Sasichay-Akkadechanunt Thitinut, Scalzi Cynthia C, Jawad Abbas F
Faculty of Nursing, Chiang Mai University, Thailand.
J Nurs Adm. 2003 Sep;33(9):478-85. doi: 10.1097/00005110-200309000-00008.
To examine the association between in-hospital mortality and four nurse staffing variables-the ratio of total nursing staff to patients, the proportion of RNs to total nursing staff, the mean years of RN experience, and the percentage of nurses with bachelor of science in nursing degrees.
Studies suggest that nurse staffing changes affect patient and organizational outcomes, but the impact of nurse staffing on patient outcomes has not been studied sufficiently and the results of the previous studies are equivocal. Additionally, the studies of the relationship between nurse staffing and patient outcomes or the impact of nurse staffing on patient outcomes had not been previously examined in Thailand.
A retrospective, cross-sectional, observational research design was employed to study the research questions. Data of 2531 patients admitted to seven medical units and 10 surgical units of a 2300-bed university hospital in Thailand was used. All data of patients admitted to this hospital with four common groups of principal diagnoses (diseases of the heart, malignant neoplasms [cancer of all forms], hypertension and cerebrovascular diseases, and pneumonia and other diseases of the lung) was extracted from patient charts and discharge summaries in the calendar year 1999. Nurse staffing variables for each nursing unit in 1999 came from nursing service department databases. Multivariate logistic regression was used to determine the relationship between nurse staffing variables and in-hospital mortality.
The findings of this study revealed that the ratio of total nurse staffing to patients was significantly related to in-hospital mortality in both partial and marginal analyses, controlling for patient characteristics. In addition, the ratio of total nursing staff to patients was found to be the best predictor of in-hospital mortality among the four nurse staffing variables, controlling for patient characteristics. The study did not find any significant relationship between in-hospital mortality and three nurse staffing variables (the proportion of RNs to total nursing staff, the mean years of RN experience, and the percentage of bachelor degree prepared nurses) probably due to the low variation of these variables across nursing units or because they may have correlated with other variables.
The findings of this study add to our understanding of the importance of nurse staffing and its relationship to the patient outcome of hospital mortality. Further, the findings also provide information for hospital and nursing administrators to use when restructuring the clinical workforce, revising hospital policies, or making contractual decisions on behalf of nursing and public beneficiaries.
研究住院死亡率与四个护士人员配置变量之间的关联，这四个变量分别是：护士总数与患者的比例、注册护士占护士总数的比例、注册护士的平均工作年限，以及拥有护理学学士学位的护士所占百分比。
研究表明，护士人员配置的变化会影响患者和组织的结局，但护士人员配置对患者结局的影响尚未得到充分研究，且先前研究的结果存在争议。此外，泰国此前尚未对护士人员配置与患者结局之间的关系或护士人员配置对患者结局的影响进行过研究。
采用回顾性横断面观察研究设计来研究这些研究问题。使用了泰国一家拥有2300张床位的大学医院7个内科病房和10个外科病房收治的2531例患者的数据。从1999年的患者病历和出院总结中提取了该医院收治的患有四种常见主要诊断组（心脏病、恶性肿瘤[各种形式的癌症]、高血压和脑血管疾病，以及肺炎和其他肺部疾病）患者的所有数据。1999年每个护理单元的护士人员配置变量来自护理服务部门的数据库。采用多因素logistic回归分析来确定护士人员配置变量与住院死亡率之间的关系。
本研究结果显示，在控制患者特征的情况下，护士总数与患者的比例在单因素和多因素分析中均与住院死亡率显著相关。此外，在控制患者特征的情况下，护士总数与患者的比例被发现是四个护士人员配置变量中住院死亡率的最佳预测指标。该研究未发现住院死亡率与三个护士人员配置变量（注册护士占护士总数的比例、注册护士的平均工作年限，以及拥有学士学位的护士所占百分比）之间存在任何显著关系，这可能是由于这些变量在各护理单元之间的差异较小，或者它们可能与其他变量相关。
本研究结果增进了我们对护士人员配置的重要性及其与医院死亡率患者结局之间关系的理解。此外，研究结果还为医院和护理管理人员在重组临床工作人员、修订医院政策或代表护理人员和公众受益者做出合同决策时提供了信息。
