ICU护士人力配置的组织：定性研究

Abstract

Aims

To examine the organisation of the nursing workforce in intensive care units and identify factors that influence how the workforce operates.

Background

Pre-pandemic UK survey data show that up to 60% of intensive care units did not meet locally agreed staffing numbers and 40% of ICUs were closing beds at least once a week because of workforce shortages, specifically nursing. Nurse staffing in intensive care is based on the assumption that sicker patients need more nursing resource than those recovering from critical illness. These standards are based on historical working, and expert professional consensus, deemed the weakest form of evidence.

Methods

Focus groups with intensive care health care professionals (n = 52 participants) and individual interviews with critical care network leads and policy leads (n = 14 participants) in England between December 2019 and July 2020. Data were analysed using framework analysis.

Findings

Three themes were identified: the constraining or enabling nature of intensive care and hospital structures; whole team processes to mitigate nurse staffing shortfalls; and the impact of nurse staffing on patient, staff and intensive care flow outcomes. Staff made decisions about staffing throughout a shift and were influenced by a combination of factors illuminated in the three themes.

Conclusions

Whilst nurse:patient ratios were clearly used to set the nursing establishment, it was clear that rostering and allocation/re-allocation during a shift took into account many other factors, such as patient and family nursing needs, staff well-being, intensive care layout and the experience, and availability, of other members of the multi-professional team. This has important implications for future planning for intensive care nurse staffing and highlights important factors to be accounted for in future research studies.

Implications for Nursing Management

In order to safeguard patient and staff safety, factors such as the ICU layout need to be considered in staffing decisions and the local business case for nurse staffing needs to reflect these factors. Patient safety in intensive care may not be best served by a blanket ‘ratio’ approach to nurse staffing, intended to apply uniformly across health services.

摘要翻译（仅供参考）

目的

研究重症监护室护理人员的组织，并确定影响护理人员工作方式的因素。

研究背景

英国大流行前的调查数据显示，高达60%的重症监护室没有达到当地约定的人员配置数量，40%的重症监护室由于劳动力短缺，特别是护理人员短缺，每周至少关闭一次病床。重症监护室的护士配置是基于这样的假设，即病情较重的病人比从危重病中恢复的病人需要更多的护理资源。这些标准是基于历史工作和专家的专业共识，被认为是最弱的证据形式。

方法

2019年12月至2020年7月期间，在英格兰与重症监护医护人员进行焦点小组讨论（n = 52名参与者），与重症监护网络负责人和政策负责人进行个别访谈（n = 14名参与者）。采用框架分析法对数据进行分析。

研究结果

确定了三个主题：重症监护和医院结构的限制性或扶持性；缓解护士人员短缺的整个团队过程；以及护士人员配置对患者、员工和重症监护流程结果的影响。工作人员在整个轮班期间对人员配置做出决定，并受到三个主题中所阐明的各种因素的影响。

结论

虽然护士与病人的比例被明确用于确定护理人员的编制，但很明显，轮班和分配/再分配要考虑到许多其他因素，如病人和家属的护理需求、工作人员的福利、重症监护布局和多专业团队其他成员的经验和可用性。这对未来的重症监护护士配置计划有重要意义，并强调了未来研究中需要考虑的重要因素。

对护理管理的影响

为了保障病人和工作人员的安全，在人员配置决策中需要考虑诸如ICU的布局等因素，并且当地的护士配置的商业案例需要反映这些因素。重症监护室的病人安全可能不适合用一揽子 "比率 "的方法来配置护士，因为这种方法旨在统一适用于所有医疗服务。

THE

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