背景：通过建立更安全的医疗体系，在不影响护士工作成果的前提下，提高护理质量是包括中国在内的全球普遍关注的问题。目前的证据大多来自于西方国家的横断面研究,这限制了因果关系和概括的推论。
目的：这项纵向研究的目的是比较护理质量的变化，护士工作成果，护理工作环境,非专业任务，2014年至2018年期间，中国急症医院的护理仍未完成。其次,我们想确定护理工作环境变化的关联，非专业任务，护理与护士工作结果和护理质量无关。
方法：在广东省23家医院的108个成人内科和外科单位进行的前瞻性两阶段小组研究，中国在2014年和2018年重复。
方法：采用护理工作指标的实践环境量表对工作环境进行测量。非专业任务是通过七个项目量表来衡量的，该量表调查了非专业任务的表现和花费的时间。未完成的护理由12项解决必要的护理活动来衡量。护士的工作成果包括职业倦怠，不满,和保留。护理质量通过四个项目来衡量，这些项目指示了由护士（三个项目）和患者（一个项目）评估的整体护理质量。采用线性回归的广义估计方程对数据进行分析。
结果：2018年，与2014年相比，护理工作环境有所改善，非专业工作量的减少幅度最小.未完成的12项护理任务的平均数量从2014年的5.6项增加到6.5项。更少的护士报告工作不满意或打算离开。根据护士和患者的评估，护理质量略有改善。至于医院组织因素的变化对护理质量的影响，更好的护理工作环境与更好的护士工作结果和护理质量相关.更多的非专业任务与更高水平的护士职业倦怠有关。未完成的护理较少与护士评估的护理质量有关。有更多护士经历职业倦怠和不满的单位可能会有较差的护士评估的护理质量。
结论：改善护理工作环境，支持护士从事专业和直接的患者护理，而不是非专业工作，可能有利于护士工作成果和提高护理质量。
BACKGROUND: Strengthening quality of care without compromising nurse job outcomes by building a safer health care system is a common concern worldwide including in
China. Most of the current evidence comes from cross-sectional studies conducted in western countries, which limits inferences of causality and generalization.
OBJECTIVE: The objectives of this longitudinal study were to compare changes in quality of care, nurse job outcomes, nursing work environment, non-professional tasks, and nursing care left undone in acute hospitals in
China between 2014 and 2018. Secondly, we wanted to determine the association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care.
METHODS: A prospective two-stage panel study conducted in 108 adult medical and surgical units from 23 hospitals in Guangdong province,
China in 2014 and repeated in 2018.
METHODS: Work environment was measured by the Practice Environment Scale of the Nursing Work Index. Non-professional tasks were measured with a seven-item scale surveying the performance of and time spent on non-professional tasks. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse job outcomes included burnout, dissatisfaction, and retention. Quality of care was measured by four items indicating overall quality of care as assessed by nurses (three items) and patients (one item). Generalized estimating equations with linear regression were employed to analyze data.
RESULTS: In 2018, compared with 2014, the nursing work environment had improved, and non-professional workloads had decreased minimally. The average number of the 12 nursing care tasks left undone had increased to 6.5 from 5.6 in 2014. Fewer nurses reported job dissatisfaction or intention to leave. Quality of care was improved slightly as assessed by nurses and patients. As for the changes of hospital organizational factors on quality of care, a better nursing work environment was related to better nurse job outcomes and quality of care. More non-professional tasks were related to higher levels of nurse job burnout. Less nursing care left undone was associated with better nurse-assessed quality of care. Units with more nurses experiencing job burnout and dissatisfaction were likely to have poorer nurse-assessed quality of care.
CONCLUSIONS: Improving nursing work environment and supporting nurses to engage in professional and direct patient care as opposed to non-professional work may be beneficial to nurse job outcomes and promote quality of care.
PDF(Sci-hub)