University of Alabama at Birmingham, AL, USA.
MCN Am J Matern Child Nurs. 2009 Nov-Dec;34(6):365-71. doi: 10.1097/01.NMC.0000363685.20315.0e.
To examine and describe neonatal resuscitation preparedness, presence of connections to wider systems of care, continuing education activities, presence of trained staff, and other indicators of high performance in rural perinatal microsystems.
A nonexperimental, retrospective, descriptive, cross-sectional design was utilized. Rural hospitals (n = 124) providing perinatal services in five southern states were invited to participate. Nurse managers completed the Hospital Neonatal Resuscitation Survey, describing policies, healthcare team members, educational activities, organizational culture, system connections, and process improvement. Descriptive data were also collected.
A total of 44 (35.1%) hospitals participated. Annual birth volume ranged from 22 to 1,614 (M = 515.53; SD = 336.27). Low birth volume hospitals (<125 births per year) had significantly lower levels of preparedness than high volume hospitals (>125 births per year). Preparedness was not influenced by rurality. One-third (34.1%) did not identify relationships with Level III NICUs. Support of continuing education was universal. Efforts to increase interdisciplinary teamwork were common. Medical provider shortages were prevalent (n = 25: 56.8%), and the presence of midwifery services was infrequent (n = 12; 27.2%). Hospital nursing shortages (n = 35; 81.8%) were widespread.
Challenges faced by rural hospitals and healthcare professionals in the delivery of perinatal care emphasize the importance of creating and maintaining high performance microsystems that are responsive to the changing needs of providers and the populations they serve. Lower levels of preparedness and the lack of established relationships with level III NICUs is concerning.
检查和描述新生儿复苏准备情况、与更广泛的医疗保健系统的联系、持续教育活动、培训人员的存在情况以及农村围产期微型系统中其他高绩效的指标。
采用非实验性、回顾性、描述性、横断性设计。邀请五个南部州提供围产期服务的农村医院参与。护士长填写《医院新生儿复苏调查》，描述政策、医疗保健团队成员、教育活动、组织文化、系统联系和流程改进情况。还收集了描述性数据。
共有 44 家（35.1%）医院参与。年分娩量从 22 到 1614 例不等（M = 515.53；SD = 336.27）。低出生量医院（每年<125 例）的准备程度明显低于高出生量医院（每年>125 例）。农村性对准备程度没有影响。三分之一（34.1%）的医院没有与三级新生儿重症监护病房建立联系。对继续教育的支持是普遍的。增加跨学科团队合作的努力是常见的。医疗服务提供者短缺普遍存在（n = 25：56.8%），而且助产服务的存在频率较低（n = 12：27.2%）。医院护理人员短缺（n = 35：81.8%）普遍存在。
农村医院和围产期保健专业人员在提供围产期保健方面面临的挑战，强调了创建和维持对提供者和服务人群不断变化的需求做出响应的高绩效微型系统的重要性。准备程度较低以及与三级新生儿重症监护病房缺乏既定联系令人担忧。
