CRITICAL CARE NURSING SYSTEMS, RETENTION & PT OUTCOMES

我们建议扩展最近两项研究的发现， 组织护理和护士之间的协作， 医生与医疗保健组织同样重要， 技术在确定令人信服的临床结果，如过度 mortality. 这项研究的主要目的是扩大研究结果， 美国重症监护护士协会（AACN） 通过描述组织结构和过程的组合来进行项目 在工作单位层面的因素，是最好的预测所需的 组织和病人护理成果，包括护理成果 保持和患者死亡率。 这项以区域为基础的工作被认为是一项 在大规模的国家调查中审查这些决定因素的基础 重症监护病房的概率样本。 该研究将使用 假设检验相关设计，以重症监护室为 主要分析单位。 一个单位偏离一个 “理想型”自由裁量工作模式的设计与运作是 假设与各种组织和 临床表现。 我们期望一个单位越接近“理想- 在组织方面， 结果（留住护士和缩短住院时间）和临床 结果（护理质量，降低超额死亡率，以及更多 满意的患者）。 我们将调查和观察病人、护士和 华盛顿14家医院27个重症监护室的医生 关于各种组织和临床因素的国家认为， 与组织成果相关，如护士保留和 临床结果，如护理质量、患者满意度和过量 mortality.

We propose to expand on the findings of two recent studies that suggest the organization of nursing care and collaboration between nurses and physicians are as important as the organization of medical care and technology in determining compelling clinical outcomes such as excess mortality. The primary objective of the research is to extend the findings of the American Association of Critical Care Nurses (AACN) Demonstration Project by delineating combination of organizational structure and process factors at the work unit level that are the best predictors of desired organizational and patient care outcomes, including outcomes as nursing retention and patient mortality. This regionally based work is sen as a foundation for examining such determinants in a large scale national probability sample of critical care nursing units. The study will use an hypothesis-testing correlational design with the critical care unit as the primary unit of analysis. The degree to which a unit departs from an "ideal-type" discretionary pattern of work design and operation is hypothesized to be correlated with various measures of organizational and clinical performance. We expect that the closer a unit is to the "ideal- type" the better will be its performance in terms of organizational outcomes (retaining nurses and shorter length of stay) and clinical outcomes (quality of nursing care, less excess mortality, and more satisfied patients). We will survey and observe patients, nurses and physicians in each of 27 critical care units in 14 hospitals in Washington State regarding a variety of organizational and clinical factors believed to be associated with organizational outcomes, such as nurse retention and clinical outcomes such as quality of care, patient satisfaction, and excess mortality.