Sochalski Julie
School of Nursing, University of Pennsylvania, Philadelphia 19104-6096, USA.
Med Care. 2004 Feb;42(2 Suppl):II67-73. doi: 10.1097/01.mlr.0000109127.76128.aa.
The objective of this study was to examine the effects of nurse staffing and process of nursing care indicators on assessments of the quality of nursing care.
This study examined the variation in inpatient hospital staff nurses' assessments of the quality of nursing care and the effects of nurse staffing (patient workload), patient safety problems (medication errors and patient falls with injuries), and unfinished care (number of nursing tasks left undone) on the variation in those assessments. Secondary analysis of a survey of nurses using multivariate regression models was undertaken.
Data were derived from a 1999 statewide survey of 8670 inpatient staff nurses working in acute care hospitals in Pennsylvania.
Quality of nursing care ratings were significantly associated with the number of patients who nurses care for, rates of unfinished care for those patients, and the frequency of patient safety problems. The effect of patient workload on quality ratings was attenuated substantially by the effects of unfinished care and patient safety problems. Unfinished care had the strongest relationship of all, with over 40% of the variation in quality ratings associated with the number of tasks left undone.
Assessments of the quality of nursing are associated with both structural (workload) and process of care indicators (unfinished clinical care and patient safety problems), with the relationship strongest between process of care and quality. Explicating the interrelationship between structure and process of care is key to understanding the influence of both on quality. Studies that assess the causal influence of these features on quality of care and patient outcomes are warranted.
本研究的目的是检验护士配备和护理过程指标对护理质量评估的影响。
本研究考察了住院医院工作人员护士对护理质量评估的差异，以及护士配备（患者工作量）、患者安全问题（用药错误和患者受伤跌倒）和未完成护理（未完成的护理任务数量）对这些评估差异的影响。采用多元回归模型对护士调查进行二次分析。
数据来自1999年对宾夕法尼亚州急性护理医院8670名住院工作人员护士进行的全州范围调查。
护理质量评分与护士护理的患者数量、这些患者的未完成护理率以及患者安全问题的发生率显著相关。未完成护理和患者安全问题的影响使患者工作量对质量评分的影响大幅减弱。未完成护理的相关性最强，质量评分差异的40%以上与未完成的任务数量有关。
护理质量评估与结构（工作量）和护理过程指标（未完成的临床护理和患者安全问题）均相关，护理过程与质量之间的关系最强。阐明护理结构与过程之间的相互关系是理解两者对质量影响的关键。有必要开展研究评估这些特征对护理质量和患者结局的因果影响。
