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Open Access Evaluation of a Patient Care Delivery Model: System Outcomes in Acute Cardiac Care Évaluation d'un modèle de prestation des soins : résultats systémiques en soins cardiaques actifs

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Abstract:

Hierarchical linear modelling was used to evaluate the influence of nurse staffing, work environment, and nurse and patient variables on system outcomes based on data collected in Canadian cardiac and cardiovascular inpatient units. Staffing utilization levels below 80% at the unit level and less overtime optimized perceived care quality and the completion of therapeutic interventions. Fewer patients per nurse improved perceived care quality and reduced longer-thanexpected length of stay. Nurse reports of greater resource adequacy were associated with less absenteeism and fewer uncompleted or delayed nursing interventions. System outcomes were also influenced by patient characteristics (health, pre-operative education, nursing diagnoses); nurse characteristics (experience, expertise, health, effort-reward imbalance); and work-environment factors (autonomy, unit instability).

French
Nous avons recouru à la modélisation linéaire hiérarchique afin d'évaluer, à partir de données recueillies auprès de services hospitaliers de cardiologie, l'incidence sur les résultats systémiques de la dotation en personnel infirmier, du milieu de travail et de variables relatives aux infirmières et aux patients. Une utilisation inférieure à 80 % de l'effectif du service et un moindre recours aux heures supplémentaires accroissent au maximum la perception de la qualité des soins et l'exécution des interventions thérapeutiques. Un ratio infirmière/ patients peu élevé améliore la perception de la qualité des soins tout en réduisant les séjours prolongés imprévus. Une dotation jugée adéquate par le personnel infirmier est associée à une diminution de l'absentéisme et du nombre d'interventions infirmières inachevées ou remises à plus tard. Les résultats systémiques sont également tributaires des caractéristiques de la clientèle (état de santé, éducation pré–opératoire, diagnostics infirmiers), des caractéristiques du personnel infirmier (expérience, expertise, état de santé, déséquilibre effort-récompense) et des facteurs associés au milieu de travail (autonomie, instabilité au sein du service).

Keywords: ABSENTEEISM; LENGTH OF STAY; NURSE STAFFING; NURSING INTERVENTIONS; QUALITY OF CARE; WORK ENVIRONMENTS

Document Type: Research Article

Publication date: 2010-12-01

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