| Popis: |
Primary continuity intensivists and nurses for long-stay patients (LSP) in pediatric intensive care unit (PICU) are understudied strategies used to mitigate the fragmented care of typical rotating care models.To investigate the advantages and disadvantages of primary continuity intensivists and nurses for LSP as perceived by their parents and PICU providers.Prospective cross-sectional mixed-methods study of 1) the perspectives of parents whose children were admitted to a PICU for10 days and had1 complex chronic condition regarding the care provided their PICU intensivists and nurses. As part of a trial, patients had been randomized to care from a rotating on-service intensivist who changed weekly and by PICU nurses who changed every 12 hours (usual care group) or to care from the same on-service intensivist plus a primary continuity intensivist and primary nurses (primary group). Additionally, 2) their PICU providers (intensivists, fellows, nurses) were queried for their perspectives on primary intensivists and nurses. Novel questionnaires, assessed for content and face validity and readability, were used. The parental questionnaire involved indicating their degree of agreement to 16 statements about their care. The provider questionnaire involved rating potential advantages of primary continuity intensivists and nurses and estimating the frequency of disadvantages. Descriptive statistics and divergent stack bar charts were used; parents' and providers' responses were compared, stratified by their child's group (usual care or primary) and provider role, respectively.There was 71% parental response rate (120 completed questionnaires). For 10 of 16 statements, parents whose children received primary continuity intensivists and nurses indicated significantly more positive perceptions of care (eg, communication, listening, decision-making, problems due changing providers). There was a 61% provider response rate (117 completed questionnaires);80% felt that primary intensivists and nurses were highly or very highly beneficial for LSP. Providers perceived more benefits for patients/families (eg, informational continuity and facilitating/expediting decision-making) than for staff/institutions (eg, staff satisfaction). Providers reported associated stress, expenditure of time/effort, and decreased staffing flexibility with primary practices.Perceived benefits of primary continuity intensivists and nurses by both parents and providers support more widespread adoption and study of these continuity strategies. |
