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Mann C, Montoya L, Taylor J, Barton G. Measuring the PULSE of Nursing: Development of a Dashboard to Evaluate and Monitor Nursing Care Models. J Nurs Care Qual 2024; 39:273-278. [PMID: 38470854 DOI: 10.1097/ncq.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated into acute inpatient care settings. PROBLEM A mechanism to continuously monitor the impact of this staffing change was not available. APPROACH Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics. OUTCOMES The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators. CONCLUSION The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.
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Kuusi T, Kulvik M, Härmä M, Ropponen A. Workload and short sickness absences in a cohort of Finnish hospital employees. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01698-8. [PMID: 38780861 DOI: 10.1007/s10198-024-01698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
This article used register data on day-to-day working hours of hospital employees combined with patient characteristics at work unit (wards) level to measure workload and its implications for short, self-certified sickness absences. We measured statistically the average nursing treatment burden of different patient mixes in hospital wards, and then analyzed the overall workload (intensity) of working days by comparing it to the actual available nursing workforce. We found that a significant part of the workload variation occurred between working days, and it was related to unexpected changes in the number of employees. In atypical situations a long work shift was associated with caring for patients with fewer resources. The high workload of a day increased the risk of short sickness absences along the following 3-week period. The results show that managing short-term workload variability should be a key aim from the perspective of well-being at work, and that combining different data sources can provide novel, important insights to the measurement of workload.
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Affiliation(s)
- Tero Kuusi
- Etla Economic Research, Helsinki, Finland.
| | - Martti Kulvik
- Etla Economic Research, Helsinki, Finland
- Etlatieto Oy, Helsinki, Finland
| | - Mikko Härmä
- The Finnish Institute of Occupational Health, Helsinki, Finland
| | - Annina Ropponen
- The Finnish Institute of Occupational Health, Helsinki, Finland
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Han KT, Kim S. Does improved nurse staffing impact patient outcomes in cancer? Association between chronic diseases and mortality among older adult patients with lung cancer in Korea. PLoS One 2024; 19:e0301010. [PMID: 38718027 PMCID: PMC11078420 DOI: 10.1371/journal.pone.0301010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/09/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Evidence regarding the impact of nurse staffing on the health outcomes of older adult patients with cancer is scarce. Therefore, this study aimed to evaluate the impact of nurse staffing on long-term and short-term mortality in elderly lung cancer patients. METHODS This study analyzed data from 5,832 patients with lung cancer in Korea from 2008 to 2018. Nursing grade was considered to assess the effect of nursing staff on mortality in older adult patients with lung cancer. The Cox proportional hazards model was used to evaluate the effect of the initial treatment hospital's nursing grade on one- and five-year mortality. Additionally, economic status and treatment type of patients were analyzed. RESULTS Approximately 31% of older adult patients with lung cancer died within one year post-diagnosis. Patients in hospitals with superior nursing grades (lower nurse-to-bed ratios) exhibited lower mortality rates. Hospitals with nursing grades 2 and 3 exhibited approximately 1.242-1.289 times higher mortality than grade 1 hospitals. Further, the lower the nursing grade (higher nurse-to-bed ratio), the higher the five-year mortality rate. CONCLUSION Both short- and long-term mortality rates for older adult patients with lung cancer increased at inferior nursing grades. Treatment in hospitals having inferior nursing grades, upon initial hospitalization, may yield better outcomes. This study provides valuable insight into the quality of adequate staffing to improve the quality of care for elderly cancer patients.
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Affiliation(s)
- Kyu-Tae Han
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Seungju Kim
- Department of Health System, College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
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Malinowska-Lipień I, Put D, Maluchnik M, Gabryś T, Kózka M, Gajda K, Gniadek A, Brzostek T, Squires A. Influence of the work environment of nurses on the 30-day mortality of patients hospitalized in Polish hospitals. cross-sectional studies. BMC Nurs 2024; 23:117. [PMID: 38360713 PMCID: PMC10870652 DOI: 10.1186/s12912-024-01762-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates. AIM To understand the relationships between the work environment as perceived by nurses on the 30-day mortality of patients treated in Polish hospitals. BACKGROUND An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates. MATERIAL AND METHODS The analysis used discharge data from 108,284 patients hospitalized in internal medicine and surgery departments in 21 hospitals (with 24/7 operations) in Poland. Administrative data included coded data to estimate 30-day mortality. A Nurses' satisfaction questionnaire, including the PES-NWI scale and the SAQ questionnaire, was used to assess the work environment of nurses (n = 1,929). Correlations between variables were assessed using the Pearson coefficient. The analysis used a Poisson regression model, which belongs to the class of generalized linear models. RESULTS A lower 30-day mortality rate amongst patients was found among those treated in hospitals where the personnel feel that they may question the decisions or actions of their superiors regarding the care provided (r = - 0.50); nurses are informed about changes introduced on the basis of reports about negligence and mistakes (r = - 0.50); the ward nurse is a good manager (r = - 0.41); nurses receive timely information from the head of the department that may have an impact on their work (r = - 0.41). CONCLUSIONS Factors related to care during hospital stay such as the organization of care at the ward level, analysis of care errors, the number of staff providing direct patient care, informing nurses about mistakes without punishment, and the possibility of nurses challenging the decisions or actions of superiors, which concerns care providing, affect the 30-day mortality of patients after the end of hospitalization in Polish hospitals.
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Affiliation(s)
- Iwona Malinowska-Lipień
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland.
| | - Dariusz Put
- Department of Computational Systems, Krakow University of Economics, Krakow, Poland
| | - Michał Maluchnik
- Department of Adult Neurology, Medical University of Gdansk and University Clinical Center, Gdansk, Poland
- Ministry of Health, Warsaw, Poland
| | - Teresa Gabryś
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Maria Kózka
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Krzysztof Gajda
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University- Medical College, Krakow, Poland
| | - Agnieszka Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Tomasz Brzostek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, USA
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Shapiro L, Scherger S, Franco-Paredes C, Gharamti A, Henao-Martinez AF. Anakinra authorized to treat severe coronavirus disease 2019; Sepsis breakthrough or time to reflect? Front Microbiol 2023; 14:1250483. [PMID: 37928695 PMCID: PMC10620707 DOI: 10.3389/fmicb.2023.1250483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction The European Medicines Agency (EMA) and the United States Food and Drug Administration (FDA) announced conditions for using recombinant human interleukin-1 receptor antagonist (rhIL-1ra) to treat hospitalized patients with Coronavirus disease 2019 (COVID-19) and risk for progression. These decisions followed publication of the suPAR-guided Anakinra treatment for Validation of the risk and early Management OF seveRE respiratory failure by COVID-19 (SAVE- MORE) phase 3 clinical trial that yielded positive results. Methods We conducted a literature review and theoretical analysis of IL-1 blockade as a therapy to treat COVID-19. Using a stepwise analysis, we assessed clinical applicability of the SAVE-MORE results and evaluated conceptual support for interleukin-1 suppression as a suitable approach to COVID-19 treatment. This therapeutic approach was then examined as an example of inflammation-suppressing measures used to treat sepsis. Results Anakinra use as a COVID-19 therapy seems to rely on a view of pathogenesis that incorrectly reflects human disease. Since COVID-19 is an example of sepsis, COVID-19 benefit due to anti-inflammatory therapy contradicts an extensive history of unsuccessful clinical study. Repurposing rhIL-1ra to treat COVID-19 appears to exemplify a cycle followed by inflammation-suppressing sepsis treatments. A landscape of treatment failures is interrupted by a successful clinical trial. However, subsequent confirmatory study fails to replicate the positive data. Discussion We suggest further experimentation is not a promising pathway to discover game-changing sepsis therapies. A different kind of approach may be necessary.
