Linking outcomes to the quality of the process of nursing care
Abstract
A substantial share of hospital nurses report having not enough time to provide necessary care for patients. Nursing care left undone can be expected to adversely affect quality of care. The purpose of this study was to examine the relationship between nurse reported (N= 10, 184) unmet nursing care needs as an indicator of the quality of nursing care and patient (N = 232,342) and hospital (N = 168) outcomes for general, orthopedic, and vascular surgery patients. It was hypothesized that there would be significant variation in unmet nursing care needs across hospitals; hospitals with a greater proportion of unmet nursing care needs would have a significantly higher occurrence of adverse events; and, hospitals with a greater proportion of unmet nursing care needs would have significantly higher rates of mortality and failure-to-rescue and longer average lengths of stay. The variation in unmet nursing care needs was assessed using descriptive and comparative statistics. After assessing bivariate associations among independent variables, regression techniques were used to estimate the effects of unmet nursing care needs on risk adjusted outcomes. The unmet nursing care needs composite measure developed from nurse reported care needs left undone had moderate internal consistency among nurses. An average of 2 out of 7 necessary care needs were left undone which varied significantly across hospitals. The frequency of patients receiving the wrong medication or dose, nosocomial infections, and patient falls with injury was significantly higher when the proportion of unmet nursing care needs was greater in hospitals. However, after taking into account patient and care environment variables, unmet nursing care needs did not fully or significantly explain the observed association between features of the care environment (i.e. staffing and education) and mortality, failure-to-rescue, or length of stay. This study provides evidence that poor quality nursing care is a significant predictor of hospital level risk adjusted nurse reported adverse events including medication errors, nosocomial infections, and patient falls with injury. The aim for hospitals and nurses is to reduce harm to patients by integrating organizational and individual practices, such as adequate resource allocation to allow nurses time to organize, evaluate, and deliver necessary nursing care.
Recommended Citation
Robert James Lucero,
"Linking outcomes to the quality of the process of nursing care"
(January 1, 2008).
Dissertations available from ProQuest.
Paper AAI3328614.
http://repository.upenn.edu/dissertations/AAI3328614
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