An assessment of decubitus ulcers, contractures, urinary-tract infec/ tions and hypostatic pneumonia as indices of nursi-ngcare in three extended care facilities in the Salt Lake Valley.

This study was undertaken in an attempt to determine whether certain physiological complications commonly found in incapacitated patients are correlated with an agency's staffing pattern and to detect if a difference exists in the nursing care rendered to patients in three extended care facilities. Fifteen patients requiring varying levels of nursing care were selected from the tree extended care facilities. The subjects included women and men of varying age levels. All of the subjects had cerebral or spinal tract impairment from various etiological causes. At each extended facility, one subject with a similar activity level was assigned to one of five patient classifications. A tool in the form of checklist was designed by the investigator to measure the presence or absence of specific signs and symptoms related to the occurrence of decubitus ulcers, contractures, urinary tract infections and hypostatic pneumonia. As each subject was assessed by means of the tool, a score was obtained for each of the variables as well as a total score. Each subject was assessed on an initial visit an again four weeks later. On the assessment tool, a high score indicated either an absence or low occurrence of the physiological complications. Correlations were computed between the dependent variables (decubitus ulcers, contractures, urinary tract infections an hypostatic pneumonia), the independent variables (ratio of nursing personnel to patient), and the various covariates (agency, patient classification, age, sex and length of stay in months) to determine any statistically significant results at the .05 confidence level. Analyses of variance were also computed on the individual and total scores between the three extended care facilities by the investigator to determine if there were any statistically significant findings at the .05 confidence level. Twelve hypotheses were proposed that correlated a low occurrence of the four physiological complications to the RN/patient ratio and a higher occurrence of the same complications when correlated with the LPN/patient ration and NA/patient ratio. None of these hypotheses was supported completely, while those hypotheses correlating urinary tract infection on the initial assessment with an RN/patient ratio and LPN/patient ratio as well a hypostatic pneumonia on the difference score with the RN/patient ratio and LPN/patient ratio were partially supported. The results from the analyses of variance indicated that there were no statistically significant differences in the nursing care rendered to patients in the three extended care facilities. There is a slight improvement in the physiological measurements between the first and second assessment in all three extended care facilities in this particular study. While not statistically significant, the data suggests that this improvement is more closely related to the ratios of LPN/patient and NA/patient than the ratios of RN/patients. The findings suggest that large scale studies of a similar nature be conduced which include such additions as changes over loner periods of time, effects of previous hospitalization, numbers of various levels on incapacitated patients in an institution and analyses of personnel preparation and functions in the extended care facilities.