Strategies to sustain a quality improvement initiative in neonatal resuscitation

BACKGROUND : Many neonatal deaths can be prevented globally through effective resuscitation. South Africa (SA) committed towards attaining the Millennium Development Goal 4 (MDG4) set by the World Health Organization (WHO). However, SA’s district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes associated with patient-related, administrative and health care provider factors contribute to neonatal mortality. A quality improvement initiative in neonatal resuscitation could contribute towards decreasing neonatal mortality, thereby contributing towards the attainment of the MDG4. AIM : The aim of this study was, (1) to explore and describe the existing situation regarding neonatal resuscitation in a district hospital, (2) to develop strategies to sustain a neonatal resuscitation quality improvement initiative and (3) to decrease neonatal mortality. Changes that occurred and the sustainability of strategies were evaluated. SETTING : A maternity section of a district hospital in South Africa. METHODS : The National Health Service (NHS) Sustainability Model formed the theoretical framework for the study. The Problem Resolving Action Research model was applied and the study was conducted in three cycles. Purposive sampling was used for the quantitative and qualitative aspects of data collection. Data was analysed accordingly. RESULTS : The findings indicated that the strategies formulated and implemented to address factors related to neonatal resuscitation (training, equipment and stock, staff shortages, staff attitude, neonatal transport and protocols) had probable sustainability and contributed towards a reduction in neonatal mortality in the setting. CONCLUSION : These strategies had the probability of sustainability and could potentially improve neonatal outcomes and reduce neonatal mortality to contribute toward South Africa’s’ drive to attain the MDG4.C.v.H. was the main researcher as doctoral candidate at the time of the study and main author of this study. C.M. was the supervisor and E.v.R. was the co-supervisor for the study.http://www.phcfm.orgam2016Nursing Scienc

Strategies to sustain a quality improvement initiative in neonatal resuscitation in a district hospital in Gauteng province South Africa

The neonatal mortality rate globally and in South Africa is high. South African district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes contribute to this rate. The causes are associated with patient-related factors, for example, immaturity or illness, administrative factors such as inadequate facilities or equipment for resuscitation, and healthcare provider factors such as insufficiently trained or an insufficient number of staff. Competent resuscitation is a critical intervention for the survival of infants in need of respiratory or cardiac support in the neonatal period. The lack of neonatal resuscitation skills contributes to the high mortality rates in these settings. This multifaceted problem persists in spite of various neonatal resuscitation training in district hospitals. This prompted the following main research question: How can a quality improvement initiative in neonatal resuscitation be sustained in a district hospital in Gauteng? The aim of this study was to explore and describe the existing situation regarding neonatal resuscitation to enable the researcher and stakeholders in the specific district hospital in developing strategies to sustain the neonatal resuscitation quality improvement initiative in an effort to decrease neonatal mortality. In addition, to determine what changes occurred as a result of these strategies and whether these changes were sustainable. The Problem Resolving Action Research model was the methodology of choice and the National Health Service (NHS) Sustainability Model was used as the theoretical framework for the study. The study was conducted in three cycles. Each cycle answered a sub-question: CYCLE 1: What is the existing situation regarding factors influencing neonatal resuscitation and neonatal mortality in a district hospital in Gauteng? CYCLE 2: What strategies can be implemented to sustain a quality improvement initiative in neonatal resuscitation in a district hospital in Gauteng? CYCLE 3: What were the changes that occurred as a result of the strategies for a quality improvement initiative in neonatal resuscitation that were implemented? Were the strategies implemented to sustain a quality improvement initiative sustainable? A literature review was done to determine the background and rationale and for the purpose of literature control. Both qualitative and quantitative methods of data collection and analyses were used to determine the existing situation regarding neonatal resuscitation, develop and implement the strategies, and to evaluate the changes. Ethical considerations and methods to ensure trustworthiness and validity and reliability were taken into consideration and adhered to. Based on the findings it could be concluded that the strategies to sustain a quality improvement initiative in neonatal resuscitation had the probability of sustainability. Furthermore there was also a marked decrease in the neonatal mortality in the maternity section of this district hospital. Based on the findings the researcher was able to make conclusions and recommendations for practice, education and future research.Thesis (PhD)--University of Pretoria, 2015.tm2015Nursing SciencePhDUnrestricte

