New Tool Helps Nurses Access Needs of Kids with Cerebral Palsy and Other Complex Conditions

A study evaluated the design and effectiveness of a new tool to assist nursing care of pediatric patients with complex medical conditions, including cerebral palsy. The pediatric-specific tool, N-KICS (Nursing-Kids Intensity of Care Survey), was found to be an accurate and fast method of assessing these patients’ needs and relocating the resources necessary to meet those needs.

An article detailing the tool, “Assessing Nursing Care Needs of Children With Complex Medical Conditions: The Nursing-Kids Intensity of Care Survey (N-KICS),” was published in the Journal Pediatric Nursing.

Children with complex medical conditions (CMC), a medical term that includes cerebral palsy, major congenital heart diseases, complex chromosomal anomalies, and respiratory disease, are living longer due to improved treatments. But their healthcare needs are complex — ranging from and lack pediatric-specific care guidelines.

The researchers used an unpublished intensity worksheet, developed by pediatric nurses, and with assistance from three pediatric care facilities designed and tested the N-KICS tool to describe the intensity of nursing care for children with CMC. The tool’s reliability, feasibility, validity, and acceptability was assessed through three rounds of testing, spanning 18 months.

N-KICS, a survey, assesses 40 factors individually, such as vital signs, ambulation/mobility functionality, observation, weight, bathing, and respiratory support and care, grading need intensity on a scale of one (not relevant to care needs) to four (very relevant). After final revisions, N-KICS was implemented in a pediatric long-term care facility, with six nurse managers participating in the survey.

According to the results of the intensity scores, infection control was consistently was given a high rating, as prolonged hospitalization and the use of devices such as catheters increase the potential for infections. Other high rated needs included administering medications, seizures, bathing, diaper changes, nutrition, and mouth care.

“Infection control was one of the higher intensity ratings, and this makes sense,” said the study’s first author, Dr. Ann-Margaret Navarra, in a news release, “because these kids with chronic illness — they’re in these facilities for a long time, interacting with a lot of professionals. Many have in-dwelling devices — whether it’s an essential line or catheter, there are a lots of reasons why this could be. There’s also, of course, the risk of hospital-acquired infection.”

Researchers believe the data will contribute to a better understanding of the healthcare needs of CMC children in long-term care facilities, and that the survey will be well-received by nurses, as it takes 10 minutes to complete. Since its development, the tool has been tested at 11 U.S. sites.

“I think N-KICS represents, really, an initial first step to describe what the needs are for this population because it’s a pediatric-specific tool,” Dr. Navarra concluded. “We achieved our intent, which was really to look at what was needed so that there could be allocation of the best, optimal resources for these kids.”