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人员配备水平与内科和外科患者的不良结局之间的关系，包括压疮、患者福尔斯和用药错误等。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。护士敏感的结果被定义为一种条件，状态，或感知（无论是病人或家庭照顾者），这是响应护士的行动。尽管对急症护理环境中内科和外科患者的护士敏感性结局进行了广泛的研究，但很少有关于育龄妇女的护士敏感性结局的研究，评估护士配置对不良产科（OB）事件的影响的研究更少。ICU（包括新生儿ICU [NICU]）的人员配备数量较少与发病率和死亡率增加有关，尽管目前尚不清楚分娩和分娩（L&D）的人员配备水平在多大程度上（如果有的话）影响随后的NICU入院或其他不良事件，例如意外剖腹产。使用Donabedian的经典结构，过程和结果（SPO）模型，这项创新的研究将确定L&D护士人员配置和不良孕产妇和新生儿结局之间是否存在关系。本研究的具体目的如下：（a）确定L&D护士配备对足月妊娠（>37周）低风险初产母亲剖宫产可能性的影响， 单个胎儿，和（B）确定L&D护士人员配置对NICU入院或新生儿转移（对于那些没有NICU的医院）到足月妊娠低风险单胎初产妇的可能性的影响。了解围产期护理人员配备与孕产妇和新生儿健康之间的联系对于改善分娩结局和促进育龄家庭中的患者安全至关重要。如果这些关系表明这些结局对人员配备敏感，则将允许进一步研究检查操纵人员配备水平是否可以减轻不良出生结局。

 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.