A quantitative systematic review of the association between nurse skill mix and nursing‐sensitive patient outcomes in the acute care setting

To examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals.A quantitative systematic review included studies published in English between January 2000 - September 2018.Cochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix-methods designs were included if the quantitative component met the criteria.The Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument were used. An inverse association was determined when seventy-five percent or more of studies with significant results found this association.Sixty-three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e., higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure-to-rescue; pneumonia; sepsis; urinary tract infection; mortality/30-day mortality; pressure injury; infections and shock/cardiac arrest/heart failure.Nursing skill mix affected 12 patient outcomes. However, further investigation using experimental or longitudinal study designs are required to establish causal relationships. Consensus on the definition of skill mix is required to enable more robust evaluation of the impact of changes in skill mix on patient outcomes.Skill mix is perhaps more important than the number of nurses in reducing adverse patient outcomes such as mortality and failure to rescue, albeit the optimal staffing profile remains elusive in workforce planning.目的: 在于探讨护士技巧组合(注册护士提供的总时数比例)与急性护理医院患者结果之间的联系。 设计: 一项定量系统综述包括2000年1月至2018年9月期间以英语发表的各项研究。 资料来源: 搜索了Cochrane Library、CINAHL Plus with Full Text、MEDLINE、Scopus、Web of Science和Joanna Briggs Institute。纳入了观察性和实验性研究设计。如果定量成分符合标准,则纳入混合方法设计。 综述方法: 使用了Joanna Briggs Institute的系统综述指南及其关键评估工具。当75%或者更多具备显著结果的研究发现这种联系时,就确定了反向关联。 结果: 共纳入了63篇文章。12名患者的结果与护理技巧组合呈负相关(即,较高的护理技能组合与患者结果的改善显著相关)。这些是住院天数;溃疡、胃炎和上消化道出血;急性心肌梗死;约束使用;救援失败;肺炎;败血症;尿路感染;死亡率/30天死亡率;压力性损伤;感染和休克/心脏骤停/心力衰竭。 结论: 护理技巧组合影响了12例患者的结果。然而,需要使用实验性或纵向研究设计来进一步调查,从而建立因果关系。需要就技巧组合的定义达成共识,以便能够更有力地评估技巧组合变化对患者结果的影响。 影响: 在降低死亡率和救援失败等不良患者结果方面,技巧组合可能比护士人数更为重要,尽管最佳的人员配置在人力资源规划中仍然让人难懂。.