Jiaqian Li1, Xinjuan Wu1, Zhen Li1, Xinmei Zhou2, Jing Cao1, Zhaoxia Jia3, Xia Wan2, Jing Jiao1, Ge Liu1, Ying Liu1, Fangfang Li1, Baoyun Song4, Jingfen Jin5, Yilan Liu6, Xianxiu Wen7, Shouzhen Cheng8. 1. Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China. 2. Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China. 3. Department of Information and Statistics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China. 4. Department of Nursing, Henan Provincial People's Hospital, Zhengzhou, China. 5. Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China. 6. Department of Nursing, Wuhan Union Hospital, Wuhan, China. 7. Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China. 8. Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Abstract
BACKGROUND: Being bedridden, which is a common clinical phenomenon, causes a series of complications related to immobilization. Effective management of immobility complications requires a reasonable allocation of nursing resources. Unit-level evidence about the relationship between nursing resources and immobility complications is lacking. OBJECTIVES: To gain insight into nursing resources in China and explore the relationship between nursing resources and the incidence of major immobility complications among bedridden patients. The major immobility complications included in our study were pressure ulcers, deep vein thrombosis, pneumonia and urinary tract infection. DESIGN: A nationwide, multicenter, cross-sectional survey. SETTING: From November 2015 to June 2016, 18 hospitals (six tertiary and 12 secondary) from six provinces and cities in different geographic regions (eastern, southern, western, northern and central) in China participated in our study. PARTICIPANT: Intensive care units, internal medicine and surgery wards with high proportions of bedridden patients were chosen as investigation sites. Of the total of 23,637 available patients in the selected wards, 19,530 were recruited. METHODS: Data on nursing resources and ward characteristics were collected mainly by questionnaire. The incidence of major immobility complications among bedridden patients was measured by trained investigators. Data on patient characteristics were collected from the patient record system of each hospital. Multilevel regression analysis was used to estimate the impact of nursing resources on the incidence of major immobility complications, adjusting for patient and ward characteristics. RESULTS: The study included 23,637 patients in 213 wards, and 19,530 were recruited. The incidence of the four complications was 0.77% (pressure ulcers), 0.82% (deep vein thrombosis), 3.39% (pneumonia) and 0.86% (urinary tract infection), and the overall incidence of major immobility complications was 5.41%. The incidence of major immobility complications was higher in wards not attaining the target bed-to-nurse ratios than in those that met these criteria (β = 0.44, 95% confidence interval [CI]: 0.02-0.87; OR = 1.553, 95% CI: 1.002-2.387). The incidence of major immobility complications was negatively associated with the proportion of nurses with intermediate or senior job titles (β = -2.12, 95% CI: -3.78 to -0.45; OR = 0.120, 95% CI: 0.023-0.638). However, the incidence of major immobility complications was unexpectedly positively associated with the proportion of nurses with a bachelor's degree or higher (β = 1.06, 95% CI: 0.31-1.81; OR = 2.886, 95% CI: 1.363-6.110). CONCLUSIONS: Sufficient nurse staffing and higher professional titles of nurses might contribute to reducing the incidence of major immobility complications. Nurse experience was not related to the incidence of major immobility complications. However, the association between nurse education level and the incidence of major immobility complications requires further investigation. IMPLICATIONS FOR NURSING MANAGEMENT: More nurses,especially nurses with higher professional titles may reduce the incidence of major immobility complications.
BACKGROUND: Being bedridden, which is a common clinical phenomenon, causes a series of complications related to immobilization. Effective management of immobility complications requires a reasonable allocation of nursing resources. Unit-level evidence about the relationship between nursing resources and immobility complications is lacking. OBJECTIVES: To gain insight into nursing resources in China and explore the relationship between nursing resources and the incidence of major immobility complications among bedridden patients. The major immobility complications included in our study were pressure ulcers, deep vein thrombosis, pneumonia and urinary tract infection. DESIGN: A nationwide, multicenter, cross-sectional survey. SETTING: From November 2015 to June 2016, 18 hospitals (six tertiary and 12 secondary) from six provinces and cities in different geographic regions (eastern, southern, western, northern and central) in China participated in our study. PARTICIPANT: Intensive care units, internal medicine and surgery wards with high proportions of bedridden patients were chosen as investigation sites. Of the total of 23,637 available patients in the selected wards, 19,530 were recruited. METHODS: Data on nursing resources and ward characteristics were collected mainly by questionnaire. The incidence of major immobility complications among bedridden patients was measured by trained investigators. Data on patient characteristics were collected from the patient record system of each hospital. Multilevel regression analysis was used to estimate the impact of nursing resources on the incidence of major immobility complications, adjusting for patient and ward characteristics. RESULTS: The study included 23,637 patients in 213 wards, and 19,530 were recruited. The incidence of the four complications was 0.77% (pressure ulcers), 0.82% (deep vein thrombosis), 3.39% (pneumonia) and 0.86% (urinary tract infection), and the overall incidence of major immobility complications was 5.41%. The incidence of major immobility complications was higher in wards not attaining the target bed-to-nurse ratios than in those that met these criteria (β = 0.44, 95% confidence interval [CI]: 0.02-0.87; OR = 1.553, 95% CI: 1.002-2.387). The incidence of major immobility complications was negatively associated with the proportion of nurses with intermediate or senior job titles (β = -2.12, 95% CI: -3.78 to -0.45; OR = 0.120, 95% CI: 0.023-0.638). However, the incidence of major immobility complications was unexpectedly positively associated with the proportion of nurses with a bachelor's degree or higher (β = 1.06, 95% CI: 0.31-1.81; OR = 2.886, 95% CI: 1.363-6.110). CONCLUSIONS: Sufficient nurse staffing and higher professional titles of nurses might contribute to reducing the incidence of major immobility complications. Nurse experience was not related to the incidence of major immobility complications. However, the association between nurse education level and the incidence of major immobility complications requires further investigation. IMPLICATIONS FOR NURSING MANAGEMENT: More nurses,especially nurses with higher professional titles may reduce the incidence of major immobility complications.
Authors: Remy Cardoso; Vitor Parola; Hugo Neves; Rafael A Bernardes; Filipa Margarida Duque; Carla A Mendes; Mónica Pimentel; Pedro Caetano; Fernando Petronilho; Carlos Albuquerque; Liliana B Sousa; Cândida Malça; Rúben Durães; William Xavier; Pedro Parreira; João Apóstolo; Arménio Cruz Journal: Int J Environ Res Public Health Date: 2022-05-25 Impact factor: 4.614