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Introduction: The birth of a preterm child requires hospitalization in a neonatal intensive care unit (NICU), which is a very stressful experience for parents. Aim: To determine the stress level of parents of preterm babies admitted to intensive and sub-intensive units in two hospitals in Northern Italy and its association with their sociodemographic variables and the clinical conditions of their newborns.

The sampling was non-probabilistic and included parents of preterm babies admitted to intensive and/or sub-intensive care for at least 10 days. Instruments: (1) information deduced from the clinical record of preterm newborns; (2) sociodemographic determinants of parents' well-being deduced from a questionnaire; (3) parental stress scale: neonatal intensive care unit (PSS:NICU), which measures the perception of parents about stressors from the physical and psychological environment of the NICU.

Results: A total of 104 parents of 59 hospitalized preterm babies participated in the study. The average parental stress level was 1.87 ± 0.837. The subscale score that got higher was parent-infant relationship subscale. Concerning the infant characteristics, the birth weight of the babies and the length of their hospitalization affected the parents' stress level. Looking at parents' sociodemographic characteristics instead, the greater predictors were gender, age and occupational social class.

The parental role alteration caused by infant premature birth and consequent hospitalization is a major stressor for parents and in particular for mothers. The variables that resulted positively associated with higher stress in parents of preterm infants hospitalized are specific parental characteristics, including not adequately or previously studied ones, and infant characteristics.

This study aims to develop a practical methodology to identify possible areas of improvements as well as exploring how to improve the health-care staff flow within a selected department in a hospital.

It focuses on showing how to properly study and analyze the health-care services and processes practiced at a selected department within a hospital. For this, several techniques like non-value-adding activities, time motion study, spaghetti diagram, layout analysis, etc. are used.

To test the proposed methodology, a neonatal intensive care unit (NICU) of a hospital in Oman was considered as a case study. The study revealed that this unit has several potential improvements capabilities. Further, this study also discussed possible areas of improvements of this case unit and suggested how such improvements can be implemented.

Several possible improvements are suggested and are discussed with the hospital authority, which can be clarified as the re-layout of the NICU rooms, reorganization of the store to improve the staff flow, increase the work efficiency, introduction of Help Us Support Healing policy, etc., which can enhance the entire operational system at the studied NICU.

The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards.

The process started with the department head's decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families.

In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved.

The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard.

The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard.

ISO 9001 is becoming a recommended tool to improve clinical service quality.

South East Thames Regional Health Authority (SETRHA), in conjunction with the Brighton Health Authority, have negotiated a prospective contract for the provision of NICU services by Brighton Health Authority to district health authorities in the South West Thames Region.

Autonomy has long been established as a critical component of professional work. Traditionally, autonomy has been examined as the extent to which an individual or a professional group controls the decisions and knowledge used in their work. Yet, this framework does not capture the additional work activities that professionals are increasingly expected to perform. Therefore, this chapter argues for theoretically expanding our understanding of professional autonomy by bringing in the concept of articulation work. Using the case of healthcare organisational change, this study assesses how shifts in work practices impact autonomy. Data come from longitudinal ethnographic fieldwork and in-depth interviews conducted at a Neonatal Intensive Care Unit as it underwent significant structural changes. Findings show that professionals were forced to change articulation work strategies in response to new organisational structures. This included changes in the way professionals monitored, assessed, coordinated and collaborated around patient care. Furthermore, these shifts in articulation work held important implications for both workplace and professional autonomy, as professionals responded to changes in their work conditions.

Only recently has physical space design become more widely recognized as playing a critical role in delivery of care, with an emerging body of literature on the application of human factors approaches to design and evaluation. This chapter describes the use of human factors approaches to develop and conduct an evaluation of a proposed Neonatal Intensive Care Unit redesign in a Midwestern children’s hospital. Methods included observations and knowledge elicitation from stakeholders to characterize their goals, challenges, and needs. This characterization is integral to informing the design of user-centered solutions, including physical space design. We also describe an approach to evaluating the proposed design that yielded actionable recommendations specific to hospital-driven design goals.

Twin to Twin Transfusion Syndrome (TTTS) is a well understood, yet under-recognized, placental disease affecting any given pregnancy at a rate of 1 in 1,000. There is no clustering of TTTS; instead the threat remains pathologically distinctive due to its pervasiveness. However, while incidence rates are random, survival rates are not. Despite compliant acceptance of “routine prenatal care,” sadly, there are many women who for currently unknown reasons are not receiving the advanced prenatal care needed to appropriately screen for, diagnosis and treat TTTS. And these women are paying the ultimate price for such obstetrical oversight.

