评价一所三级教学医院重症监护病房护士的工作量与患者疾病严重程度的关系：一项前瞻性研究。
Evaluation of nurses' workload in intensive care unit of a tertiary care university hospital in relation to the patients' severity of illness: A prospective study.
机构信息
Cardiac Surgery Intensive Care Unit, Department for Anesthesiology and Intensive Care, Clinical Hospital Centre Rijeka, Rijeka, Croatia.
Department of Biotechnology, University of Rijeka, Rijeka, Croatia.
出版信息
Int J Nurs Stud. 2017 Nov;76:100-105. doi: 10.1016/j.ijnurstu.2017.09.004. Epub 2017 Sep 13.
BACKGROUNDS
Costs of intensive care reach up to 30% of the hospital budget with workforce expenses being substantial. Determining proper nurse-patient ratio is necessary for optimizing patients' health related outcomes and hospitals' cost effective functioning.
OBJECTIVES
To evaluate nurses' workload using Nine Equivalents of Nursing Manpower Use Score and Nursing Activities Score scoring systems while assessing correlation between both scores and the severity of illness measured by Simplified Acute Physiology Score II.
DESIGN
A Prospective study SETTINGS: Cardiac Surgery Intensive Care Unit of the Clinical Hospital Centre Rijeka, Croatia, from October 2014 to February 2015. This Intensive Care Unit has 3 beds that can be expanded upon need.
PARTICIPANTS
The study included 99 patients treated at this Unit during the study's period. The scores were obtained by 6 nurses, working in 12h shifts.
METHODS
Measurements were obtained for each patient 24h after admission and subsequently twice a day, at the end of the day shift (7pm) and at the end of the night shift (7 am). The necessary data were obtained from the patient's medical records.
RESULTS
Nursing Activities Score showed significantly higher number of nurses are required for one 12h shift (Z=3.76, p<0.001). Higher scores were obtained on day shifts vs. night shifts. (Nursing Manpower Use Score, z=3.25, p<0.001; Nursing Activities Score, z=4.16, p<0.001). When comparing Nursing Activities Score and Nursing Manpower Use Score during the week, we calculated higher required number of nurses on weekdays than on weekends and holidays, (Nursing Manpower Use Score, p<0.001; Nursing Activities Score, p<0.001). Correlation analysis of Nursing Activities Score and Nursing Manpower Use Score with Simplified Acute Physiology Score II has shown that Nursing Manpower Use Score positively associated with severity of disease, while Nursing Activities Score shows no association.
CONCLUSION
Both scores can be used to estimate required number of nurses in 12-h shifts, although Nursing Activities Score seems more suitable for units with prolonged length of stay, while Nursing Manpower Use Score appears better for units with shorter duration of stay (up to four days). Higher workload measured by Nursing Manpower Use Score scale can be predicted with higher Simplified Acute Physiology Score II. However, with low Simplified Acute Physiology Score II scores it cannot be assumed that the nursing workload will also be low. Further research is needed to determine the best tool to asses nursing workload in intensive care units.
背景
重症监护病房的费用占医院预算的 30%，而劳动力支出是其中的重要部分。确定适当的护患比例对于优化患者的健康相关结局和医院的成本效益运作是必要的。
目的
使用 9 个同等护理人力使用评分和护理活动评分评分系统评估护士的工作量，同时评估这两个评分与简化急性生理学评分 II 测量的疾病严重程度之间的相关性。
设计
前瞻性研究
地点
克罗地亚里耶卡临床中心医院的心脏外科重症监护病房，时间为 2014 年 10 月至 2015 年 2 月。该重症监护病房有 3 张床，可以根据需要扩展。
参与者
该研究包括在研究期间在该单位接受治疗的 99 名患者。评分由在 12 小时轮班工作的 6 名护士获得。
方法
在入院后 24 小时内以及随后每天两次（下午 7 点和晚上 7 点结束时）和夜班结束时（上午 7 点），为每位患者进行测量。必要的数据从患者的病历中获得。
结果
护理活动评分显示，每 12 小时轮班需要的护士人数明显更多（Z=3.76，p<0.001）。白天轮班的评分高于夜班（护理人力使用评分，z=3.25，p<0.001；护理活动评分，z=4.16，p<0.001）。当比较一周内的护理活动评分和护理人力使用评分时，我们计算出工作日比周末和节假日需要更多的护士（护理人力使用评分，p<0.001；护理活动评分，p<0.001）。护理活动评分和护理人力使用评分与简化急性生理学评分 II 的相关性分析表明，护理人力使用评分与疾病严重程度呈正相关，而护理活动评分则无相关性。
结论
这两个评分都可以用来估计 12 小时轮班的护士人数，尽管护理活动评分似乎更适合住院时间较长的科室，而护理人力使用评分似乎更适合住院时间较短（最多四天）的科室。护理人力使用评分量表测量的较高工作量可以通过较高的简化急性生理学评分 II 来预测。然而，简化急性生理学评分 II 得分较低并不能假设护理工作量也会较低。需要进一步研究以确定评估重症监护病房护理工作量的最佳工具。
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