Xiangya School of Nursing, Central South University, Hunan, China.
Ingram School of Nursing, McGill University, Quebec, Canada.
Int Nurs Rev. 2020 Sep;67(3):362-371. doi: 10.1111/inr.12587. Epub 2020 May 4.
There have been many single cross-sectional studies on nurse or patient outcomes. However, long-term evidence on improving nurse and patient outcomes is still limited. The High-Quality Care Project is a national project in China for improving nurse and patient outcomes by implementing primary nursing.
(1) To assess the long-term changes in nurse and patient outcomes in the context of the High-Quality Care Project. (2) To explore the potential influences of primary nursing on nurse and patient outcomes based on this study and broader existing evidence.
The data of two cross-sectional studies were used for analysis. The two cross-sectional studies were conducted before (2009) and after (2016) the High-Quality Care Project. A total of 1376 nurses and 904 patients from 40 units of 10 tertiary hospitals were surveyed. Reliable and validated instruments were used to measure nurse and patient outcomes. Multilevel modelling was the main method for data analysis.
Nurses in 2016 were more satisfied than nurses in 2009 with most dimensions of nurse work environment and job satisfaction. However, they were not more satisfied with burnout, global job satisfaction or intention to leave their job. Nurses in 2016 also reported better quality of patient care and patient safety while their patients reported higher patient satisfaction.
The analysis of our results based on existing evidence indicates that primary nursing could be considered as a potentially effective way to improve nurse work environment and patient outcomes. More studies with rigorous study design from micro perspectives would be useful to further explore the direct effects of primary nursing on nurse or/and patient outcomes.
Policymakers, healthcare service leaders and nurse managers should make efforts to provide multi-level supports to cultivate an encouraging environment for nurses to practice primary nursing, because the implementation of primary nursing may improve the nurse work environment and patient outcomes. Furthermore, improving nurse participation in hospital affairs and developing nursing discipline and education for increasing nursing staff resource and nurses' capacity - which all need policy and management supports - are crucial to further improve nurse and patient outcomes.
已有许多关于护士或患者结局的单项横断面研究。然而，关于改善护士和患者结局的长期证据仍然有限。优质护理工程是中国的一项全国性项目，旨在通过实施责任制整体护理来改善护士和患者的结局。
（1）评估优质护理工程背景下护士和患者结局的长期变化。（2）基于本研究和更广泛的现有证据，探讨责任制整体护理对护士和患者结局的潜在影响。
使用两项横断面研究的数据进行分析。这两项横断面研究分别在优质护理工程实施前（2009 年）和实施后（2016 年）进行。共调查了来自 10 家三级医院 40 个科室的 1376 名护士和 904 名患者。采用可靠和有效的工具测量护士和患者的结局。多水平模型是数据分析的主要方法。
与 2009 年相比，2016 年的护士对大多数护士工作环境和工作满意度维度更为满意。然而，他们对工作倦怠、总体工作满意度或离职意愿的满意度并没有提高。2016 年的护士还报告了更好的患者护理质量和患者安全，而他们的患者报告了更高的患者满意度。
基于现有证据分析我们的结果表明，责任制整体护理可被视为改善护士工作环境和患者结局的一种潜在有效方法。从微观角度进行更多设计严谨的研究将有助于进一步探索责任制整体护理对护士或/和患者结局的直接影响。
政策制定者、医疗服务领导者和护士管理者应努力提供多层次的支持，为护士提供一个鼓励实践责任制整体护理的环境，因为实施责任制整体护理可能会改善护士的工作环境和患者的结局。此外，提高护士参与医院事务的程度，发展护理学科和教育，以增加护理人员资源和护士的能力——这都需要政策和管理支持——对于进一步改善护士和患者的结局至关重要。
