Nurses’ perceptions of hospital-acquired conditions in older adults in acute care settings: A randomized vignette-based study

PURPOSE: This study aimed to identify specific factors that nurses perceive as contributing to hospital-acquired conditions in older adults in acute care settings and to quantify the influence of these factors on nurses' perceptions about their preventability. METHODS: A randomized vignette-based survey was conducted. Each vignette included three manipulated factors (patient-related, process-related, structure-related). Participants received four vignettes and were blinded to alternative versions. Associations between manipulated factors and preventability ratings were analyzed using ordinal regression models. An additional analysis captured individual response tendencies using model residuals. RESULTS: Among the 12 manipulated factors, cognitive impairment of patients was the only factor significantly influencing nurses' perceptions. It was associated with a decreased likelihood of hospital-acquired conditions being perceived as preventable (OR=0.32; 95% CI: 0.14-0.69). Additionally, nurses' gender was the only individual characteristic significantly associated with the propensity to perceive hospital-acquired conditions as preventable (p= 0.048). CONCLUSION: Cognitive impairment of patients was the only factor significantly influencing nurses' perceptions on the preventability of hospital-acquired conditions. This finding highlights the need to strengthen awareness and training on the preventability of hospital-acquired conditions in older adults in acute care settings.