Critical Care Nursing’s Impact on Pediatric Patient Outcomes

详细信息    查看全文

• 作者：Patricia A. Hickey ; PhD ; RN^a ; ^{patricia.hickey@childrens.harvard.edu" class="auth_mail" title="E-mail the corresponding author} ; Sara K. Pasquali ; MD ; MHS^b ; J. William Gaynor ; MD^c ; Xia He ; MS^d ; Kevin D. Hill ; MD ; MS^d ; Jean A. Connor ; PhD ; RN^a ; Kimberlee Gauvreau ; ScD^e ; Marshall L. Jacobs ; MD^f ; Jeffrey P. Jacobs ; MD^g ; Jennifer C. Hirsch-Romano ; MD^h
• 关键词：ACLS ; Advanced Cardiovascular Life Support ; ANCC ; American Nurses Credentialing Center ; BSN ; Bachelor of Science in Nursing ; CCRN ; Certification for Adult ; Pediatric and Neonatal Critical Care Nurses ; CHSD ; Congenital Heart Surgery Database ; CI ; confidence intervals ; CPN ; Certified Pediatric Nurse ; DNP ; Doctor of Nursing Practice ; EACTS ; European Association for Cardiothoracic Surgery ; FTR ; failure to rescue ; MS ; Master of Science ; OR ; odds ratio ; PALS ; Pediatric Advanced Life Support ; PhD ; Doct
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：102
• 期：4
• 页码：1375-1380
• 全文大小：146 K

文摘

Previous studies have demonstrated the effect of adult nursing skill mix, staffing ratios, and level of education on patient deaths, complication rates, and failure to rescue (FTR). To date, only one known study had examined the effect of nursing experience and education on postoperative pediatric cardiac operations.

Methods

Nursing survey data were linked to The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database for patients undergoing cardiac operations (2010 to 2011). Logistic regression models were used to estimate associations of nursing education and years of clinical experience with in-hospital mortality rates, complication rates, and FTR. Generalized estimating equations and robust standard error estimates were used to account for within-center correlation of outcomes.

Results

Among 15,463 patients (29 hospitals), the in-hospital mortality rate was 2.8%, postoperative complications occurred in 42.4%, and the FTR rate was 6.4%. After covariate adjustment, pediatric critical care units with a higher proportion of nurses with a Bachelor of Science degree or higher had lower odds of complication (odds ratio for 10% increase, 0.85; 95% confidence interval, 0.76 to 0.96; p = 0.009). Units with a higher proportion of nurses with more than 2 years of experience had lower mortality rates (odds ratio for 10% increase, 0.92; 95% confidence interval, 0.85 to 0.99; p = 0.025).

Conclusions

This is the first study to demonstrate that higher levels of nursing education and experience are significantly associated with fewer complications after pediatric cardiac operations and aligns with our previous findings on their association with reduced deaths. These results provide data for pediatric hospital leaders and reinforce the importance of organization-wide mentoring strategies for new nurses and retention strategies for experienced nurses.