Impact of Nurse Work Environment and Staffing on Hospital Nurse and Quality of Care in Thailand
Impact of Nurse Work Environment and Staffing on Hospital Nurse and Quality of Care in Thailand
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DOI：
10.1111/j.1547-5069.2011.01419.x
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发表时间：
2011-12-01
影响因子：
3.4
通讯作者：
Aiken, Linda H.
中科院分区：
文献类型：
--
作者：
Nantsupawat, Apiradee;Srisuphan, Wichit;Aiken, Linda H.
目的：探讨护士工作环境和人员配置对护士工作满意度、职业倦怠和护理质量的影响。设计：2007年泰国护士调查的二次数据分析。方法：样本包括5247名护士，他们为泰国39家公立医院的患者提供直接护理。采用多变量logistic回归估计护士工作环境和人员配置对护理结果和护理质量的影响。结果：护士平均每人照顾10名病人。马斯拉克职业倦怠量表（Maslach burnout Inventory）显示，41%的护士职业倦怠得分较高；28%的护士对自己的工作不满意；27%的人认为护理质量一般或较差。在医院层面，在控制护士特征（年龄、住院年数）后，每增加一名护士的工作量，护士报告情绪高度衰竭的几率增加2%（优势比[OR] 1.02； 95%可信区间[CI] 1.00-1.03; p < 0.05）。报告良好工作环境的护士与报告不良工作环境的护士相比，报告良好或差护理质量的可能性约低30% （OR 0.69; 95% CI 0.48-0.98; p < 0.05）。每增加一名护士的工作量，护士报告护理质量为一般或较差的几率增加4% （or 1.04; 95% CI 1.02-1.05; p < 0.001）。结论：改善泰国医院的护士工作环境和护士人员配备有望减少护士倦怠，从而提高医院床边的护士保留率，并有可能提高护理质量。临床意义：护士应与管理层和决策者合作，在世界各地的医院实现安全的人员配备水平和良好的工作环境。
Purpose: To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care.Design: Secondary data analysis of the 2007 Thai Nurse Survey.Methods: The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care.Findings: Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p < .05). Nurses who reported favorable work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p < .05) compared with nurses who reported unfavorable work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p < .001).Conclusions: Improving nurse work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care.Clinical Relevance: Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world.