Healthcare services for pediatric patients are complex and these very young and very ill patients often experience frequent transitions across care providers with poor coordination, leading to increased hospitalization. There are available instruments for determining severity of illness and patient needs in adult patients, but a nationally used measure for pediatrics has not been published.
It’s not clear what pediatric healthcare needs are, especially in regards to nursing, but children with complex medical conditions require a lot of health care resources for reasons that we don’t yet understand.
In an attempt to create a nursing intensity measure specific to pediatrics and pediatric long-term care facilities, Dr. Navarra, a pediatric nurse practitioner and assistant professor at New York University, and Elaine L. Larson, RN, PhD, FAAN, CIC, from Columbia University School of Nursing, published one of the first survey instruments to specifically identify long-term nursing care needs of very young and very ill patients.
These two researchers conducted their study with the help of three pediatric care facilities who assisted in designing and testing the N-KICS tool (Nursing-Kids Intensity of Care Survey) by describing intensity of nursing care for children with complex medical conditions. An unpublished intensity worksheet developed by clinical pediatric nurses was used in three rounds of testing the N-KICS. Testing of the survey included measuring forty factors, amongst which were vital signs, weight, observation, bathing, ambulation/mobility functionality, respiratory support and care, skin care, and behavior. All of these factors were rated on a scale from one (not relevant to care needs) to four (very relevant to care needs).
After three rounds of testing and revisions of the survey, it was employed at a pediatric long-term care facility with 97 beds and six nurse managers involved in testing the survey with their patients. High intensity score items primarily included infection control, medical administration, nutritional intervention, diaper changes, bathing, and respiratory care. Analyzing this data identifies the more important healthcare needs of pediatric populations in long-term care.
Overall the survey was well received by nursing staff involved in testing, who were pleased with the average time of ten minutes to complete the survey. Dr. Navarra and her research team developed an effective study of the N-KICS which represents a first step toward describing the needs of pediatric populations using a pediatric-specific tool. Further studies have been conducted since the development of the N-KICS, whose findings have not yet been published but will greatly contribute to allocation of the best resources for this delicate population.
Future testing of the N-KICS may include an evaluation of service needs for families to help with discharge planning.
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