重症监护病房护理缺失现状及影响因素研究

doi:10.3761/j.issn.1672-9234.2025.12.011

摘要/Abstract

摘要：

目的探究重症监护病房护理缺失现况并分析其影响因素，以期减少临床实践中的护理缺失现象。方法 2025年1月—4月采用便利抽样法选取来自14个省级行政区的18所三级医院、7所二级医院的840名ICU护士作为研究对象，使用一般资料调查表和ICU护理缺失量表进行问卷调查。结果 ICU护理缺失量表总分为（98.9±22.4）分。其中缺失最多的项目为心理支持类、基础护理类和康复训练类。导致护理缺失的主要原因为人力资源绝对不足、人力资源相对不足和沟通交流因素。回归分析结果显示，每班次平均负责的患者数量、是否为ICU专科护士、职称和医院级别是ICU护理缺失的影响因素（P<0.05），共解释总变异的24.4%。结论 ICU护理缺失情况需要引起重视，尤其是心理支持类和基础护理类缺失较为严重。提示护理管理者应优化人力资源配置，加强护士培训，改善工作班次安排，加强团队协作，以减少护理缺失，提高ICU护理质量。

关键词: 重症监护病房, 护理缺失, 横断面调查, 护理质量

Abstract:

Objective To understand the current situation of missed nursing care in ICU in China and analyze its influencing factors，so as to reduce the phenomenon of nursing deficiency in clinical practice and optimize the nursing quality for critically ill patients. Methods A convenience sampling method was employed between January 2025 and April 2025. The study ultimately included 840 ICU nurses from 18 tertiary hospitals and 7 secondary hospitals across 14 provinces/municipalities. Data were collected using a demographic questionnaire and the ICU Missed Nursing Care Scale. Results The total score on the ICU Missed Nursing Care Scale was （98.9±22.4） points. The items with the most deficiencies were psychological support，basic nursing，and rehabilitation training. The causes of ICU missed nursing care were primary reasons being absolute shortage of human resources，relative shortage of human resources，and communication factors. The regression analysis results indicated that the average number of patients per shift，whether the nurse was an ICU specialist，professional title，and hospital level were influencing factors of ICU nursing omissions，collectively explaining 24.4% of the total variation. Conclusion The level of missed nursing care in ICU in China is relatively high，with serious deficiencies in psychological support and basic nursing. It is suggested that nursing managers should optimize the allocation of human resources，strengthen nurse training，improve work shift arrangements，and enhance team collaboration to reduce missed nursing care and improve the nursing quality in ICU.

Key words: Intensive Care Unit, Missed Nursing Care, Cross-sectional Survey, Nursing Quality

肖苏琴, 任杰, 江榕, 刘洪所, 熊琴. 重症监护病房护理缺失现状及影响因素研究[J]. 中华护理教育, 2025, 22(12): 1475-1481.

XIAO Suqin, REN Jie, JIANG Rong, LIU Hongsuo, XIONG Qin. A multi-center cross-sectional study on the current status of missed nursing care in intensive care unit[J]. Chinese Journal of Nursing Education, 2025, 22(12): 1475-1481.

