Assessing the impacts of nurse staffing and work schedules on nurse turnover: A systematic review

AIM

This study aimed to investigate and synthesize the impacts of nurse staffing and work schedules on nurse turnover in acute hospitals.

BACKGROUND

The retention of nurses during the COVID-19 pandemic was critical due to the increased demand for nurses. Among the multifaceted factors contributing to nurse turnover, it is worth examining nurse staffing and work schedules while considering policy intervention.

METHODS

The findings of this systematic literature review were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Using eight databases, including CINAHL and PubMed, research articles published from January 2000 until June 2021 were reviewed. The inclusion criteria were original peer-reviewed research, nonexperimental studies published in English or Korean languages, and studies examining the impacts of nurse staffing and work schedules on nurses' actual turnover.

RESULTS

Fourteen articles were reviewed. Among them, 12 studies investigated the relationship between nurse staffing and turnover, and four examined the impact of work schedules on nurse turnover. Nurse staffing levels are strongly related to nurse turnover in the expected direction. However, few studies have found that work schedules are significantly related to nurse turnover.

CONCLUSION

Inadequate and unsafe nurse staffing leads to increased nurse turnover rates. More studies are needed to investigate the impacts of work schedules on nurse turnover.

IMPLICATIONS FOR NURSING, HEALTH, AND SOCIAL POLICY

Several states in the United States have adopted the nurse staffing policy during the COVID-19 pandemic. More hospitals and the government should adopt and implement policies to regulate nurse staffing, reduce nurse turnover, and increase retention. Policy intervention in nurse work schedules should also be considered to prevent nurse turnover.

Mediating effects of workgroup processes on the relationship between nurse turnover and nurse outcomes in hospitals

Background

Nurse turnover is often considered to be an outcome, and few studies have investigated its consequences in nursing care. The underlying mechanism of the nurse turnover-nurse outcome relationship has not been empirically investigated. Therefore, this study examines workgroup processes and nurse outcomes as the consequences of nurse turnover and the mediating effect of workgroup processes on the nurse turnover-nurse outcomes relationship.

Methods

A cross-sectional design was adopted to investigate the data collected from 264 staff nurses. Furthermore, six-month turnover rates, workgroup processes (nurse-nurse collaboration, team cohesion), and nurse outcomes (job satisfaction, intent to leave) were utilized in the multivariate regression models.

Results

Overall, 53 (24.4%) nurses had worked in nursing units with a zero six-month turnover rate. The average mean six-month turnover rate was 15.5%. Nurse turnover adversely affected nurses' job satisfaction and several subscales of team cohesion including task cohesion and social cohesion. Team cohesion partially mediated the relationship between nurse turnover and job satisfaction.

Conclusion

Nurse turnover decreased job satisfaction and team cohesion, and team cohesion partially mediated the nurse turnover-nurse outcomes relationship. These findings provide evidence supporting the significant adverse effects of nurse turnover and suggest the potential role of workgroup processes in explaining the underlying mechanism of the relationship between nurse turnover and nurse outcomes.

Implications for nursing and health policy

Healthcare organizations must create a positive work environment to reduce nurse turnover. Further, states and countries should try to develop and establish nursing and health policies to prevent turnover.

Comprehensive assessment of factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals: a systematic review

BACKGROUND

During the COVID-19 pandemic, the demand for nursing care increased, making the retention of nurses even more important. Among staff nurses, it is reported that the turnover rate of newly licensed registered nurses is higher. However, no systematic reviews have focused on the factors that influence newly licensed registered nurses' turnover. Additionally, because newly licensed registered nurses are a major source of the supply of nurses, it is critical to retain them to meet patient needs. Therefore, this study aimed to systematically synthesize the factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals.

METHODS

CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS, and Web of Science were searched for studies published between January 2000 and June 2021. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Ten articles from 9029 were included in this review. All studies used a longitudinal design. The annual turnover rates of newly licensed registered nurses ranged from 12 to 25%. Health status, including sleep and healthy lifestyles, were significant factors affecting turnover. Most studies focused on work environment factors, and emotional exhaustion, job satisfaction, peer support, and intent to leave, were significantly associated with newly licensed registered nurses' turnover. Small hospitals located in nonmetropolitan areas were at risk of high turnover of newly licensed registered nurses.