Strategies to sustain a quality improvement initiative in neonatal resuscitation

Background: Many neonatal deaths can be prevented globally through effective resuscitation. South Africa (SA) committed towards attaining the Millennium Development Goal 4 (MDG4) set by the World Health Organization (WHO). However, SA’s district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes associated with patient-related, administrative and health care provider factors contribute to neonatal mortality. A quality improvement initiative in neonatal resuscitation could contribute towards decreasing neonatal mortality, thereby contributing towards the attainment of the MDG4. Aim: The aim of this study was, (1) to explore and describe the existing situation regarding neonatal resuscitation in a district hospital, (2) to develop strategies to sustain a neonatal resuscitation quality improvement initiative and (3) to decrease neonatal mortality. Changes that occurred and the sustainability of strategies were evaluated. Setting: A maternity section of a district hospital in South Africa. Methods: The National Health Service (NHS) Sustainability Model formed the theoretical framework for the study. The Problem Resolving Action Research model was applied and the study was conducted in three cycles. Purposive sampling was used for the quantitative and qualitative aspects of data collection. Data was analysed accordingly. Results: The findings indicated that the strategies formulated and implemented to address factors related to neonatal resuscitation (training, equipment and stock, staff shortages, staff attitude, neonatal transport and protocols) had probable sustainability and contributed towards a reduction in neonatal mortality in the setting. Conclusion: These strategies had the probability of sustainability and could potentially improve neonatal outcomes and reduce neonatal mortality to contribute toward South Africa’s drive to attain the MDG4

Action research as sustainable healthcare quality improvement : advances in neonatal care emphasising collaboration, communication and empowerment

Neonatal resuscitation can save newborn lives when performed by competent staff in a setting that is adequately equipped and organised. To develop strategies to sustain quality improvement in neonatal resuscitation, an initiative was launched in a maternity section of a district hospital in Gauteng, South Africa, using Piggot-Irvine’s Problem Resolving Action Research model. The application of the Problem Resolving Action Research model, using multiple data collection and analysis techniques in three cycles, facilitated improvement and transformation towards sustainable changes related to neonatal resuscitation in the specific context. The changes included development of policies, improved infrastructure, enhanced teamwork and collaboration, empowerment and professional development of staff, and integrating theory in neonatal practice. The outcomes resulted in improved staff competency and reduced neonatal mortality and morbidity in the particular setting.https://journals.sagepub.com/home/arjahj2020Nursing Scienc

One-day workshops, a platform for continuous professional development of nursing staff in a neonatal intensive care unit

The neonatal field is constantly changing with the development of new evidence-based practice and technology. The purpose of this paper is to report on a research project that aimed to create a platform for continuous professional development to improve evidence-based neonatal practice using action research. Using Problem Resolving Action Research, a process consisting of plan, act, observe and reflect was applied by a steering committee. A nominal group discussion technique determined training priorities of nursing staff in a neonatal intensive care unit and questionnaires obtained demographic data of participants and information pertaining to workshops and professional development over a period of two years. The findings indicate that one-day workshops serve as a valuable platform to contribute to professional development to improve quality care in neonatal practice.https://journals.sagepub.com/home/aduhj2019Nursing Scienc

South African neonatal nurse specialization – is professional licensing justifiable?

Neonatal nursing is currently not acknowledged as a clinical nurse specialization in the South African context. It is argued that neonatal nursing meets all criteria for designating nursing specialists as specified by the International Council of Nursing. A competency framework is proposed aligned with the country's qualification framework. Acknowledgement of neonatal nurses as clinical nurse specialists is expected to influence policy in education and clinical practice that in turn will influence neonatal care practices and outcomes for preterm and critically ill neonates and their families.The Neonatal Nurses' Association of South Africahttps://www.elsevier.com/locate/jnn2021-09-30hj2021Nursing Scienc