[Nursing outcomes in medical wards (ESAMED Study): the results of a multicenter longitudinal study]

. Factors associated to patients' outcomes in medical units: lessons learnt from an Italian multicentric longitudinal study design (ESAMED study).

Research on nursing outcomes attempted to identify the associated factors, however, with mainly retrospective or descriptive studies. In 2011, an Italian network was established and a multicentric longitudinal study aimed at exploring factors associated with nursing outcomes among in-hospital medical patients was started.

To summarise (a) how the research project was originated, (b) which patients have been involved, variables and instruments used, (c) the main findings, and (d) the lessons learnt.

12 acute medical units from 11 Italian hospitals were involved. A consecutive sample was adopted: on a daily basis, data has been collected at the (a) patient; (b) nursing care, and (c) hospital levels.

The effect of the variability in the amount of nursing care and skill mix in medical units was explored on the following outcomes: (a) hospital-acquired functional dependence, (b) prevalence and incidence of (i) episodes of hyperactive delirium, (ii) avoidable pressure ulcers; (iii) peripheral venous catheter phlebitis; (c) dissatisfaction with the nursing care; and (d) in-hospital mortality; 1464 out of 2082 eligible patients were involved. The frequency and reasons of Missed Nursing Care (MNC), as well as the presence of family caregivers at the bedside were also measured.

The study confirmed that (a) the amount of nursing care provided by graduate nurses improves patient outcomes; (b) a skill mix in favour of nursing aides, negatively impacts on patients' outcomes; and (c) a higher frequency of MNC threatens patient outcomes.