The influence of nursing structure and process variables on patients' outcomes and safety within a High Dependency Unit

Outcomes of nursing practice are used to refer to patient outcomes related to, or as a consequence of, nursing care. This research, comprised two studies, extends the investigation about outcomes of nursing practice. Following Donabedian's framework, the aim was to explore which nursing structure and process variables influence patients' outcomes and safety within a Spanish High Dependency Unit (HDU) and to gain insight into the nurses' and patients' perspectives about the outcome of nursing and how nurses contribute to patient outcomes and safety.

The prospective observational study (Study I) examines if nurses structure and process variables are associated with patients' outcomes and safety in a HDU. The exploratory interview study (Study II) undertaken in the same setting reveals the nurses' and patients' perspectives. To inform the research, a literature review on healthcare quality and a concept analysis of 'the outcomes of nursing practice' was undertaken.

Findings from Study I reproduce similar results to those reported in the wider literature. Nurses' variables, such as years of experience or educational level, impact on patients' outcomes such as mortality and failure to rescue. Theoretical explanations generated by grounded theory in Study II, from the patients' perspective, highlight the core category of 'adapting to HDU admission' and for nurses that of 'enabling patient comfort'. This nurses' intervention led to patient adaptation promoting better patient outcomes and safe process of care.

The study adds to knowledge about the outcomes of nursing care, within the particular context of the HDU, and points to ways that the nurse promotes patients outcomes and safety. Recommendations for future research suggest the need to develop instruments to systematically test the link between nursing interventions to patients' safety and outcomes. The main recommendations for nurse education and training and within practice relate to promoting the importance of patient comfort as an essential aspect of care and the monitoring of its achievement. Recommendations at management level include the need to be aware and to guarantee the necessary conditions to deliver quality and safe care.