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Affiliation(s)
- Leland Shapiro
- Division of Infectious Diseases, Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Sias Scherger
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Carlos Franco-Paredes
- Hospital Infantil de México, Federico Gómez, México City, México
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Collins, CO, United States
| | - Amal Gharamti
- Department of Internal Medicine, Yale University, Waterbury, CT, United States
| | - Andrés F. Henao-Martinez
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Sikora A. Critical Care Pharmacists: A Focus on Horizons. Crit Care Clin 2023; 39:503-527. [PMID: 37230553 DOI: 10.1016/j.ccc.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Critical care pharmacy has evolved rapidly over the last 50 years to keep pace with the rapid technological and knowledge advances that have characterized critical care medicine. The modern-day critical care pharmacist is a highly trained individual well suited for the interprofessional team-based care that critical illness necessitates. Critical care pharmacists improve patient-centered outcomes and reduce health care costs through three domains: direct patient care, indirect patient care, and professional service. Optimizing workload of critical care pharmacists, similar to the professions of medicine and nursing, is a key next step for using evidence-based medicine to improve patient-centered outcomes.
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Affiliation(s)
- Andrea Sikora
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, 120 15th Street, HM-118, Augusta, GA 30912, USA; Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.
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Genna C, Thekkan KR, Raymakers-Janssen PAMA, Gawronski O. Is nurse staffing associated with critical deterioration events on acute and critical care pediatric wards? A literature review. Eur J Pediatr 2023; 182:1755-1770. [PMID: 36763191 DOI: 10.1007/s00431-022-04803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023]
Abstract
UNLABELLED Pediatric and neonatal patients admitted to acute and critical care wards may experience critical deterioration events that may lead to unexpected deaths if unrecognized and untreated promptly. Adequate levels and skill-mix of nurse staffing are essential for the quality of patient monitoring and response to deteriorating patients. Insufficient staffing may have an impact on the occurrence of missed care and consequently on critical deterioration events, increasing the risk of mortality and failure-to-rescue. To review the literature to explore the association between nurse staffing levels or skill-mix and pediatric and neonatal critical deterioration events, such as mortality, pediatric intensive care unit (PICU)/neonatal intensive care unit (NICU) unplanned admissions, cardiac arrests, and failure-to-rescue. A structured narrative literature review was performed. Pubmed, Cinhal, and Web of Science were searched from January 2010 to September 2022. Four independent reviewers conducted the study screening and data extraction. The quality of the studies included was evaluated using the Joanna Briggs Institute critical appraisal tools. Out of a total of 2319 studies, 15 met the inclusion criteria. A total of seven studies were performed in PICU, six in NICU, and two in general pediatric wards. Nurse staffing measures and outcomes definitions used were heterogeneous. Most studies suggested nursing skill-mix, increased working experience, or higher nursing degrees were associated with increased survival in PICU. Decreased nursing staffing levels were associated with increased mortality in NICU and mechanically ventilated patients in PICU. CONCLUSION Evidence on the association of nurse staffing and critical deterioration events in PICU and NICU is limited, while there is no evidence reported for pediatric wards. Future research is needed to determine adequate levels of nurse/patient ratios and proportion of registered nurses in the skill-mix for pediatric acute and critical care nursing to improve outcomes on in-patient wards. WHAT IS KNOWN • Adult nursing skill-mix, staffing ratios, and level of education are associated with patient mortality and failure to rescue. • In children, nurse staffing levels are associated with clinical outcomes. WHAT IS NEW • Evidence on the association of nurse staffing levels or skill-mix with pediatric or neonatal mortality is limited. • There is some evidence regarding the association of nursing work experience, certification, higher level degree with in-hospital survival in PICU.
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Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paulien A M A Raymakers-Janssen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Van den Heede K, Balcaen K, Bouckaert N, Bruyneel L, Cornelis J, Sermeus W, Van de Voorde C. Improving hospital nurse staffing during the pandemic: Implementation of the 2019 Fund for Health Care Staff in Belgium. Health Policy 2023; 128:69-74. [PMID: 36462953 PMCID: PMC9701585 DOI: 10.1016/j.healthpol.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/08/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Chronic hospital nurse understaffing is a pre-existing condition of the COVID-19 pandemic. With nurses on the frontline against the pandemic, safe nurse staffing in hospitals is high on the political agenda of the responsible ministers of Health. This paper presents a recent Belgian policy reform to improve nurse staffing levels. Although the reform was initiated before the pandemic, its roll-out took place from 2020 onwards. Through a substantial increase of the hospital budget, policy makers envisaged to improve patient-to-nurse ratios. Yet, this ambition was considerably toned down during the implementation. Due to a shortage of nurses in the labour market, hospital associations successfully lobbied to allocate part of the budget to hire non-nursing staff. Moreover, other healthcare settings claimed their share of the pie. Elements of international best-practice examples such as ward managers supernumerary to the team and increasing the transparency on staffing decisions were adopted. Other measures, such as mandated patient-to-nurse ratios, nurse staffing committees, or the monitoring or public reporting of ratios, were not retained. Additional measures were taken to safeguard that bedside staffing levels would improve, such as the requirement to demonstrate a net increase in staff to obtain additional budget, staffing plan's approval by local work councils and recommendation to base staff allocation on patient acuity measures. This policy process makes clear that the engagement of budgets is only a first step towards safe staffing levels, which needs to be embedded in a comprehensive policy plan. Future evaluation of bedside nurse staffing levels and nurse wellbeing is needed to conclude about the effectiveness of these measures and the intended and unintended effects they provoked.
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Affiliation(s)
- Koen Van den Heede
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium,Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium,Corresponding author at: KCE Belgian Health Care Knowledge Centre: Federaal Kenniscentrum voor de Gezondheidszorg, Kruidtuinlaan 55 doorbuilding 9th… 1000 Brussels, Belgium
| | - Koen Balcaen
- University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Nicolas Bouckaert
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Justien Cornelis
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Carine Van de Voorde
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
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Riman KA, Doupnik SK, Kutney-Lee AM, Lake ET. Nurse Education and Hospital Readmissions for Children With and Without a Mental Health Condition. Hosp Pediatr 2023; 13:72-79. [PMID: 36477797 PMCID: PMC9808724 DOI: 10.1542/hpeds.2022-006602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In adults, receiving care in a hospital with more baccalaureate-prepared nurses improves outcomes. This relationship is magnified in adults with serious mental illness or cognitive impairment. Whether the same is true in children with and without a mental health condition is unknown. The study purposes were to determine 1) whether the proportion of baccalaureate-prepared nurses affected the odds of readmission in children; and 2) whether this relationship differed for children with a mental health condition. PATIENTS AND METHODS We linked cross-sectional data from the 2016 Healthcare Cost and Utilization Project State Inpatient Databases, the RN4CAST-US nurse survey in Florida, and the American Hospital Association. Inclusion criteria were ages 3 to 21 years. Mental health conditions were defined as psychiatric or developmental/behavioral diagnoses. These were identified using the Child and Adolescent Mental Health Disorders Classification System. We used multivariable, hierarchical logistic regression models to assess the relationship between nurse training and readmissions. RESULTS In 35 081 patients admitted to 122 hospitals with 4440 nurses, 21.0% of patients had a mental health condition and 4.2% had a 7-day readmission. For individuals without a mental health condition, each 10% increase in the proportion of baccalaureate-prepared nurses was associated with 8.0% lower odds of readmission (odds ratio = 0.92, 95% confidence interval = 0.87-0.97). For those with a mental health condition, each 10% increase in the proportion of baccalaureate-prepared nurses was associated with 16.0% lower odds of readmission (odds ratio = 0.84, 95% confidence interval = 0.78-0.91). CONCLUSIONS A higher proportion of baccalaureate-educated nurses is associated with lower odds of readmission for pediatric patients. This association has a larger magnitude in patients with a mental health condition.
