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S/N SHINY VARGHESE Neurosurgery ICU, JPNATC
Effect of New Joinees as Staff Nurses on patient
care in Neurosurgery ICU
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BACKGROUND
• 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.
• Sudden increase in nursing strength by
inexperienced nurses brings with it its own set of
difficulties in patient care.
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BACKGROUND (cont…….)
• 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.
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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.
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MATERIAL & 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.
• There was sudden increase in new joinees
by 100% in Decmeber 2010
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Different phases
1) Control phase (Oct 2010-Nov 2010)
When the nurse:patient ratio was 1:4
2) Training phase (Dec 2010-Jan 2010)
When the nurse: patient ration was 1:1 but new
nurses were inexperienced
3) Final phase (Feb 2011-march 2011)
When the nurse: patient ration was 1:1 and all
nurses had been trained in neuro-ICU care.
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EVALUATION PARAMETERS
1. GROSS INFECTION RATE
This is defined as no. of patients getting
infected(tracheal, urine and blood ) in respect of total no.
of patients getting admitted in neurosurgery, ICU in a
particular phase.
2. HOSPITAL MORTALITY RATE
This is defined as no. of deaths in respect
of total no. of patients in a particular phase.
3. NURSE PATIENT RATIO IN EACH PHASE
The average no. of patients a nurse is
assigned with
in a particular phase.
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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
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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 %
RESULT
HOSPITAL MORTALITY RATE
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GROSS INFECTION RATE
INFECTION IN TRACHEAL CULTURE
S No.
Phases Nurse Patient ratio
Total no. of
patients
No. of culture positiv
e patient
s
%
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 %
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INFECTION IN URINE CULTURE
S No.
Phases Nurse Patient ratio
Total no. of
patients
No. of culture positiv
e patient
s
%
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 %
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INFECTION IN BLOOD CULTURE
S No.
Phases Nurse Patient ratio
Total no. of
patients
No. of culture positiv
e patient
s
%
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 %
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CONCLUSIONS
• 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.
• This mortality further decreased significantly
following in house training to new recruits.
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CONCLUSIONS
• There is a significant role of nurse patient ratio in
the improvement of nursing care standards as it is
obvious from the study that by making nurse patient
ratio 1:1 there is a huge decrease in infection 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.
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• There was no significant difference between the
control & training phases in the incidence of blood,
tracheal & urine infection. However, Trend towards
improvement in all parameters of patient outcome is
seen following the induction of fresh staff nurses in
the system which became significant later.
• Structured programs and mentorship plays a
vital role in improving the nursing practices .
CONCLUSION
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