Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstr.1, 80336 Munich, Germany.
Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstr.1, 80336 Munich, Germany.
Int J Nurs Stud. 2019 Nov;99:103390. doi: 10.1016/j.ijnurstu.2019.103390. Epub 2019 Aug 6.
Understaffing in hospitals is a serious problem in healthcare work since it jeopardizes efficiency, reliability and quality of care as well as the work life of the healthcare professionals. However, estimates on the associations of understaffing and cardiovascular health in healthcare professionals are lacking. Further shortcomings refer to the problem, that determinant and outcome measures are often assessed via self-reports what increases the risk of spurious estimates due to common source bias.
We sought to reliably identify associations between understaffing and cardiovascular health in hospital nurses.
Multi-source and cross-sectional study. N = 273 nurses of a large academic hospital were surveyed. All filled out a standardized questionnaire to report psychosocial work conditions and underwent a standardized medical examination. Cardiovascular health outcomes were blood pressure and blood cholesterol (total cholesterol level, LDL-cholesterol) as well as the SCORE classification. Logistic regression analyses were applied to calculate risk estimates for the understaffing and cardiovascular health relationship, adjusted for individual and life-style factors (e.g., sex, age, BMI, alcohol consumption, smoking) and work related characteristics (i.e., shift work, leadership position, work load, autonomy, social support at work).
Multivariate associations revealed significant relationships of perceived understaffing with increased blood pressure [OR = 1.60, 95% CI: 1.05, 2.43] and increased total cholesterol [OR = 1.42, 95 CI: 1.04, 1.95]. LDL cholesterol level was associated with understaffing. We furthermore observed associations of high autonomy and high cholesterol levels.
Nurses in hospital units with lower staffing ratios had an increased risk for adverse cardiovascular health, irrespective of workload and social support. We discuss implications for future research on potential mechanisms of understaffing and nurses' health outcomes. The associated risks of poor nurse-patient-ratios for provider health need to be addressed through work and organizational design efforts.
医院人手不足是医疗保健工作中的一个严重问题，因为它危及医疗保健专业人员的效率、可靠性和护理质量以及工作生活。然而，缺乏关于人手不足与医疗保健专业人员心血管健康之间关联的估计。进一步的缺点是，决定因素和结果衡量标准通常通过自我报告来评估，这由于共同来源偏差增加了虚假估计的风险。
我们旨在可靠地确定医院护士人手不足与心血管健康之间的关联。
多源和横断面研究。对一家大型学术医院的 273 名护士进行了调查。所有护士都填写了一份标准化问卷，报告了心理社会工作条件，并接受了标准化体检。心血管健康结果是血压和血液胆固醇（总胆固醇水平、LDL 胆固醇）以及 SCORE 分类。应用逻辑回归分析计算人手不足与心血管健康关系的风险估计值，调整了个体和生活方式因素（例如，性别、年龄、BMI、饮酒、吸烟）以及与工作相关的特征（即，轮班工作、领导职位、工作量、自主权、工作中的社会支持）。
多变量关联显示，感知人手不足与血压升高[OR=1.60，95%CI：1.05，2.43]和总胆固醇升高[OR=1.42，95%CI：1.04，1.95]显著相关。LDL 胆固醇水平与人手不足有关。我们还观察到高自主权和高胆固醇水平之间的关联。
人手不足的医院科室护士发生不良心血管健康的风险增加，无论工作量和社会支持如何。我们讨论了未来关于人手不足和护士健康结果的潜在机制的研究意义。需要通过工作和组织设计努力来解决人手不足对提供者健康的不良影响的相关风险。
