OUTCOMES OF NURSING MANAGEMENT PRACTICE IN NURSING HOMES

养老院的管理在美国是一个紧迫的问题。 全国有23，000家养老院，150万居民。的 联合S.参议院最近估计，近一半的美国护士 家庭提供的护理不合格。大多数研究工作都是为了改善 疗养院的患者结局集中在临床方面， 护理之家手术我们对人类的影响知之甚少 护理管理流程（NMPs）和环境因素对结果的影响 在疗养院。本研究旨在调查 关于患者结局、工作人员结局和财务结局的NMP， 同时考虑了病例组合和背景因素的影响。 了解NMP影响结果的内容、方式和原因， 疗养院将为护士管理者提供有价值的信息， 为更好的护理管理成果做好规划。长期目标 本研究的目的是制定护理管理干预措施， 改善患者、员工和财务状况， 为今后的干预研究奠定基础。 这项为期5年的两阶段研究的目的是：1）探索 NMPs与情境因素的关系及其独立性 以及对患者结局、员工结局和财务状况的共同影响 护理院的结果; 2）确定其他NMP和上下文 导致更好结果的因素; 3）确定哪些条件促进 使用有效的国家管理计划或对有效的国家管理计划构成障碍;以及 解释模型之间的联系，背景变量， 通过比较和整合I期和II期的结果变量 结果在第一阶段，对150名随机选择的 疗养院，使用定量方法，将用于实现目标 I.第一阶段的结果将是基本了解什么是NMP， 背景因素与结果有关。开展护理管理 然而，要想取得更好的结果， 更多的知识和理解为什么变量是 相关的，为什么一些护士管理人员已经能够发展和 成功地实施了国家管理计划，而其他国家则没有。因此在第二阶段， 将进行4项使用定性方法的案例研究， 第一阶段，实现目标二-目标四。多个数据源将 在第二阶段使用，包括面试，文件和非正式 意见。为了获得一个详细的图片之间的关系， 变量，在整个第一阶段将采用多重三角测量， 第二阶段。

The management of nursing homes is a pressing problem in the U.S. Nationally there are 23,000 nursing homes with 1.5 million residents. The U. S. Senate recently estimated that almost one-half of U.S. nursing homes are providing substandard care. Most research efforts to improve patient outcomes in nursing homes have focused on clinical aspects of nursing home operations. Little is yet know about the influence of nursing management processes (NMPs) and contextual factors on outcomes in nursing homes. This study is designed to investigate the impact of NMPs on patient outcomes, staff outcomes, and financial outcomes, while also accounting for the influence of case mix and contextual factors. Having knowledge about what, how, and why NMPs influence outcomes in nursing homes will provide valuable information for nurse managers to use in planning for better nursing management outcomes. The long range goal of this research is to develop nursing management interventions that improve patient, staff, and financial outcomes and that will serve as the basis for future intervention research. The aims of this 5 year, two-phase study are to: 1) explore the relationship between NMPs and contextual factors and their independent and joint influence on patient outcomes, staff outcomes, and financial outcomes in nursing homes; 2) identify additional NMPs and contextual factors that lead to better outcomes; 3) identify what conditions promote the use of, or pose barriers to, effective NMPs; and 4) develop an explanatory model of the linkages between NMPs, contextual variables, and outcome variables by comparing and integrating Phase I and Phase II results. In Phase I, a correlational study of 150 randomly selected nursing homes, using quantitative methods, will be used to accomplish Aim I. The result of Phase I will be basic understanding of what NMPs and contextual factors are related to outcomes. To develop nursing management interventions that will lead to better outcomes, however, requires additional knowledge and understanding about why the variables are related and why some nurse managers have been able to develop and implement NMPs successfully while others have not. Therefore in Phase II, 4 case-studies using qualitative methods will be conducted to extend Phase I by accomplishing Aim II - Aim IV. Multiple sources of data will be used in Phase II including interviews, documentation, and informal observations. To obtain a detailed picture of the relationships among the variables, multiple triangulation will be employed throughout Phase I and Phase II.