Date of Award
2003
Document Type
Practicum
Degree Name
Doctor of Education
Department
Programs for Higher Education
Keywords
All Children's Hospital, clinical coverage, comparative study, computerized patient profiles, cost effectiveness, discharge summaries, ex post facto design, first feeding age, graduate medical education, health care providers, hospital administration, hyperalimentation, infant outcomes, infant mortality, intensive care units, length of stay, medical coverage, neonatal intensive care unit, neonatal nurse practitioners, neonates, neonatologists, NICU, NICUs, nursing education, outcome evaluation, packed red blood cell transfusions, pediatric residents, premature infants, provider behavior, provider outcomes, retrospective research, staffing alternatives, transfusions
Abstract
Shifts in graduate medical education have caused a reduction in the number of hours worked by pediatric residents. With the reduced number of resident hours, and the growing need for provision of increasingly complex patient care, an effective, alternative, health care provider to supplement medical coverage was needed in the neonatal intensive care unit (NICU) at All Children's Hospital. The purpose of the study was to determine if the use of neonatal nurse practitioners (NNPs) was an effective alternative in providing clinical coverage in the NICU.
The clinical outcomes of neonates managed by NNPs and pediatric residents were compared to answer the five research questions posed: was there a difference in the mean length of stay (LOS), in mean number of packed red blood cell (PRBC) transfusions received, in the mean number of days on hyperalirnentation (HAF), and in the mean age when the first feeding was started in infants managed by NNPs compared to residents? And, was there a relationship in the mortality rates of premature infants managed by NNPs compared to pediatric residents?
A retrospective research methodology utilizing a two-group comparative, ex post facto design was employed. Data were obtained through the review of the infants' discharge summaries and computerized patient profiles. The study sample included 55 infants (resident n = 23, NNP n = 32). The results showed that there was no statistically significant difference, at the .05 level, between infants managed by NNPs and pediatric residents in the LOS (df= 50, t = -1.52, p = .13), and number ofPRBC transfusions (df= 53, t = -1.33, p = .18). There was a statistically significant difference, at the .05 level, in number of on RAF days ( df = 53, t = 2.22, 3 p = .03), and age to first feedings (df = 53, t = 3.41, p = .001). The infants managed by the NNPs receiving fewer days on HAF and were started on feedings at an earlier age. There was no relationship found, at the .01 level, between mortality rates of infants and the type of care provider (df = I, X2 = .08, p = .76).
From the analysis of the data it was concluded that NNPs, in collaboration with neonatologists, provide care to infants weighing between 1000-1750 grams that was comparable in outcomes to the care of pediatric residents, in collaboration with neonatologists. And, it was concluded that NNPs were an acceptable alternative provider to medical house staff in the NICU.
There were five recommendations. First, continued support for the role of the NNP was recommended. Second, that the results are disseminated to hospital administration. Third, the study be replicated across different NICUs settings. Fourth, future research should evaluate outcomes and cost effectiveness of the NNP. And, fifth, that nursing and medical graduate education focuses not only on outcomes but also on the process that influence provider behavior and outcomes of care.