背景
護理人員為第一線照護人員，現今因醫療結構型態改變，醫院管理階層以降低護理人員數量節省成本，使照護品質下降。不適當護理人力會影響照護品質及病人照護結果。護理時數多寡與病人照護結果及死亡率息息相關，然而國內較少相關研究探討護理時數與病人照護品質之關係，無法以此為實證資料，協助護理人力資源爭取。
目的
調查台灣醫療院所平均護理時數及瞭解護理時數與病患住院死亡率之關聯性；研究問題為台灣平均護理時數與病患住院死亡率之相關性為何？
方法
為相關性研究，採次級資料庫分析，資料來源為衛生福利部研究計畫之「護理人力資源對病患照顧結果之影響」。該資料庫以分層取樣並隨機抽取醫院共35家、117個單位。研究者經過原作者同意之後，使用作者提供之去連結化資料，執行階層線性迴歸模式，了解矯正相關混淆因子後，護理時數與病人死亡率之關係。
結果
控制相關混淆變項後，護理時數與病人死亡率間有顯著的負相關，多元線性迴歸模式總解釋變異量為19.9％。除此之外，區域醫院／地區醫院（β = -.155，p < .01）、第四季／第一季（β = -.133，p < .01）及護理人員工作年資（β = .13，p < .001）與病人死亡率有顯著相關性。
結論
護理時數為影響病人死亡率的重要因子。然而，本研究解釋變異量較低，以及各混淆變項與病人死亡率間的相關，是未來的研究可以繼續探索的。
關鍵字：護理時數、住院死亡率

Background
Higher nursing hours per patient day (NHPPD) is associated with better patient outcomes, such as a lower inpatient mortality rate. There is currently a shortage of nursing staff in Taiwan due to changes in the healthcare and global budget systems, and this may decrease the NHPPD and harm patient safety. The literature remained inconclusive on the relationship between NHPPD and inpatient mortality rate, and no studies have yet examined this issue in Taiwan.
Purpose
This research was to explore the relationship between NHPPD and inpatient mortality rate at nursing units in Taiwanese hospitals.
Method
This was a retrospective longitudinal study using data from “Nursing Utilization of Resources, Staffing and Environment on Outcome Study: NURSE - outcome study”, which was funded by the Taiwan Ministry of Health and Welfare from 2009 to 2010. We retrieved the NHPPD, inpatient mortality rate, aggregated patients’ and nurse staffing variables from this database. Data was analyzed using a hierarchical regression model to estimate the relationship between NHPPD and the in-hospital mortality rate after controlling the confounding variables that affected the inpatient mortality rate.
Result
Higher NHPPD was related to a lower inpatient mortality rate after controlling the confounding variables. The average NHPPD in Taiwan was 2.32 hours, and inpatient mortality rate would decrease 4.543%, 2.271%, 1.514% when the NHPPD increased by 4.64 hours, 6.96 hours and 9.28 hours. The total explained variation of the hierarchical regression model was 19.9%. In addition, there was significant relationships between inpatient mortality rate and three other variables which were regional hospital/ district hospital (β = -.155, p < .01), quarter 4/ quarter 1 (β = -.133, p < .01) and nurses’ work experience (β = .13, p < .001).
Conclusion
NHPPD affected the risk-adjusted mortality rate among hospitalized patients in Taiwan. Nevertheless, low explained variation in the study has remained to be addressed in future work. Each confounding variable in this study is an important issue that also needs to be explored separately.

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