NURSE STAFFING AND QUALITY OF CARE

护士人员配置和护理质量

• 批准号: 6393055
• 负责人: MARY A. BLEGEN
• 金额: $ 38.64万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-07-01 至 2003-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6393055
• 关键词: accidental falls; clinical research; health services research tag; human data; nosocomial infections; nursing administration; nursing care evaluation; nursing care quality; nursing personnel; nursing skill /technique; patient safety /medical error

The Institute of Medicine committee on the adequacy of Nurse Staffing concluded that there is insufficient research linking nurse staff patterns and patient outcomes. Subsequently, a collaborative research agenda was released by the National Institute of Nursing Research, Agency for Health Care Policy and Research, and the Division of Nursing of the Health Resources and Service Administration. This research project was designed in response to that research agenda, "Nurse Staffing and Quality of Care in Health Care Organizations". The purpose of the study is to determine the relationship between nurse staffing patterns and quality of care in hospitals. A sample of 300 patient care units (200 medica/surgical and 100 intensive care) will be obtained from 50 community hospitals in the US. Nurse staffing indicators, at the patient care unit level, include the number of hours of care from all nursing personnel, i.e. RNs, LPNs, nursing assistants (Total Hours) and the proportion of the total hours of care from delivered by professional nurses, the RNs (Staff Mix). Patient care quality will be measured using unit rates of adverse occurrences; e.g., medication administration errors, skin breakdown, patient falls, and nosocomial infections. Data will be collected for each quarter of 2000. The levels of nurse staffing variables and the changes over the 4 quarters will be described. The rates of occurrences and the levels of nurse staffing will be described within unit type (medical/surgical and intensive care). Hierarchical modeling procedures will be used to determine the relative effects of hospital level and unit level characteristics and test the hypotheses: Higher Staff Mix will be associated with higher quality of care after controlling for Total Hours of care, patient severity and unit and organization effects of Staff Mix, patient severity, and unit and organizational characteristics, and there will be an interaction effect between Staff Mix and Total Hours. In addition, the characteristics of nurses (e.g. education and experience), quality independent of nurse staffing will be determined. The personnel costs for staffing at various levels of Total Hours and Staff Mix will be described. This study adds substantially to the current literature by using a large nationwide sample while measuring nurse staffing at the level of the patient care unit, measuring quality of care with indicators more sensitive to nursing care than mortality rates, examining the interaction between total hours of care and staff mix. In addition, hierarchical linear model analysis will assist in the description of the relative effects on the quality of care of hospital level and patient care unit level variables.

医学研究所护士人员配置充足性委员会得出的结论是，将护士人员模式与患者结果联系起来的研究不足。随后，国家护理研究所、卫生保健政策与研究机构以及卫生资源和服务管理局护理司发布了合作研究议程。该研究项目是为了响应该研究议程“医疗保健组织中的护士人员配置和护理质量”而设计的。该研究的目的是确定医院护士配备模式与护理质量之间的关系。将从美国 50 家社区医院获得 300 个患者护理单位的样本（200 个医疗/外科护理单位和 100 个重症监护单位）。患者护理单位层面的护士人员配备指标包括所有护理人员（即注册护士、LPN、护理助理）的护理小时数（总小时数）以及专业护士提供的护理总小时数的比例， RN（人员组合）。将使用不良事件的单位发生率来衡量患者护理质量；例如，用药错误、皮肤破损、患者跌倒和医院感染。将收集 2000 年每个季度的数据。将描述护士人员配置变量的水平以及 4 个季度的变化。发生率和护士人员配备水平将在单位类型（内科/外科和重症监护）内描述。将使用分层建模程序来确定医院级别和单位级别特征的相对影响并测试假设：在控制护理总时间、患者严重程度以及单位和组织的影响后，较高的人员组合将与较高的护理质量相关。人员组合、患者严重程度以及单位和组织特征，人员组合和总小时数之间会存在交互作用。此外，还将确定护士的特征（例如教育和经验）、独立于护士人员配置的质量。将描述不同级别的总工时和人员结构的人员成本。这项研究对现有文献进行了实质性补充，使用了全国范围内的大量样本，同时测量了患者护理单位一级的护士人员配置，使用对护理比死亡率更敏感的指标来测量护理质量，检查了总护理时间之间的相互作用和人员组合。此外，分层线性模型分析将有助于描述医院级别和患者护理单位级别变量对护理质量的相对影响。