Relationships among nursing demographics, nursing unit characteristics and quality of care in Thailand

The purpose of this study was to identify if nursing demographics and nursing unit characteristics are good predictors of quality of care in Thailand as measured by patient satisfaction, length of patient stay (LOS), and overall nosocomial infections (NIs). The study setting was a 1134-bed, public hospital in northeastern Thailand. Two study samples were comprised of 340 patient subjects admitted to 17 inpatient units and 303 nurse subjects working in the same units as patient subjects. A cross-section design was selected and the data were collected from September 2002 to December 2002. Two standardized instruments, the Thai short version of Client Satisfaction Questionnaire and the Thai version of Service Quality Scale, were used to measure general patient satisfaction and patient satisfaction with nursing service quality respectively. Contextual regression analyses were performed to identify significant predictors of each outcome. Results indicated that patient characteristics and nursing demographics possess more influence on patient outcomes than do nursing unit characteristics. A particular patient characteristics variable, age, was the most important and significant determinant of variation in both general satisfaction and satisfaction with nursing service quality. Regarding predictors of LOS, patient characteristics, nursing demographics, and nursing unit characteristics together significantly explained 28.5% variation in LOS (p = .000). A particular nursing demographics variable, years in current unit (standardized beta = -1.086) had the largest significant largest effect. For predictors of NIs, three sets of patient characteristics, nursing demographics, and nursing unit characteristics variables significantly explained 82.94% variance in NIs (p = .000). A significant large effect of NIs was indicated by a nursing demographic variable (years in current unit [standardized beta = -.485]). Across 17 inpatient units, there were statistically significant differences in the two outcomes---general patient satisfaction and LOS. This study revealed the high prevalence of NIs in inpatient units that need more specialized care, while they have less experienced nurses. The study results implied an adoption of appropriate policy and plan for infection control in high-risk units and reflects a need to optimize nursing staff assignments and to decrease adverse events and health care cost.