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Affiliation(s)
- Kathryn A. Riman
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie K. Doupnik
- University of Pennsylvania School of Medicine & Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ann M. Kutney-Lee
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Eileen T. Lake
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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van Kraaij J, Veenstra M, Stalpers D, Schoonhoven L, Vermeulen H, van Oostveen C. Uniformity along the way: A scoping review on characteristics of nurse education programs worldwide. NURSE EDUCATION TODAY 2023; 120:105646. [PMID: 36463593 DOI: 10.1016/j.nedt.2022.105646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The changing demands on healthcare require continuous development and education in the nursing profession. Homogeneity in nursing qualifications reduces educational inconsistencies between and within countries. However, despite various initiatives, modifying nurse education remains challenging because different countries have their own legislations, structures, motivations, and policies. OBJECTIVES To summarize the characteristics of nurse education programs around the globe and analyze the similarities and differences between them. DESIGN AND METHODS A scoping review was performed to identify different characteristics of nurse education programs in Organization for Economic Co-operation and Development (OECD) countries. Records published between January 2016 and July 2021 were searched in the PubMed, Cinahl, and ERIC databases. The reference lists of all included articles were also searched manually for relevant studies. Articles were eligible if they described nurse education in one or more of the selected countries with a focus on nursing degrees (both undergraduate and postgraduate programs), nursing titles, program duration, study load hours, or practice hours. Data were independently extracted using a predefined extraction sheet. We asked the respective nursing associations for confirmation and to provide any additional information. RESULTS After searching 9769 records, 117 were included in the synthesis. The included records described characteristics of undergraduate nursing educational programs (n = 50), postgraduate programs (n = 30), or both (n = 37). In total, 86 undergraduate and 82 postgraduate programs were described, with a great variety in degrees, nursing titles, study load hours, and practice hours. CONCLUSIONS This study demonstrates that there is still considerable variation in nurse education programs between countries. These diverse educational pathways lead to different nursing titles and internationally standardized definitions of nursing roles have not been established. This makes it difficult to understand the healthcare role of nurses. Hence, efforts are needed to increase the quality and uniformity of nurse education around the world.
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Affiliation(s)
- Julia van Kraaij
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
| | - Marloes Veenstra
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Dewi Stalpers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Hester Vermeulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
| | - Catharina van Oostveen
- Spaarne Gasthuis Hospital, Spaarne Gasthuis Academy, P.O. Box 417, 2000 AK Haarlem, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, Campus Woudestein, 3000 DR Rotterdam, the Netherlands.
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Catholic Ownership, Physician Leadership and Operational Strategies: Evidence from German Hospitals. Healthcare (Basel) 2022; 10:healthcare10122538. [PMID: 36554062 PMCID: PMC9777963 DOI: 10.3390/healthcare10122538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Previous research has revealed that Catholic hospitals are more likely follow a strategy of horizontal diversification and maximization of the number of patients treated, whereas Protestant hospitals follow a strategy of horizontal specialization and focus on vertical differentiation. However, there is no empirical evidence pertaining to this mechanism. We conduct an empirical study in a German setting and argue that physician leadership mediates the relationship between ownership and operational strategies. The study includes the construction of a model combining data from a survey and publicly available information derived from the annual quality reports of German hospitals. Our results show that Catholic hospitals opt for leadership structures that ensure operational strategies in line with their general values, i.e., operational strategies of maximizing volume throughout the overall hospital. They prefer part-time positions for chief medical officers, as chief medical officers are identified to foster strategies of maximizing the overall number of patients treated. Hospital owners should be aware that the implementation of part-time and full-time leadership roles can help to support their strategies. Thus, our results provide insights into the relationship between leadership structures at the top of an organization, on the one hand, and strategic choices, on the other.
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De Baetselier E, Dijkstra NE, Batalha LM, Ferreira PAC, Filov I, Grøndahl VA, Heczkova J, Helgesen AK, Hirdle J, Jordan S, Kolovos P, Langer G, Ličen S, Lillo-Crespo M, Malara A, Padyšáková H, Prosen M, Pusztai D, Raposa B, Riquelme-Galindo J, Rottková J, Sino CG, Talarico F, Tziaferi S, Van Rompaey B, Dilles T. Nurse students’ competences in interprofessional pharmaceutical care in Europe: Cross-sectional evaluation. Nurse Educ Pract 2022; 65:103485. [DOI: 10.1016/j.nepr.2022.103485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
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Dall'Ora C, Saville C, Rubbo B, Turner L, Jones J, Griffiths P. Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. Int J Nurs Stud 2022; 134:104311. [DOI: 10.1016/j.ijnurstu.2022.104311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 02/08/2023]
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Sheehan TO, Davis NW, Guo Y, Kelly DL, Yoon SL, Horgas AL. Predictors of Time to Aneurysm Repair and Mortality in Aneurysmal Subarachnoid Hemorrhage. J Neurosci Nurs 2022; 54:182-189. [PMID: 35796309 DOI: 10.1097/jnn.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND : Prompt aneurysm repair is essential to prevent rebleeding after aneurysmal subarachnoid hemorrhage. To date, most studies on this topic have focused on 1 set of predictors (eg, hospital or patient characteristics) and on 1 outcome (either time to aneurysm repair or mortality). The purpose of this study was to test a model that includes hospital and patient characteristics as predictors of time to aneurysm repair and mortality, controlling for disease severity and comorbidity, and considering time to aneurysm repair as a potential influence in these relationships. METHODS : A sample of aneurysmal subarachnoid hemorrhage patients with a principal procedure of clipping or coiling was selected (n = 387) from a statewide administrative database for cross-sectional retrospective analysis. The primary study outcome was in-hospital mortality. Independent variables were level of stroke center, age, race, sex, and type of aneurysm repair. Hierarchical logistic regression was used to estimate the probability of in-hospital death. RESULTS : Patients who underwent a coiling procedure were more likely to be treated within the first 24 hours of admission compared with those undergoing clipping (odds ratio, 0.54; 95% CI, 0.35-0.84; P = .01). Patients treated at a certified comprehensive stroke center (CSC) had a 72% reduction in odds of death compared with those treated at primary stroke centers (odds ratio, 0.28; 95% CI, 0.10-0.77; P = .01), after controlling for disease severity and comorbid conditions. Time to aneurysm repair was not significantly associated with mortality and did not influence the relationship between hospital and patient characteristics and mortality. CONCLUSION : Our results indicate that treatment at a CSC was associated with a lower risk of in-hospital mortality. Time to aneurysm repair did not influence mortality and did not explain the mortality benefit observed in CSCs. Research is needed to explore interdisciplinary hospital factors including nursing and nurse-sensitive interventions that may explain the relationship between CSCs and mortality outcomes.
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Factors influencing patient safety culture in operating room in a teaching hospital in Jordan: a qualitative descriptive study. TQM JOURNAL 2022. [DOI: 10.1108/tqm-04-2022-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeTo explore the perceptions of surgical team members in a tertiary hospital in Jordan toward the factors influencing patient safety culture (PSC).Design/methodology/approachThis was a qualitative descriptive study intended to characterize the factors that influence PSC. Interviews were conducted with health-care providers in the operation room (OR) in a tertiary Jordanian hospital. Participants included surgeons, anesthetists, nurses and senior surgical residents who had worked for three years minimum in the OR. Thematic analysis was used to analyze the data.FindingsA total of 33 interviews were conducted. Thematic analysis of the content yielded four major themes: (1) operational factors, (2) organizational factors, (3) health-care professionals factors and (4) patient factors. The respondents emphasized the role of the physical layout of the OR, implementing new techniques and new equipment, and management support to establish a safety culture in the operating room setting.Originality/valueThe present research study will have implications for hospitals and health-care providers in Jordan for developing organizational strategies to eliminate or decrease the occurrence of adverse events and improve patient safety in the OR.
