Impact of Continuity in Nursing Care on Patient Outcomes in the Pediatric Intensive Care Unit

Background: Nursing care is known to improve patient outcomes during hospitalization, but the mechanisms by which outcomes are improved have not been fully explicated. Continuity in nursing care (CINC) may be an important characteristic of nursing care delivery that impacts patient outcomes. However, evidence linking CINC to patient outcomes is limited. Purpose: The first aim of this study was to examine the relationship between CINC and patient outcomes length of intensive care unit (ICU) stay, duration of mechanical ventilation, adverse events, and ICU-acquired infections in a pediatric ICU. The second aim was to examine whether the match of nursing expertise to mortality risk enhances the relationship between CINC and patient outcomes. Methods: This cross-sectional study was a secondary data analysis of prospectively collected data that were merged from multiple databases from one pediatric ICU. The analytical database was a combination of four databases: the Nightingale Metrics database, the Virtual Pediatric Intensive Care Unit Performance System database, the Medical/ Surgical Intensive Care Unit-Acquired Infection database, and the Safety Errors Reporting System database. The relationships between CINC and patient outcomes were assessed using a proportional hazard regression model and a logistic regression model. The final sample included 332 pediatric ICU subjects. Results: In multivariable regression analyses, more CINC was associated with a longer ICU stay and a longer duration of mechanical ventilation. CINC was not significantly associated with adverse events and ICU-acquired infections. A match of nursing expertise and mortality risk did not have a significant effect on the relationship between CINC and any of the four patient outcomes. However, the moderating effect of the match variable on the negative association between CINC and nurse-sensitive adverse event was significantly less for the matched group; specifically fewer different experienced nurses created a safer environment, than the mismatched group. Conclusion: This study provides preliminary data evaluating the relationship between CINC and pediatric ICU patient outcomes. Additional studies in other settings are needed to better understand these findings. Future research should focus on refining the measurement of CINC and exploring links between CINC and other outcomes such as patient/family satisfaction and being well-cared-for. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Nursing First Advisor Martha A. Curley This dissertation is available at ScholarlyCommons: http://repository.upenn.edu/edissertations/581