Adomat Renee, Hewison Alistair
School of Health Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
J Nurs Manag. 2004 Sep;12(5):299-308. doi: 10.1111/j.1365-2834.2004.00439.x.
A huge range of patient classification systems/tools are used in critical care units to inform workforce planning, however, they are not always applied appropriately. Many of these systems/tools were not originally developed for the purposes of workforce planning and so their use in determining the nurse:patient ratio required in critical care settings raises a number of issues for the organisation and management of these services.
The aim of this paper is to review the three main assessment systems that are commonly used in critical care settings in the UK and evaluate their effectiveness in accurately determining nurse : patient ratios. If the application of these systems/tools is to enhance care, a thorough understanding of their origins and purpose is necessary. If this is lacking, then decisions relating to workload planning, particularly when calculating nurse : patient ratios, may be flawed.
Patient dependency/classification systems and patient dependency scoring systems for severity of illness are robust measures for predicting morbidity and mortality. However, they are not accurate if used to calculate nurse : patient ratios because they are not designed to measure nursing input. Nursing intensity measures provide a useful framework for calculating the cost of providing a nursing service in critical care and can serve as a measure of nursing input, albeit a fairly basic one. However, many components of the nursing role are not "accounted" for in these measures.
The implications of these findings for the organization and management of critical care services are discussed. Careful consideration of these areas is vital if a cost efficient and cost-effective critical care service is to be delivered.
重症监护病房使用了大量的患者分类系统/工具来为劳动力规划提供信息，然而，它们的应用并不总是恰当的。这些系统/工具中许多最初并非为劳动力规划目的而开发，因此在确定重症监护环境所需的护士与患者比例时，其使用给这些服务的组织和管理带来了诸多问题。
本文旨在回顾英国重症监护环境中常用的三种主要评估系统，并评估它们在准确确定护士与患者比例方面的有效性。如果这些系统/工具的应用是为了改善护理，那么有必要深入了解它们的起源和目的。如果缺乏这一点，那么与工作量规划相关的决策，尤其是在计算护士与患者比例时，可能会有缺陷。
患者依赖程度/分类系统以及针对疾病严重程度的患者依赖程度评分系统是预测发病率和死亡率的可靠方法。然而，如果用于计算护士与患者比例，它们并不准确，因为它们并非设计用于衡量护理投入。护理强度测量为计算重症监护中提供护理服务的成本提供了一个有用的框架，并且可以作为护理投入的一种衡量标准，尽管是相当基本的一种。然而，这些测量并未“涵盖”护理角色的许多组成部分。
讨论了这些发现对重症监护服务组织和管理的启示。如果要提供具有成本效益和性价比高的重症监护服务，仔细考虑这些方面至关重要。
