護理人力對病患結果影響之文獻探討

Effect of Nurse Staffing on Patient Outcomes: A Review of the Literature

世界各國均面臨護理人力短缺問題，護理人員因為工作壓力大與工時過長紛紛離開護理工作。台灣的醫療機構為因應全民健保的多項費用抑制措施，護理人力的彈性運用成為重要策略，包括緊縮護理人力、遇缺不補、以約聘僱與部分工時型式處理護理人力資源問題。然而國內探討護理人力對病患結果影響之研究較為少見，有鑑於此，本文簡要回顧護理人力分類與台灣護理人力概況，檢視國內外護理人力配置規定，再對護理人力與病患結果的研究進行回顧，期盼能做為國內未來相關研究的參考。本研究的回顧顯示護理人力不足與住院病人的感染率、死亡率、跌倒、壓瘡以及病人和家屬的滿意度有關。病人發生不良事件不僅延長病人住院天數，也提高病人安全上的風險，導致醫院成本及總體醫療支出的增加。現有的證據顯示臨床護理人力配置與病患照護結果具有高度相關。

Staff shortages present nurses with ever increasing levels of stress and working hours. This has resulted in a corresponding increase in talent flight away from the nursing profession. Responding to financial constraints imposed by the Bureau of National Health Insurance (NHI), Taiwan hospitals have reduced nursing staff numbers and recruited nurses at lower levels of competencies and experience. However, few studies have explored the impact of nurse staffing on patient outcomes in Taiwan. Accordingly, we review relevant literature on nurse classifications, the current status of Taiwan nursing manpower, Taiwan and other national regulations on nursing staffing, and the impact of nursing staffing on patient outcomes in an effort to facilitate future study. Our literature review demonstrated that insufficient nursing staffing relates significantly to rates of nosocomial infections, patient mortality, patient falls, pressure ulcers, and rates of patient and family satisfaction. Insufficient nurse staffing leads to increases in adverse patient events, prolonged average hospital stay lengths, and total healthcare expenditures. Evidence shows that nurse staffing is closely linked to patient outcomes.