护士的个人责任和病房责任与护理缺失：一项横断面研究。
Nurses' personal and ward accountability and missed nursing care: A cross-sectional study.
机构信息
School of Nursing, University of Haifa, Haifa, Israel.
School of Nursing, University of Haifa, Haifa, Israel.
出版信息
Int J Nurs Stud. 2017 Oct;75:163-171. doi: 10.1016/j.ijnurstu.2017.08.003. Epub 2017 Aug 16.
BACKGROUND
Missed nursing care is considered an act of omission with potentially detrimental consequences for patients, nurses, and organizations. Although the theoretical conceptualization of missed nursing care specifies nurses' values, attitudes, and perceptions of their work environment as its core antecedents, empirical studies have mainly focused on nurses' socio-demographic and professional attributes. Furthermore, assessment of missed nursing care has been mainly based on same-source methods.
OBJECTIVES
This study aimed to test the joint effects of personal and ward accountability on missed nursing care, by using both focal (the nurse whose missed nursing care is examined) and incoming (the nurse responsible for the same patients at the subsequent shift) nurses' assessments of missed nursing care.
DESIGN
A cross-sectional design, where nurses were nested in wards.
PARTICIPANTS
A total of 172 focal and 123 incoming nurses from 32 nursing wards in eight hospitals.
METHODS
Missed nursing care was assessed with the 22-item MISSCARE survey using two sources: focal and incoming nurses. Personal and ward accountability were assessed by the focal nurse with two 19-item scales. Nurses' socio-demographics and ward and shift characteristics were also collected. Mixed linear models were used as the analysis strategy.
RESULTS
Focal and incoming nurses reported occasional missed nursing care of the focal nurse (Mean=1.87, SD=0.71 and Mean=2.09, SD=0.84, respectively; r=0.55, p<0.01). Regarding the focal nurse's assessment of his/her own missed nursing care, findings showed that, above and beyond nurses' overload and personal socio-demographic characteristics, higher personal accountability was significantly associated with decreased missed care (β=-0.29, p<0.01), whereas ward accountability was not (β=-0.23, p>0.05). The interaction effect was significant (β=-0.31, p<0.05); the higher the ward accountability, the stronger the negative relationship between nurses' personal accountability and missed nursing care. Similar patterns were obtained for the incoming nurses' assessment of focal nurse's missed care.
CONCLUSIONS
Use of focal and incoming nurses' missed nursing care assessments limited the common source bias and strengthened our findings. Personal and ward accountability are significant values, which are associated with lower missed nursing care, beyond scarce resources. Implementation of local and national education programs for nurses and managers, accompanied with empirical research, might increase personal and ward accountability, thereby decreasing missed nursing care. This might help to create a safety culture and reduce negative outcomes for patients, nurses, and organizations.
背景
遗漏护理被认为是一种行为疏忽，可能对患者、护士和组织造成潜在的不利后果。尽管遗漏护理的理论概念将护士的价值观、态度和对工作环境的看法作为其核心前提，但实证研究主要集中在护士的社会人口统计学和职业属性上。此外，遗漏护理的评估主要基于同源方法。
目的
本研究旨在通过使用焦点（接受检查的护士）和传入（负责后续班次同一患者的护士）护士对遗漏护理的评估，测试个人和病房责任对遗漏护理的共同影响。
设计
这是一项横断面设计，其中护士被嵌套在病房中。
参与者
来自 8 家医院 32 个护理病房的 172 名焦点护士和 123 名传入护士。
方法
使用 22 项 MISSCARE 调查评估遗漏护理，采用两种来源：焦点护士和传入护士。个人和病房责任由焦点护士使用两个 19 项量表进行评估。还收集了护士的社会人口统计学特征以及病房和班次特征。混合线性模型被用作分析策略。
结果
焦点和传入护士报告了焦点护士偶尔发生的遗漏护理（焦点护士的平均值=1.87，标准差=0.71；传入护士的平均值=2.09，标准差=0.84；r=0.55，p<0.01）。关于焦点护士对自己遗漏护理的评估，结果表明，除了护士的超负荷工作和个人社会人口统计学特征外，较高的个人责任与减少遗漏护理显著相关（β=-0.29，p<0.01），而病房责任则没有（β=-0.23，p>0.05）。交互效应具有显著性（β=-0.31，p<0.05）；病房责任越高，护士个人责任与遗漏护理之间的负相关关系越强。传入护士对焦点护士遗漏护理的评估也得到了类似的模式。
结论
使用焦点和传入护士对遗漏护理的评估限制了共同来源偏差，并加强了我们的发现。个人和病房责任是重要的价值观，与稀缺资源相比，它们与较低的遗漏护理有关。为护士和管理人员实施地方和国家教育计划，并辅以实证研究，可能会增加个人和病房责任，从而减少遗漏护理。这可能有助于营造安全文化，减少患者、护士和组织的负面后果。
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