University of Pennsylvania ScholarlyCommons Publicly Accessible Penn Dissertations 2012 Impact of Continuity in Nursing Care on Patient Outcomes in the Pediatric Intensive Care Unit Kee Chen Elaine Siow University of Pennsylvania, [email protected] Follow this and additional works at: https://repository.upenn.edu/edissertations Part of the Nursing Commons Recommended Citation Siow, Kee Chen Elaine, "Impact of Continuity in Nursing Care on Patient Outcomes in the Pediatric Intensive Care Unit" (2012). Publicly Accessible Penn Dissertations. 581. https://repository.upenn.edu/edissertations/581 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations/581 For more information, please contact [email protected]. Impact of Continuity in Nursing Care on Patient Outcomes in the Pediatric Intensive Care Unit Abstract 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 ot 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 ewerf 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. uturF e 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 Keywords Continuity of care, Healthcare delivery, Nursing care, Patient outcomes Subject Categories Nursing This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations/581 IMPACT OF CONTINUITY IN NURSING CARE ON PATIENT OUTCOMES IN THE PEDIATRIC INTENSIVE CARE UNIT Kee Chen Elaine Siow A DISSERTATION in Nursing Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy 2012 Supervisor of Dissertation ______________ Martha A. Q. Curley, PhD, RN, FAAN Professor of Nursing Graduate Group Chairperson ________________ Marilyn S. Sommers, PhD, RN, FAAN Professor of Nursing Dissertation Committee Therese S. Richmond, PhD, CRNP, FAAN Associate Professor of Nursing Jeannie P. Cimiotti, DNSc, RN Associate Professor of Nursing IMPACT OF CONTINUITY IN NURSING CARE ON PATIENT OUTCOMES IN THE PEDIATRIC INTENSIVE CARE UNIT COPYRIGHT 2012 Kee Chen Elaine Siow DEDICATION To my parents, Siow See Quan and Ng Jee Pua Sally; and my husband, Jeffrey Ng and my son, Edward Ng iii ACKNOWLEDGMENTS I am grateful to my mentor and dissertation chair, Dr Martha A. Q. Curley, for her invaluable mentorship, support, and patience throughout my PhD program and towards my development both as a researcher and a scholar. She has been generous with her time, dedication, and guidance. Thank you very much for everything that you have done for me. I am also grateful to the members of my dissertation committee, Dr Therese S. Richmond and Dr Jeannie P. Cimiotti, who have generously given their time, expertise, commitment, and support throughout the development of my dissertation. I would like to acknowledge the staff at Children’s Hospital Boston for their expertise, guidance, and support, especially Dr Patricia Hickey, Aimee Lyons, Patricia Berry, Maggie Geller, Brad Frithsen, and Dr David Wypij who has helped me in numerous ways which I am extremely grateful for. I appreciate the Children’s Hospital Boston for allowing me the opportunity to use the databases for this dissertation. I would like to thank my peers, friends, colleagues, and teachers for making this PhD journey a fun and learning experience for me. I am thankful for your friendship and will always treasure those wonderful memories we shared. I would like to thank my husband, Jeffrey Ng, who though his unending love, support, and many sacrifices, has made this dream possible. Lastly, I share this accomplishment with my late grandfather, who encouraged me in my educational pursuit, he would have been proud of me. iv ABSTRACT IMPACT OF CONTINUITY IN NURSING CARE ON PATIENT OUTCOMES IN THE PEDIATRIC INTENSIVE CARE UNIT Kee Chen Elaine Siow Martha A. Q. Curley, Dissertation Chair 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 v 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. vi TABLE OF CONTENTS DEDICATION ................................................................................................................... iii ACKNOWLEDGMENTS ................................................................................................. iv ABSTRACT ........................................................................................................................ v TABLE OF CONTENTS .................................................................................................. vii LIST OF TABLES ............................................................................................................. xi LIST OF ILLUSTRATIONS ............................................................................................ xii CHAPTER 1: INTRODUCTION .................................................................................... 1 Background ............................................................................................................