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Idea Transcript
The Relationship Between Nurses’ Perception of Work Environment and Nurse-sensitive Patient Outcomes in Adult Critical Care by
Christine A. Boev
Submitted in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy
Supervised by Professor Gail Ingersoll
School of Nursing University of Rochester Rochester, New York 2011
ii Curriculum Vitae The author was born in Johnson City, New York. She attended Allegheny College from 1993-1997, and graduated with a Bachelor of Science degree in 1997. She attended Binghamton University from 1997-1999, and graduated with a Bachelor of Science degree in 1999. She attended Georgia College and State University from 2002-2004, and graduated with a Master’s of Science in 2004. She came to the University of Rochester in the Fall of 2007 and began doctoral studies in Health Practice Research. She pursued her research in outcomes evaluation under the direction of Professor Gail Ingersoll. Her study was funded through a grant from the American Association of Critical Care Nurses and Sigma Theta Tau International. The author has worked in critical care nursing since 1999 and continues to work in the pediatric cardiac intensive care unit at Golisano Children’s Hospital at Strong Memorial Hospital.
iii Acknowledgements I would like to acknowledge my dissertation chair, Dr. Gail Ingersoll for her guidance and expertise in this area along with my other committee members, Dr. Ying Xue, Dr. Ann Dozier, and Dr. Lisa Norsen. I would also like to acknowledge the American Association of Critical Care Nurses and Sigma Theta Tau International for helping to fund this project. Finally, I would like to thank my family including my husband, children, parents, and extended family for their support and encouragement.
iv Abstract Purpose: The purpose of this study was to examine the relationship between nurses’ perception of work environment and nurse-sensitive patient outcomes in adult critical care. Methods: This study was a secondary analysis of existing data. Perception of work environment was measured annually for five years (2005-2009) using the Index of Work Satisfaction (IWS) and the Practice Environment Scale of the Nurses Work Index (PESNWI). Nurse-sensitive patient outcomes measured were ventilator-associated pneumonia (VAP), central line-associated blood stream infection (CLABSI), patient falls, pressure ulcer prevalence, medication errors, and patient satisfaction. Multilevel modeling was used to examine the relationships between perception of work environment and nursesensitive patient outcomes. Results: As measured by the IWS, task requirements (p