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Bruyneel A, Larcin L, Tack J, Van Den Bulke J, Pirson M. Association between nursing cost and patient outcomes in intensive care units: A retrospective cohort study of Belgian hospitals. Intensive Crit Care Nurs 2022; 73:103296. [PMID: 35871959 DOI: 10.1016/j.iccn.2022.103296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/07/2022] [Accepted: 06/28/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hospitals with better nursing resources report more favourable patient outcomes with almost no difference in cost as compared to those with worse nursing resources. The aim of this study was to assess the association between nursing cost per intensive care unit bed and patient outcomes (mortality, readmission, and length of stay). METHODOLOGY This was a retrospective cohort study using data collected from the intensive care units of 17 Belgian hospitals from January 01 to December 31, 2018. Hospitals were dichotomized using median annual nursing cost per bed. A total of 18,235 intensive care unit stays were included in the study with 5,664 stays in the low-cost nursing group and 12,571 in the high-cost nursing group. RESULTS The rate of high length of stay outliers in the intensive care unit was significantly lower in the high-cost nursing group (9.2% vs 14.4%) compared to the low-cost nursing group. Intensive care unit readmission was not significantly different in the two groups. Mortality was lower in the high-cost nursing group for intensive care unit (9.9% vs 11.3%) and hospital (13.1% vs 14.6%) mortality. The nursing cost per intensive care bed was different in the two groups, with a median [IQR] cost of 159,387€ [140,307-166,690] for the low-cost nursing group and 214,032€ [198,094-230,058] for the high-cost group. In multivariate analysis, intensive care unit mortality (OR = 0.80, 95% CI: 0.69-0.92, p < 0.0001), in-hospital mortality (OR = 0.82, 95% CI: 0.72-0.93, p < 0.0001), and high length of stay outliers (OR = 0.48, 95% CI: 0.42-0.55, p < 0.0001) were lower in the high-cost nursing group. However, there was no significant effect on intensive care readmission between the two groups (OR = 1.24, 95% CI: 0.97-1.51, p > 0.05). CONCLUSIONS This study found that higher-cost nursing per bed was associated with significantly lower intensive care unit and in-hospital mortality rates, as well as fewer high length of stay outliers, but had no significant effect on readmission to the intensive care unit. .
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Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium; CHU Tivoli, La Louvière, Belgium. https://twitter.com/@ArnaudBruyneel
| | - Lionel Larcin
- Research Centre for Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Jérôme Tack
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Julie Van Den Bulke
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
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Santana-Padilla YG, Bernat-Adell MD, Santana-Cabrera L. Nurses’ perception on competency requirement and training demand for intensive care nurses. Int J Nurs Sci 2022; 9:350-356. [PMID: 35891902 PMCID: PMC9305005 DOI: 10.1016/j.ijnss.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/29/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yeray Gabriel Santana-Padilla
- Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Canary Islands, Spain
- Corresponding author.
| | | | - Luciano Santana-Cabrera
- Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Canary Islands, Spain
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Moyo N, Jones M, Dennis S, Sharma K, Gray R. The Association between Nursing Skill Mix and Patient Outcomes in a Mental Health Setting: Protocol for an Observational Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074357. [PMID: 35410046 PMCID: PMC8998938 DOI: 10.3390/ijerph19074357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Abstract
International research on nursing skill mix has focused primarily on medical and surgical patient populations. The association between nursing skill mix and clinical outcomes for psychiatric inpatients has not been explored. The aim of this study is to establish the feasibility of extracting and linking nurse and inpatient data from hospital administrative data sources. This is an observational study. Data will be extracted from hospital administrative sources and linked together. Patient information will include duration and number of psychiatric hospital admissions. We will extract information on the educational preparation of nurses working in the participating hospitals to enable us to calculate estimates of the nursing skill mix. The study will be conducted in two psychiatric inpatient services in Australia. Our study will test the feasibility of extracting and linking nursing skill mix and patient data in a mental health setting and will inform the methodological development of an appropriately powered observational study. Australian and New Zealand clinical trial registry: ACTRN12619001337167p.
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Affiliation(s)
- Nompilo Moyo
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia; (M.J.); (R.G.)
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC 3000, Australia
- Correspondence:
| | - Martin Jones
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia; (M.J.); (R.G.)
- Department of Rural Health, University of South Australia, Whyalla Norrie, SA 5608, Australia
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia
| | - Shaun Dennis
- Whyalla Integrated Mental Health Service, Flinders & Upper North Local Health Network, Whyalla, SA 5600, Australia;
| | | | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia; (M.J.); (R.G.)
- Department of Rural Health, University of South Australia, Whyalla Norrie, SA 5608, Australia
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Cost-Effectiveness Analysis of Improving Nurses' Education Level in the Context of In-Hospital Mortality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020996. [PMID: 35055820 PMCID: PMC8775363 DOI: 10.3390/ijerph19020996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: an assessment of the cost-effectiveness of employing an increased number of nurses with higher education from the perspective of the service provider. (2) Methods: Based on a year-long study results and data collected from a large hospital, we conducted of the costs of preventing one death. The study involved intervention by 10% increase in the percentage of nursing care hours provided by nurses with higher education. The measure of health effects was the cost of avoiding one death (CER). The cost-effectiveness analysis (CEA) was used as the evaluation method. (3) Results: The cost of employing a larger percentage of nurses with higher education amounts to a total of amounts to a USD 11,730.62 an increase of 3.02% as compared to the base costs. The estimated number of deaths that could be prevented was 44 deaths. Mortality per 1000 patient days was 9.42, mortality after intervention was 8.41. The cost of preventing one death by the 10% increase in BSN/MSN NCH percentage in non-surgical wards USD 263.92. (4) Conclusions: increasing the percentage of care hours provided by nurses with tertiary education is a cost-effective method of reducing in-hospital mortality.
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20
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Variations in nursing baccalaureate education and 30-day inpatient surgical mortality. Nurs Outlook 2022; 70:300-308. [PMID: 34763898 PMCID: PMC9095709 DOI: 10.1016/j.outlook.2021.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2010, the IOM recommended an increase in the proportion of bachelor's-prepared (BSN) nurses to 80% by 2020. This goal was largely based on evidence linking hospitals with higher proportions of BSN nurses to better patient outcomes. Though, evidence is lacking on whether outcomes differ by a hospital's composition of initial BSN and transitional RN-to-BSN nurses. PURPOSE The purpose of this study is to determine whether risk-adjusted odds of surgical mortality are associated with a hospital's proportion of initial BSN and transitional RN-to-BSN nurses. METHODS Logistic regression models were used to analyze cross-sectional data of general surgical patients, nurses, and hospitals in four large states in 2015 to 2016. FINDINGS Higher hospital proportions of BSN nurses, regardless of educational pathway, are associated with lower odds of 30-day inpatient surgical mortality. DISCUSSION Findings support promoting multiple BSN educational pathways to reach the IOM's recommendation of at least an 80% BSN workforce.
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Perruchoud E, Weissbrodt R, Verloo H, Fournier CA, Genolet A, Rosselet Amoussou J, Hannart S. The Impact of Nursing Staffs’ Working Conditions on the Quality of Care Received by Older Adults in Long-Term Residential Care Facilities: A Systematic Review of Interventional and Observational Studies. Geriatrics (Basel) 2021; 7:geriatrics7010006. [PMID: 35076476 PMCID: PMC8788263 DOI: 10.3390/geriatrics7010006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Little documentation exists on relationships between long-term residential care facilities (LTRCFs), staff working conditions and residents’ quality of care (QoC). Supporting evidence is weak because most studies examining this employ cross-sectional designs. Methods: Systematic searches of twelve bibliographic databases sought experimental and longitudinal studies, published up to May 2021, focusing on LTRCF nursing staff’s working conditions and the QoC they provided to older adults. Results: Of the 3577 articles identified, 159 were read entirely, and 11 were retained for inclusion. Higher nursing staff hours worked per resident per day (HPRD) were associated with significant reductions in pressure sores and urinary tract infections. Overall staff qualification levels and numbers of RNs had significant positive influences on QoC. Conclusions: To the best of our knowledge, this systematic review is the first to combine cohort studies with a quasi-experimental study to explore associations between LTRCF nursing staff’s working conditions and older adult residents’ QoC. Human factors (including HPRD, staff turnover, skill mix, staff ratios) and the specific working contribution of RNs had overwhelmingly significant influences on QoC. It seems essential that LTRCF supervisory and decision-making bodies should promote optimal working conditions for nursing staff because these have such a direct impact on residents’ QoC.
