RELATIONSHIPS OF NURSE STAFFING AND SELECTED PATIENT OUTCOMES IN SKILLED NURSING FACILITIES.
Contributors: University of California, San Francisco.
Published: 1987
Number of pages: 210
Subjects: Health Sciences, Nursing.
Description: Nursing home facilities and their Medicare-certified units traditionally have provided long-term health care and restorative services to the chronically ill, aged, and disabled. Historically, according to the literature, nursing home care has been considered substandard. Lack of quality of care may be caused by an inappropriate distribution of nursing personnel, i.e., registered nurses (RNs), licensed practical/vocational nurses (LPN/LVNs), and nursing assistants (NAs).

This research examined the relationships between the level and type of nurse staffing hours and selected poor patient outcomes (bladder incontinence, bowel incontinence, and decubitus ulcers). The study was based on a convenience sample of seven California Medicare-certified skilled nursing facilities that primarily serve Medicare patients. The research design utilized a standardized instrument to collect data on a nonrandom sample of (n = 302) Medicare patients. Study data were generated as s subset from a larger research project (Fries & Cooney, 1985). The theoretical framework for the study was derived from systems theory.

The findings showed low levels of nurse staffing hours per patient and high levels of selected patient problems (outcomes). The nurse staffing hours averaged 23.54 RN minutes, 22.62 LPN/LVN minutes, and 82.82 NA minutes per patient (direct and indirect nursing care activities) for the combined day and evening shifts studied. The data suggested that of the three patient problems researched, at least 50 percent of the sample patients were bladder incontinent; approximately 45 percent lacked bowel control; and more than 30 percent had some degree of skin breakdown, or decubitus ulcers.

Multiple regressions determined relationships between each level and type of nursing staff hours and the three selected negative patient problems. The study findings, controlled for case mix and other factors, showed a positive relationship rather than the expected negative correlations between nurse staffing hours and the three patient problems. Negative correlations would have supported the hypotheses that more RN management hours and/or more other nursing hours would result in fewer selected poor patient outcomes.

Because this study was limited to nonexperimental, cross-sectional design, determinations could not be made in either the admitting patient conditions or changes after admission. Further research is needed in nursing homes that focus on nurse staffing hours and level(s) relative to specific patient problems and their outcomes from patient admission over time.
Notes: Source: Dissertation Abstracts International, Volume: 48-11, Section: B, page: 3250.

Thesis (D.N.SC.)--UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, 1987.

School code: 0034.