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

Christian M Rochefort; Bailey A Rathwell; Sean P Clarke

doi:10.1186/s12912-016-0169-z

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

BMC Nurs. 2016 Aug 2:15:46. doi: 10.1186/s12912-016-0169-z. eCollection 2016.

Authors

Christian M Rochefort¹, Bailey A Rathwell², Sean P Clarke³

Affiliations

¹ School of Nursing, Faculty of Medicine, University of Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Room 200, Longueuil, Quebec J4K 0A8 Canada ; Centre de recherche, Hôpital Charles-LeMoyne, 150 Place Charles-LeMoyne, Room 200, Longueuil, Quebec J4K 0A8 Canada ; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2 Canada.
² Ingram School of Nursing, McGill University, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7 Canada.
³ Ingram School of Nursing, McGill University, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7 Canada ; William F. Connell School of Nursing, Maloney Hall, Room 218, 140 Commonwealth Avenue, Chestnut Hill, MA 02467 USA ; McGill University Health Centre, Montréal, Canada.

Abstract

Background: Evidence 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.

Methods: In 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.

Results: Overall, 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.

Conclusions: The 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).

Keywords: Care rationing; Comfort care; Cross-sectional survey; Donabedian; Neonatal Extent of Work Rationing Instrument; Neonatal intensive care unit; Neonatal pain; Readiness for hospital discharge; Registered nurses.