Background:
Escalating and aggressive visitor behaviors have become increasingly common in healthcare settings nationally, negatively impacting staff and patients alike. Most healthcare providers do not innately possess the specific skills to manage such behaviors. Management of escalating and aggressive behaviors presents a particularly bedeviling challenge when staff safety must be balanced with the needs of parent–neonate bonding.
Purpose:
In the Intensive Care Nursery (ICN), the frequency of aggressive and hostile incidents from visitors increased such that the staff felt frustrated by and uneasy about their work environment.
Methods:
The ICN convened an interprofessional team to strategize interventions aimed at consistently managing aggressive behavior and supporting the staff after aggressive and/or hostile visitor encounters.
Findings:
Following staff education and training, the unit launched a de-escalation management algorithm in July 2018 that assisted in identifying high-risk families at admission and drove consistent action and management of all visitor behaviors. In the 12 months following the intervention, the frequency of behavioral escalation decreased by 75% and staff perception of safety increased by 25%.
Implications for Practice:
Collaborating with staff to design consistent strategies to manage aggressive and escalating visitor behavior can improve safety and improve employee satisfaction in the ICN.
Implications for Research:
Additional research on the effectiveness of the algorithm in other ICNs and alternative areas of practice is needed. Furthermore, validation of a staff perception survey measuring the impact of escalating visitor behaviors on employees would be an important next step in this research.
Video abstract available at
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=43
Knowledge acquisition on the subject of hyperoxia in VPIs was achieved. Decreasing the percent time VPIs were exposed to hyperoxia was not attained. The postintervention VPI cohort spent more time above the target saturation range despite greater knowledge among clinicians.
Hyperbilirubinemia continues to be a common problem of the term and near-term neonate. Each year more than 60% of infants born in the United States develop jaundice, making it difficult at times to differentiate jaundice due to pathologic reasons from jaundice due to physiologic ones. Now, the knowledge that bilirubin may even have a beneficial role as an antioxidant has caused a great deal of renewed interest in the management of jaundice. The American Academy of Pediatrics has published revised guidelines for management of neonatal jaundice that have resulted in much discussion. The article reviews current theories of bilirubin production and clearance, noninvasive and nonintrusive techniques to assess and care for jaundice, and newer concepts of preventive and treatment modalities from a nursing perspective.
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