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Affiliation(s)
- Elodie Perruchoud
- Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, CH-1950 Sion, Switzerland; (R.W.); (H.V.); (C.-A.F.); (A.G.); (S.H.)
- Correspondence: ; Tel.: +41-58-606-86-78
| | - Rafaël Weissbrodt
- Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, CH-1950 Sion, Switzerland; (R.W.); (H.V.); (C.-A.F.); (A.G.); (S.H.)
| | - Henk Verloo
- Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, CH-1950 Sion, Switzerland; (R.W.); (H.V.); (C.-A.F.); (A.G.); (S.H.)
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Route de Cery 60, CH-1008 Lausanne, Switzerland
| | - Claude-Alexandre Fournier
- Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, CH-1950 Sion, Switzerland; (R.W.); (H.V.); (C.-A.F.); (A.G.); (S.H.)
| | - Audrey Genolet
- Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, CH-1950 Sion, Switzerland; (R.W.); (H.V.); (C.-A.F.); (A.G.); (S.H.)
| | - Joëlle Rosselet Amoussou
- Psychiatry Library, Education and Research Department, Lausanne University Hospital and University of Lausanne, Site de Cery, CH-1008 Lausanne, Switzerland;
| | - Stéphanie Hannart
- Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, CH-1950 Sion, Switzerland; (R.W.); (H.V.); (C.-A.F.); (A.G.); (S.H.)
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Lu H, Hou L, Zhou W, Shen L, Jin S, Wang M, Shang S, Cong X, Jin X, Dou D. Trends, composition and distribution of nurse workforce in China: a secondary analysis of national data from 2003 to 2018. BMJ Open 2021; 11:e047348. [PMID: 34706946 PMCID: PMC8552175 DOI: 10.1136/bmjopen-2020-047348] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Given the increased ageing population and frequent epidemic challenges, it is vital to have the nurse workforce of sufficient quantity and quality. This study aimed to demonstrate the trends, composition and distribution of nurse workforce in China. DESIGN Secondary analysis using national public datasets in China from 2003 to 2018. SETTING/PARTICIPANTS National population, nurse workforce and physician workforce. PRIMARY AND SECONDARY OUTCOME MEASURES Frequency and proportion were used to demonstrate: (1) the longitudinal growth of nurse workforce; (2) the diversity of nurse workforce in gender, age, work experience and education level; and (3) the distribution of nurse workforce among provinces, rural-urban areas and hospital/community settings. The Gini coefficient and Theil L index were used to measure the inequality trends of nurse workforce. RESULTS The total number of nurses increased from 1.3 million to 4.1 million and the density increased from 1 to 2.94 per 1000 population over 2003-2018. The nurses to physician ratio changed from 0.65:1 to 1.14:1. The majority of the nurse workforce was female, under 35 years old, with less than 30 years of work experience, with an associate's degree and employed within hospitals. Central and eastern regions had more nurses and there were 5.08 nurses per 1000 population in urban areas while less than two in rural areas in 2018. The Gini coefficient and between-provincial Theil index experienced a consistent decline. Within-province inequality accounted for overall inequality has risen from 52.38% in 2010 to 71.43% in 2018 suggested that the differences of distribution are mainly reflected in urban and rural areas. CONCLUSION Chinese nurse workforce has been changed significantly in the past 15 years that may be associated with the reformations of policy, nursing education in China. Our study suggests current features in the nurse workforce and can be used to strengthen future health services.
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Affiliation(s)
- Han Lu
- Peking University School of Nursing, Beijing, China
| | - Luoya Hou
- Peking University School of Nursing, Beijing, China
| | - Weijiao Zhou
- University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Liqiong Shen
- Wuhan University Zhongnan Hospital, Wuhan, Hubei, China
| | - Shida Jin
- Peking University School of Nursing, Beijing, China
| | - Mengqi Wang
- Peking University School of Nursing, Beijing, China
| | | | - Xiaomei Cong
- Nursing Biobehavioral Research Laboratory (BBL), University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - Xiaoyan Jin
- Peking University School of Nursing, Beijing, China
| | - Dou Dou
- Forth Department of Health Sciences, National Natural Science Foundation of China, Beijing, China
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23
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Van Kraaij J, Lalleman P, Walravens A, Van Oostveen C. Differentiated nursing practice as a catalyst for transformations in nursing: A multiphase qualitative interview study. J Adv Nurs 2021; 78:165-175. [PMID: 34375011 PMCID: PMC9292649 DOI: 10.1111/jan.15001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/17/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Aim To identify and follow‐up on the transition towards differentiated nursing practice among bachelor trained and vocationally trained nurses in Dutch hospitals. Design A multiphase general qualitative interview study. Methods Fifty semi‐structured interviews with project managers in charge of introducing differentiated nursing practice to their hospital were conducted. Purposive sampling was used, and data were collected in 2017, 2019 and 2020. A meta‐analysis was conducted after independent primary thematic analysis of each data collection. Results The introduction of differentiated nursing practice to Dutch hospitals was perceived as uncertain and ambiguous. Three themes were identified during the transition towards differentiated nursing practice: (1) call to action; (2) sitting and waiting; and (3) new beginnings and open ends. The change to differentiated nursing practice is not straightforward and these findings highlight the emerging awareness among project managers of the nature and complexity of the transition. During the study period, professionalization of the nursing profession was recognized as fundamental in hospital organizations. Conclusion Nursing cannot be separated from differentiated nursing practice. Visible leadership is important at all organizational levels and nurses’ opinions must be considered as nurses are essential to such changes in healthcare. Impact Differentiated nursing practice based on nursing education allows nurses to make the best use of their experience, skills and competencies, and could promote the provision of effective and high‐quality patient care. However, in many cases, a nurse's practice role is based on their nursing licensure instead of their educational background. The change to differentiated nursing practice in hospitals is not straightforward and the nature and complexity of the transition needs to be acknowledged. Nurses have an important role in healthcare transformation and need to be active in developing and formulating rather than just implementing the changes.
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Affiliation(s)
- Julia Van Kraaij
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Anoesjka Walravens
- Avans University of Applied Sciences 's Hertogenbosch, Breda, The Netherlands
| | - Catharina Van Oostveen
- Spaarne Gasthuis Hospital, Spaarne Gasthuis Academy, Haarlem, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Lasater KB, Sloane DM, McHugh MD, Porat-Dahlerbruch J, Aiken LH. Changes in proportion of bachelor's nurses associated with improvements in patient outcomes. Res Nurs Health 2021; 44:787-795. [PMID: 34128242 DOI: 10.1002/nur.22163] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 11/11/2022]
Abstract
This study uses data from two cross-sections in time (2006, 2016) to determine whether changes over time in hospital employment of bachelor's of science in nursing (BSN) nurses is associated with changes in patient outcomes. Data sources include nurse survey data, American Hospital Association Annual Survey data, and patient administrative claims data from state agencies in California, Florida, New Jersey, and Pennsylvania. The study sample included general surgical patients aged 18-99 years admitted to one of the 519 study hospitals. Multilevel logistic regression and truncated negative binomial models were used to estimate the cross-sectional and longitudinal effects of the proportion of hospital BSN nurses on patient outcomes (i.e., in-hospital mortality, 7- and 30-day readmissions, length of stay). Between 2006 and 2016, the average proportion of BSN nurses in hospitals increased from 41% to 56%. Patients in hospitals that increased their proportion of BSN nurses over time had significantly reduced odds of risk-adjusted mortality (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), 7-day readmission (OR: 0.96, 95% CI: 0.94-0.99) and 30-day readmission (OR: 0.98, 95% CI: 0.95-1.00), and shorter lengths of stay (incident rate ratio [IRR]: 0.98, 95% CI: 0.97-0.99). Longitudinal findings of an association between increased proportions of BSN nurses and improvements in patient outcomes corroborate previous cross-sectional research, suggesting that a better educated nurse workforce may add value to hospitals and patients.
