Doctoral Dissertations

Date of Award

5-1999

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nursing

Major Professor

Martha R. Alligood

Committee Members

Mitzi Davis, Mark Baylord, Tom Ladd, Johnie Mozingo

Abstract

Infants born prematurely are suddenly and often traumatically thrust from a securehome in the womb into a foreign world for which they are not yet adapted to survive. The role of the neonatal intensive care nurse is to provide nursing care which both protects the infant from this foreign extrauterine environment and which also supports the adaptive efforts of both the infant and the family during this period of crisis. The purpose of this descriptive study was to examine the relationship of nursing care to the health outcomes of preterm infants by testing a Theory of Health Promotion for Preterm Infants derived fi-omLevine's Conservation Model of Nursing. An ex post facto study design was used, with retrospective collection of data fi^om the archival records of a Level 3 Neonatal IntensiveCare Unit. The statistical methodology was structural equation modeling, using theLISREL ® 8.3 statistical package.The primary research question for this study was:How do the intensity of nursing care and the consistency of nursing caregivers relate to the health outcomes of preterm infants at the time of initial hospital discharge?Two subsidiary research questions were also addressed:1. How do the intensity of nursing care and the consistency of nursing caregivers relate to the severity of illness of preterm infants at the time of initial hospital discharge?2. How do the intensity of nursing care and the consistency of nursing caregivers relate to the utilization of health care resources by preterm infants during the initial hospital stay?Three different path diagrams were drawn to test each of the above stated questions.The path diagram models as originally proposed were not supported by the sample data, however the models were then respecified based on the results of the successful structural equation modeling test and on the theory. The respecified model of the primary research question testing the Theory of Health Promotion for Preterm Infants provided a reasonably good fit of the model to the data, with a Satorra-Bentler Scaled Chi-Square Value of 5.77 with 32 degrees of fi-eedom (p-value = 1.0000), Goodness of Fit Index(GFI) of 0.905, Adjusted Goodness of Fit Index (AGFI) of0.836, and Conservative Goodness of Fit Index (CFI) of 0.928. The dimension of nursing care that was tested most extensively in the respecified models was the consistency of nursing caregivers during the initial hospital stay in the Neonatal Intensive Care Unit and the IntermediateCare Nursery. A statistically significant inverse relationship was demonstrated between the consistency of musing caregivers and the age at which health was attained by preterm infants (that is, an increased level of consistency of nursing caregivers resulted in a decrease in the age at which health was attained). This model was a complete mediation model, with the effects of integrity at birth on the age at which health was attained by preterm infants con:q)letely mediated by the consistency of nursing caregivers.The structural equation modeling test of the subsidiary question # 2 could not be completed due to the presence of an extremely strong correlation between the latent variables representing the consistency of nursing caregivers and the morbidity of the infant at the time of discharge (which was incompatible with use of the structural equation modeling methodology). The test of subsidiary research question # 2 demonstrated only affair fit of the model to the sample data, with a Satorra-Bentler Scaled Chi-Square value of 14.15 with41 degrees offreedoin(p-value = 0.99997), Goodness of Fit Index 0.811,Adjusted Goodness of Fit Index (AGFI) 0.696, and Comparative Fit Index (0.837).A statistically significant inverse relationship was demonstrated between the consistency of nursing caregivers and the level of resource utilization by preterm infants during the initial hospital stay (that is, an increase in the consistency of nursing caregivers resulted in a decrease in resource utilization). This model was a partial mediation model, with the effects of integrity at birth on the level of resource utilization partially mediated by the consistency of nursing caregivers. The results of this study provide support for the validity of the Theory of Health Promotion for Preterm Infants based on Levine'sConservation Model of Nursing and indicate that the theory holds promise as a theoretical framework to guide neonatal nursing practice.

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