Pediatric patients are a significant group in emergency care due to the high number of annual visits and special needs within this population. Therefore, the quality of pediatric emergency care is an essential research topic of health care and nursing science.
Master of Health Sciences Katja Janhunen’s dissertation research included three quantitative cross-sectional sub-studies. In sub-study I, the nursing staff (n=147) assessed the care quality in general and pediatric emergency departments (PEDs) by participating in a survey. The instrument used for this study modified the Children Revised Humane Caring Scale (CRHCS) with 41 items (scale 0–10) and four satisfaction items. The study was conducted in two PEDs and two general EDs in Finland. Nursing staff assessed pediatric emergency care quality using values between 4 and 8. The higher values were given the staff’s professional practice (8.1) and the lowest value was given the ED’s human resources (mean 4.7). Nurses in general EDs gave significantly lower assessments for pediatric patients’ information, participation in their care, and pediatric patients’ pain and apprehension management.
In sub-study II, 98 children and 98 parents assessed pediatric care quality in the same four EDs using the CRHCS instrument. In addition, the relationship between ED process factors (length of stay [LOS], number of diagnostic tests and procedures, admission/discharge, triage level) and children’s (n=89) and parents’ (n=89) assessed care quality was analyzed. Children and parents assessed quality in all six subscales between 7 and 9. Children’s assessments were lower than their parents’ with regard to three items: professionalism of the nursing staff, the ability to participate in planning their care, and the ability to talk privately with the staff. Parents’ vocational degrees and the smaller number of previous ED visits were predicted, such as children’s and parents’ high satisfaction with care in the ED. Child–parent pairs with higher evaluations of care and satisfaction with care were predicted on the pediatrician care track. Pairs’ high satisfaction with care was related to the more acute triage level and the larger number of procedures.
In sub-study III, the relationship between nurse staffing and patients’ ED LOS and the number of patients who left before treatment completion (LBTC) was assessed using the administrative data of 21 956, patient visits, and nurse staffing (n=50). PEDS’ nurse-patient ratios varied for the day shift with one nurse per five patients; on the evening shift, the ratio was six patients per nurse, and night shifts had three nurses per four patients. The decrease in ED LOS was related to the increase of the nurse-patient ratio. Patients’ high acuity (Emergency Severity Index 1–3), hospital admission, and increases in patients’ age increased ED LOS. Those LBTC patients had a significantly lower nurse-patient ratio during their visit. In addition, the survey data of nursing staff, children, and parents were re-analyzed to determine if there are differences in the assessments about care quality. Janhunen found that pediatric care quality were statistically significantly lower through nurses’ assessments in four subscales: interdisciplinary collaboration, professional practice, information, and participation in their own care and human resources.
In conclusion, pediatric emergency care is assessed to be of a high quality; however from the view of nursing staff, the quality of pediatric care appeared to be at a lower level in general EDs than in PEDs. Overall, nursing staff assessed pediatric care quality more critically than did children and parents. A bidirectional relationship was observed between the care process factors and the satisfaction of children and parents. In addition, the study addressed the relationship between nurse staffing and the pediatric emergency care process factors LOS and LBTC.
The doctoral dissertation on Katja Janhunen, Master of Health Sciences, entitled Pediatric care quality in emergency departments. A view of children, parents, nursing staff, and administrative data will be examined at the Faculty of Health Sciences. The Opponent in the public examination will be Professor Sanna Salanterä of Turku University, and the Custos will be Professor Tarja Kvist of the University of Eastern Finland. The public examination will be held online in Finnish on 11 June 2021 starting at 12 noon.
Public examination online (in Finnish)
