Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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The Impact of Nurse Staffing Level on In-hospital Death and Infection in Cancer Patients Who Received Surgery

간호사 확보수준이 수술한 암환자의 원내 사망 및 감염에 미치는 영향

  • 김묘경 (서울여자간호대학교 간호학과)
  • Received : 2017.01.06
  • Accepted : 2017.04.07
  • Published : 2017.04.30
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Abstract

This study was conducted to examine the influence of the nurse staffing level on the level of in-hospital death and infection in cancer patients who received surgery. Secondary data were used and the subjects of this study were 24,510 patients who received surgery for six types of cancer with a high postoperative mortality rate in the first half of 2012 at 260 hospitals. Simple logistic and GEE multiple logistic regression analyses were used. After adjusting for the patient and hospital characteristics, a greater likelihood of dying was found in the nurse staffing level 2-3 group (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.00-2.11) and in the level 6-7 group (OR, 3.28; 95% CI, 1.87-5.74) compared to the level 0-1 group. The likelihood of in-hospital infection increased with each additional bed per nurse, being 6.63 times higher (95% CI, 3.00-14.62) in the level 2-3 group, 5.79 times higher (95% CI, 1.88-17.78) in the level 4-5 group, and 8.4 times higher (95% CI, 1.82-38.84) in the level 6-7 group, as compared to the level 0-1 group. A lower nurse staffing level was associated with higher in-hospital death and infection levels. This shows that an appropriate nurse staffing level is associated with superior postoperative cancer patient outcomes. Policies for providing adequate nurse staffing should be maintained for the sake of ensuring improved care quality and patient safety.

본 연구의 목적은 의료기관 간호사 확보수준이 수술한 암환자의 원내 사망과 원내 감염에 어떠한 영향을 미치는지 알아보고자 하였다. 이차자료를 이용하였으며, 2012년 상반기에 260개 의료기관에서 수술 후 사망률이 높은 6개 암으로 수술받은 암환자 24,510명을 대상으로 하였다. 단순 로지스틱 회귀분석과 일반화추정방정식(GEE) 모형을 이용하여 분석하였다. 환자 및 의료기관 특성(기관 종별 유형, 소재지, 수술건수)을 보정 후, 사망 가능성은 간호사 확보수준 0-1등급에 비해 2-3등급 군(odds ratio [OR], 1.46; 95% confidence interval [CI], 1.00-2.11), 6-7등급 군(OR, 3.28; 95% CI, 1.87-5.74)에서 더 높은 것으로 나타났다. 병원 감염이 발생할 가능성은 간호사 1인당 침상수가 하나씩 증가할 때마다 증가하여, 0-1등급 군에 비해 2-3등급 군은 6.63배(95% CI, 3.00-14.62), 4-5등급 군은 5.79배(95% CI, 1.88-17.78), 6-7등급 군은 8.4배(95% CI, 1.82-38.84) 높은 것으로 나타났다. 낮은 간호사 확보수준은 환자안전과 의료의 질을 반영하는 지표인 높은 수술 후 원내 사망과 감염발생과 관련이 있었다. 이는 적절한 간호사 확보 수준은 수술 후 암 환자 결과와 관련 있음을 보여준다. 수술한 암환자의 의료의 질 향상과 환자 안전을 위해서는 적절한 간호사 수가 확보되어야 하며, 이를 위한 정책 유지가 필요하다.