CONCLUSIONS

Turnover is inevitable in the process of employment, but high turnover can be prevented. Through reviewing ten articles, significant contributing factors for newly licensed registered nurses' turnover included personal factors of health status; work environment factors of physical exhaustion, emotional exhaustion, depersonalization, occupational injuries, income, intent to stay, job satisfaction, and peer support; and hospital factors of hospital size, location, and unionization. Most existing studies focus on work environment factors, which reflects the significance of fostering healthy work conditions to prevent high turnover. These findings can be used to develop strategies and policies for work environment to reduce high turnover of newly licensed registered nurses, and support high-risk groups, such as small hospitals located in nonmetropolitan areas with high levels of nurses' turnover.

Association of Work Schedules With Nurse Turnover: A Cross-Sectional National Study

Objective: To examine the relationship of work schedules with nurse turnover across various work settings. Methods: A cross-sectional study design was used with data collected from 17,046 nurses who participated in the 2018 National Sample Survey of Registered Nurses in the U.S. Multivariate logistic regression was used to examine the effects of work hours and overtime on nurse turnover. Results: Longer weekly work hours increased nurse turnover (OR = 1.104, 95% confidence interval [CI] = 1.006-1.023). A non-linear relationship was observed between overtime and turnover. Compared with nurses with no overtime, the turnover for nurses working 1-11 h overtime per week decreased (OR = 0.893, 95% CI = 0.798-0.999). When nurses worked ≥12 h, turnover increased (OR = 1.260, 95% CI = 1.028-1.545). Earning from the primary nursing position decreased turnover among nurses working in hospitals, other inpatient settings, and clinics. Job satisfaction decreased turnover. Conclusion: To prevent nurse turnover, it is important to monitor and regulate nurses' working hours at institutional and government levels. Government support and policy implementations can help prevent turnover.

Socially Disadvantaged Community Structures and Conditions Negatively Influence Risky Sexual Behavior in Adolescents and Young Adults: A Systematic Review

Objectives: This review aims to examine the association between community-level factors, namely, community structure and condition, and risky sexual behavior (RSB) including early sexual debut, having multiple sex partners, and unprotected sex, in adolescents and young adults.

Methods: In total, 17 observational studies were identified for review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Among the 11,216 identified articles, excluded articles comprised 8,361 duplicates, 2,855 articles by title screening, 893 by abstract screening, and 667 by full-text screening. Finally, eight additional articles were added by manual search.

Results: The community structural factors included social disadvantage, economic, employment, education status, racial or ethnic composition, residential stability, and physical environment. The current review found that social disadvantage (six studies) and economic status (10 studies) were most frequently examined. Particularly, higher levels of social disadvantage were associated with higher rates of early sexual initiation, inconsistent condom use, and multiple sexual partners.

Conclusion: This study highlights that community structure and conditions in terms of social disadvantages should be addressed to prevent RSB in the young population.

Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review

AIM

To examine and synthesize the noneconomic and economic impacts of nurse turnover in acute hospitals.

BACKGROUND

Nurse turnover occurs when nurses leave their jobs or the profession and is a major concern for the healthcare industry. Many studies have investigated the determinants of nurse turnover.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was utilized in the current review. Article search was conducted in June 2021. Research articles published since January 2000 were included. Eight databases (e.g., CINAHL, PubMed, PsycINFO, and Web of Science) were used. The following eligibility criteria were applied for inclusion: Articles that (1) were nonexperimental quantitative studies, (2) examined the impact of actual nurse turnover in acute hospitals, (3) were a peer-reviewed original research article, and (4) were written in English or Korean.

RESULTS

Among 9,041 searched articles, 16 were included in the review. Seven studies investigated the association of nurse turnover with processes and outcomes (workgroup processes, nurse staffing, nurse outcomes, and patient outcomes), and partially supported the negative impact of turnover. Nine studies found that nurse turnover is very costly.

CONCLUSION

Most studies investigated the turnover cost, which is costly. The negative noneconomic impact of nurse turnover was partially supported.

IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY

To prevent the adverse noneconomic and economic impacts of nurse turnover and retain nurses, healthcare organizations, nurse managers, and hospital staff nurses need to develop and implement prevention strategies and policies to address nurse turnover. Efforts to address nurse turnover can increase hospital competency to improve the quality of nursing care services and patient safety.

Candidates' and policymakers' perspectives on the needs for a master's program in nursing

BACKGROUND

Quality and safe care requires nurses with advanced knowledge and skills. Cambodia does not have a graduate-level nursing program; therefore, nurses are required to pursue advanced degrees in other countries. However, a master's degree nursing program is being established in this country.

OBJECTIVES

To explore the needs of stakeholders in the master's nursing program in Cambodia to establish the curriculum.

DESIGN

Students and graduates of Bachelor of Sciences in Nursing were surveyed, and policymakers were interviewed face-to-face.

PARTICIPANTS

As candidates for the master's nursing program, 94 undergraduates and 37 graduates participated in the survey, and four policymakers working at the Ministry of Health and Cambodian Council of Nurses were interviewed.

METHODS

Descriptive statistics and frequency analyses were utilized for quantitative data and qualitative data were thematically analyzed.

RESULTS

All 131 undergraduates and graduates were willing to apply to the master's program in nursing mainly to improve their knowledge and skills. They cited financial burden as a challenge for their study. Their educational demands were closely related to Cambodia's social situation and reflected their aspiration for advanced degrees and to become nursing leaders. The policymakers unanimously agreed on the need for the program and suggested policies and strategies to operate the course and recognize the role of graduates with this qualification. They reinforced that the curriculum should be based on the law, regulation, and policy and reflect Cambodia's current situation by identifying the needs of students and hospital officials and investigating available resources. Their perspectives revealed their expectations for graduates to plan healthcare policies and support them as their coworkers.

CONCLUSIONS

The establishment of nursing master's course should be accompanied by a policy to support nursing students. Nursing educators and experienced senior nurses should be included in this policymaking and they must participate in the development of the curriculum. It is suggested to develop an eclectic master's program in nursing that aggregates all opinions of stakeholders.

Work hours and overtime of nurses working in Cambodian hospitals

Aim

To examine the nature and prevalence of Cambodian nurses’ work hours and overtime and related factors

Background

The chronic shortage of nursing workforce is a major cause of overtime among nurses.

Introduction

Nursing shortage and working overtime among nurses negatively affect nurse and patient outcomes, but nurses’ work hours and overtime in Cambodia have not been comprehensively examined.

Methods

A multicenter cross‐sectional study was conducted in four Cambodian hospitals. Data were collected from 253 nurses providing direct nursing care using a questionnaire. The STROBE checklist was used for reporting this study.

Results

More than a fifth of staff nurses worked more than 48 h, which is the legal work hour limit in Cambodia. Two major reasons for working mandatory or voluntary overtime, on‐call or 24‐h on‐call were (a) not wanting to let down colleagues and (b) able to get all work done. The number of patients cared for was related to whether or not nurses worked 48 h or more.

Conclusion

Overtime work and adverse nurse scheduling are common in Cambodia.

Implications for nursing and health policy

Nurse managers and healthcare institutes in Cambodia need to monitor Cambodian nurses’ work hours, which are often beyond the legal work hour limit. Moreover, it is important to understand why nurses work overtime and develop health policies, strategies, and programs that can help promote patient and nurse safety and retain qualified nursing staff. The 24‐h on‐call practice needs to be regulated according to the labor policy in healthcare institutes to prevent adverse nurse and patient outcomes.

The association between health status and job satisfaction among female workers: A nationwide cross-sectional study

The purpose of this study was to determine the job satisfaction among female workers in Korea and the association between health status and job satisfaction. The Korean Longitudinal Survey of Women and Families was used for this nationwide cross-sectional study. Data from 1570 female workers were analyzed to determine job satisfaction and examine the association between health status and job satisfaction, controlling for other variables such as personal characteristics, work attributes, job opportunities, and work conditions. Analyses included descriptive statistics, independent t-tests, ANOVA, Pearson's correlation, and multivariate regression. Subjective health status was positively related, while diagnosed disease and depressive symptoms were negatively associated with job satisfaction. Monthly salary, work hours, fringe benefits, and geographical region were also significantly related to female workers' job satisfaction, and commute distance was related to job satisfaction with a small effect size. This study thus found that subjective health status, diagnosed disease, and depressive symptoms were related to female workers' job satisfaction. Health promotion and supporting mental health among female workers may be important managerial strategies for supporting increased job satisfaction in female workers.