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Affiliation(s)
- Karen B Lasater
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua Porat-Dahlerbruch
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ansah Ofei AM, Paarima Y, Barnes T, Kwashie AA. Staffing the unit with nurses: the role of nurse managers. J Health Organ Manag 2021; ahead-of-print. [PMID: 33998223 DOI: 10.1108/jhom-04-2020-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore the staffing practices of nurse managers at the unit. DESIGN/METHODOLOGY/APPROACH Introduction: Ensuring that units are staffed with adequate nurses to render quality nursing care to clients has become increasingly challenging for most hospitals. There is growing evidence linking best patient outcomes and fewer adverse events to the presence of nurses at the bedside. Hospitals require to attract and retain nurses in the units to address the issues of quality, staff and patient safety. Methods: The study used a descriptive phenomenological design to purposively select 15 nurse managers (NMs) and 47 nurses for in-depth interviews and focus group discussions respectively. FINDINGS The study found that the demand for nurses to work in the unit was not scientific. Nurses affirmed their frustration of inadequate numbers of staff in the unit especially, at the periphery hospitals. Time can be used as a source of motivation for nurses and nurses should be involved in the development of the duty roster to enable effective compliance. Compensation for additional duties is relevant in nursing. RESEARCH LIMITATIONS/IMPLICATIONS The research was carried only in one region in Ghana, and the findings may not be the same in the other regions. PRACTICAL IMPLICATIONS Inadequate staffing level has serious implications on patient safety, quality of care and staff outcomes. This situation necessitates the implementation of health sector staffing norms to ensure the right calibre of mix staff are recruited and retained. ORIGINALITY/VALUE This study is the first in Ghana that we aware of that explore staffing practices at the unit that identifies factors that impact staff schedules for effective care.
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Affiliation(s)
- Adelaide Maria Ansah Ofei
- Department of Research, Education and Administration, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Yennuten Paarima
- Department of Research, Education and Administration, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Theresa Barnes
- Department of Research, Education and Administration, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Atswei Adzo Kwashie
- Department of Research, Education and Administration, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
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Lasater KB, Aiken LH, Sloane DM, French R, Anusiewicz CV, Martin B, Reneau K, Alexander M, McHugh MD. Is Hospital Nurse Staffing Legislation in the Public's Interest?: An Observational Study in New York State. Med Care 2021; 59:444-450. [PMID: 33655903 PMCID: PMC8026733 DOI: 10.1097/mlr.0000000000001519] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Safe Staffing for Quality Care Act under consideration in the New York (NY) state assembly would require hospitals to staff enough nurses to safely care for patients. The impact of regulated minimum patient-to-nurse staffing ratios in acute care hospitals in NY is unknown. OBJECTIVES To examine variation in patient-to-nurse staffing in NY hospitals and its association with adverse outcomes (ie, mortality and avoidable costs). RESEARCH DESIGN Cross-sectional data on nurse staffing in 116 acute care general hospitals in NY are linked with Medicare claims data. SUBJECTS A total of 417,861 Medicare medical and surgical patients. MEASURES Patient-to-nurse staffing is the primary predictor variable. Outcomes include in-hospital mortality, length of stay, 30-day readmission, and estimated costs using Medicare-specific cost-to-charge ratios. RESULTS Hospital staffing ranged from 4.3 to 10.5 patients per nurse (P/N), and averaged 6.3 P/N. After adjusting for potential confounders each additional patient per nurse, for surgical and medical patients, respectively, was associated with higher odds of in-hospital mortality [odds ratio (OR)=1.13, P=0.0262; OR=1.13, P=0.0019], longer lengths of stay (incidence rate ratio=1.09, P=0.0008; incidence rate ratio=1.05, P=0.0023), and higher odds of 30-day readmission (OR=1.08, P=0.0002; OR=1.06, P=0.0003). Were hospitals staffed at the 4:1 P/N ratio proposed in the legislation, we conservatively estimated 4370 lives saved and $720 million saved over the 2-year study period in shorter lengths of stay and avoided readmissions. CONCLUSIONS Patient-to-nurse staffing varies substantially across NY hospitals and higher ratios adversely affect patients. Our estimates of potential lives and costs saved substantially underestimate potential benefits of improved hospital nurse staffing.
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Affiliation(s)
- Karen B. Lasater
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Linda H. Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Douglas M. Sloane
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
| | - Rachel French
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Colleen V. Anusiewicz
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Brendan Martin
- National Council of State Boards of Nursing, Chicago, IL
| | - Kyrani Reneau
- National Council of State Boards of Nursing, Chicago, IL
| | | | - Matthew D. McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Lerbæk B, McCloughen A, Lauritsen MB, Aagaard J, Nordgaard J, Jørgensen R. Barriers and Possible Solutions to Providing Physical Health Care in Mental Health Care: A Qualitative Study of Danish Key Informants' Perspectives. Issues Ment Health Nurs 2021; 42:463-472. [PMID: 32990129 DOI: 10.1080/01612840.2020.1823537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Provision of physical health care to people diagnosed with severe mental illness is widely reported as inadequate. This interview study explored perspectives of a group of key informants on current practices of providing physical health care within two mental health care settings in Denmark. Thematic analysis of their accounts provided insights into 1) barriers to the provision of physical health care in mental health settings, and 2) possible solutions to overcome existing barriers. Negative attitudes and limited specialist health care knowledge among mental health care professionals constituted serious barriers. To effectively address these barriers, mental health services need to be reoriented towards the prioritisation of physical health alongside mental health. This will require equipping mental health professionals with relevant knowledge and skills and organisational resources, to effectively work with people experiencing or at risk of physical comorbidities.
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Affiliation(s)
- Birgitte Lerbæk
- Clinic for Internal and Emergency Medicine, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Clinic Psychiatry South, Aalborg University Hospital, Psychiatry, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Andrea McCloughen
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Marlene Briciet Lauritsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | | | - Julie Nordgaard
- Mental Health Center Amager, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark
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Inclusion of Children's Surgery in National Surgical Plans and Child Health Programmes: the need and roadmap from Global Initiative for Children's Surgery. Pediatr Surg Int 2021; 37:529-537. [PMID: 33399928 DOI: 10.1007/s00383-020-04813-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
About 1.7 billion children and adolescents, mostly in low- and middle-income countries (LMICs) lack access to surgical care. While some of these countries have developed surgical plans and others are in the process of developing theirs, children's surgery has not received the much-needed specific emphasis and focus in these plans. With the significant burden of children's surgical conditions especially in low- and middle-income countries, universal health coverage and the United Nations' (UN) Sustainable Development Goals (SDG) will not be achieved without deliberate efforts to scale up access to children's surgical care. Inclusion of children's surgery in National Surgical Obstetric and Anaesthesia Plans (NSOAPs) can be done using the Global Initiative for Children's Surgery (GICS)-modified Children's Surgical Assessment Tool (CSAT) tool for baseline assessment and the Optimal Resources for Children Surgical Care (OReCS) as a foundational tool for implementation.
