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Assessment of nursing care quality and the judgment of the professional nurse as reflected in nurse-determined patient acuity classification and staffing decisions.

机译：护理质量评估和专业护士的判断，反映在护士确定的患者敏锐度分类和人员配备决策中。

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摘要

There is a need to study the process which links structure with positive patient outcomes. Nursing research has concentrated on staffing predictors of skill mix, nurses' participation in decision-making, and identifying patient outcomes attributable to quality of nursing care. Few research papers have examined the process link between nurse staffing practices (structure) and patient outcomes. The purpose of this evaluation research was to determine whether the judgments made by the “frontline” nurse caregivers could affect quality patient care—as evidenced by decreased incidences of adverse nurse-sensitive patient outcomes (medication errors, patient falls, nosocomial pressure ulcers)—when those decisions were utilized to determine patient acuities and to predict acuity-adjusted staffing needs.; The interrupted time-series design evaluated whether utilizing a nurse-determined patient classification and staffing system improved good patient outcomes. The setting was a small, rural, Western Pennsylvania hospital; the environment was one of organizational autonomy with decentralized control of decision-making regarding staffing patterns and patient care at the unit level. The focus of data collection was on incidences of nurse-sensitive outcomes—patient falls, medication errors, and nosocomial pressure ulcers. Structural indicators used to analyze the medical/surgical unit's stability over time were “average daily census,” “average nursing care hours per patient day,” “average reimbursement patient acuity index,” “average length of stay,” “percentage of female patients,” “percentage of Medicare patients,” “skill mix” (RNs, LPNs, NAs, and unit clerks), and “turnover rates of professional nursing staff.” The analyses involved archival data collected as a set of 36 time-ordered observations; 442 adverse events were evaluated.; “Ordinary least squares” regression analyses yielded insufficient statistical evidence to determine significant results. However, the new PCSS has been shown to have practical utility for nurses regarding decreased medication errors. Overall, nurses were less likely to make medication errors after the implementation of a patient classification system in which RNs providing direct patient care determined patients' acuity classifications. Nursing staff productivity, sex of patient, and time (shift, day of week, seasonal effects) were ruled out as plausible rival explanations for incidences or errors.
机译：有必要研究将结构与患者积极结果联系起来的过程。护理研究集中在技能组合的人员预测，护士参与决策以及确定可归因于护理质量的患者结局方面。很少有研究论文研究过护士人员配备实践（结构）与患者结果之间的过程联系。这项评估研究的目的是确定“第一线”护士看护者的判断是否会影响优质的患者护理，如对护士敏感的患者不良结局（用药错误，患者跌倒，医院内压疮）的发生率下降证明了这一点。这些决定何时用于确定患者的敏锐度并预测敏锐度调整后的人员需求。中断的时间序列设计评估了使用护士确定的患者分类和人员配备系统是否改善了患者的良好结局。地点是宾夕法尼亚州西部的一所乡村小型医院。环境是组织自治的一种，对单位级别的人员配备模式和患者护理进行分散的决策控制。数据收集的重点是对护士敏感的结果的发生率—患者跌倒，用药错误和医院内压疮。用于分析医疗/外科部门随时间推移的稳定性的结构性指标为“平均每日普查”，“每位患者每天的平均护理时间”，“平均报销患者视力指数”，“平均住院时间”，“女性患者的百分比” ”，“ Medicare患者的百分比”，“技能组合”（RN，LPN，NA和部门文员）以及“专业护理人员的流失率”。分析涉及以36个按时间顺序排列的观测值集合收集的档案数据；评价了442次不良事件。 “普通最小二乘”回归分析得出的统计证据不足以确定重大结果。但是，新的PCSS在减少用药错误方面对护士具有实用性。总体而言，在实施患者分类系统后，护士不太可能犯用药错误，在该系统中，提供直接患者护理的护士确定患者的敏锐度分类。排除了护理人员的生产率，患者性别和时间（轮班，星期几，季节性影响），作为对发生率或错误率的合理解释。

著录项

  • 作者

    Zidek, Cynthia K.;

  • 作者单位

    Indiana University of Pennsylvania.;

  • 授予单位 Indiana University of Pennsylvania.;
  • 学科 Health Sciences Nursing.; Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2003
  • 页码 252 p.
  • 总页数 252
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;预防医学、卫生学;
  • 关键词

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