Department of Nursing Science, University of Applied Sciences, Bochum, Germany.
School of Health and Welfare, Dalarna University, Falun, Sweden.
JMIR Res Protoc. 2024 Apr 22;13:e56262. doi: 10.2196/56262.
Nursing-sensitive events (NSEs) are common, accounting for up to 77% of adverse events in hospitalized patients (eg, fall-related harm, pressure ulcers, and health care-associated infections). NSEs lead to adverse patient outcomes and impose an economic burden on hospitals due to increased medical costs through a prolonged hospital stay and additional medical procedures. To reduce NSEs and ensure high-quality nursing care, appropriate nurse staffing levels are needed. Although the link between nurse staffing and NSEs has been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing patient-level exposure to nurse staffing during the hospital stay. Few studies have assessed nurse staffing and patient outcomes using a single-center longitudinal design, with limited generalizability. There is a need for multicenter longitudinal studies with improved potential for generalizing the association between individual nurse staffing levels and NSEs.
This study aimed (1) to determine the prevalence, preventability, type, and severity of NSEs; (2) to describe individual patient-level nurse staffing exposure across hospitals; (3) to assess the effect of nurse staffing on NSEs in patients; and (4) to identify thresholds of safe nurse staffing levels and test them against NSEs in hospitalized patients.
This international multicenter study uses a longitudinal and observational research design; it involves 4 countries (Switzerland, Sweden, Germany, and Iran), with participation from 14 hospitals and 61 medical, surgery, and mixed units. The 16-week observation period will collect NSEs using systematic retrospective record reviews. A total of 3680 patient admissions will be reviewed, with 60 randomly selected admissions per unit. To be included, patients must have been hospitalized for at least 48 hours. Nurse staffing data (ie, the number of nurses and their education level) will be collected daily for each shift to assess the association between NSEs and individual nurse staffing levels. Additionally, hospital data (ie, type, teaching status, and ownership) and unit data (ie, service line and number of beds) will be collected.
As of January 2024, the verification process for the plausibility and comprehensibility of patients' and nurse staffing data is underway across all 4 countries. Data analyses are planned to be completed by spring 2024, with the first results expected to be published in late 2024.
This study will provide comprehensive information on NSEs, including their prevalence, preventability, type, and severity, across countries. Moreover, it seeks to enhance understanding of NSE mechanisms and the potential impact of nurse staffing on these events. We will evaluate within- and between-hospital variability to identify productive strategies to ensure safe nurse staffing levels, thereby reducing NSEs in hospitalized patients. The TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) study will focus on the optimization of scarce staffing resources.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56262.
护理敏感事件（NSEs）很常见，占住院患者不良事件的比例高达 77%（例如，与跌倒相关的伤害、压疮和医疗保健相关感染）。NSEs 导致不良的患者结局，并由于延长住院时间和额外的医疗程序而导致医院增加医疗费用，从而给医院带来经济负担。为了减少 NSEs 并确保高质量的护理，需要适当的护士人员配备水平。尽管许多研究已经描述了护士人员配备与 NSEs 之间的联系，但缺乏适当的护士人员配备水平。现有的研究描述了在单位或医院层面的固定人员配备暴露，而没有评估患者在住院期间对护士人员配备的个体暴露。很少有研究使用单中心纵向设计评估护士人员配备和患者结局，其普遍性有限。需要进行多中心纵向研究，以提高将个体护士人员配备水平与 NSEs 之间的关联推广的潜力。
本研究旨在：（1）确定 NSEs 的发生率、可预防程度、类型和严重程度；（2）描述 across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals across hospitals （3）评估护士人员配备对患者 NSEs 的影响；（4）确定安全护士人员配备水平的阈值，并在住院患者中对其进行测试。
这项国际多中心研究采用纵向和观察性研究设计；涉及 4 个国家（瑞士、瑞典、德国和伊朗），共有 14 家医院和 61 个医疗、外科和混合单位参与。16 周的观察期将使用系统的回顾性记录审查来收集 NSEs。将审查 3680 名患者入院情况，每个单位随机选择 60 名入院患者。要纳入研究，患者必须至少住院 48 小时。护士人员配备数据（即护士人数及其教育水平）将每天为每个班次收集，以评估 NSEs 与个体护士人员配备水平之间的关联。此外，还将收集医院数据（即类型、教学状态和所有权）和单位数据（即服务线和床位数量）。
截至 2024 年 1 月，正在对所有 4 个国家的患者和护士人员配备数据的合理性和可理解性进行验证。计划于 2024 年春季完成数据分析，并预计第一批结果将于 2024 年末公布。
这项研究将提供关于 NSEs 的全面信息，包括其在各国的发生率、可预防程度、类型和严重程度。此外，它旨在增强对 NSE 机制的理解以及护士人员配备对这些事件的潜在影响。我们将评估 within- and between-hospital variability 以确定确保安全护士人员配备水平的有效策略，从而减少住院患者的 NSEs。TAILR（护理敏感事件及其与个体护士人员配备水平的关联）研究将侧重于优化稀缺的人员配备资源。
国际注册报告标识符（IRRID）：DERR1-10.2196/56262。