Improving Treatment Adherence with Integrated Patient Management for TB Patients in Morocco

In Morocco, there are challenges in the management of high-risk tuberculosis (TB) patients, including paper-based management and a shortage of healthcare workers related to TB. Additionally, TB management has not been accounted for in various patient types, which affects treatment adherence. This study aims to examine the delivery model of TB management and the outcomes of an integrated patient management system that uses a patient-centered and community-based approach, along with mobile health technology. A total of 3605 TB patients were enrolled in this program in Morocco’s five prefectures (Rabat, Salé, Kénitra, Khemisset, Skhirat–Témara) from January 2018 to December 2019. Patients were managed based on demographic characteristics, socioeconomic status, areas (rural or urban), health literacy levels, and distance to primary health centers. Our mobile health intervention “smart pillbox” was interposed with high-risk TB patients, along with patient education. The rate of successful treatment was 92.2%, which was higher than the national rate (88%). The “lost to follow-up” rate was 4.1%, which was significantly lower than the existing non-adherence rate of 7.9%. Therefore, integrated patient management for TB patients in Morocco is more effective than the existing conventional programs. This comprehensive approach provides an alternative method for countries with limited resources.

Predictors of actual turnover among nurses working in Korean hospitals: A nationwide longitudinal survey study

AIM

To examine the factors affecting actual turnover among nurses working in hospitals using the Brewer-Kovner synthesis model.

BACKGROUND

To increase retention of nurses, it is important to understand factors contributing to actual turnover among nurses.

METHODS

A longitudinal study design was utilized with 2,633 of 20,613 eligible female hospital nurses who participated in Korea Nurses' Health Study. We created two age groups: a younger group (20-35 years) and an older group (36-49 years). Multivariate logistic regression was used to identify the factors influencing turnover by age group.

RESULTS

Pregnancy and childbirth increased young nurses' turnover. When we excluded intent to leave, depression and burnout were significant factors affecting young nurses' turnover. Salary and hospital size were factors predicting nurse turnover among nurses older than 36 years.

CONCLUSIONS

It is essential to develop prevention strategies of female nurse turnover based on the age group in Korea.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers and health care institutes need to develop new managerial and policy strategies to reduce nurse turnover in each age group.

Relationships between comprehensive characteristics of nurse work schedules and adverse patient outcomes: A systematic literature review

AIMS

To review the comprehensive characteristics of adverse nurse work schedules and to synthesise the evidence of their relationships with adverse patient outcomes.

BACKGROUND

To manage nurse shortages and fluctuations in patient censuses, nurses often work overtime. This increases nurses' work hours and causes them to have fewer breaks. Such extended work schedules, long shift length, long weekly work hours and insufficient beaks can be considered as adverse nurse work schedules. Understanding how these adverse nurse work schedules affect patient outcomes is important to ensure patient safety.

DESIGN

A systematic review of nursing and healthcare literature was conducted in this study.

METHODS

Eight electronic bibliographic databases (CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS and Web of Science) were used to search research articles published from 2000 to 2019. The study selection process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

RESULTS

From the search, 2,366 articles were identified, 22 of which were included in this review. Working more than 12 hours in a day had an adverse effect on patient outcomes, as was working more than 40 hours per week. There were mixed findings in the relationship between nurse overtime and adverse patient outcomes.

CONCLUSIONS

This study found a conclusive relationship between excessive nurse work hours and adverse patient outcomes. This review highlights the importance of managing adverse nurse schedules such as long daily and weekly work hours to improve patient safety and prevent adverse patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

Study findings support the importance of monitoring and regulating nurse work schedules and adverse scheduling practices to improve nurse well-being and health and to prevent adverse patient outcomes.

