Associate Professor, College of Nursing, Ewha Womans University, Seoul, South Korea.
J Nurs Scholarsh. 2019 Sep;51(5):569-579. doi: 10.1111/jnu.12498. Epub 2019 Jul 22.
To encourage the enactment of laws about mandatory nurse staffing in nursing homes, researchers should provide evidence of concrete nurse hours per resident day (HPRD). This article estimates optimal nurse staffing HPRD to achieve increased quality-of-care outcomes for nursing home residents.
Secondary analysis of longitudinal data.
This study used secondary analysis of longitudinal nursing home survey data. Nurse staffing HPRD and quality-of-care survey data accrued from nursing homes operating under long-term-care insurance in Korea. The collected data include a total of six quarterly base measurements on nurse staffing HPRD and 15 quality indicators from 2014 to 2017. The proposed optimization model emerged to most appropriately combine nurse staffing HPRD to increase quality-of-care outcomes for nursing home residents by 3% to 8%. Optimal outcome measures were fixed as best outcomes and compiled from 15 nursing-sensitive quality indicators.
Constrained nonlinear optimization was used for analysis. A 12% increase in registered nurse (RN) HPRD (from 0.168 HPRD [10 min 5 s] to 0.177 [10 min 38 s]) aligned with a 3% improvement in quality-of-care outcomes. A 20% RN HPRD increase aligned with a commensurate 5% to 8% increase in compiled quality-of-care outcomes (from 0.168 HPRD [10 min 5 s] to 0.202 HPRD [12 min 6 s]) without increasing certified nurse aide HPRD. About a 30% RN HPRD increase aligned with a commensurate 5% to 8% increase in compiled quality-of-care outcomes (from 0.168 HPRD [10 min 5 s] to 0.218 HPRD [13 min 6 s]) without increasing certified nurse aide HPRD.
It is urgent to institute mandatory nurse HPRD for nursing homes in Korea by law. This research provides evidence that increasing nursing HPRD improved residents' outcomes in nursing homes.
Findings from the optimization model implied that stable care by RNs in nursing homes is a key factor in achieving acceptable quality of care for residents.
为了鼓励制定有关疗养院强制性护士配置的法律，研究人员应提供具体的每位居民每天护士工时（HPRD）的证据。本文旨在估计最佳护士配置 HPRD，以提高疗养院居民的护理质量。
纵向数据的二次分析。
本研究使用了韩国长期护理保险下运营的疗养院纵向调查数据的二次分析。护士配置 HPRD 和护理质量调查数据来自于 2014 年至 2017 年的疗养院。收集的数据共包括六个季度的护士配置 HPRD 基础测量值和 15 个来自 2014 年至 2017 年的护理敏感质量指标。所提出的优化模型旨在最恰当地结合护士配置 HPRD，将疗养院居民的护理质量提高 3%至 8%。最优结果测量值被固定为最佳结果，并从 15 个护理敏感质量指标中编制而成。
使用约束非线性优化进行分析。注册护士（RN）HPRD 增加 12%（从 0.168 HPRD[10 分钟 5 秒]到 0.177[10 分钟 38 秒]）与护理质量提高 3%相一致。RN HPRD 增加 20%与编译后的护理质量提高 5%至 8%相一致（从 0.168 HPRD[10 分钟 5 秒]到 0.202 HPRD[12 分钟 6 秒]），而无需增加认证护士助理 HPRD。RN HPRD 增加约 30%与编译后的护理质量提高 5%至 8%相一致（从 0.168 HPRD[10 分钟 5 秒]到 0.218 HPRD[13 分钟 6 秒]），而无需增加认证护士助理 HPRD。
韩国迫切需要通过法律为疗养院制定强制性护士 HPRD。本研究提供的证据表明，增加护士 HPRD 可以改善疗养院居民的预后。
优化模型的结果表明，RN 在疗养院的稳定护理是为居民提供可接受护理质量的关键因素。
