rates of mothers breastfeeding at discharge and 4 months post discharge - Mothers are very positive about the privacy of SFRs, which gives them a sense of ownership of the space and enables them to care more for their infants. In turn they report less alteration to their role as parents and lower levels of anxiety compared to OW mothers However, mothers in SFRS also said that: - Nurses could be hard to find and communicated less about mothering activities (e.g., feeding, bathing). Mothers felt isolated and it was difficult talking to other parents; whereas - mothers in OW valued seeing nurses caring for other infants and having multiple nursing staff in one room, where they could see how the different nurses interacted with infants and the information they shared with parents. They also liked seeing nurses working together. Key findings for nurses Overall, there was no difference in perceptions of supervisor and peer support, turnover intentions, overall job satisfaction or emotional exhaustion between the 2 nursery designs. Nurses also recognised a number of benefits of SFRs: - Significant decrease in noise and stimulation for infants and increased privacy for mothers - Parents present more, personalised the space and are more engaged and competent in infant care “know more, do more”. - Nurses report the increased satisfaction they get from observing parents in SFRs and working in the SFR environment. - Nurses also said SFRs improved their communication with parents, enabling them to customise what they say to parents and providing more privacy to talk and support. SFRs also protect parents from what is happening with other infants. - Nurses have higher levels of personal accomplishment in SFRs 5 However, nurses also reported that in SFRs: - Their workload had increased and they felt more isolated. - They found challenging dividing their time between different parents, they could “get tied up”, and they were chatting less to parents. - Parents isolated from other parents. - There is a suggestion that an increased number of nurses may be in the moderate range for burnout in SFRs

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© Griffith University 2015.
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Final report
This study was made possible by the collaboration and assistance of the Director of Nursing, Nurse Unit Manager, the Neonatology staff and the nursing staff of the Gold Coast Hospital Special Care Nursery.
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newborn care
singe family rooms
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The effects of single family rooms in a newborn care unit on the social and care environment for mothers and nurses project