Shin Juh Hyun, Hyun Ta Kyung
Assistant Professor, Ewha Womans University, College of Health Sciences, Division of Nursing Science, Seoul, Korea.
Doctoral Student, Kyonggi University, Social Work, Kyonggido, Korea.
J Nurs Scholarsh. 2015 Nov;47(6):555-64. doi: 10.1111/jnu.12166. Epub 2015 Oct 14.
To investigate the relationship between nurse staffing and quality of care in nursing homes in Korea.
This study used a cross-sectional design to describe the relationship between nurse staffing and 15 quality-of-care outcomes. Independent variables were hours per resident day (HPRD), skill mix, and turnover of each nursing staff, developed with the definitions of the Centers for Medicare & Medicaid Services and the American Health Care Association. Dependent variables were prevalence of residents who experienced more than one fall in the recent 3 months, aggressive behaviors, depression, cognitive decline, pressure sores, incontinence, prescribed antibiotics because of urinary tract infection, weight loss, dehydration, tube feeding, bed rest, increased activities of daily living, decreased range of motion, use of antidepressants, and use of restraints. Outcome variables were quality indicators from the U.S. Centers for Medicare & Medicaid and 2013 nursing home evaluation manual by the Korean National Health Insurance Service.
The effects of registered nurse (RN) HPRD was supported in fall prevention, decreased tube feeding, decreased numbers of residents with deteriorated range of motion, and decreased aggressive behavior. Higher turnover of RNs related to more residents with dehydration, bed rest, and use of antipsychotic medication.
Study results supported RNs' unique contribution to resident outcomes in comparison to alternative nurse staffing in fall prevention, decreased use of tube feeding, better range of motion for residents, and decreased aggressive behaviors in nursing homes in Korea. More research is required to confirm the effects of nurse staffing on residents' outcomes in Korea.
We found consistency in the effects of RN staffing on resident outcomes acceptable. By assessing nurse staffing levels and compositions of nursing staffs, this study contributes to more effective long-term care insurance by reflecting on appropriate policies, and ultimately contributes to the stable settlement of the long-term care insurance system for elders.
探讨韩国养老院护士配备与护理质量之间的关系。
本研究采用横断面设计来描述护士配备与15项护理质量结果之间的关系。自变量为每位居民每天的护理时长（HPRD）、技能组合以及每位护理人员的离职率，这些变量依据医疗保险和医疗补助服务中心以及美国医疗保健协会的定义得出。因变量包括在最近3个月内跌倒不止一次的居民患病率、攻击性行为、抑郁、认知衰退、压疮、失禁、因尿路感染而开具抗生素、体重减轻、脱水、鼻饲、卧床休息、日常生活活动增加、活动范围减小、使用抗抑郁药以及使用约束措施。结果变量为来自美国医疗保险和医疗补助服务中心的质量指标以及韩国国民健康保险服务局2013年养老院评估手册中的指标。
注册护士（RN）的HPRD在预防跌倒、减少鼻饲、减少活动范围恶化的居民数量以及减少攻击性行为方面的作用得到了证实。注册护士的高离职率与更多居民出现脱水、卧床休息以及使用抗精神病药物有关。
研究结果支持了在韩国养老院中，与其他护士配备方式相比，注册护士对居民护理结果具有独特贡献，在预防跌倒、减少鼻饲使用、改善居民活动范围以及减少攻击性行为方面表现突出。需要更多研究来证实韩国护士配备对居民护理结果的影响。
我们发现注册护士配备对居民护理结果的影响具有一致性且可以接受。通过评估护士配备水平和护理人员组成，本研究有助于通过思考适当政策来实现更有效的长期护理保险，最终有助于长期护理保险制度在老年人中的稳定实施。
