Nursing Department, Children's Hospital of Fudan University, Shanghai, P.R. China.
Pediatric Intensive care unit, Children's Hospital of Fudan University, Shanghai, P.R. China.
Nurs Crit Care. 2017 Nov;22(6):355-361. doi: 10.1111/nicc.12246. Epub 2016 May 23.
Nursing-sensitive indicators are considered effective tools for improving the quality of care in hospitals. However, these have not been used in paediatric intensive care units (PICUs) in China.
To develop nursing-sensitive indicators for PICUs and to assess the quality of nursing in PICUs in China based on the nursing-sensitive indicators.
Multi-centre, cross-sectional study.
Structure, process and outcome indicators were developed and measured from 1 January to 31 March 2014 in seven PICUs in China.
The structure indicators showed that one nurse cared for an average of 2·8 patients in a PICU, and 44% of nurses had a bachelor's degree. The process indicators revealed that hand-washing compliance varied across PICUs, whereas pain management and physical restraint have not been adequately addressed in China. The outcome indicators revealed that the incidence rates of ventilator-associated pneumonia and central-line-associated blood stream infections were 2·96 and 0·7, respectively, per 1000 device days. Patients were intubated for a total of 4392 mechanical ventilator days, and 32 patients (7·29‰) had an unplanned extubation. Nurses were moderately satisfied in their jobs (3·1 ± 0·3), and parents reported that nurses provide high quality of care.
This study developed and used nursing-sensitive indicators to assess the quality of nursing in PICUs in China, which provided a reference for national and international comparisons of nursing quality in PICUs. Nursing staffing levels and education should be improved. Pain management and physical restraints should be regulated in China's PICUs. Nurse managers need to explore staff attitudes towards implementation of family-centred care. The development of a national database of nursing quality indicators can contribute to quality and safety improvement.
This study developed a set of nursing-sensitive indicators, and these indicators were used to assess and improve the quality of nursing in PICUs.
护理敏感指标被认为是提高医院护理质量的有效工具，但尚未在我国儿科重症监护病房（PICU）使用。
制定儿科重症监护病房护理敏感指标，并基于这些指标评估我国儿科重症监护病房的护理质量。
多中心、横断面研究。
2014 年 1 月 1 日至 3 月 31 日，在中国 7 家儿科重症监护病房制定和测量结构、过程和结果指标。
结构指标显示，每位护士平均负责 2.8 名 PICU 患者，44%的护士拥有学士学位。过程指标显示，手卫生依从性在不同的儿科重症监护病房之间存在差异，而疼痛管理和身体约束在中国尚未得到充分解决。结果指标显示，呼吸机相关性肺炎和中心静脉相关血流感染的发生率分别为每 1000 个设备日 2.96 例和 0.7 例。患者总共进行了 4392 个机械通气日的插管，有 32 名患者（7.29‰）发生计划外拔管。护士对工作满意度中等（3.1±0.3），家长报告护士提供高质量的护理。
本研究制定并使用护理敏感指标评估我国儿科重症监护病房的护理质量，为国际和国内儿科重症监护病房护理质量比较提供了参考。应提高护理人员配备水平和教育程度。应规范我国儿科重症监护病房的疼痛管理和身体约束。护士长需要探讨护士对实施以家庭为中心的护理的态度。开发国家护理质量指标数据库有助于提高质量和安全性。
本研究制定了一套护理敏感指标，并使用这些指标评估和改进儿科重症监护病房的护理质量。
