Are Staffing, Work Environment, Work Stressors, and Rationing of Care Related to Care Workers' Perception of Quality of Care? A Cross-Sectional Study

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• 作者：Franziska Zú ; ñ ; iga ; MSN ; RN^a ; ^{franziska.zuniga@unibas.ch" class="auth_mail" title="E-mail the corresponding author} ; Dietmar Ausserhofer ; PhD ; RN^a ; ^b ; Jan P.H. Hamers ; PhD ; RN^c ; Sandra Engberg ; PhD ; RN^a ; ^d ; Michael Simon ; PhD ; RN^a ; ^e ; René ; Schwendimann ; PhD ; RN^a
• 关键词：Nursing homes ; quality of health care ; work environment ; rationing of care ; staffing
• 刊名：Journal of the American Medical Directors Association
• 出版年：2015
• 出版时间：1 October 2015
• 年：2015
• 卷：16
• 期：10
• 页码：860-866
• 全文大小：596 K

文摘

To describe care worker–reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care.

Design

Cross-sectional study.

Setting

National, randomly selected sample of Swiss nursing homes, stratified according to language region and size.

Participants

A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013.

Measurements

Care worker–reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale–Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care.

Results

Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36–8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08–4.15); less stress due to workload (OR 0.71, 95% CI 0.55–0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24–0.49); and less rationing of social care (OR 0.80, 95% CI 0.69–0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care.

Conclusions

Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes.