Section of Hygiene and Public Health, Università Politecnica delle Marche, Ancona, Italy.
Geriatrics, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano (PU), Italy.
PLoS One. 2021 Apr 15;16(4):e0249630. doi: 10.1371/journal.pone.0249630. eCollection 2021.
There is growing evidence about the role of nurses in patient outcomes in several healthcare settings. However, there is still a lack of evidence about the transitional care setting. We aimed to assess the association between patient characteristics identified in a multidimensional nursing assessment and outcomes of mortality and acute hospitalization during community hospital stay.
A retrospective observational study was performed on patients consecutively admitted to a community hospital (CH) in Loreto (Ancona, Italy) between January 1st, 2018 and May 31st, 2019. The nursing assessment included sociodemographic characteristics, functional status, risk of falls (Conley Score) and pressure damage (Norton scale), nursing diagnoses, presence of pressure sores, feeding tubes, urinary catheters or vascular access devices and comorbidities. Two logistic regression models were developed to assess the association between patient characteristics identified in a multidimensional nursing assessment and outcomes of mortality and acute hospitalization during CH stay.
We analyzed data from 298 patients. The mean age was 83 ± 9.9 years; 60.4% (n = 180) were female. The overall mean length of stay was 42.8 ± 36 days (32 ± 32 days for patients who died and 33.9 ± 35 days for patients who had an acute hospitalization, respectively). An acute hospitalization was reported for 13.4% (n = 40) of patients and 21.8% (n = 65) died. An increased risk of death was related to female sex (OR 2.25, 95% CI 1.10-4.62), higher Conley Score (OR 1.19; 95% CI 1.03-1.37) and having a vascular access device (OR 3.64, 95% CI 1.82-7.27). A higher Norton score was associated with a decreased risk of death (OR 0.71, 95% CI 0.62-0.81). The risk for acute hospitalization was correlated with younger age (OR 0.94, 95% CI 0.91-0.97), having a vascular access device (OR 2.33, 95% CI 1.02-5.36), impaired walking (OR 2.50, 95% CI 1.03-6.06) and it is inversely correlated with a higher Conley score (OR 0.84, 95% CI 0.77-0.98).
Using a multidimensional nursing assessment enables identification of risk of nearness of end of life and acute hospitalization to target care and treatment. The present study adds further knowledge on this topic and confirms the importance of nursing assessment to evaluate the risk of patients' adverse outcome development.
越来越多的证据表明，在多个医疗保健环境中，护士在患者结局方面发挥着重要作用。然而，在过渡性护理环境方面，仍缺乏证据。我们旨在评估多维护理评估中确定的患者特征与社区住院期间的死亡率和急性住院之间的关系。
对 2018 年 1 月 1 日至 2019 年 5 月 31 日期间连续入住洛雷托社区医院（意大利安科纳）的患者进行了回顾性观察性研究。护理评估包括社会人口统计学特征、功能状态、跌倒风险（康利评分）和压疮风险（诺顿量表）、护理诊断、压疮、喂养管、导尿管或血管通路装置的存在以及合并症。开发了两个逻辑回归模型来评估多维护理评估中确定的患者特征与社区住院期间死亡率和急性住院之间的关系。
我们分析了 298 名患者的数据。平均年龄为 83 ± 9.9 岁；60.4%（n=180）为女性。总体平均住院时间为 42.8 ± 36 天（死亡患者为 32 ± 32 天，急性住院患者为 33.9 ± 35 天）。报告了 13.4%（n=40）的患者发生急性住院，21.8%（n=65）死亡。女性（OR 2.25，95%CI 1.10-4.62）、较高的康利评分（OR 1.19；95%CI 1.03-1.37）和血管通路装置（OR 3.64，95%CI 1.82-7.27）与死亡风险增加相关。较高的诺顿评分与降低的死亡风险相关（OR 0.71，95%CI 0.62-0.81）。急性住院的风险与年龄较小（OR 0.94，95%CI 0.91-0.97）、血管通路装置（OR 2.33，95%CI 1.02-5.36）、行走障碍（OR 2.50，95%CI 1.03-6.06）相关，与较高的康利评分呈负相关（OR 0.84，95%CI 0.77-0.98）。
使用多维护理评估可以识别接近生命终点和急性住院的风险，从而针对护理和治疗进行定位。本研究进一步增加了这方面的知识，并证实了护理评估在评估患者不良结局发展风险方面的重要性。
