Smith Jessica G, Plover Colin M, McChesney Moira C, Lake Eileen T
University of Texas at Arlington College of Nursing and Health Innovation, 411 S. Nedderman Drive, Arlington, TX, 76019.
Thomas Jefferson University College of Population Health, 901 Walnut Street, Philadelphia, PA, 19107.
SAGE Open Nurs. 2019 May 14;5:2377960819848246. doi: 10.1177/2377960819848246. eCollection 2019 Jan-Dec.
Though rural hospitals serve about one fifth of the United States (U.S.), few studies have investigated relationships among nursing resources and rural hospital adverse events.
The purpose was to determine relationships among nursing skill mix (proportion of Registered Nurses (RNs) to all nursing staff), the work environment and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals.
Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. The work environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurses reported adverse event frequency. Data analyses were descriptive and inferential.
On average, 72% of nursing staff were RNs (range = 45% to 100%). Adverse event frequency ranged from 0% to 67%, across 76 hospitals. In regression models, a 10-point increase in the proportion of RNs among all nursing staff and a one standard deviation increase in the PES-NWI score were significantly associated with decreased odds of frequent adverse events.
Rural hospitals that increase the nursing skill mix and improve the work environment may achieve reduced adverse event frequency.
尽管乡村医院服务于约五分之一的美国人口，但很少有研究调查护理资源与乡村医院不良事件之间的关系。
旨在确定乡村医院中护理技能组合（注册护士占所有护理人员的比例）、工作环境与不良事件（用药错误、患者跌倒致伤、压疮和尿路感染）之间的关系。
采用横断面设计，将一项来自美国四个州的关于护士组织因素、患者安全和质量的大型研究中的护士调查数据与2006年美国医院协会的数据相联系。工作环境采用护理工作指数实践环境量表（PES-NWI）进行测量。护士报告不良事件发生频率。数据分析包括描述性分析和推断性分析。
平均而言，72%的护理人员为注册护士（范围为45%至100%）。在76家医院中，不良事件发生频率范围为0%至67%。在回归模型中，所有护理人员中注册护士比例每增加10分，以及PES-NWI得分每增加一个标准差，与频繁发生不良事件的几率降低显著相关。
增加护理技能组合并改善工作环境的乡村医院可能会降低不良事件发生频率。
