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从 12 小时轮班改为 8 小时轮班:对护理组织和人员配置影响的定性探讨。

Changing from 12-hr to 8-hr day shifts: A qualitative exploration of effects on organising nursing care and staffing.

机构信息

London South Bank University, London, UK.

出版信息

J Clin Nurs. 2019 Jan;28(1-2):148-158. doi: 10.1111/jocn.14674. Epub 2018 Oct 5.


DOI:10.1111/jocn.14674
PMID:30230087
Abstract

AIMS AND OBJECTIVES: To investigate (a) How nursing care is organised on wards where nursing staff work different lengths of day shifts, and (b) How length of day shift affects the staffing of wards. BACKGROUND: Twelve-hour shifts have become increasingly common worldwide but there are concerns about impact on care quality and safety. Eight-hour shifts, and how day shift length affects how nurses organise their work, and staffing, have been little studied. DESIGN: Case study. METHODS: The setting was two older people's wards in an acute hospital in England. Nursing staff on one ward continued to work 12-hr day shifts; staff on the other ward worked 8 hr late and early day shifts, with an afternoon overlap, for 6 months. Qualitative interviews were conducted with 22 nursing staff. Semi-structured observations were conducted from 12-15.00 (5 × 3 hr episodes on each ward). Data analysis was conducted using the Framework approach. RESULTS: Theme 1: Organising nursing care and staff activities, (sub-themes: Care delivery across a 12 hr shift; Care delivery on early and late 8 hr shifts; Staff communication and documentation; Staff breaks; Teaching, supervision and staff development); Theme 2: Staffing wards with different length of day shift (sub-themes:: Adequacy of staffing and use of temporary staff; Recruitment and retention of staff after introducing 8 hr shifts). CONCLUSION: Nursing staff organised care on 8-hr shifts similarly to 12-hr shifts but then felt dissatisfied with their care delivery and handovers. Nursing staff on both wards approached care in a task-focused way. There were concerns that adopting an 8-hr shift pattern negatively affected recruitment and retention. RELEVANCE TO CLINICAL PRACTICE: Changing from 12 hr to 8 hr day shifts may affect nursing staff satisfaction with their care delivery and handovers, and have a negative effect on staffing wards.

摘要

目的和目标:(a)调查护理人员工作长短不一的病房如何组织护理工作,(b)轮班时长如何影响病房人员配备。

背景:12 小时轮班制在全球范围内越来越普遍,但人们担心这会对护理质量和安全产生影响。8 小时轮班制以及轮班时长如何影响护士组织工作和人员配备的问题研究甚少。

设计:案例研究。

方法:研究地点是英格兰一家急性医院的两个老年人病房。一个病房的护理人员继续上 12 小时的日班;另一个病房的护理人员则上 8 小时的早晚班,下午重叠,为期 6 个月。对 22 名护理人员进行了定性访谈。在每个病房进行了 12-15 点(每个病房 5 次 3 小时的观察)的半结构化观察。使用框架方法进行数据分析。

结果:主题 1:组织护理和员工活动(子主题:12 小时轮班期间的护理提供;8 小时早班和晚班期间的护理提供;员工沟通和文件记录;员工休息;教学、监督和员工发展);主题 2:不同时长的日班对病房人员配备的影响(子主题:人员配备和临时员工的使用充足性;引入 8 小时轮班制后员工的招聘和保留)。

结论:护理人员在 8 小时轮班时,组织护理工作与 12 小时轮班类似,但随后对护理提供和交接班感到不满。两个病房的护理人员都以任务为中心的方式提供护理。有人担心采用 8 小时轮班模式会对招聘和保留产生负面影响。

临床相关性:从 12 小时轮班改为 8 小时轮班可能会影响护理人员对护理提供和交接班的满意度,并对病房人员配备产生负面影响。

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