The Nursing Activities Score Per Nurse Ratio Is Associated With In-Hospital Mortality, Whereas the Patients Per Nurse Ratio Is Not
The Nursing Activities Score Per Nurse Ratio Is Associated With In-Hospital Mortality, Whereas the Patients Per Nurse Ratio Is Not
复制标题
DOI：
10.1097/ccm.0000000000004005
复制
发表时间：
2020-01-01
影响因子：
8.8
通讯作者：
de Keizer, Nicolette
中科院分区：
文献类型：
--
作者：
Margadant, Charlotte;Wortel, Safira;de Keizer, Nicolette
目的：研究表明，护理工作量和死亡率之间的关系存在矛盾的结果。大多数研究将工作量表示为患者/护士比率;然而，这并没有考虑到某些患者比其他患者需要更多的护理时间。护理时间可以通过护理活动评分等工具量化。我们调查了护理活动得分每护士比率的相关性，分别为，患者每护士比率与ICU院内死亡率的相关性。设计：回顾性分析国家重症监护评估数据库。设置：15个荷兰ICU。患者：2016年1月1日至2018年1月1日期间，所有ICU患者入院并在15个荷兰ICU工作的注册ICU护士均被纳入。使用逻辑回归模型分析平均值或第1天患者/护士比率和护理活动评分/护士比率与住院死亡率的相关性。干预措施：无。测量和主要结果：每名护士的护理活动得分比率大于41，第1天每名护士的平均护理活动得分比率以及每名护士的护理活动得分比率均与较高的住院率相关。住院死亡率（比值比分别为1.19和1.17）。病例组合调整后，护理活动得分每护士比率大于61的平均护理活动得分每护士比率以及护理活动得分每护士比率在第1天和住院死亡率之间的关联仍然显着（比值比，分别为1.29和1.26）。患者与护士比率与住院死亡率无关。结论：较高的护理活动评分与较高的住院死亡率相关。相比之下，在荷兰，没有发现患者/护士比率与住院死亡率之间的相关性。因此，我们的结论是，更重要的是把重点放在病人产生的护理工作量，而不是护士在ICU照顾的病人的数量。
Objectives: Studies have shown contradicting results on the association of nursing workload and mortality. Most of these studies expressed workload as patients per nurse ratios; however, this does not take into account that some patients require more nursing time than others. Nursing time can be quantified by tools like the Nursing Activities Score. We investigated the association of the Nursing Activities Score per nurse ratio, respectively, the patients per nurse ratio with in-hospital mortality in ICUs.Design: Retrospective analysis of the National Intensive Care Evaluation database.Setting: Fifteen Dutch ICUs.Patients: All ICU patients admitted to and registered ICU nurses working at 15 Dutch ICUs between January 1, 2016, and January 1, 2018, were included. The association of mean or day 1 patients per nurse ratio and Nursing Activities Score per nurse ratio with in-hospital mortality was analyzed using logistic regression models.Interventions: None.Measurements and Main Results: Nursing Activities Score per nurse ratio greater than 41 for both mean Nursing Activities Score per nurse ratio as well as Nursing Activities Score per nurse ratio on day 1 were associated with a higher in-hospital mortality (odds ratios, 1.19 and 1.17, respectively). After case-mix adjustment the association between a Nursing Activities Score per nurse ratio greater than 61 for both mean Nursing Activities Score per nurse ratio as well as Nursing Activities Score per nurse ratio on day 1 and in-hospital mortality remained significant (odds ratios, 1.29 and 1.26, respectively). Patients per nurse ratio was not associated with in-hospital mortality.Conclusions: A higher Nursing Activities Score per nurse ratio was associated with higher in-hospital mortality. In contrast, no association was found between patients per nurse ratios and in-hospital mortality in The Netherlands. Therefore, we conclude that it is more important to focus on the nursing workload that the patients generate rather than on the number of patients the nurse has to take care of in the ICU.