背景: 隨著人口老化及醫療保健需求日益增加，全球醫療體系皆面臨需增加照護工作壓力，進而導致全球性護理人力短缺。護理人員在負擔過重、工作壓力過大等影響下，促使護理人員的工作負荷對護理人員自身健康與病患照護結果之影響於國際上被受重視。研究指出，病患於醫院內產生壓瘡會導致病患疼痛、功能喪失、感染、延長住院時間且增加住院支出與家屬負擔增加，故壓瘡成為醫療照護品質重要議題。然而，過去研究僅探討護理人力與壓瘡影響，尚未同時探討護理人員在心理層面之工作疲潰感與病患壓瘡相關性。

目的: 本研究分為兩大部份:第一部份為探討我國護理人力與工作疲潰和病患壓瘡平均發生率之現況，並進一步進行我國護理人力與立法規範國家進行比較，另外也探討我國工作疲潰情形與其他國工作疲潰研究結果比較。第二部份為考量醫院與護理單位鑲嵌性情況下，探討護理人力及工作疲潰感與病患壓瘡平均發生率之間相關性，與進一步了解醫院等級與醫師數對護理人力及工作疲潰使否於病患壓瘡中存在跨層次交互作用影響。

方法: 本研究使用衛生福利部「護理人力資源對病患成果資料庫」(衛福部計畫編號：DOH097-TD-M-113-97025)，該資料庫共調查35間醫院，117個護理單位。第一部份利用描述型統計，探討我國護理人力及工作疲潰與病患壓瘡平均發生率現況，並進一步針對護理人力與工作疲潰與立法規範國家護病比與其他國研究護理人員工作疲潰情形做比較。第二部份則是考量醫院與護理單位鑲嵌性情況下，使用多層次模型(multilevel linear models)，探討護理人力及工作疲潰與病患壓瘡平均發生率及有或無發生壓瘡之間相關性。

結果: 第一部份，我國每位護理人員照護病患數量不分班別為11.0位，三班分別為白班6.9-8.6位、小夜班10.7-13.0位、大夜班14.4-15.8位，相較於國際已明定最低護病比保障護理人員工作負荷及病患安全之國家(美國加州、澳洲維多利亞、日本)，我國照護負荷相較其他立法國高。護理人員工作疲潰感整體分數為32.8分，內科與外科護理人員以區域醫院工作疲潰分數較高(32.4分及32.8分)，綜合科以地區醫院較高(32分)且都為高疲潰之情形，進一步與美國、加拿大、日本、英國、德國紐西蘭護理人員工作疲潰分數調查比較，台灣護理人員工作疲潰分數為7國中最高。第二部份，控制醫院層級、護理人員特徵、病患嚴重度及住院時間，護理人力與病患平均發生率達統計上顯著相關(β=0.22, P=0.03)，意指護理人員每多增加照護一位病患，單位病患壓瘡平均發生率會增加0.22，此外，護理人員工作疲潰感於單位有或無發生病患壓瘡模型達統計上顯著相關，(OR=1.25, P=0.03)，指出護理人員工作疲潰感每增加一分，單位壓瘡發生機會相較於沒發生單位，病患發生壓瘡機會增加25%。

討論: 整體來說，護理人力及工作疲潰感與病患壓瘡有關，不同臨床照護單位受所屬醫院影響，故醫院增加護理人力與降低護理人員工作疲潰感，能夠提升照護品質，減少病患於醫院內壓瘡發生。

Background- Nursing staffing is associated with the patient safety and quality of patient care. Recently, studies have indicated that nurse burnout is another important factor of patient outcome. However, little research has considered care units and hospital levels when examining nursing staffing, burnout and patient care. Pressure sores is a common indicator to evaluate clinical care quality. Therefore, the aim of this study is to examine the relationship between nursing staffing, burnout and pressure sores in different hospitals and units in Taiwan.

Methods- This study used a nationally representative sample from Taiwan NURSE-outcomes database, which used stratified random sampling approach according to hospital level in four districts in Taiwan. A total of 35 hospitals, 117 nursing units and 1808 nurses were recruited as the study sample. The relationship of nursing staffing, nurse burnout and pressure sores incidence density were analyzed by multilevel linear model. Other control variables include hospital level and nurse characteristics, patient severity (ADL) and average length of stay.

Results- Nurse staffing is significantly associated with the incidence density of pressure sores (β=0.22, P=0.03), after controlling for hospital level, nurse characteristics, patient severity and length of stay. However, when coding pressure sores as binary (yes/no), only nurse burnout show significantly association (OR=1.25, P=0.03).

Conclusions- On the whole, both nursing staffing and nurse burnout are associated with pressure sores. Because quality of clinical care in different units is associated with hospitals, increasing nursing staffing and decreasing nurse burnout may help enhance care quality and reduce pressure sores.

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