Association of Clinical Nursing Work Environment with Quality and Safety in Maternity Care in the United States.
Association of Clinical Nursing Work Environment with Quality and Safety in Maternity Care in the United States.
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DOI：
10.1097/nmc.0000000000000653
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Lake ET
中科院分区：
文献类型：
--
作者：
Clark RRS;Lake ET
在所有高收入国家中，美国的产妇结果是最差的。个别医院经常报告提高产妇护理质量和安全的努力，限制了普遍性。本研究的目的是描述四个州医院的产科护理质量和安全。这项横断面研究是对护理变化对患者结局数据影响的小组研究的二次分析。注册护士报告了产科病房的质量、安全和工作环境。采用描述性统计和聚类线性回归。样本包括2015年在加利福尼亚州、新泽西州、宾夕法尼亚州和佛罗里达州的166个单位报告的1165名护士。平均有三分之一的护士给所在单位的整体安全评分为“优秀”，但在工作环境较差的单位，这一比例降至不到六分之一。总体而言，65%的护士报告说，他们的错误是针对他们的。与差的工作环境相比，良好的工作环境与较少的护士将安全评为差的显著相关（β - 35.6, 95% CI - 42.9 - 28.3）。我们的研究发现，在四个州设有产科病房的大多数医院，护士认为他们的病房不能提供优质的护理，而且没有最佳的安全环境。这些医院占全国每年出生人数的四分之一。
Maternal outcomes in the United States are the poorest of any high-income country. Efforts to improve the quality and safety of maternity care are frequently reported by individual hospitals, limiting generalizability. The purpose of this study is to describe maternity care quality and safety in hospitals in four states. This cross-sectional study is a secondary analysis of the Panel Study of Effects of Changes in Nursing on Patient Outcomes data. Registered nurses reported on maternity unit quality, safety, and work environment. Descriptive statistics and clustered linear regressions were used. The sample included 1,165 nurses reporting on 166 units in California, New Jersey, Pennsylvania, and Florida in 2015. One-third of nurses, on average, gave their units an overall safety grade of “excellent,” but this decreased to less than one-sixth of nurses in units with poor work environments. Overall, 65% of nurses reported that their mistakes were held against them. A good work environment, compared with poor, was significantly associated with fewer nurses grading safety as poor (β −35.6, 95% CI −42.9 – −28.3). Our research found that the nurses in the majority of hospitals with maternity units in four states representing a quarter of the nation’s annual births felt their units do not provide excellent quality care and have a less than optimal safety climate.