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2016 Small Grants Winner

Melinda Colleen Brand, PhD APRN NNP-BC

Texas Children’s Hospital
Pilot Study on the Impact of Unit Design and Shift Assignment on Stress in NICU Nurses

At what institute are you currently conducting your research?

Texas Children's Hospital is one of the nation's largest, not-for-profit pediatric hospitals. The Newborn Center at this facility provides care for a diverse population of chronically and acutely ill neonates. Neonatal Intensive Care Units (NICUs) at Texas Children’s are arranged either in single family rooms or in open bays, providing the opportunity to compare the effects of these designs on stress in NICU nurses.

This is a great place to do research, not only because of the number and variety of patients cared for, but because the importance of research is understood and supported. Our team includes myself, the Co-Principal Investigator Holly Boyd, a nurse scientist, a statistician and nurses from each NICU. An employee assistance specialist and a faculty member from The University of Texas Health Science Center at Houston with expertise in salivary cortisol are also valuable members of our team.  

What is the main focus of your research?

The focus of this research is stress in NICU nurses. Nurses who care for these small and critically ill patients often put patient’s needs ahead of their own. Long hours and shift work caring for critically ill and fragile patients can be stressful. Stress results in a number of physical and somatic illnesses, absenteeism and staff turnover. While stress is not limited to nursing staff, the role of the bedside nurse is unique, given their 24/7 contact with patients and their families. Compassionate nursing is at the heart of neonatal care. Identifying sources of stress is the first step in addressing the problem.

How did receiving the NANN Research Institute’s Small Grants Award positively impact your career?

The NANN Research Institute’s Small Grants Award allows funding opportunities for neonatal nurses to conduct clinically meaningful research. The NANN small grant will allow the analysis of salivary cortisol, a non-invasive biomarker of stress collected for this study. While self-identified stress (survey) is important, individuals may under-estimate their actual level of stress. Cortisol levels will provide a quantitative measurement of stress and a higher level of understanding of this phenomenon.

Why is your work important and how does it advance the field of neonatal nursing?

This study is important to identifying ways to maintain the healthy and stable NICU nursing staff needed to care for chronic and critically ill neonates and their families. This study specifically looks at the differences in NICU design and shift assignment on stress. This is the first study to compare NICUs arranged in single family room designs with open bay designs simultaneously. The study will also compare differences in permanent night and day shift assignments, a gap in the evidence that primarily centers on rotating shifts. Work should not be a burden, it should be fulfilling while also promoting work-life balance.

This work is also important to staff development and to engaging frontline staff in clinical research. Staff nurses from each unit participated in the development of this study and in the collection of surveys and samples. They will also be involved in analyzing the results and dissemination of the findings.

In what ways does NANN membership add value to your professional development?

I am a member of NANN because it is my professional organization. The organization provides a united voice for NICU nurses and nurse practitioners. Practice guidelines, education, support for research and a venue for disseminating information through both a peer reviewed journal and at annual conferences are also benefits of belonging to NANN.