Organization of nursing and quality of care for veterans at the end of life.
Organization of nursing and quality of care for veterans at the end of life.
复制标题
退伍军人临终护理的组织和护理质量。
DOI：
10.1016/j.jpainsymman.2014.07.002
复制
发表时间：
2015
影响因子：
4.7
通讯作者：
Ersek,Mary
中科院分区：
文献类型：
--
作者：
Kutney-Lee,Ann;Brennan,CaitlinW;Meterko,Mark;Ersek,Mary
背景退伍军人健康管理局（VA）在过去几年中提高了临终关怀的质量。一些结构和过程变量与更好的结果有关。然而，鲜为人知的是，关于组织的护理和EOL outcomes.ObjectivesTo检查组织的护理，包括护士的工作环境和护士的人员配备水平，并在VA急性护理facility.MethodsSecondary分析相关数据从家属调查（BFS），电子病历，行政数据，和退伍军人管理局护理结果数据库样本包括4908名退伍军人，他们在2010年10月至2011年9月期间在全国116个VA急性护理设施中死亡。未经调整和调整的广义估计方程被用来检查护理和BFS outcome.ResultsBFS受访者之间的关联是17%更有可能给一个优秀的整体评价的质量EOL护理的退伍军人在设施，更好的护士工作环境（P≤ 0.05）。护士的工作环境也是一个重要的预测供应商听取关注和提供所需的治疗。护士人员配备显着相关的一个优秀的整体评级，提醒家人死亡前，注意个人护理需求，并提供情感支持后，病人的death.ConclusionImprovement的护士工作环境和护士人员在VA急性护理设施可能会导致在EOL住院退伍军人接受的护理质量提高。
ContextThe Veterans Health Administration (VA) has improved the quality of end-of-life (EOL) care over the past several years. Several structural and process variables are associated with better outcomes. Little is known, however, about the relationship between the organization of nursing care and EOL outcomes.ObjectivesTo examine the association between the organization of nursing care, including the nurse work environment and nurse staffing levels, and quality of EOL care in VA acute care facilities.MethodsSecondary analysis of linked data from the Bereaved Family Survey (BFS), electronic medical record, administrative data, and the VA Nursing Outcomes Database. The sample included 4908 veterans who died in one of 116 VA acute care facilities nationally between October 2010 and September 2011. Unadjusted and adjusted generalized estimating equations were used to examine associations between nursing and BFS outcomes.ResultsBFS respondents were 17% more likely to give an excellent overall rating of the quality of EOL care received by the veteran in facilities with better nurse work environments (P≤ 0.05). The nurse work environment also was a significant predictor of providers listening to concerns and providing desired treatments. Nurse staffing was significantly associated with an excellent overall rating, alerting of the family before death, attention to personal care needs, and the provision of emotional support after the patient's death.ConclusionImprovement of the nurse work environment and nurse staffing in VA acute care facilities may result in enhanced quality of care received by hospitalized veterans at the EOL.