每个护士与护理活动得分的比率与住院死亡率相关，而护患比则不是

Abstract

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.

摘要翻译（仅供参考）

目标： 

研究表明，护理工作量与死亡率之间的关联结果相互矛盾。这些研究中的大多数将工作量表示为患者与护士的比率；然而，这并没有考虑到一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进行量化。我们分别调查了每名护士的护理活动评分、每名护士的患者比与 ICU 住院死亡率之间的关联。

设计： 

全国重症监护评估数据库的回顾性分析。

环境： 

十五个荷兰重症监护病房。

患者： 

包括在 2016 年 1 月 1 日至 2018 年 1 月 1 日期间在 15 家荷兰 ICU 入住并注册 ICU 护士的所有 ICU 患者。使用逻辑回归模型分析平均或第 1 天患者/护士比率和每个护士比率的护理活动评分与院内死亡率之间的关联。

干预措施： 

没有。

测量和主要结果： 

每名护士的平均护理活动得分和第 1 天每名护士的护理活动得分均大于 41，与更高的院内死亡率相关（优势比分别为 1.19 和 1.17）。在病例组合调整后，每个护士的平均护理活动评分和第 1 天每个护士的护理活动评分均大于 61 的护理活动评分与住院死亡率之间的关联仍然显着（优势比， 1.29 和 1.26）。患者/护士比率与院内死亡率无关。

结论： 

每个护士比率较高的护理活动评分与较高的院内死亡率相关。相比之下，在荷兰，没有发现患者/护士比率与院内死亡率之间存在关联。因此，我们得出的结论是，更重要的是关注患者产生的护理工作量，而不是护士必须在 ICU 中照顾的患者数量。

原文链接：

doi：10.1097/CCM.0000000000004005

THE

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