Labor and Delivery Nurse Staffing: A patient safety intervention

 描述(由申请人提供)：许多研究已经确定了护士配置水平与内科和外科患者的不良后果之间的关系，包括压疮、患者跌倒和用药错误等。由于这些不良事件可能与护理和人员配备水平有关，因此它们通常被称为“护士敏感”结果。护士敏感型结局被定义为对护士的行为作出反应的条件、状态或知觉(对病人或家属照顾者)。尽管在急诊护理环境中对内科和外科病人的护士敏感结局进行了广泛的研究，但很少有关于什么构成育龄妇女的护士敏感结局的研究发表，更少有评估护士人员配备对产科不良事件的影响的研究发表。ICU(包括新生儿ICU[NICU])的人员配备数量少与发病率和死亡率的增加有关，尽管尚不清楚分娩和分娩(L和D)的人员配备水平对后续NICU住院或其他不良事件(如意外剖腹产)的影响程度(如果有的话)。使用唐纳贝迪安的经典结构、过程和结果(SPO)模型，这项创新研究将确定L&D护士配置与不良母婴结局之间是否存在关系。这项研究的具体目的如下：(A)确定L&D护士配备对足月妊娠(&gt；37周)低风险初产母亲合并以下疾病的剖宫产可能性的影响 本研究的目的是：(A)通过对单胎妊娠的研究，(B)确定L&D护理人员配置对NICU入院或新生儿转院的可能性的影响(对于那些没有NICU的医院)；以及(B)确定有单胎的低风险第一胎母亲足月妊娠的可能性。了解围产期护士人员配备与产妇和新生儿健康之间的联系，对于改善结局和促进生育家庭患者的安全至关重要。如果这些关系表明这些结果是斯塔芬敏感的，它将允许进一步的研究，以检验操纵人员配备水平是否可以减轻不利的分娩结果。

 DESCRIPTION (provided by applicant): Numerous studies have identified a relationship between nurse staffing levels and adverse outcomes for medical and surgical patients including pressure ulcers, patient falls, and medication errors, among others. Because these adverse events can be linked to nursing care and staffing levels, they're often referred to as `nurse-sensitive' outcomes. Nurse-sensitive outcomes are defined as a condition, state, or perception (of either the patient or family caregiver) that is responsive to the action of the nurse. Despite wide range of studies on nurse-sensitive outcomes for medical and surgical patients in the acute care setting, little has been published on what constitutes a nurse- sensitive outcome in the childbearing woman, and even less that assesses the influence of nurse staffing on adverse obstetrical (OB) events. Low staffing numbers in ICUs (including newborn ICUs [NICUs]) are associated with increased morbidity and mortality although it is not known to what extent (if any) staffing levels in labor and delivery (L&D) influence subsequent NICU admissions or other adverse events such as unanticipated cesarean births. Using Donabedian's classic Structure, Process, and Outcomes (SPO) model, this innovative study will determine whether a relationship exists between L&D nurse staffing and adverse maternal and newborn outcomes. The specific aims of this study are as follows: (a) determine the influence of L&D nurse staffing on the likelihood of cesarean birth in term gestation (>37 weeks) low-risk first birth mothers with a single fetus, and (b) Determine the influence of L&D nurse staffing on the likelihood of NICU admissions or newborn transfers (for those hospitals without an NICU) to term gestation low-risk first-birth mothers with a single fetus. Understanding the link between perinatal nurse staffing and maternal and neonatal well- being is fundamental to enhancing outcomes and promoting patient safety in the childbearing family .If the relationships indicate these outcomes are staffin sensitive, it will allow further studies that examine whether manipulating staffing levels can mitigate adverse birth outcomes.