Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, PA 19104-4217, USA.
Med Care. 2011 Dec;49(12):1047-53. doi: 10.1097/MLR.0b013e3182330b6e.
Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes.
To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Outcomes of 665 hospitals in 4 large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nurses, and American Hospital Association data.
A 30-day inpatient mortality and failure-to-rescue.
The effect of decreasing workloads by 1 patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by 9% and 10%, respectively. The effect of 10% more Bachelors of Science in Nursing Degree nurses decreases the odds on both outcomes in all hospitals, regardless of their work environment, by roughly 4%.
Although the positive effect of increasing percentages of Bachelors of Science in Nursing Degree nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments.
更好的医院护士配置、受过更好教育的护士以及改善的护士工作环境已被证明与降低医院死亡率有关。但对于每种类型的投资在改善结果方面的效果更好，以及在什么条件下效果更好，人们知之甚少。
确定医院护士配置、护士教育和工作环境的影响与患者结果相关的条件。
设计、设置和参与者：通过来自 4 个大州的 665 家医院的出院摘要的链接数据，对 1262120 名普通、骨科和血管外科患者、39038 名随机抽取的医院在职护士以及美国医院协会的数据进行了研究。
30 天住院死亡率和未抢救死亡率。
在工作环境较差的医院中，每减少 1 名患者/护士的工作量对死亡和抢救失败的影响几乎为零，但在环境一般的医院中，这两种情况的几率分别降低了 4%，在环境最好的医院中分别降低了 9%和 10%。每增加 10%的护理学学士学位护士，无论其工作环境如何，都会使这两种结果的几率降低约 4%。
尽管增加护理学学士学位护士的比例的积极影响在所有医院中都是一致的，但降低患者与护士的比例在工作环境良好的医院中显著改善了患者的预后，在环境一般的医院中略有改善，而在工作环境较差的医院中则没有效果。