This study hypothesizes that differential care being given by primary obstetricians of TTTS patients is resulting in experienced inequalities. Utilizing social reproduction theory, and through ethnographic and quantitative analyses of primary data, this study seeks to divulge the complex social processes taking place (or failing to take place) within the world of American obstetrics, and begin to understand how they are affecting TTTS mortality and morbidity rates.

Findings illuminate a profound imbalance of power and influence amongst the following entities: American Congress of Obstetricians and Gynecologists and Society of Maternal Fetal Medicine; obstetrical training and practice; and levels of patient awareness and advocacy.

This study argues that the current social relations being reproduced by these entities are perpetuating a climate that allows for disregard of proper TTTS management. Specifically, this study theoretically explores what social relations and subsequent (in)actions are being reproduced prior to TTTS diagnoses, and applies the effects of those observations.

In Great Britain in the 1960s and 1970s, a physician (Lorber, 1971) developed criteria that would exclude from treatment many babies born with spina bifida (“open spine”) based on what he perceived to be a poor projected quality of life. In the US, the parameters of the modern debate developed around the case of “Baby Doe,” a child born in the early 1980s with Down syndrome and duodenal atresia, an intestinal blockage. Without surgery to correct the blockage, the baby would not survive. Because the infant also had Down syndrome, which typically includes some degree of intellectual disability, the parents decided not to consent to the surgery. The parents’ decision was met with outrage by disability advocacy groups, as was a similar decision a few years later to forego surgery to repair a myelomeningocele (spina bifida) in the case of “Baby Jane Doe.” The publicity surrounding these and other non-treatment decisions resulted in the US in the passage of the Child Abuse Amendments of 1984, largely through the efforts of then Surgeon General C. Everett Koop. This legislation effectively mandated universal treatment of newborns with disabilities. However, several court cases since have resulted in rulings allowing parents to discontinue life support based on quality-of-life issues, resulting in the establishment of state standards in addition to the federal ones (Clark, 1994). Still, the norm in the case of Down syndrome and spina bifida, two of the most common childhood impairments apparent at birth, continues to support the treatment of virtually all children born with these conditions. As a result, most post-natal decision making today involves infants with other, often more serious, impairments that result from perinatal complications or from extreme prematurity. Even in those cases, a bias toward treatment seems to prevail (Levin, 1990).

Purpose – This chapter discusses the relationship between health insurance and hospitals’ decisions to adopt medical technologies. I focus on both how the extent of insurance coverage can increase incentives to adopt new treatments, and how the parameters of the insurance contract can impact the types of treatments adopted.

Methodology/approach – I provide a review of the previous theoretical and empirical literature and highlight evidence on this relationship from previous expansions of Medicaid eligibility to low-income pregnant women.

Findings – While health insurance has important effects on individual-level choices of health care consumption, increases in the fraction of the population covered by insurance has also been found to have broader supply side effects as hospitals respond to changes in demand by changing the type of care offered. Furthermore, hospitals respond to the design of insurance contracts and adopt more or less cost-effective technologies depending on the incentive system.

Research limitations/implications – Understanding how insurance changes supply side incentives is important as we consider future changes in the insurance landscape.

Originality/value of paper – With these previous findings in mind, I conclude with a discussion of how the Affordable Care Act may alter hospital technology adoption incentives by both expanding coverage and changing payment schemes.

This paper aims to present an integrative review of the research studies on nursing unit layouts.

Studies selected for review were published between 1956 and 2014. For the purpose of this review, a framework for integrative review was developed using research orientations. The three primary dimensions – technical, psychological and social – of the designed environment and various combinations of these dimensions were used to define the research orientations of these studies.

Of all the publications reviewed for the paper, 21 presented technical orientations, 16 psychological orientations, 3 social orientations, 20 psychotechnical orientations, 10 sociotechnical orientations, 2 psychosocial orientations and 13 presented psychosociotechnical orientations. With only a few exceptions, several issues related to nursing unit layouts were investigated no more than one time in any one category of research orientations. Several other seemingly important issues including patient and family behavior and perception, health outcomes and social and psychosocial factors in relation to unit layouts have not been studied adequately.

Future studies on nursing unit layouts will need to focus on patient and family behavior and perception, health outcomes and social and psychosocial factors in different units. They will also need to focus on developing theories concerning the effects of layouts on the technical, psychological and social dimensions of nursing units.

Despite a long history of research on nursing unit layouts, an integrative review of these studies is still missing in the literature. This review fills in the gap using a novel framework for integrative review developed based on research orientations.