Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis
Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis
复制标题
医院护理组织因素、未完成护理和护士职业倦怠对患者安全的预测作用：结构方程模型分析
DOI：
10.1016/j.ijnurstu.2018.05.005
复制
发表时间：
2018-10-01
影响因子：
8.1
通讯作者：
You, Liming
中科院分区：
文献类型：
--
作者：
Liu, Xu;Zheng, Jing;You, Liming
背景：促进患者安全是包括中国在内的世界各国医疗保健系统最重要的目标和挑战之一。Donabedian的结构-过程-结果模型表明，病人安全受医院护理组织因素和护理过程的影响。然而，研究是必要的，以明确了解的机制，患者安全受到影响，以指导practice.Objective：本研究的目的是探讨医院护理工作环境，工作量，护理未完成，护士职业倦怠对patientsafety.Design的影响：这是一个横断面研究，在2014年在广东省的23家医院进行。方法：采用护理工作指数中的实践环境量表对111个随机抽样的内、外科单位的1542名直接护理护士的工作环境进行调查分析。以日班单位、护患比和护士完成的非专业任务为测量指标。护理未完成的12个项目解决必要的护理活动。采用Maslach职业倦怠量表-人类服务调查表中的情绪耗竭分量表测量护士职业倦怠。患者安全性通过三个项目来衡量，表明护士对患者整体安全性的看法，并通过九个项目来衡量患者不良事件。采用结构方程模型对工作环境和工作量通过护理未完成和护士职业倦怠对病人安全的直接和间接影响进行了验证。更好的工作环境与更好的患者安全直接或间接相关。较低的工作量主要与更好的患者安全间接相关。结论：改善工作环境、增加护士人力配置、提供足够的支持让护士花更多的时间直接照顾病人，将有利于病人安全的改善。
Background: Promotion of patient safety is among the most important goals and challenges of healthcare systems worldwide in countries including China. Donabedian's Structure-Process-Outcome model implies that patient safety is affected by hospital nursing organizational factors and nursing care process. However, studies are imperative for a clear understanding about the mechanisms by which patient safety is affected to guide practice.Objective: The objective of this study was to explore the impact of hospital nursing work environment, workload, nursing care left undone, and nurse burnout on patient safety.Design: This was a cross-sectional study conducted in 23 hospitals in Guangdong province, China in 2014. Data from nurses (n = 1542) responsible for direct care on 111 randomly sampled medical and surgical units were analyzed.Methods: Work environment was measured by the Practice Environment Scale of Nursing Work Index. Workload was measured by day shift unit patient-nurse ratio and non-professional tasks conducted by nurses. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse burnout was measured by the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey. Patient safety was measured by three items indicating nurses' perception of overall patient safety and nine items addressing patient adverse events. Structural equation modeling was used to examine a hypothesized model that supposed work environment and workload have both direct and indirect effects on patient safety through nursing care left undone and nurse burnout.Results: The findings generally supported the hypothesized model. Better work environment was associated with better patient safety both directly and indirectly. Lower workload primarily indirectly related to better patient safety. Nursing care left undone and nurse burnout were mediators negatively associated with patient safety.Conclusions: Improving work environment, increasing nurse staffing levels, and providing sufficient support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement.