Kendall-Gallagher Deborah, Blegen Mary A
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104-6096, USA.
Am J Crit Care. 2009 Mar;18(2):106-13; quiz 114. doi: 10.4037/ajcc2009487.
Adverse events that place patients at risk for harm are common in intensive care units. Clinicians' level of knowledge and judgment appear to play a role in the prevention, mitigation, and creation of adverse advents. Research suggests a possible association between nurses' specialty certification and clinical expertise. The relationship between specialty certification and clinical competence of registered nurses and safety of patients is a relatively new area of inquiry in nursing.
To explore the relationship between the proportion of certified staff nurses in a unit and risk of harm to patients.
Hierarchical linear modeling was used in a secondary data analysis of 48 intensive care units from a random sample of 29 hospitals to examine the relationships between unit certification rates, organizational nursing characteristics (magnet status, staffing, education, and experience), and rates of medication administration errors, falls, skin breakdown, and 3 types of nosocomial infections. Medicare case mix index was used to adjust for patient risk.
Unit proportion of certified staff registered nurses was inversely related to rate of falls, and total hours of nursing care was positively related to medication administration errors. The mean number of years of experience of registered nurses in the unit was inversely related to frequency of urinary tract infections; however, the small sample size requires that caution be exercised when interpreting results.
Specialty certification and competence of registered nurses are related to patients' safety. Further research on this relationship is needed.
在重症监护病房中，使患者面临伤害风险的不良事件很常见。临床医生的知识水平和判断力似乎在不良事件的预防、缓解及发生过程中发挥作用。研究表明护士的专业认证与临床专业技能之间可能存在关联。注册护士的专业认证与临床能力以及患者安全之间的关系是护理领域一个相对较新的研究方向。
探讨一个单位中获得认证的护士比例与患者伤害风险之间的关系。
采用分层线性模型，对来自29家医院随机样本中的48个重症监护病房进行二次数据分析，以检验单位认证率、组织护理特征（磁性状态、人员配备、教育程度和经验）与用药错误率、跌倒率、皮肤破损率以及3种医院感染类型之间的关系。使用医疗保险病例组合指数来调整患者风险。
获得认证的注册护士在单位中的比例与跌倒率呈负相关，护理总时长与用药错误率呈正相关。单位中注册护士的平均工作年限与尿路感染频率呈负相关；然而，样本量较小，在解释结果时需谨慎。
注册护士的专业认证和能力与患者安全相关。需要对这种关系进行进一步研究。
