Uses of Statistical Information

Uses of Statistical Information

Jean Matsche

University of Phoenix

Statistical Applications

Tammy Czarnecki

October 5, 2007

Uses of Statistical Information

The expansion of the responsibilities of nurses, the nursing shortage, and increasing specialization make it more important than ever that nursing practice be evidence-based (Understanding Nursing Research, 2007). This expectation has made it evident that clinical nurses acquire skills in reading and evaluating the results of statistical tests.

This systematic evaluation of practice is essential to providing quality care (Dorn, 2004).

One reason that nurses may avoid statistics is that may were taught only the mathematical procedures of calculating equations, with little or no explanation of the logic behind those procedures, or what the results mean. Involving the clinical nurse at all stages of the process may help to alleviate some of those fears, and making the nurses accountable for the data gives them a sense of ownership. This sense of ownership from nurses directly involved in patient care will have the greatest influence on research efforts and the programs success (Dorn).

Current Studies in the Neonatal Intensive Care Unit

The Neonatal Intensive Care Unit (NICU) at Saint Joseph's Children's Hospital is part of the Vermont Oxford Network, a nonprofit voluntary collaboration of healthcare professionals whose goal is to improve the quality and safety of the care newborns infants and their families receive (Vermont Oxford Network, 2007).

Through Saint Joseph's participation in the Vermont Oxford Network, the NICU has current studies on Delivery Room Management and Hypothermia Effects on Long-term Prognosis (HELP).

Independent of the Vermont Oxford Network, the NICU has ongoing studies that include; accidental extubation rates, central line complications, and transport related data on departure time, mode of transport and thermoregulation. These independent studies are important because they are unit specific to our population, and initiated by the nursing staff. Compliance with data collection and changes in practice are improved when the staff has a vested interest in the outcome.

Through data analysis it was noted that the accidental extubation rate in the NICU was higher than the national rate. The data also showed a mix in terms of which infant's were at a higher risk for self-extubation and that the practice of how to secure endotracheal tubes showed many different options, no one superior method. The NICU changed it procedure on how to secure the endotracheal tube (ETT), and a new data collection form was initiated. Unfortunately, after the initial instruction and implementation, no one has looked at the data to analyze if there has been a decrease in our accidental extubation rate.

What Studies Should Be Done

The NICU needs to look at the data collected since the change in practice of securing ETTs. Unplanned extubation requiring re-intubation significantly increases the duration of mechanical ventilation, length of stay, and risk of acquiring pneumonia. It also increases the risk of complications associated with any intubation (mal-position of tube leading to atelectasis, perforation of the esophagus or tracheal, and lacerations to the tongue and gums.

In order to find the efficacy of this change in practice and to support this change as evidence based, the NICU needs to finish the project it started. It needs to analyze the data collected since the change in practice. Analyzing the data may show that the change in practice has not impacted the accidental extubation rate and a new method will need to be trialed. But the nurses who have collected the data need to see if the change is effective or not. Change is difficult, without data to confirm or deny that the change is effective, the clinical nurses may withdraw support and not continue to collect data on this or any other study initiated.

Sepsis in the neonatal period can be a devastating, life-threatening problem. For the neonate that requires assisted ventilation, the risk for infection is much higher, thus raising the morbidity and mortality rate. A Ventilator Acquired Pneumonia (VAP) is a nosocomial infection occurring in a patient requiring mechanical ventilatory support that was not present at the time of intubation. The VAP rate in the NICU at Saint Joseph's has been an ongoing problem, one that was well identified over two years ago through one of the Vermont Oxford studies on length of ventilator support. This was an unexpected result from that study, but the numbers were high enough to affect significantly the length of stay of the infants in the NICU. VAPs not only impact both the number of ventilator

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