Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Room 3218, Madison, WI 53706, USA.
BMJ Qual Saf. 2011 Jan;20(1):15-24. doi: 10.1136/bmjqs.2008.028381.
Nursing workload is increasingly thought to contribute to both nurses' quality of working life and quality/safety of care. Prior studies lack a coherent model for conceptualising and measuring the effects of workload in healthcare. In contrast, we conceptualised a human factors model for workload specifying workload at three distinct levels of analysis and having multiple nurse and patient outcomes.
To test this model, we analysed results from a cross-sectional survey of a volunteer sample of nurses in six units of two academic tertiary care paediatric hospitals.
Workload measures were generally correlated with outcomes of interest. A multivariate structural model revealed that: the unit-level measure of staffing adequacy was significantly related to job dissatisfaction (path loading=0.31) and burnout (path loading=0.45); the task-level measure of mental workload related to interruptions, divided attention, and being rushed was associated with burnout (path loading=0.25) and medication error likelihood (path loading=1.04). Job-level workload was not uniquely and significantly associated with any outcomes.
The human factors engineering model of nursing workload was supported by data from two paediatric hospitals. The findings provided a novel insight into specific ways that different types of workload could affect nurse and patient outcomes. These findings suggest further research and yield a number of human factors design suggestions.
护理工作量越来越被认为是影响护士工作生活质量和护理质量/安全的因素。先前的研究缺乏一个连贯的模型来概念化和衡量医疗保健中的工作量的影响。相比之下，我们为工作量概念化了一个人为因素模型，指定了三个不同层次的分析工作量，并具有多个护士和患者的结果。
为了测试这个模型，我们分析了来自两个学术性三级儿科医院的六个单位的护士志愿者样本的横断面调查结果。
工作量的测量指标与感兴趣的结果通常相关。一个多变量结构模型显示：单位级别的人员配备充足度指标与工作满意度（路径负荷=0.31）和倦怠（路径负荷=0.45）显著相关；任务级别的心理工作量指标与中断、注意力分散和匆忙有关，与倦怠（路径负荷=0.25）和药物错误可能性（路径负荷=1.04）相关。工作级别的工作量与任何结果都没有独特和显著的关联。
护理工作量的人为因素工程模型得到了来自两家儿科医院的数据支持。研究结果为不同类型的工作量如何影响护士和患者的结果提供了新的见解。这些发现表明需要进一步研究，并提出了一些人为因素设计建议。
