Nursing care quality and adverse events in US hospitals

Journal of Clinical Nursing - Tập 19 Số 15-16 - Trang 2185-2195 - 2010
Robert Lucero1,2,3, Eileen T. Lake1,2,3, Linda H. Aiken1,2,3
1Authors: Robert J Lucero, PhD, RN, Post-Doctoral Research Fellow, Center for Evidence-Based Practice in the Underserved, Columbia University School of Nursing, NY
2Eileen T Lake, PhD, RN, Associate Professor of Nursing, Associate Director, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing
3Linda H Aiken, PhD, RN, Claire M. Fagin Leadership Professor in Nursing and Professor of Sociology, Director, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA

Tóm tắt

Aim.  To examine the association between nurses’ reports of unmet nursing care needs and their reports of patients’ receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals.Background.  Because nursing activities are often difficult to measure, and data are typically not collected by health care organisations, there are few studies that have addressed the association between nursing activities and patient outcomes.Design.  Secondary analysis of cross‐sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US.Methods.  Multivariate linear regression models estimated the effect of unmet nursing care needs on adverse events given the influence of patient factors and the care environment.Results.  The proportion of necessary nursing care left undone ranged from 26% for preparing patients and families for discharge to as high as 74% for developing or updating nursing care plans. A majority of nurses reported that patients received the wrong medication or dose, acquired nosocomial infections, or had a fall with injury infrequently. However, nurses who reported that these adverse events occurred frequently varied considerably [i.e. medication errors (15%), patient falls with injury (20%), nosocomial infection (31%)]. After adjusting for patient factors and the care environment, there remained a significant association between unmet nursing care needs and each adverse event.Conclusion.  The findings suggest that attention to optimising patient care delivery could result in a reduction in the occurrence of adverse events in hospitals.Relevance to clinical practice.  The occurrence of adverse events may be mitigated when nurses complete care activities that require them to spend time with their patients. Hospitals should engage staff nurses in the creation of policies that influence human resources management to enhance their awareness of the care environment and patient care delivery.

Từ khóa


Tài liệu tham khảo

10.1097/00006199-195406000-00003

10.1097/00005650-199711001-00002

10.1001/jama.288.16.1987

10.1001/jama.290.12.1617

10.1097/01.NNA.0000312773.42352.d7

Aydelotte ME, 1960, An Investigation of the Relationship Between Nursing Activity and Patient Welfare

Blegen MA, 1998, A multisite study of nurse staffing and patient occurrences, Nursing Economics, 16, 196

10.1177/1077558707299248

Brewster AC, 1985, Medisgroups: a clinically based approach to classifying hospital patients at admission, The Journal of Health Care Organization Provision and Financing, 22, 377

Buerhaus PI, 2005, Hospital RNs’ and CNOs’ perceptions of the impact of the nursing shortage on the quality of care, Nursing Economics, 23, 214

10.1097/00005110-200207000-00009

Donabedian A, 1966, Evaluating quality of medical care, Milbank Memorial Fund Quarterly-Health and Society, 44, 166, 10.2307/3348969

10.1001/jama.1988.03410120089033

Donabedian A, 2003, An Introduction to Quality Assurance in Health Care

10.1111/j.1468-0009.2005.00397.x

10.1046/j.1365-2648.2002.02143.x

10.1002/nur.20110

10.1097/00006199-200503000-00002

10.2307/30142373

10.1111/j.1475-6773.2007.00825.x

10.1177/019394598100300107

10.1097/00005110-197611000-00004

Irvine D, 1998, Finding value in nursing care: a framework for quality improvement and clinical evaluation, Nursing Economics, 16, 110

Kahn KL, 1990, Measuring quality of care with explicit process criteria before and after implementation of the DRG‐based prospective payment system, Journal of the American Medical Association, 264, 1969, 10.1001/jama.1990.03450150069033

10.1016/j.outlook.2008.05.007

10.1111/1475-6773.00040

10.1111/j.1525-1497.2005.40171.x

10.1093/ageing/afh064

10.1002/nur.10032

10.1097/00006199-200601000-00001

10.1016/S0001-2092(07)60597-3

10.1111/j.1365-2648.2009.05090.x

Maas ML, 1998, Structure and process constraints on nursing accountability, Outcomes Management for Nursing Practice, 2, 51

Maas ML, 1998, Nursing outcomes accountability. Moving to measurement, Outcomes Management for Nursing Practice, 2, 139

Mitchell PH, 1989, American Association of Critical Care Nurses Demonstration Project – profile of excellence in critical care nursing, Heart and Lung, 18, 219

10.1111/j.1547-5069.1998.tb01234.x

10.1056/NEJMsa012247

10.1037/0021-9010.88.5.879

10.1097/01.mlr.0000109127.76128.aa

Spratley E, 2002, The Registered Nurse Population, March 2002

10.1097/MLR.0b013e3180383667

10.1097/00005650-200301000-00016

Thông tin
Thông tin xuất bản

Journal of Clinical Nursing

Tập 19 Số 15-16

2185-2195

Thông tin tác giả