Schubert Maria, Glass Tracy R, Clarke Sean P, Aiken Linda H, Schaffert-Witvliet Bianca, Sloane Douglas M, De Geest Sabina
Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.
Int J Qual Health Care. 2008 Aug;20(4):227-37. doi: 10.1093/intqhc/mzn017. Epub 2008 Apr 24.
To explore the association between implicit rationing of nursing care and selected patient outcomes in Swiss hospitals, adjusting for major organizational variables, including the quality of the nurse practice environment and the level of nurse staffing. Rationing was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Additional data were collected using an adapted version of the International Hospital Outcomes Study questionnaire.
Multi-hospital cross-sectional surveys of patients and nurses.
Eight Swiss acute care hospitals
Nurses (1338) and patients (779) on 118 medical, surgical and gynecological units.
Patient satisfaction, nurse-reported medication errors, patient falls, nosocomial infections, pressure ulcers and critical incidents involving patients over the previous year.
Generally, nurses reported rarely having omitted any of the 20 nursing tasks listed in the BERNCA over their last 7 working days. However, despite relatively low levels, implicit rationing of nursing care was a significant predictor of all six patient outcomes studied. Although the adequacy of nursing resources was a significant predictor for most of the patient outcomes in unadjusted models, it was not an independent predictor in the adjusted models. Low nursing resource adequacy ratings were a significant predictor for five of the six patient outcomes in the unadjusted models, but not in the adjusted ones.
As a system factor in acute general hospitals, implicit rationing of nursing care is an important new predictor of patient outcomes and merits further study.
探讨瑞士医院护理隐性配给与特定患者结局之间的关联，并对主要组织变量进行调整，包括护士执业环境质量和护士配备水平。使用新开发的巴塞尔护理配给程度（BERNCA）工具来衡量配给情况。还使用国际医院结局研究问卷的改编版收集了其他数据。
对患者和护士进行多医院横断面调查。
八家瑞士急症护理医院
118个内科、外科和妇科病房的护士（1338名）和患者（779名）。
患者满意度、护士报告的用药错误、患者跌倒、医院感染、压疮以及上一年涉及患者的严重事件。
总体而言，护士报告在过去7个工作日内很少遗漏BERNCA中列出的20项护理任务中的任何一项。然而，尽管护理隐性配给水平相对较低，但它是所研究的所有六项患者结局的重要预测因素。在未调整的模型中，护理资源充足程度是大多数患者结局的重要预测因素，但在调整后的模型中它不是独立的预测因素。在未调整的模型中，护理资源充足率低是六项患者结局中五项的重要预测因素，但在调整后的模型中则不是。
作为急性综合医院中的一个系统因素，护理隐性配给是患者结局的一个重要新预测因素，值得进一步研究。
