Rationing of nursing care interventions and its association with nurse-reported outcomes in the neonatal intensive care unit: a cross-sectional survey

Abstract

BackgroundEvidence internationally suggests that staffing constraints and non-supportive work environments result in the rationing of nursing interventions (that is, limiting or omitting interventions for particular patients), which in turn may influence patient outcomes. In the neonatal intensive care unit (NICU), preliminary studies have found that discharge preparation and infant comfort care are among the most frequently rationed nursing interventions. However, it is unknown if the rationing of discharge preparation is related to lower perceptions of parent and infant readiness for NICU discharge, and if reports of increased rationing of infant comfort care are related to lower levels of perceived neonatal pain control. The purpose of this study was to assess these relationships.MethodsIn late 2014, a cross-sectional survey was mailed to 285 Registered Nurses (RNs) working in one of 7 NICUs in the province of Quebec (Canada). The survey contained validated measures of care rationing, parent and infant readiness for discharge, and pain control, as well as items measuring RNs’ characteristics. Multivariate regression was used to examine the association between care rationing, readiness for discharge and pain control, while adjusting for RNs’ characteristics and clustering within NICUs.ResultsOverall, 125 RNs completed the survey; a 44.0 % response rate. Among the respondents, 28.0 and 40.0 % reported rationing discharge preparation and infant comfort care “often” or “very often”, respectively. Additionally, 15.2 % of respondents felt parents and infants were underprepared for NICU discharge, and 54.4 % felt that pain was not well managed on their unit. In multivariate analyses, the rationing of discharge preparation was negatively related to RNs’ perceptions of parent and infant readiness for discharge, while reports of rationing of parental support and teaching and infant comfort care were associated with less favourable perceptions of neonatal pain control.ConclusionsThe rationing of nursing interventions appears to influence parent and infant readiness for discharge, as well as pain control in NICUs. Future investigations, in neonatal nursing care as well as in other nursing specialties, should address objectively measured patient outcomes (such as objective pain assessments and post-discharge outcomes assessed through administrative data).

Competency of Nursing Care Activities at Neonatal Intensive Care Units: An Assessment Study

“…The current study revealed that more than one third of the NICU nurses were competent regarding care of neonates upon discharge from the NICU, and less than one fifth provided family education regarding baby discharge, this could have been related to the nurses' workload with neonates and nursing staff shortages. These results were in contradiction with those of Rochefort et al (2016), in the study entitled "Rationing of nursing care interventions and its association with nurse-reported outcomes in the neonatal intensive care unit: a crosssectional survey", where from a total of 285 NICU RNs, more than one third reported rationing discharge preparation for the neonates from the NICU competently, also they were able to provide infant comfort care in addition to being competent regarding providing the infant's relatives with the essential information for the care and follow up of their neonate after discharge.…”

Parent Satisfaction With Care and Treatment Relates to Missed Nursing Care in Neonatal Intensive Care Units

“…These four activities have the most direct impact on family-centered care, as compared to physical elements of care such as skin care or treatments and procedures. These results are consistent with evidence from province-wide samples of Quebec NICUs in 2007-2008, and in 2014, which showed that the most frequently missed activities were discharge planning, parental support and teaching, and comfort care (16,20).…”

“…One study in a USA medical center linked delayed feeding (a type of missed care) of NICU infants to time required to achieve full oral feedings and length of stay (19). Nurses who worked in seven Quebec NICUs reported that missed discharge teaching was inversely associated with nurse-ratings of parent-infant readiness for discharge, and that missed parental support, teaching, and infant comfort care was associated with ratings of poorer pain control (20).…”

Application of measuring tools in the assessment of the phenomenon of rationing/missed/unfinished care

“…Rochefort and Clarke (2010) first used the NEW-RI tool to identify the nursing activities mostly rationed due to lack of time: activities related to discharge planning, parental support and teaching, and comfort care of the patients. In a newer study, Rochefort et al (2016) confirmed the previous results and added a new finding: more than half of the nurses are dissatisfied with pain relief management. We can conclude that the following activities were identified among the most frequently rationing nursing activities: the education of patients and families (Jones, 2015 The conclusion from the above mentioned results is that the differences in the individual approaches caused a considerable variability of research results aimed at monitoring the level of prevalence of this phenomenon.…”