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护患比|护患比和护理复杂性：医疗机构面临的挑战( 二 )


In terms of nurse to patient ratio, a recent study carried out in Spain showed an average of 11 patients per nurse during a shift.11 This figure is similar to that obtained in the RN4CAST study, which found that the average ratio in European hospitals was 8.3 patients per nurse, and Spain was the country with the highest ratio.7, 12 This figure increased during the night shift, reaching up to 32 patients. There are data to indicate that it is during night shifts when patient care is at greater risk because some cognitive capacities and strength-based performance abilities are impaired.12 This situation implies an increased risk of adverse events and decreased quality of patient care. After this study, a bill on nurse ratios to ensure patient safety in healthcare centres and other settings was passed in Spain, which states that a maximum of 6 patients should be assigned per nurse and exceptionally 8, and that this distribution should consider the conditions of the patient, unit, and shift.13
These figures could be correct, because when a nurse is in charge of more than 9 patients during their shift in conventional units, the likelihood of a patient dying during admission increases by 19%; the profile of the patient who dies is over 73 years of age with a hospital stay of more than 15 days.11Dependency on nursing care and NSL are also associated with in-hospital mortality.14
Although the patient should be at the core of the healthcare system, another study showed that only variables linked to hospital organisation and management were associated with the distribution of patients, without considering any patient-specific variables.15 Therefore, we consider it essential to adjust the proportion of nurses to the real needs of patients, such as severity and levels of dependency, to provide quality and safety in patient care in the context of hospital management resource planning models. In other words, adjusting staffing levels not only based on the number of beds, but also on the condition of the people occupying them, factoring in other indicators such as the practice environment.
To conclude, when making decisions about human resources in our healthcare system, the distribution of patients should be based on their care dependency at various levels and not on other variables that do not really demonstrate the workload involved in delivering quality and safe care. Therefore, it is essential to reorganise health policies, placing the patient at the core and meeting their needs for comprehensive care with a care-centred approach.
全文翻译（仅供参考）
当前的 COVID-19 大流行进一步揭示了当今全球和西班牙医疗保健组织面临的护理需求和复杂性。护理复杂性已作为具有相互关联和相互依存要素的指标包含在机构结果分析中。在医院层面，护理复杂性的关键组成部分是医疗机构本身、护士和患者的护理依赖性。
这种情况令人担忧，预计到 2050 年西班牙将成为世界上大多数老龄化人口，65 岁以上人口从 16% 增加到 34%。
关于复杂性的前两个组成部分，组织因素影响医疗质量，特别是与医疗保健专业人员的工作氛围和工作满意度有关。2此外，确保根据对护理实践敏感的结果提供客观的优质护理，即，可以用一组具体的、定义的指标进行评估，这在今天仍然是一个重大挑战。
关于第三个组成部分，人口的护理依赖，我们正面临老龄化社会，预期寿命增加，这将导致急性和慢性疾病的进展。这种情况将导致在不久的将来住院的最依赖护理的人数增加。
在这种情况下，科学证据表明，护士的超负荷工作会导致院内不良事件和死亡率增加。因此，一个关键指标是每家医院的患者与护士比率，在英语文献中称为护理人员配备水平 (NSL)，定义为每班或超过 24 小时工作的护士人数除以同一时期患者占用的床位。然而，尽管许多研究使用该系统来评估医院环境中的比率，因为它既简单又便宜，但它有一定的局限性；例如，它不考虑患者护理的状态和依赖程度。

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