Lake Eileen T, Riman Kathryn A, Sloane Douglas M
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
J Nurs Manag. 2020 Nov;28(8):2157-2165. doi: 10.1111/jonm.12970. Epub 2020 Mar 10.
To document how changes in the hospital work environment and nurse staffing over time are associated with changes in missed nursing care.
Missed nursing care is considered an indicator of poorer care quality and has been associated with worse patient care experiences and health outcomes. Several systematic reviews of cross-sectional studies report that nurses in hospitals with supportive work environments and higher staffing miss less care. Causal evidence demonstrating these relationships is needed.
This panel study utilized secondary data from 23,650 nurses surveyed in 2006 and 14,935 surveyed in 2016 in 458 hospitals from a four-state survey of random samples of licensed nurses.
Over the 10-year period, most hospitals exhibited improved work environments, better nurse staffing and more missed care. In hospitals with improved work environments or nurse staffing, the prevalence and frequency of missed care decreased significantly. The effect on missed care of changes in the work environment was greater than that of nurse staffing.
Changes in the hospital work environment and staffing influence missed care.
Modifications in the work environment and staffing are strategies to mitigate care compromise. Nurse managers should investigate work settings in order to identify weaknesses.
记录医院工作环境和护士人员配备随时间的变化如何与漏护情况的变化相关联。
漏护被视为护理质量较差的一个指标，并且与更糟糕的患者护理体验和健康结果相关。几项横断面研究的系统评价报告称，在工作环境支持性强且人员配备充足的医院中，护士漏护的情况较少。需要有因果证据来证明这些关系。
这项面板研究利用了来自对四个州有执照护士随机抽样调查的458家医院的二次数据，这些数据来自2006年调查的23,650名护士以及2016年调查的14,935名护士。
在这10年期间，大多数医院的工作环境得到改善，护士人员配备更好，漏护情况更多。在工作环境或护士人员配备得到改善的医院中，漏护的发生率和频率显著下降。工作环境变化对漏护的影响大于护士人员配备变化的影响。
医院工作环境和人员配备的变化会影响漏护情况。
工作环境和人员配备的调整是减轻护理缺陷的策略。护士管理者应调查工作环境以找出薄弱环节。
