Effects of Nurse Staffing Ratios on Patient Mortality in Taiwan Acute Care Hospitals: A Longitudinal Study

台灣急性醫院病房護理人力配置對住院病人死亡率影響之縱貫研究

梁亞文(Yia-Wun Liang) ； 蔡淑鳳(Shwu-Feng Tsay) ； 陳文意(Wen-Yi Chen)

《The Journal of Nursing Research》 20卷1期 (2012/03) Pp. 1-8

https://doi.org/10.1097/JNR.0b013e3182466ddc

摘要

背景 台灣護理人員的工作負荷約為美國等其他開發國家護理人員的2─7倍。研究指出，護理人員工作負荷過重是病人可預防死亡的原因之一，然而，台灣迄今未見護理人力對病人死亡影響之研究。目的 探討台灣急性醫院病房護理人力配置對病人死亡率的影響。方法 本研究以2006年底健保特約並通過醫院評鑑地區教學醫院層級以上之441家西醫院為研究母群體，透過分層隨機抽樣，選取32家醫院108個病房，連續收集7個月的資料。在控制醫院屬性及病人嚴重度後，以廣義估計方程式估計logistic模型，藉以檢視護理人力配置對病人結果的影響。結果 高病護比病房相對於低病護比病房，發生死亡事件的母體平均勝算比為3.617（95% CI= [1.930, 6.776]），意謂著高病護比病房發生死亡事件的風險將高於低病護比病房。結論 護理人力配置影響病人結果，面對護理人力配置不當的困境，政策制定者應建立以班別為基礎的護理人力配置標準。此外，除考量護理人數外，也應將其他護理人力特性（如學歷）一併納入考量。

關鍵字

護理人力配置 ； 病人死亡率 ； 廣義估計方程式

並列摘要

Background: The nurse workload in Taiwan averages two to seven times more than that in the United States and other developed countries. Previous studies have indicated heavy nursing workload as an underlying cause of preventable patient death. No studies have yet explored the relationship between nurse staffing ratio and patient mortality in Taiwan.Purpose: This study explored the effect of nurse staffing ratios on patient mortality in acute care hospitals in Taiwan and considered the implications in terms of policy.Methods: Using stratified random sampling, 108 hospital nursing units in 32 of Taiwan's 441 accredited Western medicine district/regional hospitals and medical centers were included in the study. Variables were retrospectively measured from 108 wards by using monthly data during a 7-month period. A generalized estimating equation logistic model was used to obtain more precise estimates of the nurse staffing effect by controlling for hospital characteristic and patient acuity variables.Results: The population-averaged odds ratio for the incidence of death between the low and high patient-nurse ratio groups was 3.617 (95% CI = [1.930, 6.776]). The risk of death in the high patient-nurse ratio group was significantly higher than in the low patient-nurse ratio group.Conclusions: Nurse staffing levels affect patient outcomes. Faced with the problem of inadequate nurses for hospital healthcare needs, Taiwanese policymakers should work to implement a legislatively mandated minimum patient-nurse ratio on a shift-by-shift basis to regulate nurse staffing. In setting guidelines for nurse staffing, policymakers must consider nursing staff characteristics in addition to the number of nurses.

並列關鍵字

nurse staffing ratio ； patient mortality ； generalized estimating equation (GEE)

參考文獻

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