The challenges and achievements of graduates of the nurse bridging program in Cambodia: A qualitative study

BACKGROUND

As the shortage of qualified nurses is one of the primary healthcare issues in Cambodia, a two-year Nurse Bridging Program which grants bachelor's degrees to nurses with associate degrees was introduced.

OBJECTIVES

This study explores the challenges and achievements that the graduates experienced during and after the Nurse Bridging Program.

DESIGN

A qualitative approach was used in this study.

SETTING

The Nurse Bridging Program was conducted in a university in Cambodia from 2015 to 2016. This study was conducted 1 year after the Nurse Bridging Program.

PARTICIPANTS

A group of 38 graduates participated in the online survey and 3 graduates participated in a focus group interview.

METHODS

Sequential data collection for explanatory follow-up design was used in this study. The data obtained were analyzed using content and thematic analyses.

RESULTS

Participants reported challenges such as unfamiliarity with research, difficulty with a foreign language, and shortage of time. They tried to overcome these challenges, and this experience improved their nursing and research competencies, which improved their job prospects and aspirations of further studies.

CONCLUSIONS

The Nurse Bridging Program helped the nurses improve the quality of their work and develop their potential as nursing leaders.

Intensive care nurse staffing and nurse outcomes: A systematic review

BACKGROUND

Intensive care units (ICU) are associated with significant work stress and exert continuous physical and emotional demand upon health care providers. The health and well-being of care providers, including ICU nurses, is a matter of great concern. However, to the researcher's knowledge, there have been no reviews synthesizing the evidence about the relationship between nurse staffing and nurse outcomes in the ICU.

PURPOSE

The purpose of this systematic review was to examine nurse staffing in the ICU and synthesize literature to examine the relationship with nurse outcomes such as job satisfaction, burnout, fatigue, and intent to leave.

METHODS

This review was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed articles published between January 2000 and September 2019 were identified via eight electronic bibliographic databases. Articles were included and reviewed if they were correlational studies examining the relationships between nurse staffing and nurse outcomes in the ICU, and were published in peer-reviewed journals written in either English or Korean. The Quality Assessment and Validity Tool for Correlation Studies was used for quality appraisal.

RESULTS

From 5086 articles, eight published between 2006 and 2019 were included in this review. Three studies found expected relationships between worse nurse staffing and adverse nurse outcomes (high burnout, fatigue state, emotional exhaustion, depersonalization, and stress). However, the relationships between nurse staffing and other adverse nurse outcomes were not significant. Perceived adequate staffing was negatively related to adverse nurse outcomes. However, a non-significant relationship also was found.

CONCLUSION

This study found limited evidence on relationships between nurse staffing and nurse outcomes in the ICU. More studies are needed to conduct to find a conclusive relationship.

RELEVANCE TO CLINICAL PRACTICE

Given high demands and workload in the ICU, nurse staffing levels should be closely monitored to prevent adverse nurse outcomes.

Verbal Abuse Among Nurses Working in a Nepalese Government Hospital

Verbal abuse among nurses is the most prevailing type of violence encountered by nurses. A cross-sectional research design was used to identify the characteristics of verbal abuse among nurses. A self-administered questionnaire was completed by 201 nurses working in a government hospital of Nepal. Nurses were exposed to verbal abuse and yelling or raising voice in an angry fashion was the most common forms experienced by 96.5% of the respondents. Patient's relatives were reported as the main source of verbal abuse. Frequent exposure to verbal abuse was found in Nepalese nurses, which makes nurses feel unsupported, increased stress levels, and decreased sense of relaxation/well-being in the job. There is an immediate need of monitoring and training among nursing staff in recognition and management of aggressive behavior.

An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study

PURPOSE

To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR).

METHODS

This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11 months but was extended in a minority of cases up to 7 years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement.

RESULTS

One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1 month) was favoured by age <60 years (p < 0.005), no previous observation (p < 0.0002), duration less than 3 months (p < 0.0001), absence of CSCR in the fellow eye (p = 0.04), leakage outside of the arcade (p = 0.05) and fluid height >500 μm (p = 0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1 month was favoured by first episode (p = 0.04), height of subretinal fluid >500 μm (p < 0.0001) and short duration of observation (p = 0.02). Finally, there was no statistically significant difference among the treatments at 12 months.

