CRITICAL CARE NURSING SYSTEMS, RETENTION & PT OUTCOMES

我们建议扩大最近两项研究的结果，这两项研究表明 护理组织及护士与护士之间的协作 医生与医疗保健和组织一样重要 确定令人信服的临床结果的技术，如过量 死亡率。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)的演示 通过描述组织结构和流程的组合来实现项目 工作单元级别的因素是期望的最佳预测因素 组织和病人护理结果，包括护理结果 滞留和病人死亡率。这项以地区为基础的工作被视为 在全国范围内大规模审查这些决定因素的基金会 重症监护护理病房的概率样本。这项研究将使用 以重症监护病房为研究对象的假设检验相关设计 基本分析单位。单位偏离一个单位的程度。 “理想型”自由裁量的工作设计和运作模式是 假设与各种组织和组织措施相关 临床表现。我们预计一个单位离理想越近- 输入“在组织方面的表现越好” 结果(留住护士和较短的住院时间)和临床 结果(护理质量、超额死亡率更低、更多 患者满意)。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状态 与组织成果相关联，例如护士留任和 临床结果，如护理质量、患者满意度和超额 死亡率。

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.