School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia; Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.
Int J Nurs Stud. 2016 Nov;63:189-200. doi: 10.1016/j.ijnurstu.2016.09.008. Epub 2016 Sep 13.
The aim of this study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data.
Logistic regression modelling was used with linked administrative health data to examine the association between seven adverse patient outcomes and use of assistants in nursing utilising a pre-test/post-test design. Outcomes included were in-hospital 30-day mortality, failure to rescue, urinary tract infection, pressure injury, pneumonia, sepsis and falls with injury.
Eleven acute care metropolitan hospitals in Western Australia.
Patients were retained in the dataset if they spent any time on a medical, surgical or rehabilitation ward during their admission and excluded if they only spent time on other ward types, as the outcomes used in this study are only validated for these patient populations. There were 256,302 patient records in the total sample with 125,762 in the pre-test period (2006-2007) and 130,540 in the post-test period (2009-2010).
The results showed three significant increases in observed to expected adverse outcomes on the assistant in nursing wards (failure to rescue, urinary tract infection, falls with injury), with one significant decrease (mortality). On the non-assistant in nursing wards there was one significant decrease (pneumonia) in the observed to expected adverse outcomes and one significant increase (falls with injury). Post-test analysis showed that spending time on assistant in nursing wards was a significant predictor for urinary tract infection and pneumonia. For every 10% of extra time patients spent on assistant in nursing wards they had a 1% increase in the odds of developing a urinary tract infection and a 2% increase in the odds of developing pneumonia.
The results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which clearly defines their role, scope of practice, and working relationship with registered nurses, and the impact on patient care should be monitored.
本研究旨在利用行政健康数据评估在急性护理医院病房护士配备中增加护理助理对不良患者结局的影响。
使用逻辑回归模型和链接的行政健康数据，采用预测试/后测试设计，检查七种不良患者结局与护理助理使用之间的关联。研究的结局包括住院 30 天内死亡率、抢救失败、尿路感染、压疮、肺炎、败血症和带伤跌倒。
西澳大利亚州的 11 家急性护理大都市医院。
如果患者在住院期间在医疗、外科或康复病房中度过任何时间，则将其保留在数据集内；如果他们仅在其他病房类型中度过时间，则将其排除在外，因为本研究中使用的结局仅针对这些患者人群进行了验证。在总样本中共有 256302 份患者记录，其中前测期（2006-2007 年）有 125762 份，后测期（2009-2010 年）有 130540 份。
结果显示，护理助理病房的观察到的不良结局比预期增加了 3 项（抢救失败、尿路感染、带伤跌倒），非护理助理病房的观察到的不良结局则减少了 1 项（肺炎）。后测分析显示，在护理助理病房花费时间是尿路感染和肺炎发生的一个显著预测因素。与在护理助理病房花费时间每增加 10%相比，患者发生尿路感染的几率增加 1%，发生肺炎的几率增加 2%。
结果表明，在明确规定护理助理的角色、实践范围和与注册护士的工作关系，并监测对患者护理的影响的前提下，应按照协议以附加角色的方式将护理助理引入病房人员配备中。
