Drug use and pressure ulcers in long-term care units: do nurse time pressure and unfair management increase the prevalence?

ABSTRACT

AIMS: This study examined the associations between nurse working conditions (time pressure and perceived unfair management) and quality indicators (prevalence of antianxiety or hypnotic drug use and pressure ulcers) in long-term care units. BACKGROUND: Differences persist across long-term care facilities in their care processes and resident outcomes even after adjusting for residents' clinical conditions. Little is known about how nurses' working conditions influence the quality of care. DESIGN: Survey. METHODS: Data on working conditions were drawn in 2002 from 724 nurses in 66 long-term care units that reported quality indicators based on the Resident Assessment Instrument system as measured by Minimum Data Set. Percentage change in the quality indicators from 2002 were estimated using hierarchical multiple regression analyses with adjustments made for the baseline quality indicators (2001) and unit structural factors (unit size and staffing level). RESULTS: Unit time pressure increased the prevalence of both quality problems (p-values <0.05). Perceived unfair management was related to increased drug use (p = 0.038). CONCLUSIONS: The findings of this research suggest that quality of care can be improved by enhancing nurse working conditions. RELEVANCE TO CLINICAL PRACTICE Organisational initiatives should be aimed at reducing time pressures and promoting fair managerial procedures that engage all nursing staff in the decision-making in long-term care settings.