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García-Altés A, Subirana-Casacuberta M, Llorens D, Bullich I, Brugués A, Teixidor M, Cuxart N, Esteve M, Estrem M. The experience of Catalonia measuring nurse-sensitive indicators: Trends study 2012-2018. J Nurs Manag 2021; 29:2288-2296. [PMID: 33894075 DOI: 10.1111/jonm.13348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 01/09/2023]
Abstract
AIM To describe nursing-sensitive indicators measured in Catalonia. BACKGROUND In Catalonia, since 2012, under the umbrella of the Results Centre, outcomes of every health care setting have been published and made open to health care professionals and citizens. METHODS Trends study of nursing-sensitive indicators was based on data collected systematically from each setting from 2012 to 2018. Percentages and rates were calculated for each of 14 indicators analysed from all primary care, hospitals and long-term care centres. RESULTS Percentage of population aged 60 years or older correctly vaccinated against flu has been decreasing, while percentage of population aged 14 years or under with correct vaccine status is high (over 91%) and has remained stable over time. Mortality in patients who have developed complications has increased, from 27.1% in 2012 to 34.0% in 2017. Most centres achieved functional improvements during the first 30 days of admission. CONCLUSIONS Among all indicators measured in primary care, hospital and long-term care, only 14 analysed are nursing-sensitive; no nursing-sensitive indicators regarding mental health are measured. IMPLICATIONS FOR NURSING MANAGEMENT Research focused on development of nursing-sensitive indicators offers an opportunity to measure and benchmark nurses' quality of care and their contribution in achieving populations' health improvement and health care system sustainability.
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Affiliation(s)
- Anna García-Altés
- Generalitat de Catalunya, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Mireia Subirana-Casacuberta
- Generalitat de Catalunya, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.,Nursing Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.,Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Fsssaculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Dolors Llorens
- Consell de Col·legis d'Infermeres i Infermers de Catalunya, Barcelona, Spain
| | - Ingrid Bullich
- Nursing Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.,Grup de Recerca en Cronicitat de la Catalunya Central (C3RG), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Alba Brugués
- Consorci de Castelldefels Agents de Salut (CASAP), Avinguda de la Ciutat de Màlaga, Castelldefels, Spain
| | - Montserrat Teixidor
- Fellow of the American Academy of Nursing, Fundació Infermeria i Societat, Barcelona, Spain
| | - Nuria Cuxart
- Consell de Col·legis d'Infermeres i Infermers de Catalunya, Barcelona, Spain
| | - Marga Esteve
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Sanguino GZ, Furtado MCDC, Godoy SD, Vicente JB, Silva JRD. Management of cardiopulmonary arrest in an educational video: contributions to education in pediatric nursing. Rev Lat Am Enfermagem 2021; 29:e3410. [PMID: 33852682 PMCID: PMC8040776 DOI: 10.1590/1518-8345.3680.3410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 08/06/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to make and validate an educational video about the management of pediatric cardiopulmonary arrest caused by respiratory failure. METHOD methodological study developed in three stages: preparation and validation of a clinical case; production; and validation of educational video. To build the educational video, the Fleming, Reynolds and Wallace methodological framework was used. RESULTS the clinical case was validated by ten expert referees, who worked as nurses in different regions in Brazil, by completing an online form, with one round of evaluation and calculation of the content validity index. The educational video was validated by three expert judges and 25 nursing students in an evaluation round and contains six scenes, with duration of nine minutes and 56 seconds. An agreement over 80% was reached for most of the items in both the clinical case and the educational video. CONCLUSION the educational video proved valid regarding face and content. This educational technology has the potential to meet the demands of students, who are digital natives, related to teaching of management of pediatric cardiopulmonary arrest caused by respiratory failure.
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Affiliation(s)
- Gabriel Zanin Sanguino
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Maria Cândida de Carvalho Furtado
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Simone de Godoy
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Jéssica Batistela Vicente
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Jacqueline Rodrigues da Silva
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Arenchild M, Offodile AC, Revere L. Do We Get What We Pay For? Examining the Relationship Between Payments and Clinical Outcomes in High-Volume Elective Surgery in a Commercially-Insured Population. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020968780. [PMID: 33138676 PMCID: PMC7675868 DOI: 10.1177/0046958020968780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies evaluating the cost and quality of healthcare services have produced
inconsistent results. We seek to determine if higher paid hospitals have higher
quality outcomes compared to those receiving lower payments, after accounting
for clinical and market level factors. Using inpatient commercial claims from
the IBM® MarketScan® Research Databases, we used an
ordinal logistic regression to analyze the association between hospital median
payments for elective hip and knee procedures and 3 quality outcomes: prolonged
length of stay, complication rate, and 30-day readmission rate. Patient-level
and market factor covariates were appropriately adjusted. Hospital-level
payments were found to be not significantly correlated with hospital quality of
care. This research suggests that higher payments cannot predict higher quality
outcomes. This finding has implications for provider-payer negotiations,
value-based insurance designs, strategies to increase high-value care provision,
and consumer choices in an increasingly consumer-oriented healthcare
landscape.
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Affiliation(s)
| | - Anaeze C Offodile
- The University of Texas a MD Anderson Cancer Center, Houston, TX, USA
| | - Lee Revere
- The University of Texas Health Science Center, Houston, TX, USA
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McHugh MD, Aiken LH, Windsor C, Douglas C, Yates P. Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study. BMJ Open 2020; 10:e036264. [PMID: 32895270 PMCID: PMC7476482 DOI: 10.1136/bmjopen-2019-036264] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses. DESIGN Analysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data. SETTING Public hospitals in Queensland. PARTICIPANTS 4372 medical-surgical nurses and 146 456 patients in 68 public hospitals. MAIN OUTCOME MEASURES 30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction. RESULTS Medical-surgical nurse-to-patient ratios before implementation of ratio legislation varied significantly across hospitals (mean 5.52 patients per nurse; SD=2.03). After accounting for patient characteristics and hospital size, each additional patient per nurse was associated with 12% higher odds of 30-day mortality (OR=1.12; 95% CI 1.01 to 1.26). Each additional patient per nurse was associated with poorer outcomes for nurses including 15% higher odds of emotional exhaustion (OR=1.15; 95% CI 1.07 to 1.23) and 14% higher odds of job dissatisfaction (OR=1.14; 95% CI 1.02 to 1.28), as well as higher odds of concerns about quality of care (OR=1.12; 95% CI 1.01 to 1.25) and patient safety (OR=1.32; 95% CI 1.11 to 1.57). CONCLUSIONS Before ratios were implemented, nurse staffing varied considerably across Queensland hospital medical-surgical wards and higher nurse workloads were associated with patient mortality, low quality of care, nurse emotional exhaustion and job dissatisfaction. The considerable variation across hospitals and the link with outcomes suggests that taking action to improve staffing levels was prudent.
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Affiliation(s)
- Matthew D McHugh
- School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda H Aiken
- School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carol Windsor
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Clint Douglas
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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Interventions to improve oral health of older people: A scoping review. J Dent 2020; 101:103451. [PMID: 32810577 DOI: 10.1016/j.jdent.2020.103451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES A range of interventions have been tested to improve oral health of older people. We performed a scoping review to map interventions' aims, outcome measures and findings, and to locate them on different levels of care. DATA We systematically screened for (1) controlled studies on (2) people over 65 years of age, (3) comparing at least two interventions to improve oral health. Interventions were summarized according to their aims and the employed intervention type, mapped on their level of action, and classified as primary/secondary/tertiary prevention. SOURCES Studies retrieved via MEDLINE, EMBASE, CINAHL. STUDY SELECTION Eighty-one studies (published 1997-2019, conducted mainly in high-income countries) were included. Sample sizes varied (n = 24-1987). Follow-up was 0.25-60 months. Most studies (64/81) found a statistically significant benefit of the intervention. A total of 13 different aims were identified, and a range of intervention types employed (e.g. educational interventions, professional oral healthcare, restorative treatment, fluoride application and, generally, dentifrices, mouthwashes, chewing gums/food supplements). Most studies were located on the carer/patient level (56/81 studies) or the system/policy-maker level (44/81). The majority of studies aimed for primary prevention (64/81). CONCLUSIONS Oral health improvement interventions are widely studied. However, study aims, methods and outcome measures are highly heterogeneous, which limits the ability for robust conclusions. Current research focusses on primary prevention on the level of patients/carers or system/policy-maker level. Future studies may want to consider interventions on dentists' level focussing on secondary prevention. These studies should rely on a core set of comprehensive, standardized set of outcome measures. CLINICAL SIGNIFICANCE While specific interventions seem efficacious to improve older people's oral health, the current body of evidence is neither comprehensive (significant gaps exists in relevant levels of the care process) nor comparable enough to draw robust conclusions.
