Impact of Nurse Work Environment on Rural Quality of Care and Clinical Outcomes

描述（由申请人提供）：拟议的研究解决了NINR消除地理位置造成的健康差异的使命。现有的研究没有确定影响护理质量和临床结果的社区因素（即贫困程度）和组织因素（即护士工作环境和医院特点）。在本文提出的K01中，结构权变理论被用于概念化护士工作环境、农村社区特征、医院和护理单位特征、护理质量和临床结果（Ml死亡率）之间的关联。这项建议的指导研究的目标是：a)制定一个护士评估的质量指标，并根据既定的质量指标（医院收集的和大型公共数据集）对该指标进行测试；B)评价农村小医院质量指标与临床结果的关系；c)研究可能影响小型农村医院护理质量指标和Ml死亡率的社区、医院、护理单位和护士工作环境的特点。为了实现这一目标，候选人将参加职业发展计划，并将获得设计、开发和使用网络调查的知识和熟练程度；使用大型二级公共数据库；应对农村卫生研究带来的特殊挑战；并获得先进的统计方法和计算机应用知识，这些知识需要使用多层数据进行大规模研究。候选人将准备在规划和开展复杂的农村护理健康研究方面发挥主导作用。培训将应用于拟议的研究，邀请两个州的小型农村医院通过其首席护理官参与研究。数据将从多个来源收集：基于网络的工作人员护士调查、医院管理数据和大型公共数据库（即医院比较和州出院数据）。数据将使用多层建模和回归技术进行分析。本研究将为未来的研究奠定基础，包括将医院的护理质量扩展到患者出院后的生活质量。本研究的发现可以为管理者和政策制定者提供信息，了解小型农村医院的护理质量和患者的Ml死亡率如何受到护士工作环境因素以及农村社区、医院和护理单位特征的影响。

DESCRIPTION (provided by applicant): The proposed study addresses NINR's mission of eliminating health disparities due to geographic location. Rural hospitals are absent from existing studies that identify community factors (i.e. level of poverty) and organizational factors (i.e. the nurse work environment and hospital characteristics) that influence quality of care and clinical outcomes. In this proposed K01, structural contingency theory is used to conceptualize the association between the nurse work environment, rural community characteristics, hospital and nursing unit characteristics, quality of care, and clinical outcomes (Ml mortality). The goals of this proposed mentored research are to: a) develop a nurse assessed quality indicator and test this measure against established quality indicators (hospital collected, and large public data sets); b) evaluate the relationship between quality indicators and clinical outcomes in small rural hospitals; c) examine characteristics of the community, hospital, nursing unit, and nurse work environment that may influence quality of care indicators and Ml mortality in small rural hospitals. To accomplish this, the candidate will pursue a career development program, and will gain knowledge and proficiency in designing, developing, and using Web surveys; using large secondary public data bases; negotiating the special challenges that rural health research poses; and acquiring advanced knowledge of statistical methods and computer applications needed to do large scale studies using multilevel data. The candidate will be prepared to assume a lead role in planning and conducting complex rural nursing health studies. The training will be applied to the proposed study where small rural hospitals in two states will be invited to participate through their chief nursing officer. Data will be collected from multiple sources: Web-based staff nurse surveys, hospital administrative data, and large public data bases (i.e. Hospital Compare and state discharge data). The data will be analyzed using multilevel modeling and regression techniques. This study will form the basis for future research that includes an expansion of quality of care in the hospital to patient's quality of life after discharge. Findings from this study may inform administrators and policy makers on how quality of care and Ml mortality rates for patients in small rural hospitals are influenced by factors in the nurses' work environment as well as characteristics of the rural community, hospital, and nursing unit.