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首页> 外文期刊>Nursing research >The impact of hospital nursing characteristics on 30-day mortality.
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The impact of hospital nursing characteristics on 30-day mortality.

机译：医院护理特征对30天死亡率的影响。

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BACKGROUND: Evidence indicates that hospital nursing characteristics such as staffing contribute to patient outcomes. Less attention has been given to other hospital nursing characteristics central to optimal professional practice, namely nurse education and skill mix, continuity of care, and quality of the work environment. OBJECTIVE: To assess the relative effects and importance of nurse education and skill mix, continuity of care, and quality of work environment in predicting 30-day mortality after adjusting for institutional factors and individual patients characteristics. METHOD: A cross-sectional analysis of outcome data for 18,142 patients discharged from 49 acute care hospitals in Alberta, Canada, for diagnoses of acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or stroke between April 1, 1998, and March 31, 1999, was done. Mortality data were linked to patient demographic and comorbidity factors, institutional characteristics, and hospital nursing characteristics derived from a survey of all registered nurses working in acute care hospitals. RESULTS: Using multilevel analysis, it was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance = .044, p < .001). Patient comorbidities and age explained 44.2% of the variance in 30-day mortality. After adjustment for patient comorbidities and demographic factors, and the size, teaching, and urban status of the study hospitals in a fixed-effects model, the odds ratios (95% confidence interval) of the significant hospital nursing characteristics that predict 30-day mortality were as follows: 0.81 (0.68-0.96) for higher nurse education level, 0.83 (0.73-0.96) for richer nurse skill mix, 1.26 (1.09-1.47) for higher proportion of casual or temporary positions, and 0.74 (0.60-0.91) for greater nurse-physician relationships. The institutional and hospital nursing characteristics explained an additional 36.9%. DISCUSSION: Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients.
机译：背景：证据表明，医院的护理特点（例如人员配备）有助于患者预后。对于最佳专业实践至关重要的其他医院护理特征（即护士教育和技能组合，护理的连续性以及工作环境的质量）的关注较少。目的：评估调整机构因素和个体患者特征后，护士的教育和技能组合，护理的连续性以及工作环境质量在预测30天死亡率方面的相对作用和重要性。方法：从1998年4月1日起，从加拿大艾伯塔省49家急性护理医院中出院的18142例患者的结局数据进行横断面分析，以诊断急性心肌梗塞，充血性心力衰竭，慢性阻塞性肺疾病，肺炎或中风，并于1999年3月31日完成。死亡率数据与对所有在急诊医院工作的注册护士的调查得出的患者人口统计学和合并症因素，机构特征和医院护理特征相关。结果：使用多级分析，可以确定各医院30天死亡率的对数差异显着（差异= .044，p <.001）。患者合并症和年龄解释了30天死亡率差异的44.2％。调整患者合并症和人口统计学因素以及固定效应模型中研究医院的规模，教学和城市状况后，可预测30天死亡率的重要医院护理特征的比值比（95％置信区间）如下：较高的护士教育水平为0.81（0.68-0.96），较丰富的护士技能组合为0.83（0.73-0.96），较高的临时或临时职位比例为1.26（1.09-1.47），以及0.74（0.60-0.91）获得更大的护士与医生的关系。机构和医院的护理特点进一步说明了36.9％。讨论：医院护理特点是降低患者30天死亡风险的重要考虑因素。

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