Barry Theresa Teta, Brannon Diane, Mor Vincent
116 Henderson Building, The Pennsylvania State University, University Park, PA 16802, USA.
Gerontologist. 2005 Jun;45(3):309-17. doi: 10.1093/geront/45.3.309.
This study examines the moderating effect of staff stability on the relationship between management practices used to empower nurse aides and resident outcomes in a multistate sample of nursing homes. An adaptation of Kanter's theory of structural power in organizations guided the framework for the model used in this study.
Management practices and nurse aide staff stability measures were taken from a survey of directors of nursing (n = 156) and day-shift charge nurses (n = 430) in a stratified random sample of nursing facilities in Maine, Mississippi, New York, and Ohio (n = 156). Facility risk-adjusted pressure ulcer incidence rates and social engagement scores, taken from the Minimum Data Set, served as resident outcome measures. A hierarchical linear regression model was used to test the moderating effect of staff stability.
The situation in which higher numbers of rewards were given to nurse aide staff was associated with lower incidence of pressure ulcers, whereas the situation in which nurse aides had more influence in resident care decisions was associated with higher aggregate social engagement scores. The inclusion of nurse aide staff stability in the regression model provided additional explanatory information for the relationship between management practices and resident outcomes. Facilities experiencing low turnover and high retention were associated with lower pressure ulcer incidence, whereas facilities with high turnover and high retention were associated with higher social engagement scores.
This study suggests that certain management practices used to empower nurse aides can influence resident outcomes. Further, effects of nurse aide staff stability vary with respect to the physical versus psychosocial nature of the outcome.
本研究在一个多州养老院样本中，考察员工稳定性对用于赋予护理助理权力的管理实践与居民结局之间关系的调节作用。坎特的组织结构权力理论的一个改编版本指导了本研究中使用的模型框架。
管理实践和护理助理员工稳定性测量数据来自对缅因州、密西西比州、纽约州和俄亥俄州护理机构分层随机样本中的护理主任（n = 156）和日班主管护士（n = 430）的调查。从最低数据集获取的机构风险调整后的压疮发病率和社交参与得分用作居民结局测量指标。使用分层线性回归模型来检验员工稳定性的调节作用。
给予护理助理员工更多奖励的情况与较低的压疮发病率相关，而护理助理在居民护理决策中具有更大影响力的情况与更高的总体社交参与得分相关。在回归模型中纳入护理助理员工稳定性为管理实践与居民结局之间的关系提供了额外的解释信息。人员流动率低且留用率高的机构与较低的压疮发病率相关，而人员流动率高且留用率高的机构与更高的社交参与得分相关。
本研究表明，某些用于赋予护理助理权力的管理实践可以影响居民结局。此外，护理助理员工稳定性的影响在结局的身体方面与心理社会方面有所不同。
