敏锐度、护士人员配备与劳动力、护理缺失及患者结局：一项科室层面的描述性比较。
Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster-unit-level descriptive comparison.
作者信息
Juvé-Udina Maria-Eulàlia, González-Samartino Maribel, López-Jiménez Maria Magdalena, Planas-Canals Maria, Rodríguez-Fernández Hugo, Batuecas Duelt Irene Joana, Tapia-Pérez Marta, Pons Prats Mònica, Jiménez-Martínez Emilio, Barberà Llorca Miquel Àngel, Asensio-Flores Susana, Berbis-Morelló Carme, Zuriguel-Pérez Esperanza, Delgado-Hito Pilar, Rey Luque Óscar, Zabalegui Adelaida, Fabrellas Núria, Adamuz Jordi
机构信息
Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.
Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.
出版信息
J Nurs Manag. 2020 Nov;28(8):2216-2229. doi: 10.1111/jonm.13040. Epub 2020 Jun 19.
AIM
To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters.
BACKGROUND
Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood.
METHOD
Descriptive design with data from four unit-clusters: medical, surgical, combined and step-down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse-sensitive outcomes.
RESULTS
Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters.
CONCLUSION
Patient acuity is similar among unit-clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit-clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards.
IMPLICATIONS FOR NURSING MANAGEMENT
Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.
目的
比较医院科室集群之间的患者 acuity、护士配备与人力、遗漏的护理服务以及患者结局。
背景
acuity、护士配备与人力、遗漏的护理服务以及患者结局之间的关系尚未完全明晰。
方法
采用描述性设计，数据来自四个科室集群：内科、外科、综合科室和逐步降级护理单元。运用描述性统计方法比较 acuity、护士配备覆盖率、教育程度和专业技能、遗漏的护理服务以及选定的护士敏感结局。
结果
普通（内科、外科和综合）病房的患者 acuity 与逐步降级护理单元相似，每位患者每天平均需要 5.6 小时的注册护士护理。在普通病房，每位患者每天可获得的注册护士护理时长仅达到满足患者需求所需时长的 50%。各科室集群之间的人力指标相当，平均遗漏的护理服务为 21%。不同科室集群的患者结局存在差异。
结论
各科室集群之间的患者 acuity 相似，但普通病房的护士配备覆盖率减半。虽然各科室集群之间的注册护士教育程度、专业技能和遗漏的护理服务相当，但普通病房的死亡率、皮肤损伤以及家属同情疲劳风险率更高。
对护理管理的启示
护士长在敦促政策制定者解决普通病房结构性人员短缺问题以最大化患者安全结局方面发挥着关键作用。
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