Department of Health Sciences, University of York, UK.
Int J Nurs Stud. 2011 Jun;48(6):732-50. doi: 10.1016/j.ijnurstu.2011.02.014. Epub 2011 Mar 11.
Nursing homes have an important role in the provision of care for dependent older people. Ensuring quality of care for residents in these settings is the subject of ongoing international debates. Poor quality care has been associated with inadequate nurse staffing and poor skills mix.
To review the evidence-base for the relationship between nursing home nurse staffing (proportion of RNs and support workers) and how this affects quality of care for nursing home residents and to explore methodological lessons for future international studies.
A systematic mapping review of the literature.
Published reports of studies of nurse staffing and quality in care homes.
Systematic search of OVID databases. A total of 13,411 references were identified. References were screened to meet inclusion criteria. 80 papers were subjected to full scrutiny and checked for additional references (n=3). Of the 83 papers, 50 were included. Paper selection and data extraction completed by one reviewer and checked by another. Content analysis was used to synthesise the findings to provide a systematic technique for categorising data and summarising findings.
A growing body of literature is examining the relationships between nurse staffing levels in nursing homes and quality of care provided to residents, but predominantly focuses on US nursing facilities. The studies present a wide range and varied mass of findings that use disparate methods for defining and measuring quality (42 measures of quality identified) and nurse staffing (52 ways of measuring staffing identified).
A focus on numbers of nurses fails to address the influence of other staffing factors (e.g., turnover, agency staff use), training and experience of staff, and care organisation and management. 'Quality' is a difficult concept to capture directly and the measures used focus mainly on 'clinical' outcomes for residents. This systematic mapping review highlights important methodological lessons for future international studies and makes an important contribution to the evidence-base of a relationship between the nursing workforce and quality of care and resident outcomes in nursing home settings.
养老院在为依赖老年人提供护理方面发挥着重要作用。确保这些环境中居民的护理质量是正在进行的国际辩论的主题。护理质量差与护士人员配备不足和技能组合不佳有关。
回顾养老院护士人员配备（注册护士和支持人员的比例）与这如何影响养老院居民护理质量的证据基础，并探讨未来国际研究的方法学经验。
对文献进行系统的制图审查。
养老院护士人员配备和护理质量研究的已发表报告。
对 OVID 数据库进行系统搜索。共确定了 13411 条参考文献。对参考文献进行筛选以符合纳入标准。80 篇论文进行了全面审查，并检查了其他参考文献（n=3）。在 83 篇论文中，有 50 篇被纳入。由一名审查员完成论文选择和数据提取，并由另一名审查员进行检查。内容分析用于综合研究结果，为分类数据和总结研究结果提供系统技术。
越来越多的文献正在研究养老院护士人员配备水平与向居民提供的护理质量之间的关系，但主要集中在美国的护理设施上。这些研究提出了广泛而多样的发现，这些发现使用不同的方法来定义和衡量质量（确定了 42 项质量措施）和护士人员配备（确定了 52 种人员配备措施）。
关注护士人数并不能解决其他人员配备因素（例如，人员流动、代理人员使用）、员工培训和经验以及护理组织和管理的影响。“质量”是一个难以直接捕捉的概念，使用的措施主要集中在居民的“临床”结果上。本系统制图审查突出了未来国际研究的重要方法学经验，并为护理劳动力与护理质量以及养老院环境中居民结果之间的关系的证据基础做出了重要贡献。