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参考文献 19

[1]	Kalisch BJ, Landstrom GL, Hinshaw AS. Missed nursing care:a concept analysis[J]. J Adv Nurs, 2009, 65(7):1509-1517. doi: 10.1111/jan.2009.65.issue-7
[2]	Lake ET, Germack HD, Viscardi MK. Missed nursing care is linked to patient satisfaction:a cross-sectional study of US hospitals[J]. BMJ Qual Saf, 2016, 25(7):535-543. doi: 10.1136/bmjqs-2015-003961
[3]	Winsett RP, Rottet K, Schmitt A, et al. Medical surgical nurses describe missed nursing care tasks-evaluating our work environment[J]. Appl Nurs Res, 2016, 32:128-133. doi: S0897-1897(16)30028-3 pmid: 27969015
[4]	Recio-Saucedo A, Dall’Ora C, Maruotti A, et al. What impact does nursing care left undone have on patient outcomes? Review of the literature[J]. J Clin Nurs, 2018, 27(11/12):2248-2259. doi: 10.1111/jocn.2018.27.issue-11pt12
[5]	Ball JE, Bruyneel L, Aiken LH, et al. Post-operative mortality,missed care and nurse staffing in nine countries:a cross-sectional study[J]. Int J Nurs Stud, 2018, 78:10-15. doi: 10.1016/j.ijnurstu.2017.08.004
[6]	Mainz H, Tei R, Andersen KV, et al. Prevalence of missed nursing care and its association with work experience:a cross-sectional survey[J]. Int J Nurs Stud Adv, 2024, 6:100196.
[7]	Gong FX, Mei YC, Wu MY, et al. Global reasons for missed nursing care:a systematic review and meta-analysis[J]. Int Nurs Rev, 2025, 72(1):e13096. doi: 10.1111/inr.v72.1
[8]	周艳红, 李乐之, 刘雨安. 重症监护病房护理缺失现状及原因分析[J]. 中国护理管理, 2024, 24(5):651-656.
	Zhou YH, Li LZ, Liu YA. Status quo and cause analysis of missed nursing care in ICU[J]. Chin Nurs Manag, 2024, 24(5):651-656.
[9]	陈彬. 医学多因素分析设计样本例数估算:多因素分析设计样本例数综合估算法[J/OL]. 伤害医学(电子版), 2012, 1(4):58-60.
	Chen B. Sample size methodology for multivariate analysis: synthetic estimate method for sample size in multivariate analysis[J/OL]. Inj Med Electron Ed, 2012, 1(4):58-60.
[10]	刘雨安, 李乐之, 王惠平. ICU护理缺失量表的编制及信效度检验[J]. 中华急危重症护理杂志, 2024, 5(2):165-171.
	Liu YA, Li LZ, Wang HP. Development and reliability and validity testing of the ICU missed nursing care survey[J]. Chin J Emerg Crit Care Nurs, 2024, 5(2):165-171.
[11]	Griffiths P, Recio-Saucedo A, Dall’Ora C, et al. The association between nurse staffing and omissions in nursing care:a systematic review[J]. J Adv Nurs, 2018, 74(7):1474-1487. doi: 10.1111/jan.13564 pmid: 29517813
[12]	李莞, 田凌云, 粟亚男, 等. 护理缺失现状及对策的研究进展[J]. 解放军护理杂志, 2020, 37(10):65-67.
	Li G, Tian LY, Su YN, et al. Research progress on status quo and strategy of nursing deficiency[J]. Nurs J Chin PLA, 2020, 37(10):65-67.
[13]	Kalisch BJ, Tschannen D, Lee KH. Missed nursing care,staffing,and patient falls[J]. J Nurs Care Qual, 2012, 27(1):6-12. doi: 10.1097/NCQ.0b013e318225aa23
[14]	中国重症医学质量控制与改善中心. 中国重症医学质量控制标准(2020版)[J]. 中华医学杂志, 2020, 100(24):1851-1862.
[15]	刘鸿梅, 郝艳华. ICU护理工作量测量方法的研究进展[J]. 中国护理管理, 2017, 17(8):1069-1072.
	Liu HM, Hao YH. The measurement of nursing workload in intensive care units:a review of current practice[J]. Chin Nurs Manag, 2017, 17(8):1069-1072.
[16]	王靓, 王海播, 李文娟, 等. 自我同情在ICU护士护理工作负荷与护理缺失间的中介效应[J]. 中国临床护理, 2023, 15(7):397-401. doi: 10.3969/j.issn.1674-3768.2023.07.001
	Wang L, Wang HB, Li WJ, et al. The mediating effect of self-compassion between workload and missed nursing care among nurses in intensive care units[J]. Chin Clin Nurs, 2023, 15(7):397-401. doi: 10.3969/j.issn.1674-3768.2023.07.001
[17]	梅爱英, 李秋萍, 韩斌如. 护理工作环境对护理缺失影响的研究[J]. 中国护理管理, 2022, 22(12):1804-1809.
	Mei AY, Li QP, Han BR. Study on the influence of nursing working environment on missed nursing care[J]. Chin Nurs Manag, 2022, 22(12):1804-1809.
[18]	王爽, 吴艳梅, 刘颖, 等. 以重症专科护士为主导的重症监护室后随访方法对非计划重返患者的影响[J]. 军事护理, 2025, 42(3):14-17.
	Wang S, Wu YM, Liu Y, et al. Effect of intensive care nurse-led post-ICU follow-up approach on patients with unplanned return to ICU[J]. Mil Nurs, 2025, 42(3):14-17.
[19]	杜美晨, 汪晖, 刘于, 等. 护理人力资源配置评价指标的范围综述[J]. 中华护理杂志, 2023, 58(3):366-373. doi: 10.3761/j.issn.0254-1769.2023.03.015
	Du MC, Wang H, Liu Y, et al. Indicators to evaluate nursing staff allocation:a scoping review[J]. Chin J Nurs, 2023, 58(3):366-373.