Nurse Staffing and Adverse Events on Inpatient Units

描述（由申请人提供）：患者跌倒和压疮被美国护士协会和国家质量论坛等国家组织指定为“护理敏感质量指标”。然而，将跌倒和压疮的发生与护士配置差异联系起来的研究得出了模棱两可的结果。不良事件的不可靠测量和护士人员配备的不充分测量可能导致不确定的结果。先前的研究分析了医院和护理单位水平的这些影响，但从未同时分析过。护理实践环境的差异可能会缓和人员配备和不良事件之间的联系，尽管这还没有经过测试。提出的研究建立在证据开发的研究小组，护士人员配备和实践环境影响患者的结果。本研究通过以下方式加深了我们对人员配备与患者不良事件之间关系的理解：1)使用来自观察性流行研究和事件报告的二手数据计算不良事件；2)使用一套全面的护士配备措施，考虑到注册护士之间的定性和定量差异；3)在护理单位和医院层面检查这些关系。4)探索正式认可的良好护理实践环境对这些关系的影响。多层次模型将用于预测人员配备对护理单位层面的跌倒率和患者和护理单位层面的压疮的影响，使用来自650个社区医院的4300个护理单位的数据，这些数据来自ana赞助的国家护理质量指标数据库。美国护士资格认证中心磁铁指定状态将用于区分各医院的护理实践环境，并探索作为医院层面的因素调节人员配备和结果之间的关联。本研究将加强护士人员配置模式和实践环境如何支持患者护理质量和安全的证据基础。

DESCRIPTION (provided by applicant): Patient falls and pressure ulcers are designated as "nursing-sensitive quality indicators" by national groups such as the American Nurses Association and the National Quality Forum. Yet research linking the occurrence of falls and pressure ulcers to differences in nurse staffing has yielded equivocal findings. Unreliable measurement of adverse events and inadequate measures of nurse staffing could account for the inconclusive findings. Prior studies have analyzed these effects at hospital and nursing unit levels, but never simultaneously. Differences in the nursing practice environment may moderate the link between staffing and adverse events, although this has not been tested. The proposed study builds on evidence developed by this research team that nurse staffing and the practice environment influence patient outcomes. This study advances our understanding of the relationship between staffing and patient adverse events by 1) calculating adverse events using secondary data from observational prevalence studies and incident reports, 2) using a comprehensive set of nurse staffing measures that account for qualitative as well as quantitative differences among RNs, 3) examining these relationships at both the nursing unit and hospital levels, and 4) exploring the influence of a formally-recognized favorable nursing practice environment on these relationships. Multi-level models will be used to predict the effects of staffing on rate of falls at the nursing unit level and pressure ulcers at both the patient and the nursing unit levels using data from 4,300 nursing units in 650 community hospitals in the ANA-sponsored National Database of Nursing Quality Indicators. American Nurses Credentialing Center Magnet Designation status will be used to differentiate the nursing practice environment across hospitals and explored as a hospital-level factor moderating the associations between staffing and outcomes. This study will strengthen the evidence base on how nurse staffing patterns and practice environments support the quality and safety of patient care.