增加护士配备对遗漏护理工作的影响。
Effects of increasing nurse staffing on missed nursing care.
作者信息
Cho S-H, Kim Y-S, Yeon K N, You S-J, Lee I D
机构信息
College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, South Korea.
Public Health Policy Institute, Seoul Metropolitan Government, Seoul, South Korea.
出版信息
Int Nurs Rev. 2015 Jun;62(2):267-74. doi: 10.1111/inr.12173. Epub 2015 Mar 12.
BACKGROUND
Inadequate nurse staffing has been reported to lead nurses to omit required nursing care. In South Korea, to reduce informal caregiving by patient families and sitters and to improve the quality of nursing care, a public hospital operated by the Seoul Metropolitan Government has implemented a policy of increasing nurse staffing from 17 patients per registered nurse to 7 patients per registered nurse in 4 out of 13 general nursing units since January 2013.
AIM
The study aims to compare missed nursing care (omission of required care) in high-staffing (7 patients per nurse) units vs. low-staffing (17 patients per nurse) units to examine the effects of nurse staffing on missed care.
METHODS
A nurse survey conducted in July 2013 targeted all staff nurses in all four high-staffing and all nine low-staffing units; 115 nurses in the high-staffing units (response rate = 94.3%) and 117 nurses in the low-staffing units (response rate = 88.6%) participated. Missed nursing care was measured using the MISSCARE survey that included 24 nursing care elements. Nurses were asked how frequently they had missed each element on a 4-point scale from 'rarely' to 'always'.
RESULTS
Overall, nurses working in high-staffing units had a significantly lower mean score of missed care than those in low-staffing units. Seven out of 24 nursing care elements were missed significantly less often in high-staffing (vs. low-staffing) units: turning, mouth care, bathing/skin care, patient assessments in each shift, assistance with toileting, feeding and setting up meals.
CONCLUSION
The findings suggest that increasing nurse staffing is associated with a decrease in missed care. Less omission of required nursing care is expected to improve nursing surveillance and patient outcomes, such as patient falls, pressure ulcers and pneumonia.
IMPLICATIONS FOR NURSING AND HEALTH POLICY
Adequate nurse staffing should be ensured to reduce unmet nursing needs and improve patient outcomes.
背景
据报道，护士配备不足会导致护士遗漏必要的护理工作。在韩国，为了减少患者家属和护工的非正规护理工作，并提高护理质量，首尔市政府运营的一家公立医院自2013年1月起实施了一项政策，在13个普通护理单元中的4个单元将护士与患者的配备比例从每1名注册护士负责17名患者提高到每1名注册护士负责7名患者。
目的
本研究旨在比较高配备（每护士负责7名患者）单元和低配备（每护士负责17名患者）单元中遗漏的护理工作（必要护理的遗漏情况），以检验护士配备对遗漏护理的影响。
方法
2013年7月对所有四个高配备单元和所有九个低配备单元的所有在职护士进行了一项护士调查；高配备单元的115名护士（回复率=94.3%）和低配备单元的117名护士（回复率=88.6%）参与了调查。使用包含24项护理要素的MISSCARE调查问卷来衡量遗漏的护理工作。护士们被问及他们在从“很少”到“总是”的4级量表上遗漏每项要素的频率。
结果
总体而言，在高配备单元工作的护士遗漏护理的平均得分显著低于低配备单元中的护士。在24项护理要素中，有7项在高配备（与低配备相比）单元中被遗漏的频率显著更低：翻身、口腔护理、洗澡/皮肤护理、每班的患者评估、协助如厕、喂食和准备膳食。
结论
研究结果表明，增加护士配备与遗漏护理的减少有关。减少必要护理的遗漏预计会改善护理监测和患者结局，如患者跌倒、压疮和肺炎。
对护理和卫生政策的启示
应确保充足的护士配备，以减少未满足的护理需求并改善患者结局。
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