Page 354 - Encyclopedia of Nursing Research

NOSOCOMIAL INFeCTIONS n 321

where basic infection control measures are For the most part, research into the rela-
virtually nonexistent. Lack of basic equip- tionship between hospital organizational
ment and understaffing and overcrowding features and patient outcomes has concen- N
are generally the result of lack of financial trated on constructing multivariate models
resources. In addition, poor levels of educa- to examine the effects of structural hospital
tion, malnutrition and other types of infec- characteristics (ownership, teaching status,
tions (HIv), or diseases combine to make size, and technology) on inpatient mortality
control of HCAIs an almost insurmountable such as measurement of severity of illness
challenge (Pittet et al., 2008). Hospital-wide (Green, Passman, & Wintfeld, 1991; Mukamel,
studies report HCAI rates higher than those Zwanziger, & Tomaszewsk, 2001; Shortell
in developed countries (Allegranzi & Pittet, et al., 1994). However, there is growing interest
2007). For example, prevalence rates of up to in investigating nurses’ work environment,
19.1% were reported in 1-day prevalence sur- particularly because its importance in main-
veys recently carried out in single hospitals taining patient safety was highlighted by
in Albania (Faria et al., 2007) and Morocco the Institute of Medicine in the united States
(Jroundi et al., 2007; Subhash, Nirmala, & (Institute of Medicine, 2004b). Most often,
Shekhar, 2009). The most frequently reported when the variable “nursing” is included in
HCAIs were surgical site infections. Neonatal multivariate models investigating the effects
infections were reported to be 20 times of structural hospital characteristics, nurse
higher among hospital-born babies in devel- skill mix and staffing are reported as sig-
oping than in developed countries (Zaidi nificant predictors of mortality (estabrooks,
et al., 2005) Midodzi, Cummings, Ricker, & Giovannetti,
A limited number of studies from devel- 2005; unruh, 2008). In general, research into
oping countries assessed HCAI risk factors hospital organizational characteristics related
by multivariate analysis. Prolonged length to nursing practice and variation in hospital
of stay, surgery, and intravascular and uri- outcomes have developed independently of
nary catheters were frequently identified one another. Research on the organization of
(Agarwal, Gupta, Ray, Aggarwal, & Jindal, nursing has been primarily concerned with
2006; Gosling, Mbatia, Savage, Mulligan, & nurse outcomes such as job satisfaction and
Reyburn, 2003; Metintas, Akgun, Durmaz, & turnover (Curtis, 2007; McCarthy, Tyrrell, &
Kalyoncu, 2004). Lehane, 2007)
There is an established body of knowl- Although there are a number of stud-
edge underpinning the link that exists ies exploring the relationship between nurse
between the environment where health care staffing and patient outcomes, few have
workers deliver care and patient outcomes explored the operant mechanism through
such as mortality, morbidity, failure to res- which organizational variables (such as
cue, falls, and medication errors (Aiken, nurse staffing) influence patient outcomes.
Clarke, & Sloane, 2002; Laschinger & Leiter, Researchers who have explored the operant
2006; Rafferty et al., 2007). However, very mechanism resulting from hospital orga-
little has been written on the link that may nizational features that impact on the work
exist between the work environment and environment identify with the concept of
control of infection (Roberts & Cookson, structural empowerment (Donahue, Piazza,
2009). The focus has been predominantly on Griffin, Dykes, & Fitzpatrick, 2008; Jayne
health care workers hand hygiene practices Faulkner, 2008; Laschinger, Finegan, Shamian,
(Gould, Chudleigh, Moralejo, & Drey, 2007). & Wilk, 2001). Positive perceptions of struc-
Little success has been achieved, and health tural empowerment have been repeatedly
care workers hand hygiene practices remain reported by nurses in hospitals renowned
suboptimal (Creedon et al., 2008). for their excellence in patient outcomes,