Hurst Keith
Leeds University Health Sciences and Public Health and Research Institute, Health and Social Care Policy Group, Fairbairn House, UK.
Int J Nurs Stud. 2008 Mar;45(3):370-81. doi: 10.1016/j.ijnurstu.2006.09.007. Epub 2006 Nov 13.
There are important relationships between ward design, patient welfare and staff activity in the literature but studies seem not to have tested all the variables. Whether ward designs influence nursing structures, processes and outcomes, therefore, has not been fully answered. While studies provide helpful guidance, nursing efficiency and effectiveness implications are speculative.
To improve nursing efficiency and effectiveness by capitalizing on the best ward design features.
A database consisting of 375 UK wards, constructed for other research and development purposes, was revisited and reconfigured for the present study. The database was updated between 2003 and 2004.
Of 390 wards approached, 375 generated usable data.
Patient dependency, nursing activity, workload, nursing quality and staffing data in the original database were obtained using mainly non-participation observation methods. Later, wards were classified in eight ways and differences between ward types examined.
Patient dependency did not stand out in any ward type but as the literature predicted, direct patient care was higher in Nightingale wards. Racetrack ward nursing activity was also close to idyllic. Bay wards, owing to their greater occupancy peaks and troughs, had a propensity to generate heavier workloads. Time-out and down-time were not excessive in any ward type, and it is likely that ward leadership may be compensating for some variables' negative effects. Racetrack wards were considerably less-well staffed and grade-mix dilute and consequently the cheapest. Quality scores were higher in Nightingale wards-nurses' greater observation capability was a significant factor. Wards' central-core configurations also influenced nursing efficiency and effectiveness.
Racetrack wards have an edge over other ward designs. However, replicating Nightingale conditions by, for example, equalising occupancy, throughput and staffing and maximising nurses' substations, could engender similar outcomes elsewhere.
文献中提到病房设计、患者福利和医护人员活动之间存在重要关系，但研究似乎并未对所有变量进行测试。因此，病房设计是否会影响护理结构、流程和结果尚未得到充分解答。虽然研究提供了有益的指导，但对护理效率和效果的影响仍具有推测性。
通过利用最佳的病房设计特点来提高护理效率和效果。
为其他研发目的构建的包含375个英国病房的数据库，被重新审视并为本研究重新配置。该数据库在2003年至2004年期间进行了更新。
在390个被联系的病房中，375个产生了可用数据。
原始数据库中的患者依赖程度、护理活动、工作量、护理质量和人员配备数据主要通过非参与观察法获得。后来，病房被分为八种类型，并对不同病房类型之间的差异进行了检查。
患者依赖程度在任何病房类型中都不突出，但正如文献所预测的，南丁格尔病房的直接患者护理量更高。环形跑道式病房的护理活动也近乎理想状态。海湾病房由于其入住高峰和低谷差异较大，往往会产生更重的工作量。任何病房类型的休息时间和停机时间都不过长，很可能是病房领导在弥补某些变量的负面影响。环形跑道式病房的人员配备明显较少，人员级别混合也较分散，因此成本最低。南丁格尔病房的质量得分更高——护士更强的观察能力是一个重要因素。病房的核心配置也会影响护理效率和效果。
环形跑道式病房比其他病房设计更具优势。然而，通过例如均衡入住率、周转率和人员配备以及最大化护士工作站等方式来复制南丁格尔病房的条件，可能会在其他地方产生类似的结果。
