Kiekkas Panagiotis, Sakellaropoulos George C, Brokalaki Hero, Manolis Evangelos, Samios Adamantios, Skartsani Chrisula, Baltopoulos George I
Anesthesiology Department, University Hospital of Patras, Greece.
J Nurs Scholarsh. 2008;40(4):385-90. doi: 10.1111/j.1547-5069.2008.00254.x.
To investigate differences in mortality of intensive care unit (ICU) patients according to the ratio between total patient care demands and nurse staffing.
Observational, prospective study. Patients consecutively admitted in the medical-surgical ICU of a Greek hospital over a 1-year period were enrolled.
The Therapeutic Intervention Scoring System (TISS)-28 was used for measuring patient care demands. Daily sum of TISS-28 of patients and daily number of nurses were considered for estimating median and peak patient exposure to nursing workload. According to the values of median and peak patient exposure to nursing workload, patients were divided into three groups (low, medium, and high). Logistic regression was used for evaluating the associations between mortality during ICU length of stay and median or peak patient exposure to nursing workload, after adjusting for patient clinical severity.
396 patients were included and 102 died. Differences in ICU mortality between high and low groups of median and peak patient exposure to nursing workload, although not statistically significant, were clinically remarkable, both when all patients were studied and when medical and surgical patients were separately studied.
Consideration of individual differences in patient acuity might add sensitivity to the detection of associations between nurse understaffing and ICU mortality.
The findings indicate that not only differences among nurse characteristics, but also differences in patient care demands, are important when investigating the effect of nurse understaffing on mortality of ICU patients. Proper nurse staffing levels should be based on the estimation of total patient acuity, rather than on the absolute number of patients.
根据患者总护理需求与护士配备比例，调查重症监护病房（ICU）患者的死亡率差异。
观察性前瞻性研究。纳入一家希腊医院内科-外科ICU在1年期间连续收治的患者。
采用治疗干预评分系统（TISS）-28来衡量患者护理需求。考虑患者TISS-28的每日总和以及每日护士人数，以估计患者接触护理工作量的中位数和峰值。根据患者接触护理工作量的中位数和峰值，将患者分为三组（低、中、高）。在调整患者临床严重程度后，使用逻辑回归评估ICU住院期间死亡率与患者接触护理工作量的中位数或峰值之间的关联。
纳入396例患者，102例死亡。在研究所有患者以及分别研究内科和外科患者时，患者接触护理工作量的中位数和峰值的高分组与低分组之间的ICU死亡率差异虽然无统计学意义，但在临床上较为显著。
考虑患者病情的个体差异可能会提高检测护士配备不足与ICU死亡率之间关联的敏感性。
研究结果表明，在调查护士配备不足对ICU患者死亡率的影响时，不仅护士特征的差异很重要，患者护理需求的差异也很重要。合适的护士配备水平应基于对患者总体病情的评估，而非患者的绝对数量。
