Sjetne Ingeborg S, Veenstra Marijke, Ellefsen Bodil, Stavem Knut
Norwegian Knowledge Centre for the Health Services, Oslo, Norway Institute of Nursing and Health Sciences, University of Oslo, Norway.
J Adv Nurs. 2009 Feb;65(2):325-36. doi: 10.1111/j.1365-2648.2008.04873.x. Epub 2008 Nov 27.
This paper is a report of a study to assess: (1) the relations between nursing organization models in hospital wards and nurses' perception of the quality of patient care and dimensions of the practice environment, and (2) if these relations were modified by variations in local conditions at the ward level.
Previous literature is inconclusive concerning what model of nursing organization maximizes the quality of nursing services.
A cross-sectional survey was carried out in a representative sample of Norwegian hospital wards in 2005. Intra-ward organization models were classified as: (1) Team leader (n = 30), characterized by extensive responsibilities for team leaders, (2) Primary nurse (n = 18), with extensive responsibilities for named nurses, and (3) Hybrid (n = 37), (1) and (2) combined. We prepared multilevel regression models using scales describing quality of patient care, learning climate, job satisfaction, and relationships with physicians as dependent variables. As independent variables, we used variables representing local ward conditions.
Eighty-seven wards and 1137 nurses (55% response rate) provided complete data. The ward level proportion of variance ranged from 0.10 (job satisfaction) to 0.22 (relationships with physicians). The univariate effect of organization models on quality ratings was not statistically significant. Introducing local ward conditions led to a statistically significant effect of primary nurse organization on relationships with physicians, and to a substantial proportional reduction in ward level variance, ranging from 32% (quality of patient care) to 24% (learning climate).
Caution is needed about using service quality arguments when considering the possible benefits and drawbacks of different organizational models.
本文报告一项研究，旨在评估：（1）医院病房护理组织模式与护士对患者护理质量及实践环境维度的认知之间的关系；（2）这些关系是否因病房层面当地条件的差异而有所改变。
以往文献对于哪种护理组织模式能使护理服务质量最大化尚无定论。
2005年对挪威医院病房的代表性样本进行了横断面调查。病房内组织模式分为：（1）团队领导模式（n = 30），其特点是团队领导职责广泛；（2）责任护士模式（n = 18），指定护士职责广泛；（3）混合模式（n = 37），即（1）和（2）的结合。我们使用描述患者护理质量、学习氛围、工作满意度以及与医生关系的量表作为因变量，建立了多层次回归模型。作为自变量，我们使用了代表病房当地条件的变量。
87个病房和1137名护士（回复率55%）提供了完整数据。病房层面的方差比例从0.10（工作满意度）到0.22（与医生的关系）不等。组织模式对质量评级的单变量效应无统计学意义。引入病房当地条件后，责任护士组织模式对与医生关系产生了统计学显著效应，并使病房层面方差大幅成比例减少，范围从32%（患者护理质量）到24%（学习氛围）。
在考虑不同组织模式的可能利弊时，使用服务质量论据需谨慎。
