중환자실에서 간호인력확보수준과 환자 예후와의 상관성
The Association of Nurse Staffing Levels and Patient Outcome in Intensive Care Units
2
조회
0
다운로드
9
인용
0
참고문헌
키워드
초록
Nurses play a crucial role in providing high-quality care in intensive care units (ICU). Previous studies have shown an association between nurse staffing levels and outcome of critically ill patients. Increasing nurse staffing levels in ICU has been recommended to improve the outcome of critically ill patients. However, nursing staff shortages associated with decreased budgets may prevent adequate nurse-to-patient ratios although there lies increasing needs for critical care. Several studies have suggested that higher nurse staffing level is associated with favorable patient outcome, including mortality, length of stay, and infections, but some of studies did not find an association between nurse staffing and patient outcome. Although there are some controversies in the associations between nurse staffing levels and patient outcome, it is difficult to apply such effect as compared with other developed countries in North American and Europe as the nurse-to-patient ratio in Korea’s ICU is relatively low. By studying the nurse staffing effects for patient outcome from the Korea ICU, it is found that higher nurse staffing level is associated with improved patient mortality. This finding may suggest that a shortage of nursing staff is currently a serious issue for caring of critically ill patients in Korea.
Abstract
Nurses play a crucial role in providing high-quality care in intensive care units (ICU). Previous studies have shown an association between nurse staffing levels and outcome of critically ill patients. Increasing nurse staffing levels in ICU has been recommended to improve the outcome of critically ill patients. However, nursing staff shortages associated with decreased budgets may prevent adequate nurse-to-patient ratios although there lies increasing needs for critical care. Several studies have suggested that higher nurse staffing level is associated with favorable patient outcome, including mortality, length of stay, and infections, but some of studies did not find an association between nurse staffing and patient outcome. Although there are some controversies in the associations between nurse staffing levels and patient outcome, it is difficult to apply such effect as compared with other developed countries in North American and Europe as the nurse-to-patient ratio in Korea’s ICU is relatively low. By studying the nurse staffing effects for patient outcome from the Korea ICU, it is found that higher nurse staffing level is associated with improved patient mortality. This finding may suggest that a shortage of nursing staff is currently a serious issue for caring of critically ill patients in Korea.
참고문헌 (36)
- Pronovost PJ, "Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review", JAMA, 288, pp.2151~2162 (2002)
- Wallace DJ, "Nighttime intensivist staffing and mortality among critically ill patients", N Engl J Med, 366, pp.2093~2101 (2012)
- Kim JH, "Influence of full-time intensivist and the nurse-to-patient ratio on the implementation of severe sepsis bundles in Korean intensive care units", J Crit Care, 27(414), pp.e11~e21 (2012)
- Cho SH, "Bed-to-nurse ratios, provision of basic nursing care, and in-hospital and 30-day mortality among acute stroke patients admitted to an intensive care unit: cross-sectional analysis of survey and administrative data", Int J Nurs Stud, 46, pp.1092~1101 (2009)
- Kane RL, "Wilt TJ : The association of registered nurse staffing levels and patient outcomes : systematic review and meta-analysis", Med Care, 45, pp.1195~1204 (2007)
- Beckmann U, "Problems associated with nursing staff shortage: an analysis of the first 3600 incident reports submitted to the Australian Incident Monitoring Study (AIMS-ICU)", Anaesth Intensive Care, 26, pp.396~400 (1998)
- Offenstadt G, "Intensive care medicine in Europe", Crit Care Clin, 22, pp.425~432 (2006)
- McGahan M, "Winner ACCCN Best Nursing Review Paper 2011 sponsored by Elsevier: Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit: a literature review", Aust Crit Care, 25, pp.64~77 (2012)
- Numata Y, "Nurse staffing levels and hospital mortality in critical care settings: literature review and meta-analysis", J Adv Nurs, 55, pp.435~448 (2006)
- West E, "Nursing resources and patient outcomes in intensive care: a systematic review of the literature", Int J Nurs Stud, 46, pp.993~1011 (2009)
- Cho SH, "Nurse staffing and patient mortality in intensive care units", Nurs Res, 57, pp.322~330 (2008)
- Stone PW, "Nurse working conditions and patient safety outcomes", Med Care, 45, pp.571~578 (2007)
- Person SD, "Nurse staffing and mortality for Medicare patients with acute myocardial infarction", Med Care, 42, pp.4~12 (2004)
- Tucker J, "Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation", Lancet, 359, pp.99~107 (2002)
- Tarnow-Mordi WO, "Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit", Lancet, 356, pp.185~189 (2000)
- Kiekkas P, "et al : Association between nursing workload and mortality of intensive care unit patients", J Nurs Scholarsh, 40, pp.385~390 (2008)
- Metnitz PG, "More interventions do not necessarily improve outcome in critically ill patients", Intensive Care Med, 30, pp.1586~1593 (2004)
- Dimick JB, "Effect of nurse-to-patient ratio in the intensive care unit on pulmonary complications and resource use after hepatectomy", Am J Crit Care, 10, pp.376~382 (2001)
- Amaravadi RK, "ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy", Intensive Care Med, 26, pp.1857~1862 (2000)
- Pronovost PJ, "Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery", Eff Clin Pract, 4, pp.199~206 (2001)
- Van den Heede K, "The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: analysis of administrative data", Int J Nurs Stud, 46, pp.796~803 (2009)
- Dancer SJ, "MRSA acquisition in an intensive care unit", Am J Infect Control, 34, pp.10~17 (2006)
- Halwani M, "Cross-transmission of nosocomial pathogens in an adult intensive care unit: incidence and risk factors", J Hosp Infect, 63, pp.39~46 (2006)
- Blatnik J, "Propagation of methicillin-resistant Staphylococcus aureus due to the overloading of medical nurses in intensive care units", J Hosp Infect, 63, pp.162~166 (2006)
- Blot SI, "EU-VAP", CAP Study Group: Patient to nurse ratio and risk of ventilator-associated pneumonia in critically ill patients, 2011, pp.20, e1~e9
- Shuldham C, "The relationship between nurse staffing and patient outcomes: a case study", Int J Nurs Stud, 46, pp.986~992 (2009)
- Hugonnet S, "Staffinglevel: a determinant of late-onset ventilator-associated pneumonia", Crit Care, 11, pp.R80~ (2007)
- Dang D, "Postoperative complications: does intensive care unit staff nursing makea difference?", Heart Lung, 31, pp.219~228 (2002)
- Hugonnet S, "The effect of workload on infection risk in critically ill patients", Crit Care Med, 35, pp.76~81 (2007)
- Hugonnet S, "Nurse staffing level and nosocomial infections: empirical evaluation of the case-crossover and case-time-control designs", Am J Epidemiol, 165, pp.1321~1327 (2007)
- Alonso-Echanove J, "Effect of nurse staffing and antimicrobial- impregnated central venous catheters on the risk for bloodstream infections in intensive care units", Infect Control Hosp Epidemiol, 24, pp.916~925 (2003)
- Needleman J, "Nurse-staffing levels and the quality of care in hospitals", N Engl J Med, 346, pp.1715~1722 (2002)
- Cho SH, "The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs", Nurs Res, 52, pp.71~79 (2003)
- Unruh L, "Licensed nurse staffing and adverse events in hospitals", Med Care, 41, pp.142~152 (2003)
- Marcin JP, "Nurse staffing and unplanned extubation in the pediatric intensive care unit", Pediatr Crit Care Med, 6, pp.254~257 (2005)
- Phua J, "MOSAICS Study Group: Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study", BMJ, 342, pp.d3245~ (2011)