Nurse Staffing and Adverse Events on Inpatient Units

描述（由申请人提供）：美国护士协会和国家质量论坛等国家组织将患者福尔斯和压疮指定为“护理敏感质量指标”。然而，将福尔斯和压疮的发生与护士配备的差异联系起来的研究得出了模棱两可的结果。不良事件的不可靠测量和护理人员配备的不充分措施可以解释不确定的结果。以前的研究分析了这些影响在医院和护理单位的水平，但从来没有同时。护理实践环境的差异可能会缓和人员配置和不良事件之间的联系，虽然这还没有得到验证。这项研究的基础是该研究小组提出的证据，即护士配备和执业环境会影响患者的预后。这项研究通过以下方式促进了我们对人员配备与患者不良事件之间关系的理解：1）使用来自观察性患病率研究和事件报告的次要数据计算不良事件，2）使用一套全面的护士人员配备措施，解释RN之间的定性和定量差异，3）在护理单位和医院层面检查这些关系，（4）探讨正规认可的良好护理实习环境对这些关系的影响。将使用ANA赞助的国家护理质量指标数据库中650家社区医院的4,300个护理单位的数据，采用多水平模型预测护理单位水平人员配备对福尔斯发生率以及患者和护理单位水平压疮发生率的影响。美国护士资格认证中心磁铁指定状态将用于区分各医院的护理实践环境，并探讨作为一个医院层面的因素调节人员配置和结果之间的关联。 这项研究将加强证据基础上的护士人员配置模式和实践环境如何支持病人护理的质量和安全。

DESCRIPTION (provided by applicant): Patient falls and pressure ulcers are designated as "nursing-sensitive quality indicators" by national groups such as the American Nurses Association and the National Quality Forum. Yet research linking the occurrence of falls and pressure ulcers to differences in nurse staffing has yielded equivocal findings. Unreliable measurement of adverse events and inadequate measures of nurse staffing could account for the inconclusive findings. Prior studies have analyzed these effects at hospital and nursing unit levels, but never simultaneously. Differences in the nursing practice environment may moderate the link between staffing and adverse events, although this has not been tested. The proposed study builds on evidence developed by this research team that nurse staffing and the practice environment influence patient outcomes. This study advances our understanding of the relationship between staffing and patient adverse events by 1) calculating adverse events using secondary data from observational prevalence studies and incident reports, 2) using a comprehensive set of nurse staffing measures that account for qualitative as well as quantitative differences among RNs, 3) examining these relationships at both the nursing unit and hospital levels, and 4) exploring the influence of a formally-recognized favorable nursing practice environment on these relationships. Multi-level models will be used to predict the effects of staffing on rate of falls at the nursing unit level and pressure ulcers at both the patient and the nursing unit levels using data from 4,300 nursing units in 650 community hospitals in the ANA-sponsored National Database of Nursing Quality Indicators. American Nurses Credentialing Center Magnet Designation status will be used to differentiate the nursing practice environment across hospitals and explored as a hospital-level factor moderating the associations between staffing and outcomes. This study will strengthen the evidence base on how nurse staffing patterns and practice environments support the quality and safety of patient care.