Grants and Funded Projects

IMPACT OF SYSTEM-CENTERED FACTORS, AND PROCESSES OF NURSING CARE OF FALL PREVALENCE AND INJURIES FROM FALLS
(Robert Wood Johnson Foundation)
Principal Investigator: Marita G. Titler, PhD, RN, FAAN

The impact of nursing care in hospitals is largely invisible. Measures of nursing care processes are not standardized and thus hinder knowledge development of nursing contributions to quality patient outcomes. The study purpose is to investigate linkages among two NQF patient-centered outcome measures (falls prevalence; injury from falls), NQF system-centered measures (skill mix, nursing care hours per patient day/HPPDs, voluntary turnover, PES-NWI), and processes of care to prevent falls. The study addresses item 1 in the RWJ CFP, "identify the linkages between processes of nursing care and the quality of patient outcomes." A prospective repeated measures design using a participatory partnership research approach is planned to achieve the following aims 1) Examine the relationship of NQF system-centered factors (skill mix, HPPDs, voluntary turnover, PES-NWI), and hospital structural factors (size, RN vacancy rate) on fall prevalence and injury from falls over 18 months; 2) Examine the unique contribution of fall prevention processes of care (e.g. fall risk assessment) and hospital structural factors specific for fall prevention (e.g. use of an interdisciplinary fall prevention team) on fall prevalence and injuries from falls at 3 points in time over 18 months.; and 3) Describe the relationship between level of professional nursing practice and 1) fall prevalence and injury from falls, and 2) adoption of evidence-based practices for fall prevention. Sites for this study are 190 patient care units from 45 hospitals in the U.S. that are members of a National Nursing Practice Network. Data analysis will be conducted using the Statistical Analysis System (SAS/STAT) and Hierarchical Linear and Nonlinear Modeling (HLM 6.1). A national advisory panel will provide recommendations for dissemination of findings to impact public policy formulation.