Keywords

References

  1. Statistics Korea. Statistics of cause of death [Internet]. Daejon: Statistics Korea, c2016 [cited 2016 Sep 30], Available From: http://kosis.kr. (assessed Dec. 11, 2016)
  2. K. W. Jung, Y. J. Won, H. J. Kong, C. M. Oh, H. Cho, D. H. Lee et al., "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2012", Cancer Research and Treatment, vol. 47, no. 2, pp. 127-141, 2015. DOI: https://doi.org/10.4143/crt.2015.060
  3. K. W. Jung, S. H. Yim, H, J. Kong, S. Y. Hwang, Y, J. Won, J. K. Lee et al., "Cancer Survival in Korea 1993-2002: a population-based study", Journal of Korean Medical Science, vol. 22, Suppl, pp. S5-S10,
  4. H. Yasunaga, H. Hashimoto, H. Horiguchi, H. Miyata, S. Matsuda, "Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database", BMC Health Services Research, vol. 12, no. 129, pp. 1-7, 2012. DOI: https://doi.org/10.1186/1472-6963-12-129
  5. Y. H Kim, K. Y. Park, M. Y. Kim, M. O. Kim, "Experience of cancer patients who received surgery", Journal of Korean Academy of Nursing, vol. 34, no. 6, pp. 945-953, 2004. https://doi.org/10.4040/jkan.2004.34.6.945
  6. Y. Kim, S. H. Cho, K. J. June, S. A. Shin, J. Kim, "Effects of hospital nurse staffing on in-hospital mortality, pneumonia, sepsis, and urinary tract infection in surgical patients", Journal of Korean Academy of Nursing, vol. 42, no. 5, pp. 719-729, 2012. DOI: https://doi.org/10.4040/jkan.2012.42.5.719
  7. E. Cho, D. M. Sloane, E. Y. Kim, S. Kim, M. Choi, I. Y. Yoo et al., "Effects of nurse staffing, work environments, and education on patient mortality: an observational study", International Journal of Nursing Studies, vol. 52, no. 2, pp. 535-542, 2015. DOI: https://doi.org/10.1016/j.ijnurstu.2014.08.006
  8. S. Cho, H. Lee, J. Oh, J. Kim, "Inpatient outcomes by nurse staffing grade in Korea", Korean Journal of Health Policy & Administration, vol. 21, no. 2, pp. 195-212, 2011. DOI: https://doi.org/10.4332/KJHPA.2011.21.2.195
  9. S. Cho, K. Jeon, Y. Kim, B. Park, "Changes in the nurse staffing level since the introduction of inpatient nursing administration fee", Journal of Koran Academy of Nursing Administration, vol. 14, no. 2, pp. 167-175, 2008.
  10. OECD. Health at a glance 2015: OECD indicators. p.90-91, OECD Publishing, 2015. DOI: https://doi.org/10.1787/health_glance-2015-26-en
  11. R. L. Kane, T. Shamliyan, C. Mueller, S. Duval, T. J. Wilt, "Nurse staffing and quality of patient care", Minneapolis, Minnesota: AHRQ, Report no. 1530-4396, pp. 1530-4396, March, 2007.
  12. E. Cho, D. L. Chin, S. Kim, O. Hong, "The relationships of nurse staffing level and work environment with patient adverse events", Journal of Nursing Scholarship, vol. 48, no. 1, pp. 74-82, 2016. DOI: https://doi.org/10.1111/jnu.12183
  13. B. J. Kalisch, C. R. Friese, S. H. Choi, M. Rochman,. "Hospital nurse staffing: choice of measure matters", Medical Care, vol. 49, no. 8, pp. 775-779, 2011. DOI: https://doi.org/10.1097/MLR.0b013e318222a6df
  14. S. Cho, Y. Kim, K. Yeon, S. You, I. Lee, "Effects of increasing nurse staffing on missed nursing care", International Nursing Review, vol. 62, pp. 267-274, 2015. https://doi.org/10.1111/inr.12173
  15. B. J. Kalisch, D. Tschannen, H. Lee, C. R. Friese, "Hospital variation in missed nursing care", American Journal of Medical Quality, vol. 26, no. 4, pp. 291-299, 2011. DOI: https://doi.org/10.1177/1062860610395929
  16. L. H. Aiken, D. M. Sloane, L. Bruyneel, K. Van den Heede, P. Griffiths, R. Busse et al., "Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study", Lancet, vol. 383, no. 9931, pp. 1824-1830, 2014. DOI: https://doi.org/10.1016/S0140-6736(13)62631-8
  17. L. H. Aiken, J. P. Cimiotti, D. M. Sloane, H. L. Smith, L. Flynn, D. F. Neff, "Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments", Medical Care, vol. 49, no. 12, pp. 1047-1053, 2011. DOI: https://doi.org/10.1097/MLR.0b013e3182330b6e
  18. S. Cho, J. Hwang, J. Kim, "Nurse staffing and patient mortality in intensive care units", Nursing Research, vol. 7, no. 5, pp. 322-330, 2008. DOI: https://doi.org/10.1097/01.NNR.0000313498.17777.71
  19. S. Xesfingi, A. Vozikis, "Patient satisfaction with the healthcare system: assessing the impact of socio-economic and healthcare provision factors", BMC Health Services Research, vol. 16, no. 94, 2016. DOI: https://doi.org/10.1186/s12913-016-1327-4
  20. American Cancer Society. Infections in people with cancer [Internet]. American Cancer Society, c2016[cited 2016 July 7], Available From: http://www.cancer.org/acs/groups/cid/documents/webcont ent/002871-pdf.pdf. (accessed Nov. 10, 2016)
  21. L. H. Aiken , D. M. Sloane, J. P. Cimiotti, S. P. Clarke, L. Flynn, J. A. Seago et al., "Implications of the California nurse staffing mandate for other states", Health Services Research, vol. 45, no. 4, pp. 904-921, 2010. DOI: https://doi.org/10.1111/j.1475-6773.2010.01114.x
  22. J. D. Birkmeyer, A. E. Siewers, E. V. Finlayson, T. A. Stukel, F. L. Lucas, I. Batista et al., "Hospital volume and surgical mortality in the United States", The New England Journal of Medicine, vol. 346, no. 15, pp. 1128-1137, 2002. DOI: https://doi.org/10.1056/NEJMsa012337
  23. E. V. Finlayson, P. P. Goodney, J. D. Birkmeyer, "Hospital volume and operative mortality in cancer surgery: a national study", Archives of Surgery, vol. 138, no. 7, pp. 721-725, 2003. DOI: https://doi.org/10.1001/archsurg.138.7.721
  24. Ministry of Health, Notice 2006-106. 2006. 12.18.
  25. L. M. Enomoto, N. J. Gusani, P. W. Dillon, C. S.Hollenbeak, “Impact of surgeon and hospital volume onmortality, length of stay, and cost ofpancreaticoduodenectomy”, Journal of GastrointestinalSurgery, vol. 18, no. 4, pp. 690-700, 2014. DOI: https://doi.org.access.yonsei.ac.kr:8080/10.1007/s11605-013-2422-z
  26. J. F. Finks, N. H. Osborne, J. D. Birkmeyer, “Trends inhospital volume and operative mortality for high-risksurgery”, The New England Journal of Medicine, vol. 364, no. 22, pp. 2128-2133, 2011.DOI: https://doi.org/10.1056/NEJMsa1010705
  27. A. L. Rich, L. J. Tata, C. M. Free, R. A. Stanley, M.D. Peake, D. R. Baldwin et al. "Inequalities in outcomesfor non-small cell lung cancer: the influence of clinicalcharacteristics and features of the local lung cancerservice", Thorax, vol. 66, no. 12, pp. 1078-1084, 2011.DOI: https://doi.org/10.1136/thx.2011.158972
  28. Health Insurance Review & Assessment Service. KDRGclassification. Health Insurance Review & AssessmentService, 2011.