中东急性护理医院中护士执业环境对患者结局的影响及注册护士结局的中介效应：一项横断面研究。
The impact of nurse practice environment on patient outcomes and mediation effects of registered nurse outcomes in Middle Eastern acute care hospitals: A cross-sectional study.
机构信息
College of Nursing, King Saud University, Riyadh, Saudi Arabia.
School of Nursing, University of North Carolina at Greensboro, NC 27412, USA.
出版信息
Appl Nurs Res. 2022 Aug;66:151605. doi: 10.1016/j.apnr.2022.151605. Epub 2022 Jun 25.
AIMS
Examining associations between unit nurse practice environment and four patient outcomes (catheter-associated urinary tract infections [CAUTIs], central line-associated bloodstream infections [CLABSIs], falls, and pressure injuries) and mediation effects of three RN unit workgroup outcomes (job enjoyment, psychological safety, and intent to stay at 1 and 3 years) on these relationships.
METHODS
A cross-sectional correlational design, using the National Database of Nursing Quality Indicators® (NDNQI®) unit-level data from 2018 on inpatient units from seven Middle Eastern hospitals. Ninety units were included, where the sample of units for each patient outcome varied (n = 73-90) based on outcome data availability.
RESULTS
Higher unit nurse practice environment scores were significantly associated with higher CLABSIs (exp(b) = 8.181, 95 % CI = [2.204, 30.371], p = .002) and lower pressure injuries (exp(b) = 0.153, 95 % CI = [0.032, 0.730], p = .018). However, mediation analysis showed no significant direct effects of unit nurse practice environment on patient outcomes. Mediation analysis showed that nurses' psychological safety-respect significantly mediated the relationship between unit nurse practice environment and CAUTIs (β = 2.620, p = .013, 95 % bcb CI = [0.837, 5.070]). Nurses' intent to stay at 1-year and psychological safety-respect had significant direct effects (β = -4.784, p = .017 and β = 3.073, p = .012, respectively) on CAUTIs.
CONCLUSIONS
Nurse practice environment was significantly associated with two patient outcomes and a mediation role of RN outcomes was supported when examining one patient outcome. Future research should examine these relationships in a larger sample for replication.
TWEETABLE ABSTRACT
Although nurse practice environment can impact patient outcomes directly, nurse outcomes play a crucial role in mediating this relationship.
目的
研究单位护士实践环境与四种患者结局（导尿管相关尿路感染[CAUTIs]、中心导管相关血流感染[CLABSIs]、跌倒和压疮）之间的关联，并探讨三个注册护士单位工作组结局（工作满意度、心理安全感和 1 年和 3 年留职意愿）对这些关系的中介作用。
方法
采用横断面相关性设计，使用 2018 年来自中东 7 家医院的住院单位的国家护理质量指标数据库（NDNQI®）的单位水平数据。纳入 90 个单位，每个患者结局的单位样本量因结局数据的可用性而有所不同（n=73-90）。
结果
单位护士实践环境评分较高与 CLABSIs 较高显著相关（exp(b)=8.181，95%CI=[2.204, 30.371]，p=0.002），与压疮较低显著相关（exp(b)=0.153，95%CI=[0.032, 0.730]，p=0.018）。然而，中介分析显示单位护士实践环境对患者结局没有显著的直接影响。中介分析显示，护士的心理安全感尊重显著中介了单位护士实践环境与 CAUTIs 之间的关系（β=2.620，p=0.013，95% bcb CI=[0.837, 5.070]）。护士留职意愿和心理安全感尊重对 CAUTIs 有显著的直接影响（β=-4.784，p=0.017 和β=3.073，p=0.012）。
结论
护士实践环境与两种患者结局显著相关，当检验一种患者结局时，护士结局的中介作用得到支持。未来的研究应在更大的样本中检验这些关系，以进行复制。
推文摘要
尽管护士实践环境可能直接影响患者结局，但护士结局在中介这种关系方面起着至关重要的作用。
Zotero 插件