Analyzing economic feasibility for investing in nursing care: Evidence from panel data analysis in 35 OECD countries

Economic evaluation of the prevention of falls resulting from missed care in polish hospitals

Objectives

Falls are associated with increased morbidity, mortality, prolonged hospitalization and an increase in the cost of treatment in hospitals. They contribute to the deterioration of fitness and quality of life, especially among older patients, thus posing a serious social and economic problem. They increase the risk of premature death. Falls are adverse, costly, and potentially preventable. The aim of the study was to analyze the cost-effectiveness of avoiding one fall by nurse care provided by the nurses with higher education, from the perspective of the health service provider.

Methods

The economic analysis included and compared only the cost of nurse intervention measured by the hours of care provided with higher education in non-surgical departments (40.5%) with higher time spend by nurses with higher education level an increase in the number of hours by 10% (50.5%) to avoid one fall. The time horizon for the study is 1 year (2021). Cost-effectiveness and Cost-benefit analysis were performed. All registered falls of all hospitalized patients were included in the study.

Results

In the analyzed was based on the case control study where, 7,305 patients were hospitalized, which amounted to 41,762 patient care days. Care was provided by 100 nurses, including 40 nurses with bachelor's degrees and nurses with Master of Science in Nursing. Increasing the hours number of high-educated nurses care by 10% in non-surgical departments decreased the chance for falls by 9%; however, this dependence was statistically insignificant (OR = 1.09; 95% CI: 0.72-1.65; p = 0.65). After the intervention (a 10% increase in Bachelor's Degrees/Master of Science in Nursing hours), the number of additional Bachelor's Degrees/Master of Science hours was 6100.5, and the cost was USD 7630.4. The intervention eliminated four falls. The cost of preventing one fall is CER = USD 1697.1.

Conclusion

The results of these studies broaden the understanding of the relationship among nursing education, falls, and the economic outcomes of hospital care. According to the authors, the proposed intervention has an economic justification.

A bachelor's degree for entering the nursing profession: A scoping review for supporting informed health care policies

Background

Numerous studies have emphasized the relevance of work environment, staffing, and educational level in nursing as determinants of safe, timely, effective, equitable, and efficient patient-centered care. However, an overview of the evidence focusing on the nursing education level is still lacking.

Objective

To provide an overview of the existing evidence regarding bachelor's degree as an entry level for the nursing profession.

Design

This was a scoping review.

Methods

We conducted a systematic search of CINAHL, Medline via PubMed, Cochrane, and Web of Science Core Collection. Additionally, we conducted a free web search using Google and contacted international nursing associations via email. We summarized the evidence narratively. For reporting guidelines, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews.

Results

We included 10 studies, 12 response letters, 24 position papers, three books, and one webpage. The sources of evidence identified agreed that the inclusion of a higher number of nurses with a bachelor's degree would lead to a higher quality of care.

Conclusions

Using a bachelor's degree education as a minimum requirement to enter the nursing profession in the future is essential to generate a respected, competent, and satisfied nursing workforce that can impact the quality and safety of care; and positively influence outcome indicators for patients, nurses, healthcare organizations, and society.

Tweetable abstract

Policy makers and healthcare organizations should set bachelor's degrees as standards for registration and entry to nursing.

Nursing workforce plays a significant role in reducing COVID-19 deaths worldwide: A cross-sectional analysis of data from 178 countries

Worldwide, the role of nursing workforce in reducing COVID-19 case fatality ratio (CFR) is analyzed with scatter plots, Pearson's r and nonparametric, partial correlation and multiple linear regression models. The potential confounders, median age, health expenditure, physician density, and urbanization were incorporated for calculating the independent role of nursing workforce in protecting against COVID-19 CFR. The study findings suggested that (1) the nursing workforce inversely and significantly correlates with COVID-19 CFR; (2) this relationship remained independent of the confounding effects of each individual confounder or their combination; (3) Nursing workforce was the only variable identified as a significant contributor for reducing COVID-19 CFR, when it was incorporated into stepwise regression model with health expenditure, median age, physician density, and urbanization for analyzing their individual predicting effects on COVID-19 CFR. A strong message for the health authorities is that, although in shortage, nursing workforce showed their significant role in reducing COVID-19 deaths worldwide. This study highlights that the role of nursing workforce should be incorporated into population health research.

Latin American Nursing and Its Social and Cultural Resignification

The article reflects on the importance of leadership and empowerment in Latin American nursing as a collective body responsible for participating in and making public health and health worker policies. For this, it spotlights the contribution that nursing, as a discipline based on research and theory, makes to knowledge, which relies upon the evidence of care in the health-disease process of individuals, families, and groups. It also posits the region’s nurse shortage issue, the unequal recognition of nursing as a human care profession, and the need for action and prominence to face the challenge of redefining it.

Improvement in outpatient services using the WeChat calling system in the Shanghai Children's Hospital

Objectives:

We explored the utility of WeChat applet as part of the Outpatient Department (OPD) to provide patients with timely queuing information and compared it with the traditional calling system.

Methods:

Data for the WeChat calling system was extracted for the period of May 2018 to September 2018. Data for the traditional system was extracted for the same period from the year 2017. We compared the effective patient waiting time and nurse idle time i.e. nonproductive time spent on factors outside of employees’ control with the two systems. We also analyzed the relationship between the length of waiting time and conflicts between doctors and patients.

Results:

The mean wait time for the traditional calling system was 126 minutes, while the average idle time for nurses was 96 minutes/day. On the other hand, the mean wait time for the WeChat calling system was 33 minutes, and the average idle time for nurses was 72 minutes/day. The incremental profit (cost of traditional calling system – cost of WeChat calling system) achieved from switching systems was 13,879 yuan/month. Behavioral observations showed that wait time (OR=2.745, 95%CI 1.936~3.892 P<0.0001) was a risk factor for staff-patient conflict.

