中低收入国家急性护理医院环境中的护理缺失：系统评价。
Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review.
机构信息
KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK.
出版信息
Hum Resour Health. 2023 Mar 14;21(1):19. doi: 10.1186/s12960-023-00807-7.
BACKGROUND
Missed nursing care undermines nursing standards of care and minimising this phenomenon is crucial to maintaining adequate patient safety and the quality of patient care. The concept is a neglected aspect of human resource for health thinking, and it remains understudied in low-income and middle-income country (LMIC) settings which have 90% of the global nursing workforce shortages. Our objective in this review was to document the prevalence of missed nursing care in LMIC, identify the categories of nursing care that are most missed and summarise the reasons for this.
METHODS
We conducted a systematic review searching Medline, Embase, Global Health, WHO Global index medicus and CINAHL from their inception up until August 2021. Publications were included if they were conducted in an LMIC and reported on any combination of categories, reasons and factors associated with missed nursing care within in-patient settings. We assessed the quality of studies using the Newcastle Ottawa Scale.
RESULTS
Thirty-one studies met our inclusion criteria. These studies were mainly cross-sectional, from upper middle-income settings and mostly relied on nurses' self-report of missed nursing care. The measurement tools used, and their reporting were inconsistent across the literature. Nursing care most frequently missed were non-clinical nursing activities including those of comfort and communication. Inadequate personnel numbers were the most important reasons given for missed care.
CONCLUSIONS
Missed nursing care is reported for all key nursing task areas threatening care quality and safety. Data suggest nurses prioritise technical activities with more non-clinical activities missed, this undermines holistic nursing care. Improving staffing levels seems a key intervention potentially including sharing of less skilled activities. More research on missed nursing care and interventions to tackle it to improve quality and safety is needed in LMIC. PROSPERO registration number: CRD42021286897.
背景
护理缺失损害了护理标准，最大限度地减少这种现象对于维护足够的患者安全和护理质量至关重要。这一概念是卫生人力资源思维中被忽视的一个方面，在全球 90%的护士短缺都存在于中低收入国家（LMIC）的情况下，这一概念仍然研究不足。我们在这项综述中的目的是记录 LMIC 中护理缺失的流行程度，确定最容易被忽视的护理类别，并总结造成这种情况的原因。
方法
我们进行了一项系统综述，检索了 Medline、Embase、全球卫生、世界卫生组织全球索引医学和 CINAHL，从它们的创建开始，直到 2021 年 8 月。如果研究是在 LMIC 进行的，并报告了任何组合的类别、原因和与住院环境中护理缺失相关的因素，则将其纳入研究。我们使用纽卡斯尔-渥太华量表评估研究的质量。
结果
有 31 项研究符合我们的纳入标准。这些研究主要是横断面研究，来自中上收入国家，主要依赖于护士对护理缺失的自我报告。文献中使用的测量工具及其报告不一致。最常被忽视的护理是包括舒适和沟通在内的非临床护理活动。人员配备不足是被提到的最重要的缺失护理原因。
结论
所有关键的护理任务领域都报告了护理缺失，这威胁到护理质量和安全。数据表明，护士优先考虑技术活动，而更多的非临床活动被忽视，这破坏了整体护理。提高人员配备水平似乎是一项关键干预措施，可能包括分担较少的技能活动。需要在 LMIC 进行更多关于护理缺失和干预措施的研究，以提高质量和安全性。PROSPERO 注册号：CRD42021286897。
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