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The influence of shared mental models of nosocomial bloodstream infections on neonatal intensive care unit infection rates.

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Call No.	RJ275 .L83 2006
Author	Luan, Diana M.
Title	The influence of shared mental models of nosocomial bloodstream infections on neonatal intensive care unit infection rates.
Date	2006
Abstract	Statement of the problem. Nosocomial bloodstream infections (NBSIs) are a significant source of morbidity and mortality for the very low birth weight babies (VLBW) in neonatal intensive care units (NICUs). Efforts to reduce the rates of infection have produced mixed outcomes, and significant variation in the rates exists. The objective of this research was to identify if a shared mental model of NBSI among NICU staff as preventable was associated with lower infection rates in NICUs. Methods. Data came from surveys and interviews and site observations of six NICUs associated with the Vermont Oxford Network (VON) of staff to explore the relationship between mental models about prevention of infection and rates achieved. Results. Staff were defined to have a Prevention Mental Model when they believed that NBSI are preventable events, it is possible to reduce the rate to near zero, and infections are perceived to be errors in the process of care. This mental model contrasted to an Inevitable Mental Model where NBSIs are inevitable events, attainment of a near zero rate is not possible, and NBSIs are expected complications of care. NICUs with low NBSI rates were strongly associated with staff who shared the Prevention Mental Model. Such units were more likely to have active engagement of the unit staff in the improvement process, leadership who served as mentors, and organizational cultures that were more group-oriented. NICUs with high NBSI rates were more likely to share an Inevitable Mental Model. These NICUs were more likely to have very hierarchical approaches to the improvement process and leaders who took roles of policing and policy development. Staff at the two sites with exposure to the VON collaborative for improvement of care exhibited transitional thinking, moving from an Inevitable to a Prevention Mental Model. Conclusions. These results suggest that the dominant mental model shared by staff influences their action and behaviors in ways that may contribute to lower NBSI infection rates. Policy makers and clinical leaders may benefit from establishing an appropriate prevention-orientation among staff when trying to improve care and reduce costs in neonatal intensive care.
Description	ix, 176 leaves : ill. 28 cm.
Format	application/pdf
Advisor	Eugene C. Nelson.
Subject	Neonatal infections -- Prevention. Nosocomial infections -- Prevention. Neonatal intensive care -- Social aspects. Neonatal intensive care -- Psychological aspects.
College	Dartmouth Medical School -- Center for the Evaluative Clinical Sciences.
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Copyright	All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means without permission in writing from the author.
DOI	http://dx.doi.org/10.1349/ddlp.119

Title	Page 1
Format	application/pdf
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Full Text	THE INFLUENCE OF SHARED MENTAL MODELS OF NOSOCOMIAL BLOODSTREAM INFECTIONS ON NEONATAL INTENSIVE CARE UNIT INFECTION RATES A Thesis Submitted to the Faculty in partial fulfillment of the requirements for the degree of Doctor of Philosophy in The Evaluative Clinical Sciences by Diana M. Luan, R.N., M.P.A., M.S. DARTMOUTH COLLEGE Hanover, New Hampshire March 30, 2006 Examining Committee: ____________________________ (chair) Eugene C. Nelson, D.Sc., M.P.H. ____________________________ Ann Barry Flood, Ph.D. ____________________________ Paul B. Batalden, M.D. ____________________________ Stephen M. Shortell, Ph.D., M.P.H. ____________________________ Charles K. Barlowe, Ph.D. Dean of Graduate Studies

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