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Muir‐Cochrane E, James R. Safe and secure? The complexities of caring in hospitals. J Clin Nurs 2020; 29:3603-3604. [DOI: 10.1111/jocn.15343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/13/2020] [Accepted: 05/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Russell James
- School of Nursing College of Health and Medicine University of Tasmania Adelaide TAS Australia
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Jansson M, Ohtonen P, Syrjälä H, Ala‐Kokko T. The proportion of understaffing and increased nursing workload are associated with multiple organ failure: A cross‐sectional study. J Adv Nurs 2020. [DOI: 10.1111/jan.14410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/02/2020] [Accepted: 03/16/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Miia Jansson
- Research Group of Medical Imaging, Physics and Technology University of Oulu Oulu Finland
- Oulu University Hospital Oulu Finland
| | - Pasi Ohtonen
- Division of Operative care Oulu University Hospital Oulu Finland
- Medical Research Center Oulu University of Oulu Oulu Finland
| | - Hannu Syrjälä
- Department of Infection Control Oulu University Hospital Oulu Finland
| | - Tero Ala‐Kokko
- Medical Research Center Oulu University of Oulu Oulu Finland
- Division of Intensive Care Department of Anesthesiology Oulu University Hospital Oulu Finland
- Research Group of Surgery, Anesthesiology and Intensive Care Medical Research Center Oulu Oulu Finland
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Wieczorek-Wojcik B, Gaworska-Krzemińska A, Owczarek AJ, Kilańska D. In-hospital mortality as the side effect of missed care. J Nurs Manag 2020; 28:2240-2246. [PMID: 32239793 PMCID: PMC7754405 DOI: 10.1111/jonm.12965] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 11/02/2022]
Abstract
AIM The aim of the study was to assess the influence of the number of hours of daily nursing care for NHPPD in medical departments on missed care and the correlation between NHPPD and in-hospital mortality. BACKGROUND Patient mortality can be a consequence of missed care as it correlates with the nurse-patient ratio. One of the methods to measure missed care is the Nursing Hours per Patient Day rating. METHODS The study sample included 44,809 patients including 971 deaths in 8 wards. The influence of nursing hours, nursing education, and the percentage of patients' classification on in-hospital mortality were evaluated with backward stepwise linear regression. RESULTS One hour added to the average NHPPD in medical departments was related to a decrease in mortality rate by 6.8 per 1,000 patient days and a lower chance for the emergence of unplanned death by 36%. CONCLUSIONS The number of NHPPD and the percentage of professional nurses are factors influencing missed care and in-hospital mortality. IMPLICATIONS FOR NURSING MANAGEMENT The severe consequences of missed care, that is mortality, and the correlation between in-hospital mortality, nursing education and nursing-patient ratio, which are indicators of care quality, are arguments for maintaining adequate staffing levels to avoid missed care.
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Affiliation(s)
- Beata Wieczorek-Wojcik
- Department of Nursing, Institute of Health Sciences, Pomeranian University in Słupsk, Słupsk, Poland
| | | | - Aleksander J Owczarek
- Department of Instrumental Analysis, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Dorota Kilańska
- Department of Health System Development Medical University of Lodz, Department of Coordinated Care, Medical University of Lodz, Lodz, Poland
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Kim Y, Kim HY, Cho E. Association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery: a cross-sectional analysis using Korean administrative data. BMC Nurs 2020; 19:17. [PMID: 32189999 PMCID: PMC7076936 DOI: 10.1186/s12912-020-0410-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background The likelihood of inpatient mortality has been found to be reduced by increased nurse staffing in several settings, including general wards, emergency departments, and intensive care units. However, less research has investigated cases where patients die in the community setting due to a health problem that occurred after they were discharged post-surgery, because it is difficult to integrate hospital data and local community data. Therefore, this study investigated the association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery using national administrative data. Methods The study analyzed data from 129,923 patients who underwent surgery between January 2014 and December 2015. The bed-to-nurse ratio was categorized as level 1 (less than 2.5), level 2 (2.5–3.4), level 3 (3.5–4.4), and level 4 (4.5 or greater). The chi-square test and GEE logistic regression analyses were used to explore the association between the bed-to-nurse ratio and 30-day post-discharge mortality. Results 1355 (0.01%) patients died within 30 days post-discharge. The 30-day post-discharge mortality rate in hospitals with a level 4 was 2.5%, representing a statistically significant difference from the rates of 0.8, 2 and 1.8% in hospitals with level 1, level 2, and level 3 staffing, respectively. In addition, the death rate was significantly lower at hospitals with a level 1 (OR = 0.62) or level 2 (OR = 0.63) bed-to-nurse ratio, using level 4 as reference. Conclusion The results of this study are highly meaningful in that they underscore the necessity of in-hospital discharge nursing and continued post-discharge nursing care as a way to reduce post-discharge mortality risk. Furthermore, the relationship between nurse staffing levels and 30-day post-discharge mortality implies the need for a greater focus on discharge education. Policies are required to achieve proper nurse staffing levels in Korea, and thereby to enhance patient outcomes.
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Affiliation(s)
- Yunmi Kim
- 1College of Nursing, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam-si, 13135 Republic of Korea
| | - Hyun-Young Kim
- 2Department of Nursing, Jeonju University, 303 Cheonjam-ro, Wansan-gu, Jeonju-si, 55069 Republic of Korea
| | - Eunyoung Cho
- 3Department of Nursing, Dongseo University, 47 Jurye-ro, Saha-gu, Busan, 47011 Republic of Korea
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Kowalczuk K, Krajewska-Kułak E, Sobolewski M. Working Excessively and Burnout Among Nurses in the Context of Sick Leaves. Front Psychol 2020; 11:285. [PMID: 32158416 PMCID: PMC7052176 DOI: 10.3389/fpsyg.2020.00285] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Nurses are particularly at risk of being affected by professional burnout because of the unique patient - caregiver relationship, which requires strong emotional involvement. AIM In this study, we decided to examine the mutual correlations of working excessively and burnout - two basic occurrences affecting the mental well-being of employees - and their relationship with sick leave. MATERIALS AND METHODS The study was conducted among 460 nurses working in 3 hospitals in Poland. The polish version of Maslach Burnout Inventory and the Working Excessively Questionnaire developed by Paluchowski were used to conduct the survey. All the demographic data and data on sick leaves were obtained from surveys in the form of respondents' self-reports. RESULTS The constructed regression model shows that the tendency to work excessively, as assessed by loss of control over work (LCW), perfectionist work style (PWS), and perceived oppressiveness of the organization (OOP) measures, explains 12.4% of the variation in burnout levels. This confirms that overburden with work can be a factor contributing to the increase in burnout measures. The constructed logistic regression model showed that increase in the level of occupational burnout by 1 point, the chance of nurse having at least three sick leaves per year increases 1.029 times (i.e., by about 2.9%). None of working excessively measures affected the frequency of sick leaves. CONCLUSION (1) Excessive workload increases burnout symptoms, which in turn encourages nurses to take sick leave more frequently. (2) The tendency for nurses to overburden themselves with work may be seen by hospital managers as a positive phenomenon, but, based on this study, it is clear that this can only be done in the short term, whereas in the long term it will be clearly detrimental to the organization of hospitals and the quality of care.
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Affiliation(s)
- Krystyna Kowalczuk
- Department of Integrated Medical Care, Medical University of Białystok, Białystok, Poland
| | | | - Marek Sobolewski
- Faculty of Management, Rzeszow University of Technology, Rzeszow, Poland
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