NURSE STAFFING AND QUALITY OF CARE

医学研究所护士人员配备充足性委员会得出结论，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、卫生保健政策和研究局以及卫生资源和服务管理局护理司发布了一项合作研究议程。本研究项目是根据“保健机构的护士人员配备和护理质量”这一研究议程而设计的。本研究的目的是确定医院护士人员配置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个病人护理单位（200个内科/外科和100个重症监护室）的样本。在病人护理单位一级，护士配备指标包括所有护理人员（即注册护士、执业护士、护理助理）的护理时数（总时数），以及专业护士（注册护士）提供的护理总时数所占的比例（工作人员组合）。病人护理质量将用不良事件的单位发生率来衡量；例如，给药错误、皮肤破损、病人跌倒和医院感染。二零零零年每个季度的数据将会收集。将描述护士人员配置变量的水平和4个季度的变化。发病率和护士人员配备水平将按单位类型（内科/外科和重症监护）加以说明。将使用分层建模程序来确定医院水平和单位水平特征的相对效应，并检验假设：在控制了总护理时数、患者严重程度以及人员组合、患者严重程度、单位和组织特征的单位和组织效应后，较高的人员组合将与较高的护理质量相关，并且人员组合与总时数之间将存在交互效应。此外，护士的特点（如教育和经验），质量独立于护士人员配备将被确定。将描述总工时和工作人员组合的各级人员的人事费用。本研究通过使用全国范围内的大样本来测量病人护理单位水平的护士配备，用比死亡率更敏感的指标来衡量护理质量，检查护理总时数和人员组合之间的相互作用，从而大大增加了现有文献。此外，层次线性模型分析将有助于描述医院水平和病人护理单位水平变量对护理质量的相对影响。

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.