Failure to Rescue in the Neonatal Intensive Care Unit

Abstract

Purpose: The purpose of this study was to explore failure to rescue (FTR) in the neonatal intensive care unit through the perspective of neonatal nurses (RNs) and neonatal nurse practitioners (NNPs) as influenced by their patterns of knowing. Background: Failure to rescue (FTR) is a hospital-based phenomenon described as the probability of death following a complication in the hospital. FTR is highly correlated to nursing care. While the concept of FTR is well described in various adult populations, it has been applied sparingly in the neonatal context. Methods: A convergent mixed-methods design was utilized. This methodology merged results from the parallel collection of qualitative and quantitative data. The specific aims were: 1) describe neonatal nurses and nurse practitioners’ perceptions of factors associated with FTR and 2) describe nursing patterns of knowing used to inform decisions associated with clinical deterioration and FTR. Findings: One hundred and sixteen unique participants completed the online questionnaire and demographic information. Findings include statistically significant difference between males (n = 16) and females (n = 99) scores on the aPOK (X2(df=28) = 45.53, p = .018). All patterns of knowing were found to have a significant correlation to age, with the exception of ethical knowing (empirical: X2(df=24) = 57.32, p = <.001; aesthetic: X2(df=48) = 98.62, p = <.001; personal: X2(df=44) = 81.07, p = <.001; authority: X2(df=28) = 50.32, p = .006; aPOK: X2(df=112) = 156.93, p = .003). A significantly positive correlation was found between scores and years of nursing experience, years of NICU experience, and clinical expertise self-rating (r = .251, p = .007; r = .288, p = .002; r = .482, p = <.001). Qualitative findings of the study included nine concepts: rescue, communication, system, RN/NNP, infant, parents, actions, incivility, and ethics. These concepts were derived following the identification of 51 codes, which were evaluated for relationships. Throughout the qualitative analysis, patterns of knowing were able to be linked to various codes with the most prominent being empirical, aesthetic, and personal. Implications: RNs and NNPs leverage patterns of knowing in their responses to clinical deterioration and FTR.