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Biomedical subjects

M A Blegen

Publications and source records attributed to M A Blegen.

At least 19 recordsLinked to original sources
PubMed2001

Nurse experience and education: effect on quality of care.

OBJECTIVE: To describe the relationships between the quality of patient care and the education and experience of the nurses providing that care. BACKGROUND: There is a call for more nurses with baccalaureate degrees and more experienced nurses to work in hospitals. Previous research studies have examined the characteristics, abilities, and work assignments of nurses with and without baccalaureate degrees but have not examined the quality of the patient care delivered. It is generally believed that more experienced nurses provide higher-quality care, but again few studies have actually examined this issue. METHODS: A secondary analysis of data, collected in two previous studies of the relationship between nurse staffing (hours of care, staff mix) and the quality of patient care, was used to determine the relationship between nurses' education and experience and the quality of care provided. The data were collected at the patient care unit level (42 units in study 1 and 39 units in study 2). Quality of care was indicated by lower unit rates of medication errors and patient falls. RESULTS: Controlling for patient acuity, hours of nursing care, and staff mix, units with more experienced nurses had lower medication errors and lower patient fall rates. These adverse occurrence rates on units with more baccalaureate-prepared nurses were not significantly better.

Accidental Falls↗
PubMed1999

Residential status and birth outcomes: is the rural/urban distinction adequate?

In studies comparing the birth outcomes of rural and urban women, residency status is frequently defined dichotomously as either rural or urban. Since residency status appears to be a continuum, however, the usefulness of other categorization systems needs to be explored. The purpose of this study was to compare birth outcomes using a three-level variable for residency status (rural, rural adjacent to urban, and urban). The study population was comprised of women who delivered by cesarean section over an 18-month period (N = 263) at a tertiary care hospital. Data were collected from patient charts, interviews, and the hospital information system. Residency status was determined by county of residence. Birth outcomes examined included gestational age, birthweight, Apgar scores, maternal complications, length of hospital stay, and costs of hospital care. Rural women had worse birth outcomes overall and traveled the greatest distance for delivery. Rural-adjacent women had the best birth outcomes of the three groups, yet were the youngest, least educated, least likely to be married, and the least likely to be privately insured. By using a nondichotomous three-level variable for residency status, two distinct groups of rural women were identified whose maternal health care needs may differ from each other.

Adult↗
PubMed1998

Adverse patient occurrences as a measure of nursing care quality.

OBJECTIVE: The purpose of this study was to describe relationships among adverse patient occurrences aggregated at the unit level of measurement. Relationships between adverse occurrences and a patient acuity measure were also described. BACKGROUND: Adverse patient occurrence data have been traditionally a major indicator of quality care in hospitals; however, few studies have examined relationships among these indicators or the usefulness of these indicators for assessing the quality of nursing care. METHODS: A correlational design was used to examine and describe patterns of relationships among in-patient units in a tertiary care hospital. The results demonstrated positive correlations between medication error rates and patient falls; these adverse occurrences correlated negatively with pressure ulcers, infections, patient complaints, and death. Pressure ulcers, infections, patient complaints and death intercorrelated positively and also related positively to patient acuity levels. RESULTS: An examination of these same rates for a subset of units with similar patient acuity levels revealed that most of the interrelationships among the entire set of adverse occurrence indicators were positive. When patient acuity was taken into account, these adverse outcomes appeared to indicate some common underlying characteristic of the units, such as quality of nursing care. CONCLUSIONS: This study suggests a relationship between the adverse occurrences that were correlated (pressure ulcers, patient complaints, infection, and death) and the severity of patient illness. Medication error rates and patient fall rates were not correlated with patient acuity and are more likely to indicate quality of nursing care across all types of units.

Accidental Falls↗
PubMed1998

Nurses' perceptions of why medication administration errors occur.

Nurses play a key role in medication administration in hospital settings. Five categories of reasons for medication errors were identified in a survey of 1,384 nurses. These categories include physician, systems, pharmacy, individual, and knowledge-related factors. In this article, issues surrounding the occurrence and prevention of medication errors are discussed.

Attitude of Health Personnel↗
PubMed1997

Implications of nursing taxonomies for middle-range theory development.

Given the broad acceptance for the need to develop middle-range theory to support nursing practice, nursing scientists must consider how to proceed with dispatch to develop these theories. This article suggests using the concepts in the newly developing taxonomies of nursing knowledge as the building blocks for these theories. Taxonomies of nursing diagnoses (NANDA), nursing interventions (NIC), and nursing outcomes (NOC) can speed the construction of the theories needed for nursing practice.

Humans↗
PubMed1995

Outcomes of hospital-based managed care: a multivariate analysis of cost and quality.

