A Multi-Level Study of Nurse Leaders, Safety Climate and Care Outcomes

描述（由申请人提供）：医学研究所（IOM）的一份开创性报告发现，每年有超过98,000名美国人死于错误和不良后果，每年造成的损失在170亿至290亿美元之间。支付方、提供者和患者都要求减少这些事件。护士领导，护士的行动，和他们的工作氛围是影响病人的结果变化的关键。护士领导是重要的，然而护理研究大多依赖于全球领导力的衡量标准，而没有考虑到工业心理学的领导力研究进展。采用领导-成员交换（LMX）的领导视角对护理领导的研究有益，该视角认为领导者与员工（成员）处于持续的二元关系中，这些关系的质量是员工态度和信念的重要预测因素，从而影响结果。此外，LMX对领导力的看法为研究员工个人和工作单位等多个层面的结果提供了概念和方法上的手段。本研究的目的是使用LMX视角来检验领导对安全气候和不良患者预后的影响。目的是：1)探讨LMX与安全气候的关系；2)检查LMX和安全气候是否影响患者不良结局的发生率；3)探讨工作人员和单位特征对安全气候、LMX和患者不良预后关系的影响。提出的研究将采用多层次的横断面设计来检查34个住院单位的这些关系。受访者将是一家拥有700张床位的急症三级医疗机构的单位主任（n=34）及其相关工作人员（n=1500），他们将被要求完成医疗保健研究和质量医院调查机构关于患者安全文化和领导-成员交流工具的调查。单位特征和不良患者结果数据将从医院行政和绩效改进信息系统中获得。统计分析将使用描述性和探索性数据分析，包括标准回归和层次线性建模，以考虑嵌套的数据结构。本研究的发现有可能提高对组织特征、领导行为和不良事件之间关系的理解。有了这些知识，就有可能制定量身定制的干预措施，以促进行为改变，提高领导技能，防止患者出现不良后果。

Description (Provided by Applicant): The seminal Institute of Medicine (IOM) report found that over 98,000 Americans die every year due to errors and adverse outcomes at a cost of between 17 and 29 billion dollars per annum. Payers, providers and patients are demanding a reduction in these events. Nurse leaders, nurse actions, and their work climates are critical to effecting change in patient outcomes. The nurse leader is significant, yet nursing research has mostly relied on global measures of leadership without considering the leadership research advances from industrial psychology. Research on nursing leadership can benefit from adopting a leader member exchange (LMX) perspective on leadership, which posits that a leader is engaged in ongoing dyadic relationships with staff (member) and that the quality of these relationships is an important predictor of employee's attitudes and beliefs, thus outcomes. Moreover, the LMX perspective on leadership provides conceptual and methodological means for studying outcomes at multiple levels such as individual employees and work units. The purpose of this study is to use the LMX perspective to examine the effects of leadership on safety climate and adverse patient outcomes. The aims are: 1) to investigate the relationship between LMX and safety climate; 2) to examine if LMX and safety climate influence the rates of adverse patient outcomes; 3) to explore the effect of staff and unit characteristics on the relationship between safety climate and LMX and adverse patient outcomes. The proposed study will use a multi-level cross-sectional design to examine these relationships in 34 inpatient units. Respondents will be unit directors (n=34) and their associated staff members (n=1500) in a 700 bed acute tertiary care facility who will be asked to complete the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture and the Leader-Member Exchange Tool. Unit characteristics and adverse patient outcome data will be obtained from hospital administrative and performance improvement information systems. Statistical analysis will use descriptive and exploratory data analysis including standard regression and hierarchical linear modeling to take into account the nested data structure. Findings from this study have the potential to improve understanding of relationships between organizational characteristics, leadership behaviors, and adverse events. With this knowledge, it may be possible to develop tailored interventions to promote behavior change and enhance leadership skills to prevent adverse patient outcomes.