CONCLUSION

Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification.

Extent of and factors associated with pain among older residents in nursing homes in South Korea: A nationwide survey study

AIM

Pain can have a critical negative impact on the quality of life of institutionalized older people. This study aimed to examine the characteristics of pain and associated factors among older people at nursing homes in Korea.

METHODS

A nationwide survey was carried out on the functional status of 1444 older residents at 91 nursing homes using the interRAI Long-Term Care Facilities instrument. The frequency, intensity, severity and consistency of pain were assessed, and data on potential attributes at the resident and facility levels were collected. Multivariate and multilevel regression analysis models were developed.

RESULTS

More than one-third (36.7%) of older residents had pain. Pain prevalence differed by several sociodemographic and clinical factors, including sex, depressive symptoms, cognition, or whether or not the resident was a Medical Aid beneficiary. Pain prevalence also varied according to nursing home size and location. In the multivariate, multilevel regression analyses, both having severe pain and having consistent pain were positively associated with depressive symptoms, and the pain experience was significantly lower among older residents in nursing homes that met the nursing staffing standard.

CONCLUSIONS

This is the most comprehensive study on pain assessment in long-term care facilities in Korea using a representative sample so far. Pain is prevalent among nursing home residents in Korea. Besides individual factors, facility characteristics - in particular, meeting the staffing standard - were important to pain control, which implies there is room for improving pain assessment and management through advancing quality of care policies. Geriatr Gerontol Int 2020; 20: 118-124.

Disparities in Health Care Utilization Between Asian Immigrant Women and Non-Hispanic White Women in the United States

Background: Asians accounted for 30% of all U.S. immigrants in 2014, of which 53% were women. Foreign-born Asian immigrant (FBAI) women experience difficulties in obtaining timely and needed health care due to multifaceted barriers. This study examined factors influencing health service utilization among FBAI women compared with native-born (non-Hispanic) White American (NBWA) women. Materials and Methods: A secondary data analysis was conducted using the 2014-2015 California Health Interview Survey. Guided by a modified version of Andersen's behavioral model of health service utilization, FBAI women aged 18 to 64 (n = 1,021) were compared with NBWA women of the same ages (n = 7,086). Outcome variables included having at least one doctor's visit in the past year and having an emergency room (ER) visit in the past year. Analyses included descriptive statistics, t-tests, chi-square tests, and multivariate logistic regressions. Results: FBAI women were significantly less likely to have at least one doctor's visit in the past year and were less likely to have a usual source of care than NBWA women. Significant predictors of having at least one doctor's visit for FBAI women were having high school education, having a usual source of care, having medical insurance, and having a chronic disease. The only significant predictor of having an ER visit for FBAI women was having a chronic disease. Conclusions: Health care providers must be aware of lower levels of health service utilization among FBAI women than NBWA women regardless of whether or not the FBAI women have chronic conditions. It is important to educate these women on the importance of regular health care visits.

Early development of de novo hepatocellular carcinoma after direct-acting agent therapy: Comparison with pegylated interferon-based therapy in chronic hepatitis C patients

Patients with chronic hepatitis C who achieve a sustained viral response after pegylated interferon therapy have a reduced risk of hepatocellular carcinoma, but the risk after treatment with direct-acting antivirals is unclear. We compared the rates of early development of hepatocellular carcinoma after direct-acting antivirals and after pegylated interferon therapy. We retrospectively analysed 785 patients with chronic hepatitis C who had no history of hepatocellular carcinoma (211 treated with pegylated interferon, 574 with direct-acting antivirals) and were followed up for at least 24 weeks after antiviral treatment. De novo hepatocellular carcinoma developed in 6 of 574 patients receiving direct-acting antivirals and in 1 of 211 patients receiving pegylated interferon. The cumulative incidence of early hepatocellular carcinoma development did not differ between the treatment groups either for the whole cohort (1.05% vs 0.47%, P = .298) or for those patients with Child-Pugh Class A cirrhosis (3.73% vs 2.94%, P = .827). Multivariate analysis indicated that alpha-fetoprotein level >9.5 ng/mL at the time of end-of-treatment response was the only independent risk factor for early development of hepatocellular carcinoma in all patients (P < .0001, hazard ratio 176.174, 95% confidence interval 10.768-2882.473) and in patients treated with direct-acting agents (P < .0001, hazard ratio 128.402, 95% confidence interval 8.417-1958.680). In conclusion, the rate of early development of hepatocellular carcinoma did not differ between patients treated with pegylated interferon and those treated with direct-acting antivirals and was associated with the serum alpha-fetoprotein level at the time of end-of-treatment response.

