Rochefort Christian M, Rathwell Bailey A, Clarke Sean P
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.
Ingram School of Nursing, McGill University, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7 Canada.
BMC Nurs. 2016 Aug 2;15:46. doi: 10.1186/s12912-016-0169-z. eCollection 2016.
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.
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.
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.
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).
国际证据表明，人员配备限制和不利的工作环境会导致护理干预的分配（即限制或省略针对特定患者的干预措施），这反过来可能会影响患者的预后。在新生儿重症监护病房（NICU），初步研究发现出院准备和婴儿舒适护理是最常被分配的护理干预措施。然而，出院准备的分配是否与父母和婴儿对NICU出院准备程度的较低认知有关，以及婴儿舒适护理分配增加的报告是否与新生儿疼痛控制水平较低有关尚不清楚。本研究的目的是评估这些关系。
2014年末，向在加拿大魁北克省7个NICU之一工作的285名注册护士（RN）邮寄了一份横断面调查问卷。该调查包含经过验证的护理分配、父母和婴儿出院准备情况以及疼痛控制的测量指标，以及测量RN特征的项目。在调整RN特征和NICU内聚类的同时，使用多变量回归来检验护理分配、出院准备情况和疼痛控制之间的关联。
总体而言，125名RN完成了调查；回复率为44.0%。在受访者中，分别有28.0%和40.0%的人报告“经常”或“非常经常”分配出院准备和婴儿舒适护理。此外，15.2%的受访者认为父母和婴儿对NICU出院准备不足，54.4%的受访者认为其所在病房的疼痛管理不佳。在多变量分析中，出院准备的分配与RN对父母和婴儿出院准备程度的认知呈负相关，而父母支持与教育以及婴儿舒适护理分配的报告与对新生儿疼痛控制的较不利认知相关。
护理干预的分配似乎会影响父母和婴儿的出院准备情况以及NICU中的疼痛控制。未来在新生儿护理以及其他护理专业的调查应关注客观测量的患者预后（如客观疼痛评估和通过行政数据评估的出院后结局）。
