New York University College of Nursing, 433 First Avenue Office 506, New York, NY 10010, United States.
University of Kansas School of Nursing, 3901 Rainbow Blvd., MS 4043, Kansas City, KS 66160, United States.
Int J Nurs Stud. 2015 Oct;52(10):1565-72. doi: 10.1016/j.ijnurstu.2015.05.011. Epub 2015 Jun 6.
Nursing unit is the micro-organization in the hospital health care system in which integrated patient care is provided. Nursing units of different types serve patients with distinct care goals, clinical tasks, and social structures and norms. However, empirical evidence is sparse on unit type differences in quality of care and its relation with nurse work environment. Nurse work environment has been found as an important nursing factor predicting nurse and patient outcomes.
To examine the unit type differences in nurse-reported quality of care, and to identify the association between unit work environment and quality of care by unit types.
This is a cross-sectional study using nurse survey data (2012) from US hospitals nationwide. The nurse survey collected data on quality of care, nurse work environment, and other work related information from staff nurses working in units of various types. Unit types were systematically classified across hospitals. The unit of analysis was the nursing unit, and the final sample included 7677 units of 14 unit types from 577 hospitals in 49 states in the US. Multilevel regressions were used to assess the relationship between nurse work environment and quality of care across and by unit types.
On average, units had 58% of the nurses reporting excellent quality of care and 40% of the nurses reporting improved quality of care over the past year. Unit quality of care varied by unit types, from 43% of the nurses in adult medical units to 73% of the nurses in interventional units rating overall quality of care on unit as excellent, and from 35% of the nurses in adult critical care units to 44% of the nurses in adult medical units and medical-surgical combined units reporting improved quality of care. Estimates from regressions indicated that better unit work environments were associated with higher quality of care when controlling various hospital and unit covariates; and this association persisted among units of different types.
Unit type differences exist in the overall quality of care as well as achievement in improving quality of care. The low rates of nurses reporting improvement in the quality of nursing care to patients suggest that further interventions focusing at the unit-level are needed for achieving high care quality. Findings from our study also suggest that improving nurse work environments can be an effective strategy to improve quality of care.
护理单元是医院医疗保健系统中的微观组织，在其中提供综合的患者护理。不同类型的护理单元为具有不同护理目标、临床任务和社会结构与规范的患者提供服务。然而，关于护理单元类型差异对护理质量的影响及其与护士工作环境的关系，实证证据仍然匮乏。护士工作环境已被发现是预测护士和患者结局的重要护理因素。
检验护士报告的护理质量在护理单元类型上的差异，并确定以护理单元类型为参照的护士工作环境与护理质量之间的关系。
这是一项使用全国范围美国医院护士调查数据（2012 年）的横断面研究。该护士调查从各种类型护理单元中收集了护士关于护理质量、护士工作环境和其他工作相关信息的数据。护理单元在各医院中被系统分类。分析单位是护理单元，最终样本包括来自美国 49 个州 577 家医院的 14 种护理单元类型的 7677 个护理单元。多水平回归用于评估护士工作环境与各护理单元类型间及跨护理单元类型的护理质量之间的关系。
平均而言，有 58%的护士报告护理质量优秀，40%的护士报告过去一年护理质量得到改善。护理单元的护理质量因护理单元类型而异，从成人内科护理单元的 43%到介入护理单元的 73%的护士报告整体护理质量优秀，从成人重症监护病房的 35%到成人内科单元和内科-外科联合单元的 44%的护士报告护理质量得到改善。回归估计表明，在控制各种医院和护理单元协变量后，更好的护理单元工作环境与更高的护理质量相关；而且这种关联在不同类型的护理单元中仍然存在。
在整体护理质量以及改善护理质量方面，护理单元类型存在差异。报告患者护理质量改善的护士比例较低，这表明需要进一步采取以护理单元为重点的干预措施来实现高质量护理。我们的研究结果还表明，改善护士工作环境可以成为提高护理质量的有效策略。
