A Comparative Analysis of Nursing Care Needs Scores at Discharge and Transfer Among Survivors of Critical COVID-19 and Septic Shock: A Retrospective Observational Study Using Modified Poisson Regression From Japan

Background Research on nursing care needs (NCNs) for critically ill patients at discharge is scarce. This study aimed to quantify and compare NCNs at discharge between patients with severe COVID-19 and septic shock and to identify factors associated with higher NCNs. Methodology We retrospectively analyzed data from the Diagnosis Procedure Combination database between April 1, 2020, and March 31, 2023, on patients requiring ventilators in the intensive care unit (ICU). We excluded patients who were <15 years old, died during hospitalization, had multiple admissions during the study period, had incomplete medical records, and received extracorporeal membrane oxygenation. Differences in patient condition and nursing care implementation between COVID-19 and septic shock patients were compared using the Mann-Whitney U test. A modified Poisson regression model was used to assess factors associated with NCNs scores of 7 or more. Covariates included continuous variables such as age, duration of ventilation, length of stay, sex, use of sleeping medications, use of delirium medications, presence of risky behavior at admission, use of continuous hemofiltration, and comorbidities including cerebrovascular diseases. A categorical variable classified patients into the following three groups: COVID-19, septic shock, or other diseases. Results Among 438 ventilated patients, 33 had COVID-19, and 37 had septic shock. The Mann-Whitney U test showed no significant differences in patient condition (8 vs. 8, p = 0.34) or nursing care implementation (4.0 vs. 4.0, p = 0.72). Multivariable analysis revealed that COVID-19 was associated with a slightly higher NCNs score of ≥7 (risk ratio (RR) = 1.42, 95% confidence interval (CI) = 1.06-1.89, p = 0.018), older age (RR = 1.02, 95% CI = 1.00-1.02, p < 0.01), and prolonged ventilation (RR = 1.02, 95% CI = 1.01-1.02, p < 0.01). Notably, the use of sleeping medications was associated with a lower NCNs score (RR = 0.68, 95% CI = 0.57-0.83, p < 0.01). Conclusions While no statistically significant differences in NCNs were found between the COVID-19 and sepsis survivor groups, those groups demonstrated higher NCNs levels upon discharge. These findings could help expedite ICU liberation for critical survivors and provide valuable insights to inform evidence-based nursing practice. Our findings suggested that NCNs use may enhance the quality of nursing care, promote further nursing research, and contribute valuable insights to critical care nursing and post-ICU patient management.