Swathi S, Ramesh A, Nagapoornima M, Fernandes Lavina M, Jisina C, Rao P N Suman, Swarnarekha A
Department of Otolaryngology Head & Neck Surgery, Bangalore, India.
Department of Otolaryngology Head & Neck Surgery, Bangalore, India;
Int J Qual Stud Health Well-being. 2014 Mar 18;9:22523. doi: 10.3402/qhw.v9.22523. eCollection 2014.
The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU) of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP) during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians). Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to "sustain a culture of silence in NICU during nonemergency situations" (core category). The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The "culture of silence" reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a "noisy culture" prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs with resource constraints.
本研究的目的是生成一个实质性理论，以解释发展中国家资源有限的新生儿重症监护病房（NICU）的工作人员如何在非紧急情况下确保遵守降噪协议（NsRP）的行为修正部分。该研究是在印度南部一家三级NICU实施NsRP之后进行的。由于各类工作人员进行临床查房并随后开展护理活动，NICU的正常日常工作极具动态性。这不可预测地穿插着对突然生病的新生儿进行非常嘈杂的紧急处理。对NICU的36名工作人员（20名注册护士、6名护理助理和10名医生）进行了深入访谈。与20名注册护士和6名护理助理进行了小组讨论。数据分析是按照重新制定的扎根理论方法进行的，该方法基于对文本信息的归纳性审查。分析结果表明，主要关注点是确保遵守NsRP的行为修正部分。这通过采用“在非紧急情况下在NICU维持沉默文化”的策略（核心类别）来解决。采用的主要策略包括营造意识势头、促使意识渗透、培养主人翁意识、扩展护理实践、演变遵守情况以及展示绩效指标。“沉默文化”使现有工作人员重新适应环境，并使新加入NICU的工作人员适应环境。在紧急情况下，由于在生命支持压倒所有其他问题时对行为修正的实际忽视，“嘈杂文化”盛行。除此之外，操作性条件反射过程应每18个月正式进行一次。本研究的结果可加以调整，以制定类似策略，并在资源有限的NICU中建立因地制宜的NsRP。
