Date of Award

2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Linda H. Aiken

Abstract

The consequences of severe burns are profound, resulting in complex metabolic changes that can adversely affect every organ system. Nurses provide much of the direct care and ongoing professional clinical surveillance that burn patients require to survive and recover. Evidence suggests nursing resources vary substantially across hospitals, but surprisingly little research has been directed to understanding whether this variation is associated with burn patient outcomes. Some hospitals that care for a high volume of burn patients have better patient outcomes, but this finding is inconsistent. One explanation is that existing studies have not focused on nursing. This study examined whether nursing resources, including patient-to-nurse ratios, nurse educational preparation, and the quality of nurse work environments are associated with mortality in adult burn patients. A multivariable regression model including a linked cross-sectional database of nurse, patient, and hospital data from 2005-2006 was employed. The sample included reports on care by 29,586 nurses in 653 hospitals and independent information on the outcomes of 14,064 patients with a burn diagnosis. The main hypotheses tested were 1) nursing resources would be associated with whether patients survived their hospital stay, and 2) differences in mortality observed at high versus low-burn patient volume hospitals can be at least partly explained by nursing. No direct effect of nursing resources was found on mortality; however in the multivariable model with interaction terms, nursing was significantly associated with mortality in high-volume hospitals. In high-volume hospitals, each additional patient added to a nurse’s workload increased mortality odds by 30%, and each unit improvement in the nurse work environment score decreased mortality odds by 28%. These findings suggest that the difference in mortality odds between high and low-volume hospitals depends, in part, on nursing. The implications for practice are that high-volume burn hospitals cannot trust that their burn outcomes will be superior because “practice makes perfect.” Instead, it is a high priority to support excellent nursing care by limiting the number of patients each nurse cares for and ensuring that the nurse work environment supports nurses’ professional autonomy, effective nurse leadership, positive team functioning, and positive interprofessional relationships.

Embargoed

Available to all on Thursday, September 15, 2022

Included in

Nursing Commons

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