The Relationships Between Nursing Staff Factors and Quality of Care in Korean Long-Term Care Hospitals

Monday, July 11, 2011

Ju Young Yoon, MS, RN
Barbara J. Bowers, RN, PhD, FAAN
School of Nursing, University of Wisconsin-Madison, Madison, WI

Learning Objective 1: The learner will be able to state the influences of nursing staff factors on quality of care in long-term care settings.

Learning Objective 2: The learner will be able to state the importance of more conceptually coherent approach and sophisticated analysis methods in long-term care system research.

Purpose: In 2008, Korean long-term care hospitals (LTCHs) introduced a new nursing staff incentive system in response to concerns about the deterioration of quality of care. This new incentive system is a financial incentive policy that guarantees an adequate level of nursing staff to enhance the quality of care in LTCHs; however, few studies have explored factors that affect the quality of care at the system level due to Korea`s short history of emerging social awareness of aging issues. This proposed study is to examine how nursing staff factors influence the quality of care in Korean LTCHs.

Methods: For a more conceptually coherent approach, this proposed study is based on the research framework with some modification from Unruh & Wan (2004)`s structure, process, outcome systems model of nursing care quality in nursing homes. In particular, two factors of nursing staff are nursing staff level (the number of nursing staff) and nursing staff-mix (the ratio of RNs to the total nursing staff). The quality of care is measured using four patient outcomes: the decline of activities of daily living, the incidence of pressure ulcers, the incidence of urinary incontinence and weight loss. In addition, contextual factors, other organizational factors, and patient risk factors will be controlled. Data including patients and LTCHs will be from Health Insurance Review and Assessment Services, and include almost all older adults residing in Korean LTCHs (about 400,000 patients in 500 LTCHs). Multilevel structural equation modeling will be used for data analysis.

Results: Results will demonstrate the relationships between nursing staff factors and four separate patient outcomes.

Conclusion: These results will provide policy implications for the current nursing staff incentive system in Korean LTCHs, and practical implications for workforce management strategies to improve the quality of care in long-term care settings.