Conclusion:

The cost of the WeChat calling system was significantly lower than the traditional system. Also, the traditional calling system was time-consuming. Longer waiting time was the main factor affecting OPD quality and caused conflicts between doctors and patients.

Role of social distancing in tackling COVID-19 during the first wave of pandemic in Nordic region: Evidence from daily deaths, infections and needed hospital resources

OBJECTIVES

To measure the effect of social distancing on reducing daily deaths, infections and hospital resources needed for coronavirus disease 2019 (COVID-19) patients during the first wave of the pandemic in Nordic countries.

METHODS

The observations of social distancing, daily deaths, infections along with the needed hospital resources for COVID-19 patient hospitalizations including the numbers of all hospital beds, beds needed in ICUs and infection wards, nursing staffs needed in ICUs and infection wards were collected from the Institute for Health Metrics and Evaluation (IHME) by the University of Washington. The observations of social distancing were based on the reduction in human contact relative to background levels for each location quantified by cell phone mobility data collected from IHME. The weighted data per 100,000 population gathered in a 40-day period of the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Statistical technique of panel data analysis is used to measure the associations between social distancing and COVID-19 indicators in long-run.

RESULTS

Results of dynamic long-run models confirm that a 1% rise in social distancing by reducing human contacts may decline daily deaths, daily infections, all hospital beds needed, beds/nurses needed in ICUs and beds/nurses needed in infection wards due COVID-19 pandemic by 1.13%, 15.26%, 1.10%, 1.17% and 1.89%, respectively. Moreover, results of error correction models verify that if the equilibriums between these series are disrupted by a sudden change in social distancing, the lengths of restoring back to equilibrium are 67, 62, 40, 22 and 49 days for daily deaths, daily infections, all hospital beds needed, nurses/beds needed in ICUs and nurses/beds needed in infection wards, respectively.

CONCLUSION

Proper social distancing was a successful policy for tackling COVID-19 with falling mortality and infection rates as well as the needed hospital resources for patient hospitalizations in Nordic countries. The results alert governments of the need for continuously implementing social distancing policies while using vaccines to prevent national lockdowns and reduce the burden of patient hospitalizations.

Nursing Graduates and Quality of Acute Hospital Care in 33 OECD Countries: Evidence From Generalized Linear Models and Data Envelopment Analysis

Background

There is a lack of cross-national research to examine the role of new graduate nurses in improving the quality of nursing care and patient outcomes.

Purpose

To measure the role and clinical effectiveness of new graduate nurses in improving the quality of acute hospital care in the members of Organisation for Economic Co-operation and Development (OECD).

Methods

The total number of nursing graduates per 100,000 population and three OECD’s Health Care Quality Indicators (HCQI) in acute care including 30-day in-hospital and out-of-hospital mortality rates per 100 patients based on acute myocardial infarction (MORTAMIO), hemorrhagic stroke (MORTHSTO) and ischemic stroke (MORTISTO) were collected in 33 OECD countries. Four control variables including the number of medical graduates, practicing nurses and doctors densities per 1000 population (proxies for other health professions) and the total number of Computed Tomography scanners per one million population (proxy of medical technology level) were added in investigations. The statistical technique of Generalized Linear Models (GLM) and Data Envelopment Analysis (DEA) were used in data analysis.

Results

Results of GLM confirm the existence of meaningful association between the density of nursing graduates and improving the quality of acute care i.e. a 1% rise in the number of nursing graduates in year 2015 reduced MORTAMIO, MORTHSTO and MORTISTO by 1.11%, 0.08% and 0.46%, respectively. According to the result of DEA, clinical effectiveness of new graduate nurses – i.e. reaching the higher clinical outcomes with the same staffing level – in reducing mortality rates in patients with life-threatening conditions were at highest level in Luxembourg, Finland, Japan, Italy, Norway, Sweden and Switzerland.

Conclusions

Higher staffing level of new graduate nurses associates with better patient outcomes in acute care, although the clinical effectiveness of nursing graduates – associated with the level of education and practice – is the determinant factor of improving the quality of acute hospital care and patient survival rates in OECD.

Impact of nurse staffing on reducing infant, neonatal and perinatal mortality rates: Evidence from panel data analysis in 35 OECD countries

Objectives

To investigate the magnitude of effect nurse staffing had on decreasing the newborn mortality rates in member countries of Organisation for Economic Co-operation and Development (OECD).

Methods

The statistical technique of panel data analysis was applied to explore the possibility of association between the number of nurses’ density per 1,000 population and infant, neonatal and perinatal mortality rates (IMR, NMR and PMR) per 1000 births. The observations of 35 OECD countries were collected over the period of 2000 through 2016.

Results

There were significant associations between nurse staffing and IMR, NMR and PMR i.e. a 1% increase in nurse-staffing level reduced IMR, NMR and PMR by 0.98%, 0.97% and 0.96%, respectively. Furthermore, the role of nursing-related services in declining the average of newborn mortality rates were investigated at the highest level in Slovenia (−5.50), Sweden (−3.34), Iceland (−2.51), Czech Republic (−1.86), Japan (−1.64) and Finland (−1.64). Moreover, if the current relationship between nurse-staffing level and newborn mortality rates are disturbed with nursing shortage (e.g. in Slovak Republic and Israel), then it takes about 17 years for the mortality rates to reduce and restore back to the previous equilibrium.

Conclusions

A higher proportion of nurses’ density per 1,000 population is associated with lower newborn mortality rates. In addition, the nursing-related services of Slovenia, Sweden, Iceland, Czech Republic, Japan and Finland with the highest impact on improving the health level of newborns would be good patterns for other developed countries in maternity and child health care .