RN staffing time and outcomes of long-stay nursing home residents - Pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care.
RN staffing time and outcomes of long-stay nursing home residents - Pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care.
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DOI：
10.1097/00000446-200511000-00028
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发表时间：
2005-11-01
影响因子：
2.7
通讯作者：
Smout, RJ
中科院分区：
文献类型：
--
作者：
Horn, SD;Buerhaus, P;Smout, RJ
目的：医院较低的护士配备水平与患者不良结局之间存在明显的联系，但长期护理设施中这种关系的研究结果并不清楚。本研究探讨了护士花在直接护理上的时间以及它如何影响长期住院的结果（两周或更长时间）护理之家居民。在一项对作为国家压疮长期研究（NPULS）一部分收集的数据进行的回顾性研究中，我们分析了82家长期护理机构的1,376名住院时间为14天或更长的居民的数据，有发生压疮风险但在研究开始时没有发生压疮，且Braden量表评分为17分或更低的患者。因变量包括压疮或尿路感染（UTI）的发生、体重减轻、日常生活活动（ADL）能力下降和住院治疗。独立变量包括居民人口统计学、疾病严重程度、营养和失禁干预、药物和护士工作时间。（每名住院医生每天检查10分钟，最多30至40分钟）与较少的压疮、住院和UTI相关;体重减轻、导管插入术和进行ADL的能力下降较少;更多地使用口服标准医疗营养补充剂。更多的认证护理助理和执业护士的时间与较少的压力溃疡，但没有改善其他outcomes.CONCLUSIONS：研究人员控制的重要变量，在长期居住的疗养院居民的压力溃疡的风险，并发现更多的RN直接护理时间，每个居民每天与更好的结果密切相关。迫切需要进一步的研究来证实这些发现，如果得到证实，则需要改善养老院的RN人员配置，以减少可避免的不良后果和痛苦。
OBJECTIVE: A clear link has been demonstrated between lower nurse staffing levels in hospitals and adverse patient outcomes, but the results of studies of such relationships in long-term care facilities haven't been as clear. This study explored the time nurses spent in direct care and how it affected outcomes in long-stay (two weeks or longer) nursing home residents.METHODS: In a retrospective study of data collected as part of the National Pressure Ulcer Long-Term Study (NPULS), we analyzed data on 1,376 residents of 82 long-term care facilities whose lengths of stay were 14 days or longer, who were at risk of developing pressure ulcers but had none at study entry, and who had a Braden Scale score of 17 or less. Primary data came from residents' medical records during 12-week periods in 1996 and 1997. Dependent variables included development of pressure ulcer or urinary tract infection (UTI), weight loss, deterioration in the ability to perform activities of daily living (ADLs), and hospitalization. Independent variables included resident demographics, severity of illness, nutritional and incontinence interventions, medications, and nurse staffing time.RESULTS: More RN direct care time per resident per day (examined in 10-minute increments up to 30 to 40 minutes per resident per day) was associated with fewer pressure ulcers, hospitalizations, and UTIs; less weight loss, catheterization, and deterioration in the ability to perform ADLs; and greater use of oral standard medical nutritional supplements. More certified nursing assistant and licensed practical nurse time was associated with fewer pressure ulcers but did not improve other outcomes.CONCLUSIONS: The researchers controlled for important variables in long-stay nursing home residents at risk for pressure ulcers and found that more RN direct care time per resident per day was strongly associated with better outcomes. There's an urgent need for further research to confirm these findings and, if confirmed, for improving RN staffing in nursing homes to decrease avoidable adverse outcomes and suffering.