术后死亡率、护理缺失与九个国家护士人力配置：一项横断面研究。
Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study.
机构信息
Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet (KI), Stockholm, Sweden; University of Southampton & National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Southampton, United Kingdom.
KU Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium.
出版信息
Int J Nurs Stud. 2018 Feb;78:10-15. doi: 10.1016/j.ijnurstu.2017.08.004. Epub 2017 Aug 24.
BACKGROUND
Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery.
AIM
Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality.
METHOD
Data from the RN4CAST study (2009-2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses' staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation.
RESULTS
Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse's workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031-1.106) and 16% (OR 1.159 95% CI 1.039-1.294) increase in the odds of a patient dying within 30days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality.
CONCLUSION
Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an 'early warning' indicator of higher risk for poor patient outcomes.
背景
术后死亡率的差异与注册护士人员配备水平的差异有关。当护士人员配备水平较低时，也会有更高的必要但遗漏的护理发生率。遗漏的护理可能是手术后患者死亡的一个重要预测因素。
目的
检验遗漏护理是否在观察到的护士人员配备水平与死亡率之间的关联中起中介作用。
方法
RN4CAST 研究（2009-2011 年）的数据结合了来自 9 个国家 300 家普通急症医院的 422730 例手术患者的常规收集数据，以及来自 26516 名注册护士的调查数据，以检验护士人员配备、遗漏护理和 30 天住院患者死亡率之间的关联。人员配备和遗漏护理措施来自护士调查。广义估计方法用于检验护理人员首次配备与死亡率之间的关系。贝叶斯方法用于检验中介作用。
结果
护士人员配备和遗漏护理与 30 天病例混合调整死亡率显著相关。护士工作量增加一名患者和遗漏护理百分比增加 10%，分别与患者在入院后 30 天内死亡的几率增加 7%（OR 1.068，95%CI 1.031-1.106）和 16%（OR 1.159，95%CI 1.039-1.294）相关。中介分析表明，护士人员配备和遗漏护理之间存在关联，随后遗漏护理与死亡率之间也存在关联。
结论
与护士人员配备高度相关的遗漏护理与常见手术患者住院死亡几率增加有关。分析结果支持遗漏护理在注册护士人员配备与患者死亡率风险之间的关系中起中介作用的假设。测量遗漏护理可能为不良患者结局的高风险提供“早期预警”指标。
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