探討護理人力與病患負向結果及死亡率之關係

The Relationships Among the Nurse Staffing, Negative Patient Outcomes and Mortality

由於全球經濟蕭條，各國醫療體系面臨財政困境，造成醫療機構重整和人力緊縮的現象。因財政考量而縮減護理人力的配置，可能影響病人的照顧品質。2002年，台灣全民健保實行總額預算制度，醫療機構面臨更多的重症病人，卻因經濟緊縮，只能精簡護理人力維持營運。為了解護理人力緊縮是否對病人就醫結果造成影響，本文探討近代相關文獻及研究，結果顯示國際間相當著重護理人力和病人安全的研究，發現護理人力不足與病患產生醫療負向結果或死亡有關；但因各篇文獻之研究方法差異及收案侷限，以致無法確切推論各科別護理人力配置比率會提高多少病人死亡率或負向結果發生率；不過，可確認的是合理的護理人力配置對於住院病人安全極為重要。而台灣在此領域的研究卻極為不足，本文建議台灣需更深入此研究探討，以做為政府訂立護理人力政策及預防病人就醫風險之依據。

Since the depression of the global economy, the health-care systems of both western and eastern countries have encountered financial problems, resulting in hospital reorganizations and downsizing of health-care staffs. This reduction in nursing manpower may affect the quality of patient care. In 2001, the health-care system in Taiwan began to implement a “Global Budget” project as a National Health Insurance policy designed to control the budget. Although patient acuity has increased, health-care institutions have reduced their nursing staffs in order to continue functioning. This study was conducted to determine whether the downsizing of nursing staffs is associated with negative patient-care outcomes. A search of the international literatures revealed that many studies were conducted to explore the relationships between nursing manpower and patient safety. Most of the western studies proposed that an insufficient nursing staff level was associated with negative patient outcomes, including increased mortality. However, because of the variability of research methods and data-collection limitations of these studies, it is difficult to determine the specific staffing levels in the various nursing units that may negatively affect patient outcomes, and to what extent. Sufficient nursing manpower has been verified to be a significant factor in the safety of hospitalized patients. However, few related studies have been conducted in Taiwan. We suggest that such studies are needed in order to provide accurate information to the government of Taiwan in establishing policies regarding nursing manpower and preventing errors in patient care.