JAMK University of Applied Sciences, Jyväskylä, Finland.
Appl Nurs Res. 2020 Dec;56:151343. doi: 10.1016/j.apnr.2020.151343. Epub 2020 Aug 26.
To measure the role of nurses and midwives in reducing obstetric trauma as a proxy for safety failures during childbirth in member countries of Organization for Economic Co-operation and Development (OECD).
The number of practicing nurses' and midwives' density per 1000 population and the proportion of third- and fourth-degree obstetric trauma during vaginal delivery with instrument (OT) and without instrument (OT) in crude rates per 100 vaginal deliveries for patients aged 15 and over collected from World Development Indicators and OECD Health Statistics in 17 OECD countries during 2010-2017 period. The statistical technique of panel data analysis was applied to estimate the impact of nurses and midwives on improving patient safety during childbirth. The number of physicians per 1000 population, health care expenditure (HCE) per capita and total number of hospital beds per 1000 population were added in data analysis as control variables.
The results of panel co-integration test and dynamic long-run models confirm that there were meaningful relationships from the level of nursing and midwifery staff to reducing OECD's obstetric trauma indicators with long-run magnitudes of -15.8614 for OT and -0.0519 for OT. In addition, the results of panel error-correction model argue that if the long-run relationships between nursing and midwifery staff and obstetric trauma indicators are disturbed by the shortage in the needed nurses and midwives, then it takes at least 25 years for OT and 18 years for OT to reduce and restore back to equilibrium; that is quite a long time.
A higher proportion of nursing and midwifery staff is associated with higher patient safety during childbirth in OECD countries. Overall, our findings alert policy makers to consider the deleterious impacts of shortage in the level of nursing and midwifery staff on declining patient safety during childbirth as well as quality of acute care in OECD.
衡量护士和助产士在减少产科创伤方面的作用，以代表经合组织（OECD）成员国分娩期间安全失败的指标。
从世界发展指标和经合组织卫生统计数据库中收集了 2010-2017 年期间 17 个经合组织国家 15 岁及以上患者每 1000 名人口中执业护士和助产士的人数密度，以及每 100 例阴道分娩中未经器械使用的第三和第四度产科创伤（OT）的粗发生率，以及每 1000 名人口中医生的数量、人均医疗保健支出（HCE）和每 1000 名人口中的总病床数，作为数据分析中的控制变量。
面板协整检验和动态长期模型的结果证实，从护理和助产人员的数量水平来看，与经合组织产科创伤指标之间存在着有意义的关系，其长期幅度分别为 -15.8614 用于 OT 和 -0.0519 用于 OT。此外，面板误差校正模型的结果表明，如果护理和助产人员与产科创伤指标之间的长期关系因护士和助产士短缺而受到干扰，那么至少需要 25 年才能减少并恢复到平衡状态OT 和 18 年用于 OT；这是相当长的一段时间。
在经合组织国家，护士和助产士的比例较高与分娩期间较高的患者安全性相关。总的来说，我们的研究结果提醒决策者考虑护理和助产人员数量不足对 OECD 国家分娩期间患者安全性下降以及急性护理质量的不利影响。
