Background

Performance of function-preserving hospitalization processes related to patient mobility, use of continence aids and food intake is significantly associated with outcomes in older adults. Nurses are the front-line personnel responsible for promoting performance of such processes. The degree to which nurse staffing is related to this performance is unclear.

Objective

To identify nurse-staffing characteristics and nursing-related care needs associated with older patients’ mobility, continence care and food intake during acute hospitalization.

Design

Cross-sectional study using survey data from the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR) cohort study combined with day-level administrative nurse staffing data and clinical day-level aggregated data for all patients hospitalized during the HoPE-FOR study period.

Setting

Internal medicine units in two medical centers in Israel.

Participants

Eight hundred seventy-three older adults.

Methods

Mobility, continence care and food intake were assessed within 2 days of admission using validated questionnaires. Nurse-to-patient ratios and nursing-skill mix (i.e. registered nurses (RNs), nurse aides, nurses with advanced clinical training and RNs with an academic degree) were assessed using administrative data. Decision trees were developed for mobility, continence care and food intake, applying classification and regression-tree analysis.

Results

The mobility decision tree identified three characteristics subdividing patients into six nodes: pre-admission functioning, pre-admission activity level and percentage of nurses with advanced training. The percentage of nurses with advanced training classified low-functioning patients into those walking in corridors versus walking or sitting only inside the room. The continence-care classification decision tree identified two characteristics that subdivided the patients into four nodes: pre-admission functioning and bladder control. Nurse-to-patient-ratio variables and patients’ nursing-related care needs did not contribute to this classification. The food-intake decision tree identified four characteristics—pre-admission functioning, gender, percentage of nurses with advanced training and percentage of nurse aides—subdividing patients into eight nodes. Low-functioning patients exposed to a higher percentage of nurses with advanced training had food-intake scores 14% higher than patients exposed to a lower percentage of nurses with advanced training. Independent men exposed to a higher percentage of nurse aides had a 14% higher habitual daily in-hospital food-intake score than independent men exposed to a lower percentage of nurse aides.

Conclusions

A higher percentage of nurses with post-graduate education is associated with better performance of mobility and food intake of hospitalized older adults. To maintain the potential benefits of highly trained staff, education levels should be considered in scheduling and assignment decision-making processes in internal medicine units.

Tweetable abstract: A higher percentage of nurses with post-graduate education is associated with better mobility and food intake of hospitalized older adults.

中文翻译：

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护士人员配备在急性住院期间功能保持过程中的作用：一项横断面研究

背景

与患者活动、使用节制辅助工具和食物摄入相关的功能保持住院过程的执行与老年人的结果显着相关。护士是负责提升此类流程绩效的一线人员。护士人员配备与这种表现相关的程度尚不清楚。

目标

确定与老年患者在急性住院期间的活动能力、失禁护理和食物摄入相关的护士人员配备特征和护理相关护理需求。

设计

横断面研究使用住院过程对功能结果和恢复的影响 (HoPE-FOR) 队列研究的调查数据，结合 HoPE-FOR 研究期间住院的所有患者的日间行政护士人员配置数据和临床日级汇总数据期间。

设置

以色列两个医疗中心的内科单位。

参与者

八百七十三名长者。

方法

在入院后 2 天内使用经过验证的问卷评估活动能力、失禁护理和食物摄入量。护士与患者的比例和护理技能组合（即注册护士 (RN)、护士助理、具有高级临床培训的护士和具有学位的护士）使用行政数据进行评估。决策树是为流动性、失禁护理和食物摄入而开发的，应用分类和回归树分析。

结果

移动决策树确定了三个特征，将患者细分为六个节点：入院前功能、入院前活动水平和接受高级培训的护士百分比。接受过高级培训的护士将功能低下的患者归类为在走廊上行走的患者与步行或仅坐在房间内的患者的百分比。失禁护理分类决策树确定了将患者细分为四个节点的两个特征：入院前功能和膀胱控制。护士与患者的比率变量和患者的护理相关护理需求对这一分类没有贡献。食物摄入决策树确定了四个特征——入院前功能、性别、受过高级培训的护士的百分比和护士助理的百分比——将患者细分为八个节点。接受高级培训护士比例较高的低功能患者的食物摄入分数比接受高级培训护士比例较低的患者高 14%。与接触较低比例的护士助手的独立男性相比，接触较高比例的护士助手的独立男性的日常住院食物摄入量得分高出 14%。

结论

接受研究生教育的护士比例越高，住院老年人的行动能力和食物摄入量就越好。为了保持训练有素的员工的潜在利益，在内科单位的调度和分配决策过程中应考虑教育水平。

Tweetable 摘要：接受研究生教育的护士比例越高，住院老年人的行动能力和食物摄入量越大。