Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.
JAMA Netw Open. 2020 Jan 3;3(1):e1920092. doi: 10.1001/jamanetworkopen.2019.20092.
In Canada, approximately 81% of residents of nursing homes live with mild to severe cognitive impairment. Care needs of this population are increasingly complex, but resources, such as staffing, for nursing homes continue to be limited. Staff risk missing or rushing care tasks and interfering with quality of care and life.
To assess the association of work environment with missing and rushing essential care tasks in nursing homes.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used survey data collected from a random sample of 93 urban nursing homes in Western Canada, stratified by health region, owner-operator model, and facility size, between May and December 2017. All 5411 eligible care aides were invited to participate, and 4016 care aides agreed and completed structured, computer-assisted interviews in person. Analyses were conducted from July 4, 2018, to February 27, 2019.
Self-reported number of essential care tasks missed (range, 0-8) or rushed (range, 0-7) in the most recent shift. Two-level random intercept hurdle regressions controlled for care aide, care unit, and nursing home characteristics.
Of 4016 care aides, 2757 (68.7%) were 40 years or older, 3574 (89.1%) were women, and 1353 (66.3%) spoke English as an additional language. For their most recent shift, 2306 care aides (57.4%) reported missing at least 1 essential care task and 2628 care aides (65.4%) reported rushing at least 1 essential care task. Care aides on units with more favorable work environments (eg, more effective leadership, better work culture, higher levels of buffering resources) were less likely to miss any care tasks (odds ratio, 1.59; 95% CI, 1.34-1.90; P < .001) and less likely to rush any care task (odds ratio, 1.66; 95% CI, 1.38-1.99; P < .001).
This study found that rates of missed and rushed essential care in Canadian nursing homes were high and were higher in units with less favorable work environments. This finding suggests that work environment should be added to the list of modifiable factors associated with improving nursing home care, as it may be an important pathway for improving quality of care. Further research is needed to understand associations of missed and rushed care and of improving work environments with outcomes among residents of nursing homes.
在加拿大，大约 81%的养老院居民都有轻度到重度的认知障碍。这个群体的护理需求日益复杂，但养老院的资源，如人员配置，仍然有限。工作人员可能会错过或匆忙完成护理任务，从而影响护理质量和生活质量。
评估工作环境与养老院护理任务缺失和匆忙之间的关联。
设计、地点和参与者：这项横断面研究使用了 2017 年 5 月至 12 月期间在加拿大西部一个随机抽取的 93 家城市养老院的调查数据，这些数据按卫生区域、所有者-运营商模式和设施规模进行了分层。所有 5411 名符合条件的护理助理都被邀请参加，其中 4016 名护理助理同意并亲自完成了结构化的计算机辅助访谈。分析于 2018 年 7 月 4 日至 2019 年 2 月 27 日进行。
报告最近轮班期间错过（范围，0-8）或匆忙（范围，0-7）的基本护理任务数量。双水平随机截距障碍回归控制了护理助理、护理单元和养老院的特征。
在 4016 名护理助理中，2757 名（68.7%）年龄在 40 岁或以上，3574 名（89.1%）为女性，1353 名（66.3%）会说英语作为额外语言。在他们最近的轮班中，2306 名护理助理（57.4%）报告至少有 1 项基本护理任务被遗漏，2628 名护理助理（65.4%）报告至少有 1 项基本护理任务被匆忙完成。在工作环境更有利的单元（例如，更有效的领导、更好的工作文化、更高水平的缓冲资源）的护理助理，更不可能错过任何护理任务（优势比，1.59；95%置信区间，1.34-1.90；P<0.001），也更不可能匆忙完成任何护理任务（优势比，1.66；95%置信区间，1.38-1.99；P<0.001）。
这项研究发现，加拿大养老院中遗漏和匆忙完成基本护理任务的比例很高，在工作环境较差的单元中比例更高。这一发现表明，工作环境应该被列入与改善养老院护理相关的可改变因素清单，因为它可能是提高护理质量的一个重要途径。需要进一步研究以了解遗漏和匆忙护理以及改善工作环境与养老院居民结局之间的关联。
