NURSE STAFFING AND QUALITY OF CARE

医学研究所关于护士配备充足性的委员会得出结论，没有足够的研究将护士配备模式与患者结果联系起来。随后，国家护理研究所、卫生保健政策和研究机构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。本研究项目的目的是响应该研究议程，“护士人员配备和医疗保健组织的护理质量”。本研究旨在探讨医院护理人员配置模式与护理品质之关系。将从美国50家社区医院获得300个患者护理单元（200个内科/外科和100个重症监护）的样本。在病人护理单位层面，护士人手指标包括所有护理人员，即注册护士、本地专业护士、护理助理的护理时数（总时数），以及专业护士在护理总时数中所占的比例，即注册护士（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，给药错误、皮肤破裂、患者福尔斯和医院感染。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和4个季度的变化。发生率和护士配备水平将在单位类型（内科/外科和重症监护）中描述。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影响，并检验假设：在控制护理总小时数、患者严重程度以及人员组合、患者严重程度以及单位和组织特征的单位和组织影响后，更高的人员组合将与更高的护理质量相关，人员构成与总时数之间存在交互作用。此外，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。将说明总时数和工作人员组合的各个级别的人员配置的人事成本。这项研究增加了大量的目前的文献，使用一个大的全国性样本，同时测量护士在病人护理单位的水平，衡量护理质量的指标更敏感的护理比死亡率，检查总护理时间和工作人员组合之间的相互作用。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元级别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.