Ma Chenjuan, Park Shin Hye
Assistant Professor, New York University College of Nursing, New York, NY, USA.
Assistant Professor, University of Kansas School of Nursing, Kansas City, KS, USA.
J Nurs Scholarsh. 2015 Nov;47(6):565-73. doi: 10.1111/jnu.12173. Epub 2015 Oct 16.
To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals.
A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States.
Unit work environment was measured by the Practice Environment Scale of Nurse Working Index (PES-NWI). Multilevel logistic regressions were used to estimate the effects of unit work environment and hospital Magnet status on HAPUs. All models were controlled for hospital and unit characteristics when considering clustering of units within hospitals.
Magnet hospital units had 21% lower odds of having an HAPU than non-Magnet hospital units (95% confidence interval [CI], 0.64-0.98). With one unit increase of the PES-NWI score, units had 29% lower odds of having an HAPU (95% CI, 0.55-0.91). When including both hospital Magnet status and unit work environment in the model, hospital Magnet status no longer had a significant effect on HAPUs (odds ratio [OR] = 0.82; 95% CI, 0.66-1.02), whereas the significant effect of unit work environment persisted (OR = 0.73; 95% CI, 0.56-0.93).
Both hospital and unit environments were significantly associated with HAPUs, and the unit-level work environment can be more influential in reducing HAPUs.
Investment in the nurse work environments at both the hospital level and unit level has the potential to reduce HAPUs; and additional to hospital-level initiatives (e.g., Magnet recognition program), efforts targeting on-unit work environments deserve more attention.
确定美国急症护理医院中不同结构层面的组织护理因素（即科室层面的工作环境和医院的磁石状态）与医院获得性压疮（HAPU）之间的关联。
一项横断面观察性研究，使用来自美国国家护理质量指标数据库®的数据。33,845名注册护士（RN）的回复用于衡量科室工作环境。分析单位是护理科室，美国373家医院中有1,381个科室。
科室工作环境通过护士工作指数实践环境量表（PES-NWI）进行衡量。采用多水平逻辑回归来估计科室工作环境和医院磁石状态对医院获得性压疮的影响。在考虑医院内科室的聚类情况时，所有模型均对医院和科室特征进行了控制。
磁石医院科室发生医院获得性压疮的几率比非磁石医院科室低21%（95%置信区间[CI]，0.64 - 0.98）。PES-NWI评分每增加一个单位，科室发生医院获得性压疮的几率降低29%（95% CI，0.55 - 0.91）。当模型中同时纳入医院磁石状态和科室工作环境时，医院磁石状态对医院获得性压疮不再有显著影响（优势比[OR]=0.82；95% CI，0.66 - 1.02），而科室工作环境的显著影响依然存在（OR = 0.73；95% CI，0.56 - 0.93）。
医院和科室环境均与医院获得性压疮显著相关，且科室层面的工作环境在减少医院获得性压疮方面可能更具影响力。
在医院层面和科室层面投资护士工作环境有可能减少医院获得性压疮；除了医院层面的举措（如磁石认可计划）外，针对科室工作环境的努力应得到更多关注。
