護理人力資源對病患照護結果之影響

Nursing staffing and patient outcomes on acute care hospital units

莊家綾(Chia-ling Chuang)

指導教授 ： 陳錦杏 ； 梁亞文

中臺科技大學/管理學院/醫護管理研究所/碩士(2009年)

https://doi.org/10.6822/CTUST.2009.00015

摘要

背景及目的
護理人力係指一位護理人員在各班別實際照顧之病人數。目前台灣醫院護理人員照顧病人數是先進國家的2至數倍，造成病人死亡率及可預防意外事件增加，影響醫療品質與病人照顧。爰此，本研究目的在探討護理人力資源對病患照護結果之影響。
方法
本研究為一縱貫性研究，以病房為分析單位；透過結構式問卷收集病房護理人力配置、病患結果、病患嚴重度及醫院特性等資料；以分層隨機抽樣方式選取研究對象；統計分析方法包含描述性分析及階層線性模式。
結果
研究發現全職護理人員增加1人，死亡人數減少0.0098%；非正規護理人力與正規人力比增加1%，死亡人數減少0.00745%；護士護理師比增加1%，死亡人數減少2.6532%；護理職級N3以上增加1%，死亡人數減少0.4617%。
結論
護理人力資源對病患照護結果具有顯著影響。建議衛生主管機關及評鑑單位參考援用以制定合理護理人力配置標準，以提升病人安全。

關鍵字

階層線性迴歸 ； 病患結果 ； 護理人力組合 ； 護理人力配置

並列摘要

Objective:
The purpose of this study was to analyze the association between hospital nursing staffing (i.e., ratio of nurse to patients, skill mix) and outcomes potentially sensitive to nursing (i.e., mortality, medication errors, patient falls, infection, pressure sore) with consideration of variables influencing the primary association.
Study design:
A repeated-measures study was conducted in 33 hospitals, including two medical centers, eighteen regional hospitals, and thirteen district hospitals in Taiwan.
Population studied:
One hundred and eight hospital units from 33 stratified random sampling hospitals in Taiwan were analyzed to explore the relationship between nursing staffing measured at the hospital level and 11 outcomes potentially sensitive to nursing. Data was first analyzed by descriptive information for the 33 hospitals and 108 hospital units in this study. Hierarchical linear models was used to estimate the effects of the nursing staffing on the different dependent variables, while controlling for hospital characteristics and patient acuity level.
Principal finding:
After adjusting for hospital structural characteristics and patient characteristics, we found that nursing staffing on inpatient units in Taiwan hospitals was associated with better clinical outcomes.
Conclusions:
The results of this study suggest that the nursing staffing and the quality of nursing practice are significantly associated. Our findings provide evidence for improvements in nurse-patient ratio in hospitals have the potential to simultaneously increase outcomes potentially sensitive to nursing.

並列關鍵字

HLM ； patient outcome ； nursing mix ； nursing staffing

參考文獻

張芙美（1993）。護理學史。台北：華杏。

楊志良（1996）。健康保險。台北：巨流圖書公司。

謝臥龍（1997）。台灣外籍勞工工作滿意度與生活適應性之探討。中華衛誌，16（4），339-354。

吳肖琪、吳義勇、朱慧凡、林嘉彥、李鐘祥、張錦文、藍忠孚（2002）。我國醫院醫療品質指標使用之情形。醫療品質，2(2)，1-14。

台灣護理教育評鑑委員會（2008）。護理碩博士班評鑑指標共識會議。日期：2008年1月22日。