Nursing sensitive outcomes: the results of a multicentre study

Abstract

The relationship between staffing characteristics and nursing sensitive outcomes has been explored in several studies. To assess the effect of staffing characteristics, nurses' wellbeing at work and hours of care on pressure sores, falls and physical restrains occurrence. Longitudinal study including from February 2014 to June 2015 a total of 24110 consecutive patients and 2606 nurses of 134 units (geriatrics and medicine (GM), orthopedic-traumatology (OT) and rehabilitation and long-term care (LR) of 12 Italian regions. Data was collected up to 15 days for each included patient, and regarding the staff of each shift by ad hoc trained personnel. There is a large variability in both patients and nurses' characteristics across wards, as well as of outcomes, even in the same area (e.g., GM). Patients in GM received a mean of 144±35 minutes of care/day; 186±146 in OT and 140±40 in LR. The incidence of pressure sores was 5.3%±4.8% in GM; 5.1%±5.6% in OT and 8.6%±10.1% in LR. The incidence of falls was 1.9%±2.1% in GM, 0.8%±1% in OT and 2.9%±3.8% in LR. Restraints were used in 41.4%±30.3% of patients in GM, among 24.8%±23.4% in OT and 54.7%±29.7% in LR. The multilevel analyses confirmed the importance of clinical factors but also the positive effects of staff characteristics such as the number of expert nurses and the negative effects of a negative work environment, although with wide variations across settings have emerged. Staff characteristics related to work environment affect patient outcomes but the large variability across wards would require further stratification of the data to better understand and interpret the findings.