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A Multi-Level Study of Nurse Leaders, Safety Climate and Care Outcomes

对护士领导、安全氛围和护理结果的多层次研究

基本信息

批准号：
7673103
负责人：
Debra N. Thompson
金额：
$ 3.63万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-04-01 至 2011-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7673103
关键词：
Accidents Accounting Acute Adopted Adverse event Affect Age Air Embolism American Attitude Beds Behavior Belief Blood Cardiac Surgery procedures Caring Catheters Cessation of life Characteristics Climate Clinical Continuing Education Coronary Artery Bypass Data Data Analyses Decubitus ulcer Deterioration Discipline of Nursing Education Educational Background Elements Emergency Situation Employee Ensure Event Failure Feeling Gender Health Healthcare Hospital Costs Hospitals Hour Individual Industrial Psychology Infection Information Systems Injury Inpatients Institute of Medicine (U.S.)Intervention Job Satisfaction Knowledge Leadership Life Linear Models Literature Measures Medical Medical Errors Modeling Nurse&apos s Role Nurses Nursing Research Occupational Operative Surgical Procedures Organizational Culture Outcome Outcome Study Patient Care Patients Pennsylvania Perception Performance Policies Positioning Attribute Preparation Procedures Process Provider Race Registered nurse Reporting Research Respondent Rewards Safety Seminal Services Site Stream Surveys Trust United States Agency for Healthcare Research and Quality United States Centers for Medicare and Medicaid Services Urinary tract infection Vietnam War Work Workplace base behavior change catheter associated UTI cost data structure design experience falls financial incentive health care quality improved member organizational climate patient safety prevent reinforced behavior response skills tertiary care tool

项目摘要

Description (Provided by Applicant): The seminal Institute of Medicine (IOM) report found that over 98,000 Americans die every year due to errors and adverse outcomes at a cost of between 17 and 29 billion dollars per annum. Payers, providers and patients are demanding a reduction in these events. Nurse leaders, nurse actions, and their work climates are critical to effecting change in patient outcomes. The nurse leader is significant, yet nursing research has mostly relied on global measures of leadership without considering the leadership research advances from industrial psychology. Research on nursing leadership can benefit from adopting a leader member exchange (LMX) perspective on leadership, which posits that a leader is engaged in ongoing dyadic relationships with staff (member) and that the quality of these relationships is an important predictor of employee's attitudes and beliefs, thus outcomes. Moreover, the LMX perspective on leadership provides conceptual and methodological means for studying outcomes at multiple levels such as individual employees and work units. The purpose of this study is to use the LMX perspective to examine the effects of leadership on safety climate and adverse patient outcomes. The aims are: 1) to investigate the relationship between LMX and safety climate; 2) to examine if LMX and safety climate influence the rates of adverse patient outcomes; 3) to explore the effect of staff and unit characteristics on the relationship between safety climate and LMX and adverse patient outcomes. The proposed study will use a multi-level cross-sectional design to examine these relationships in 34 inpatient units. Respondents will be unit directors (n=34) and their associated staff members (n=1500) in a 700 bed acute tertiary care facility who will be asked to complete the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture and the Leader-Member Exchange Tool. Unit characteristics and adverse patient outcome data will be obtained from hospital administrative and performance improvement information systems. Statistical analysis will use descriptive and exploratory data analysis including standard regression and hierarchical linear modeling to take into account the nested data structure. Findings from this study have the potential to improve understanding of relationships between organizational characteristics, leadership behaviors, and adverse events. With this knowledge, it may be possible to develop tailored interventions to promote behavior change and enhance leadership skills to prevent adverse patient outcomes.

描述（申请人提供）：医学研究所（IOM）的开创性报告发现，每年有超过98，000名美国人因错误和不良后果而死亡，每年造成的损失在170亿至290亿美元之间。支付者、提供者和患者都要求减少这些事件。护士长，护士的行动，和他们的工作氛围是至关重要的影响病人的结果的变化。护士领导是重要的，但护理研究大多依赖于全球领导力的措施，而不考虑领导力的研究进展，从工业心理学。护理领导的研究可以受益于通过领导成员交换（LMX）的领导力的角度来看，它假定领导者是从事正在进行的二元关系与工作人员（成员），这些关系的质量是员工的态度和信念的重要预测因子，因此结果。此外，LMX对领导力的观点为研究多个层面的结果提供了概念和方法手段，例如员工个人和工作单位。本研究的目的是使用LMX的角度来检查的安全气氛和不良的病人结果的领导的影响。其目标是：1）调查LMX与安全气候之间的关系; 2）调查LMX和安全气候是否影响不良患者结局的发生率; 3）探讨工作人员和单位特征对安全气候与LMX和不良患者结局之间关系的影响。这项研究将采用多层次的横断面设计，在34个住院单位检查这些关系。受访者将是一家拥有700张床位的急性三级医疗机构的科室主任（n=34）及其相关工作人员（n=1500），他们将被要求完成医疗保健研究和质量医院机构关于患者安全文化的调查以及领导-成员交流工具。将从医院管理和绩效改进信息系统中获得单位特征和不良患者结局数据。统计分析将使用描述性和探索性数据分析，包括标准回归和分层线性模型，以考虑嵌套数据结构。这项研究的结果有可能提高对组织特征，领导行为和不良事件之间关系的理解。有了这些知识，就有可能制定量身定制的干预措施，以促进行为改变，提高领导技能，以防止不良的患者结果。