Web Camera Use in the Neonatal Intensive Care Unit-Impact on Nursing Workflow

More and more neonatal intensive care units (NICU) are utilizing commercially available web camera systems to facilitate family bonding with sick infants.1,2 The goal of camera services is to allow virtual visitation of the infant by family members and to enhance bonding. Parents have shown a positive attitude towards the camera service.1–3 These technologies need to be user friendly in order to minimally impact the workload of nursing staff.2 Poorly planned implementation could lead to underutilization of the camera service.2 The web-based camera service allows parents and other relatives to visualize the baby admitted in the NICU through a password protected system. The web camera is attached to the bedside of the baby; any baby admitted to the NICU can be accessed by the cameras following parental written consent. Each family is issued an individual password to login to the secure system. Families are able to share the password with their friends and relatives at their discretion. The nurses taking care of the baby are also responsible for checking that the camera’s focus is centered on the infant, and that it is switched off during procedures, physical assessment, and bathing, and that it is then switched back on afterward. There is a telephone at every infant bedside, so when parents call, the nursing staff are available to answer questions and concerns. Hawkes et al2 evaluated nursing staff perception prior to implementation of a web camera service in which a majority of nurses revealed a negative attitude; 72% of the nurses feared increased workload after the camera service started. Nurses were also concerned about security issues, an increased number of phone calls, maintaining the camera system, and the infant being seen in the view.2 Angel Eye developers, a camera company, interviewed nurses after the camera service was implemented. There were concerns regarding the design of the camera and ease of use.1 Rhoads et al1 were concerned that if the cameras were implemented haphazardly then there would be increasing resistance from the NICU staff. Piecuch et al4 noted that the increased frequency of phone calls by the video mothers compared to the control mothers might have caused distress to the nurses. There are limited data on change in workload after implementation of a camera service. It is important to understand the workload and stress factors of NICU nurses in order to prevent adverse events. Multiple factors like patient acuity, staffing and management factors, highly technical environment, death, family needs, and ongoing need for crisis intervention and decision making are implicated as stressors.5 Tucker et al6 noted that infant mortality in the NICU increased with an increase in nursing staff workload. Increased workload can, thus, adversely affect patient safety.7 Therefore, assessment of the impact of any new technology on nursing work load is essential. Filho et al8 examined the possible association between the intensity of staff workload and adverse events in the NICU like accidental extubation, obstruction of endotracheal tube, and accidental disconnection of ventilator circuit. Adverse events were noted frequently during their 6-month study period. The more infants cared for per nurse, the more likely was the occurrence of intermediate adverse events.8 We evaluated the implementation of a web camera service in our NICU. Our study hypothesis was that implementation of the web camera service would increase nursing workload. We studied this by having nurses document their time spent dealing directly with the camera system for each infant on camera during their shift. We also questioned nurses about time spent with families as a direct result of the camera. We attempted to identify determinants that might disrupt or facilitate the use of camera service among nursing staff. We further examined the parental perception and use of the camera service based on their interaction with the nursing staff.