OBJECTIVE: To determine the effects a hospital-based managed care intervention has on the cost and quality of care. METHODS: The intervention consisted of a CareMap and a nurse case manager. The CareMap contained both a critical path and a set of expected patient outcomes. The study population comprised all women who delivered by cesarean during the 18 months of the study and who were cared for in the maternity unit at a tertiary-level university hospital. The effects of the intervention were determined by comparing the after group with the before group in regard to length of stay and costs of care post-cesarean delivery, patient ratings of quality of care, and the physical recovery of the patients by discharge and 1 month later. RESULTS: After the implementation of hospital-based managed care, the average length of stay decreased 13.5% (0.7 days) and the average costs decreased 13.1% ($518). These decreases were statistically significant and remained so after controlling for co-morbid and complicating conditions. Patients perception of the quality of care increased from 4.26 to 4.41 on a 1-5 scale, a statistically significant increase. In particular, patients believed that they had an increased level of participation in their care. The physical recovery scores obtained at discharge did not change. CONCLUSION: Hospital-based managed care can reduce resource use, length of stay, and cost associated with hospital care while maintaining or improving the quality of care. Whether these effects are reproducible and generalizable to other conditions should be addressed in future studies; the duration of these effects should also be examined.

Adult↗
PubMed1994

Interactive process of conducting and utilizing research in nursing service administration.

The authors report on a project that evolved from a single-purpose project--research use in nursing service administration--to a multipurpose process. The project team initially intended to conduct a classic research use project to develop management interventions to improve job satisfaction. The team eventually conducted three basic research projects and systematically applied this knowledge to the practice of nursing service administration. The members of the team, who came from academic and service settings, collaborated in a dynamic and interactive process of generating and applying knowledge. The products of this work were immediately useful in the setting and can be used more broadly in organizing and managing the care of hospital patients.

Achievement↗
PubMed1994

Use of nursing assistants: staff nurse opinions.

Use of assistive nursing personnel generates fear, uncertainty and lack of trust in many RNs, yet most agree that "help is needed." The nursing profession must develop minimum standards, a code of ethics and appropriate preparation for nursing assistants. They are here to stay!

Attitude of Health Personnel↗
PubMed1993

Preferences for decision-making autonomy.

Nurses' lack of autonomy has been identified as a leading cause of job dissatisfaction, but attempts to increase satisfaction by increasing autonomy have not always been successful. This survey of 356 randomly selected staff nurses and 130 head nurses from 16 hospitals extends previous work by identifying the preferred level of involvement in 21 patient care and 21 unit operation decisions. Staff nurses agreed on 60 percent of the decisions and, in general, preferred independent decision-making for patient care decisions and shared decision-making for unit operation. Head nurses indicated that staff nurses should have a higher level of autonomy than the staff nurses indicated for themselves.

Adult↗
PubMed1992

Recognizing staff nurse job performance and achievements.

While recognition for work has been positively related to nurses' job satisfaction in the research literature, specific types of recognition that would be most meaningful have not been identified. In this descriptive survey, 341 randomly selected staff nurses rated the extent of meaningfulness of 38 head nurse recognition behaviors. The most meaningful, in order of importance, were monetary rewards commensurate with performance, private verbal feedback, and written acknowledgment. Three other categories of recognition were identified as moderately meaningful: public acknowledgement, schedule adjustment, and opportunities for growth and development.

Adult↗
PubMed1987

Nurses' job satisfaction: a longitudinal analysis.

A causal model of nurses' job satisfaction was tested using longitudinal analysis of 13 causal determinants and five correlates measured at Time 1, and job satisfaction measured at Time 2. Data were collected from 370 registered nurses at five hospitals using questionnaires mailed eight months apart. Four different models were analyzed using the LISREL maximum likelihood procedure to estimate the path coefficients. Variables reaching statistically significant levels included, in order of importance, routinization, promotional opportunity, distributive justice, age, day shift, workload, kinship responsibility, and opportunity for jobs outside the employing hospital. With the prior level of job satisfaction controlled, only the effects of day shift remained significant.

Adult↗
PubMedDate not supplied

Nurse staffing and patient outcomes.

BACKGROUND: Nursing studies have shown that nursing care delivery changes affect staff and organizational outcomes, but the effects on client outcomes have not been studied sufficiently. OBJECTIVE: To describe, at the level of the nursing care unit, the relationships among total hours of nursing care, registered nurse (RN) skill mix, and adverse patient outcomes. METHODS: The adverse outcomes included unit rates of medication errors, patient falls, skin breakdown, patient and family complaints, infections, and deaths. The correlations among staffing variables and outcome variables were determined, and multivariate analyses, controlling for patient acuity, were completed. RESULTS: Units with higher average patient acuity had lower rates of medication errors and patient falls but higher rates of the other adverse outcomes. With average patient acuity on the unit controlled, the proportion of hours of care delivered by RNs was inversely related to the unit rates of medication errors, decubiti, and patient complaints. Total hours of care from all nursing personnel were associated directly with the rates of decubiti, complaints, and mortality. An unexpected finding was that the relationship between RN proportion of care was curvilinear; as the RN proportion increased, rates of adverse outcomes decreased up to 87.5%. Above that level, as RN proportion increased, the adverse outcome rates also increased. CONCLUSIONS: The higher the RN skill mix, the lower the incidence of adverse occurrences on inpatient care units.

Accidental Falls↗