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The effects of changes in the hospital nursing workforce and practice environment on the outcomes of surgical oncology patients: A two-stage panel study.

机译：医院护理人员和实践环境的变化对手术肿瘤患者预后的影响：分两个阶段的小组研究。

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摘要

Prior research has documented that a better educated nursing workforce, higher nurse staffing levels, and better nurse practice environments are significantly associated with improved quality of care and lower patient mortality in multiple patient populations. Most prior research has used cross-sectional data to analyze associations between variables at a single time point. Little research has addressed whether changes in hospital nursing characteristics over time are associated with changes in outcomes. This two-stage panel study, in which cross-sectional samples of patients and nurses in acute care hospitals in Pennsylvania were compared at two time points, provides evidence of the relationship between changes in hospital nursing characteristics and patient outcomes.;The objective of this study was to examine the effects of changes in hospital-level proportion of baccalaureate-prepared nurses, nurse staffing, and the nurse practice environment on changes in rates of failure-to-rescue and 30-day mortality in a surgical oncologic patient population between two points in time. The study was a two-stage panel designed secondary analysis that examined the effect of changes between 1999 and 2006 in nursing characteristics in 135 hospitals on changes in risk-adjusted mortality and failure-to-rescue of 29, 356 adult oncology patients admitted for primary surgical intervention for the purposes of disease management. The study combined information about nursing characteristics from nurse surveys with patient characteristics and outcomes derived from a state cancer registry and hospital discharge abstracts and hospital characteristics drawn from administrative databases. Multivariate regression modeling was employed to jointly assess the effect of changes in the organization of nursing within an institution on outcomes, controlling for both patient and hospital characteristics.;The overall mean percentage of nurses with a baccalaureate degree across hospitals did not change significantly between 1999 and 2006. The mean number of patients per nurse across all hospitals was 5.81 in 1999 and 5.76 in 2006, a non-significant change, with the vast majority of hospitals decreasing or increasing the average number of patients per nurse by less than one patient. Nurse-reported practice environment scores increased significantly during the study period. A number of hospitals had increases in level of nurse education, nurse staffing, and rating of the practice environment over the period, while many others had decreases. Some of the changes in both directions were sizable.;Improvement in nurse staffing was associated with reductions in failure-to-rescue and mortality rates. The addition of one patient to the nurse's average workload resulted in an average increase of 4.34 deaths for every 1,000 patients. For the subset of patients with complications, the addition of one patient to the nurse's average workload resulted in an average increase of 13.47 deaths for every 1,000 patients. When controlling for patient characteristics, with every 10% increase in the proportion of nurses with a baccalaureate degree, hospitals had an average reduction of 5.07 deaths for every 1,000 patients. This association was not significant in models that controlled for hospital characteristics. Investments in hospital nursing features including increasing the proportion of baccalaureate-prepared nurses and lowering patient-to-nurse ratios within hospitals may contribute to improvement in outcomes of surgical oncology patients.
机译：先前的研究表明，受过良好教育的护理人员队伍，更高的护士人员配备水平和更好的护士实践环境与改善护理质量和降低多个患者人群的患者死亡率显着相关。先前的大多数研究都使用横截面数据来分析单个时间点变量之间的关联。很少有研究解决医院护理特征随时间的变化是否与结果的变化相关。这项分为两个阶段的小组研究在两个时间点比较了宾夕法尼亚州急诊医院的患者和护士的横断面样本，为医院护理特征的变化与患者预后之间的关系提供了证据。这项研究旨在检查在两个肿瘤外科手术患者中，准备学士学位的护士在医院中所占比例，护士人员配备以及护士执业环境的变化对挽救失败率和30天死亡率的影响。时间点。该研究是一个由两个阶段组成的小组设计的二级分析，研究了1999年至2006年间135家医院的护理特点变化对29例356例原发性原发性成人肿瘤患者经风险调整后的死亡率和挽救失败的变化的影响。为了疾病管理而进行的外科手术。该研究将护士调查中的护理特征信息与患者特征和从国家癌症登记处得出的结果以及从行政数据库中提取的出院摘要和医院特征相结合。多变量回归模型用于共同评估机构中护理组织的变化对结果的影响，同时控制患者和医院的特征; 1999年之间，各医院具有学士学位的护士的总体平均百分比没有显着变化和2006年。所有医院中每名护士的平均患者人数分别为1999年的5.81和2006年的5.76，这是不显着的变化，绝大多数医院将每名护士的平均患者人数减少或增加了少于一名患者。在研究期间，护士报告的练习环境得分显着提高。在此期间，一些医院的护士教育水平，护士人员配备和对实践环境的评价有所提高，而其他许多医院则有所下降。双向变化有些很大。护士配备的增加与挽救失败率和死亡率的降低有关。护士平均工作量增加一名患者，每1000名患者平均增加4.34例死亡。对于有并发症的患者子集，护士平均工作量增加一名患者，每1000名患者平均增加13.47例死亡。在控制患者特征时，具有学士学位的护士比例每增加10％，医院平均每1000名患者减少5.07例死亡。这种关联在控制医院特征的模型中并不重要。医院护理功能方面的投资，包括增加准备好学士学位的护士比例和降低医院内的患者对护士的比例，可能有助于改善手术肿瘤患者的治疗效果。

著录项

  • 作者

    Vanak, Jill Marie.;

  • 作者单位

    University of Pennsylvania.;

  • 授予单位 University of Pennsylvania.;
  • 学科 Health Sciences Nursing.;Health Sciences Oncology.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2014
  • 页码 259 p.
  • 总页数 259
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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