School of Nursing, Sun Yat-sen University, Guangzhou, China.
School of Nursing, Oregon Health & Science University, Portland, Oregon, United States.
Int J Nurs Stud. 2018 Oct;86:82-89. doi: 10.1016/j.ijnurstu.2018.05.005. Epub 2018 May 20.
Promotion of patient safety is among the most important goals and challenges of healthcare systems worldwide in countries including China. Donabedian's Structure-Process-Outcome model implies that patient safety is affected by hospital nursing organizational factors and nursing care process. However, studies are imperative for a clear understanding about the mechanisms by which patient safety is affected to guide practice.
The objective of this study was to explore the impact of hospital nursing work environment, workload, nursing care left undone, and nurse burnout on patient safety.
This was a cross-sectional study conducted in 23 hospitals in Guangdong province, China in 2014. Data from nurses (n = 1542) responsible for direct care on 111 randomly sampled medical and surgical units were analyzed.
Work environment was measured by the Practice Environment Scale of Nursing Work Index. Workload was measured by day shift unit patient-nurse ratio and non-professional tasks conducted by nurses. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse burnout was measured by the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey. Patient safety was measured by three items indicating nurses' perception of overall patient safety and nine items addressing patient adverse events. Structural equation modeling was used to examine a hypothesized model that supposed work environment and workload have both direct and indirect effects on patient safety through nursing care left undone and nurse burnout.
The findings generally supported the hypothesized model. Better work environment was associated with better patient safety both directly and indirectly. Lower workload primarily indirectly related to better patient safety. Nursing care left undone and nurse burnout were mediators negatively associated with patient safety.
Improving work environment, increasing nurse staffing levels, and providing sufficient support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement.
在包括中国在内的许多国家，促进患者安全是全球医疗系统最重要的目标和挑战之一。Donabedian 的结构-过程-结果模型表明，患者安全受到医院护理组织因素和护理过程的影响。然而，为了清楚地了解患者安全受到影响的机制，需要进行研究，以便为实践提供指导。
本研究旨在探讨医院护理工作环境、工作量、护理遗漏和护士倦怠对患者安全的影响。
这是 2014 年在中国广东省 23 家医院进行的一项横断面研究。对负责 111 个随机抽样的内科和外科病房直接护理的护士（n=1542）的数据进行了分析。
工作环境采用护理工作指数实践环境量表进行测量。工作量通过白班单位患者-护士比例和护士完成的非专业任务进行测量。护理遗漏通过 12 个项目来衡量必要的护理活动。护士倦怠采用 Maslach 倦怠量表-人类服务调查的情绪衰竭分量表进行测量。患者安全通过三个项目来衡量，这些项目表明护士对总体患者安全的看法，以及九个项目涉及患者不良事件。结构方程模型用于检验一个假设模型，该模型假设工作环境和工作量通过护理遗漏和护士倦怠对患者安全产生直接和间接影响。
研究结果普遍支持假设模型。更好的工作环境与直接和间接的更好的患者安全相关。较低的工作量主要通过间接与更好的患者安全相关。护理遗漏和护士倦怠是与患者安全呈负相关的中介因素。
改善工作环境、增加护士配置水平，并为护士提供足够的支持，使其有更多的时间直接护理患者，将有利于提高患者安全。
