建立更多受过高等教育的护士的案例
Experts recognize the tremendous contributions made by registered nurses prepared at the associate-degree and diploma levels but say more highly educated nurses are needed to navigate an increasingly complex health care system and ensure that patients—who are living longer, and sicker, often with multiple chronic conditions—have access to highly skilled, patient-centered care across the entire care continuum.
Aiken is also a National Advisory Committee member of the Interdisciplinary Nursing Quality Research Initiative (INQRI), an RWJF-supported program that supports researchers from various fields who are studying the effects of nursing on patient outcomes. Two INQRI researchers—Richard Lindrooth, PhD, an associate professor at the School of Public Health at the University of Colorado, and Olga Yakusheva, PhD, an associate professor of economics at Marquette University—are also exploring the link between nurse education levels and patient outcomes.
Putting the Results to the Test
“The body of evidence that we have now is pretty convincing that there is a correlation” between higher nurse education levels and better patient outcomes, Lindrooth said. “What we’re doing now is putting this correlation to the test.”
For one study, Lindrooth and Yakusheva are examining the effect of nurse education levels on individual patients—as opposed to entire hospital systems. In a sense, it’s like zooming in on the system-wide studies Aiken has done to determine whether patients who happen to be cared for by higher numbers of nurses with bachelor’s degrees have better outcomes.
Like Aiken, Lindrooth and Yakusheva have found positive correlations. Patients who are cared for by a higher proportion of BSN-prepared nurses were less likely to die, stayed in the hospital for shorter periods, and faced lower health care costs, they said. “We can be pretty sure that it is the BSN degree that is causing the result and not some unmeasured factor that leads to both higher quality and more BSN nurses,” Lindrooth said. The study was presented at the AcademyHealth meetings in 2013.
In another study, Yakusheva and Lindrooth are trying to tease out the effects of modern management practices and higher levels of BSN-prepared nurses on patient outcomes. The goal is to determine whether hospitals can improve outcomes by adopting modern management practices or by hiring more BSN-prepared nurses—or by doing both. They found that both factors are needed to improve outcomes, but that hiring more BSN-prepared nurses alone may be enough to improve nurse-dependent outcomes.
Yakusheva compares the findings to improving health at the individual level. “If you want to be healthy, do you eat better or exercise more? Marginally, it may be better to do one or the other, but if you want to be a lot healthier, you should do both. That’s the way I see this paper.”
More research is needed to persuade employers to spend precious resources to hire more BSN-prepared nurses, Aiken said. Still, the evidence is beginning to have an effect. “The tide is turning,” she said, noting that more nurses are getting their BSNs, and more employers are preferentially hiring nurses with bachelor’s degrees.
护理是唯一一个有多种入门级实践途径的健康职业。罗伯特·伍德·约翰逊基金会(RWJF)的三位顶尖健康科学家表明,获得护理学士学位(BSN)或更高学位的途径可能会改善患者的治疗效果。
宾夕法尼亚大学护理学院健康结果与政策研究中心主任琳达·艾肯(Linda Aiken)博士、注册护士、FAAN博士表示,雇用大量bsn准备护士的医院患者死亡率较低。她在2月份发表在《柳叶刀》(Lancet)上的一项研究中发现,拥有BSNs的护士比例增加10%,患者死亡率就会下降7%。
“有没有理由相信拥有学士学位的护士比例与更好的结果相关?”答案是肯定的,”艾肯在接受采访时说。
她有十多年的研究来证明这一点。2003年,艾肯发现,在宾夕法尼亚州的医院,如果病人在拥有较高比例的bsn准备护士的医院接受治疗,他们就有“实质性的生存优势”。这项发表在《美国医学会杂志》(Journal of American Medical Association)上的开创性研究发现,准备过bsn的护士数量每增加10%,病人死亡的可能性就会降低5%。
2011年,艾肯在《医疗保健》(Medical Care)上发表了一项研究,证实了护士教育与患者预后之间的联系。该研究发现,准备过bsn的护士比例每增加10%,死亡风险就会降低5%。2013年,艾肯在《卫生事务》(Health Affairs)上与人合著了一项研究,该研究发现,在1999年至2006年期间,聘用了更多具备bsn技能的护士的医院,其死亡率下降幅度大于没有聘用更多具备bsn技能的护士的医院。“我们一次又一次地建立了这种联系,”她说。“如果医院真的想要改善护理,他们应该雇佣更多拥有学士学位的护士。”
艾肯是一名研究经理护理的未来:行动运动这是RWJF和美国退休人员协会的共同努力,致力于通过护理改变医疗保健。它是基于证据从一个具有里程碑意义的报告美国医学研究所(IOM)建议,到2020年,全国80%的护士应拥有学士学位或更高学位,以满足日益复杂的患者需求。
专家们认识到专科和文凭水平的注册护士所做出的巨大贡献,但他们说,在日益复杂的医疗保健系统中,需要更多受过高等教育的护士,以确保那些寿命更长、病情更重、往往患有多种慢性疾病的患者,能够在整个护理过程中获得高技能的、以患者为中心的护理。
艾肯也是跨学科护理质量研究倡议(INQRI)的国家咨询委员会成员,该倡议是rwjf支持的项目,支持来自各个领域的研究人员研究护理对患者预后的影响。INQRI的两名研究人员——科罗拉多大学公共卫生学院副教授richard Lindrooth博士和Marquette大学经济学副教授Olga Yakusheva博士——也在探索护士教育水平和患者治疗结果之间的联系。
将结果付诸实践
Lindrooth说:“我们现在拥有的大量证据非常令人信服,在更高的护士教育水平和更好的患者预后之间存在相关性。”“我们现在要做的就是检验这种相关性。”
在一项研究中,Lindrooth和Yakusheva正在研究护士教育水平对单个病人的影响,而不是整个医院系统。从某种意义上说,这就像放大艾肯所做的全系统研究,以确定碰巧由更多拥有学士学位的护士照顾的病人是否有更好的结果。
和艾肯一样,林德罗斯和雅库舍娃也发现了正相关关系。他们说,有较高比例的bsn准备护士照顾的病人死亡的可能性更小,住院时间更短,面临的医疗费用也更低。Lindrooth说:“我们可以非常肯定,是BSN学位导致了结果,而不是一些不可测量的因素导致了更高的质量和更多的BSN护士。”这项研究在2013年的健康学会会议上发表。
在另一项研究中,Yakusheva和Lindrooth正试图梳理出现代管理实践和更高水平的bsn准备护士对患者结果的影响。目标是确定医院是否可以通过采用现代管理实践或雇用更多的bsn准备护士或两者兼而有之来改善结果。他们发现,这两个因素都需要改善结果,但雇用更多的bsn准备护士可能足以改善护士依赖的结果。
雅库舍娃将这些发现与改善个人健康水平进行了比较。“如果你想健康,你是吃得更好还是锻炼得更多?”从某种程度上来说,做其中一项可能更好,但如果你想更健康,你应该两者都做。这就是我对这篇论文的看法。”
艾肯说,需要更多的研究来说服雇主花费宝贵的资源来雇佣更多准备好了bsn的护士。尽管如此,证据已经开始产生影响。她说:“潮流正在转变。”她指出,越来越多的护士获得了bsn,越来越多的雇主优先雇用拥有学士学位的护士。
关于罗伯特伍德约翰逊基金会
40多年来,罗伯特·伍德·约翰逊基金会一直致力于改善所有美国人的健康和医疗保健。我们正在努力建立一种健康的国家文化,使所有美国人现在和后代都能活得更长、更健康。
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