不同护理技能配比模式对呼吸治疗中心患者结局的影响。
The impact of different nursing skill mix models on patient outcomes in a respiratory care center.
机构信息
School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
出版信息
Worldviews Evid Based Nurs. 2012 Dec;9(4):227-33. doi: 10.1111/j.1741-6787.2012.00246.x. Epub 2012 Apr 10.
BACKGROUND
Many hospitals have reformed hospital policies and changed nursing models to cope with shortages in nursing staff and control medical costs. However, the nursing skill mix model that most successfully achieves both cost effectiveness and quality care has yet to be determined.
AIM
The aim of this study was to explore the impact of different nurse staffing models on patient outcomes in a respiratory care center (RCC).
METHODS
Retrospective data from 2006 to 2008 were obtained from records monitoring nursing care quality, as well as patient records and nursing personnel costs in an RCC as a medical center, in southern Taiwan. A total of 487 patients were categorized into two groups according to the RCC's mix of nursing staff. The "RN/Aide" group comprised 247 patients who received RN and aide care, with a 0.7-0.8 proportion of RNs, from July 2006 to June 2007. The other 240 patients ("All-RN") received 100% RN care from January 2008 to December 2008.
RESULTS
The results of this study indicated no significant differences in occurrence of pressure ulcer or respiratory tract infections, days of hospitalization, mortality, or nursing costs. However, significant differences were observed in ventilator weaning and occurrence of urinary tract and bloodstream infections.
CONCLUSIONS
A higher proportion of RNs was associated not only with a lower rate of urinary tract infection but also with more patients being weaned successfully from ventilators. The findings of this study have implications for how managers and administrators manage nurse staffing in respiratory care.
背景
许多医院已经改革了医院政策并改变了护理模式，以应对护理人员短缺和控制医疗成本的问题。然而，最能同时实现成本效益和高质量护理的护理技能组合模式尚未确定。
目的
本研究旨在探讨呼吸治疗中心（RCC）中不同护理人员配置模式对患者结局的影响。
方法
本研究回顾性地收集了 2006 年至 2008 年南部地区某医学中心 RCC 的护理质量监测记录、患者记录和护理人员成本数据。根据 RCC 的护理人员组合，将 487 名患者分为两组。“RN/助理护士”组（n=247）于 2006 年 7 月至 2007 年 6 月接受 RN 和助理护士的护理，RN 与助理护士的比例为 0.7-0.8。另一组 240 名患者（“全部为 RN”组）于 2008 年 1 月至 2008 年 12 月接受 100%RN 护理。
结果
本研究结果显示，两组患者在压疮或呼吸道感染的发生率、住院天数、死亡率或护理费用方面无显著差异。然而，两组患者在呼吸机撤机和泌尿道与血流感染的发生率方面存在显著差异。
结论
较高比例的 RN 不仅与较低的泌尿道感染率相关，还与更多患者成功撤机相关。本研究结果对管理人员管理呼吸治疗中的护理人员配置具有启示意义。
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