Work Hours, Overtime, and Break Time of Registered Nurses Working in Medium-Sized Korean Hospitals

This cross-sectional study used quantitative survey data collected from registered nurses (RNs) who worked as staff nurses in medium-sized (300 beds or less) Korean hospitals. Data from 290 RNs were analyzed to examine the nature and prevalence of staff nurses’ work hours, overtime, breaks, and related work conditions. The results showed that staff nurses working in medium-sized Korean hospitals worked 9.6 hours a day on average and had 1.5 breaks daily, including mealtime. The average number of days the nurses skipped a meal due to work during the last month was 6.1. With respect to skipping bathroom breaks due to work, staff nurses reported that they could not visit the bathroom 7.3 times during the last month. Regarding work conditions, staff nurses working in intensive care units reported having longer daily work hours and were more likely to work 10 hours or more per shift. Nurses with less than 3 years of experience reported longer daily work hours and fewer breaks.

Risk factors associated with highly pathogenic avian influenza subtype H5N8 outbreaks on broiler duck farms in South Korea

Highly Pathogenic Avian Influenza (HPAI) subtype H5N8 outbreaks occurred in poultry farms in South Korea in 2014 resulting in significant damage to the poultry industry. Between 2014 and 2016, the pandemic disease caused significant economic loss and social disruption. To evaluate the risk factors for HPAI infection in broiler duck farms, we conducted a retrospective case-control study on broiler duck farms. Forty-three farms with confirmed laboratories on premises were selected as the case group, and 43 HPAI-negative farms were designated as the control group. Control farms were matched based on farm location and were within a 3-km radius from the case premises. Spatial and environmental factors were characterized by site visit and plotted through a geographic information system (GIS). Univariable and multivariable logistic regression models were developed to assess possible risk factors associated with HPAI broiler duck farm infection. Four final variables were identified as risk factors in a final multivariable logistic model: "Farms with ≥7 flocks" (odds ratio [OR] = 6.99, 95% confidence interval [CI] 1.34-37.04), "Farm owner with ≥15 years of raising poultry career" (OR = 7.91, 95% CI 1.69-37.14), "Presence of any poultry farms located within 500 m of the farm" (OR = 6.30, 95% CI 1.08-36.93) and "Not using a faecal removal service" (OR = 27.78, 95% CI 3.89-198.80). This highlights that the HPAI H5N8 outbreaks in South Korea were associated with farm owner education, number of flocks and facilities and farm biosecurity. Awareness of these factors may help to reduce the spread of HPAI H5N8 across broiler duck farms in Korea during epidemics. Greater understanding of the risk factors for H5N8 may improve farm vulnerability to HPAI and other subtypes and help to establish policies to prevent re-occurrence. These findings are relevant to global prevention recommendations and intervention protocols.

Work Hours of Immigrant Versus U.S.-Born Female Workers

This study was a secondary analysis of cross-sectional data extracted from the 2011-2012 California Health Interview Survey. Data from 8,931 full-time (i.e., 21 hours or more per week) women workers aged 18 to 85 years were analyzed to examine the nature and prevalence of immigrant female workers’ work hours, overtime, and related factors in the United States compared to U.S.-born female workers. Results showed that foreign-born female workers did not work longer hours than U.S.-born female workers. Foreign-born female workers who reported poor health worked longer hours than did their U.S.-born counterparts. Foreign-born female workers who were self-employed or worked in family businesses tended to work longer hours than did those women who worked for private companies or nonprofit organizations.

Transmission of 51.56-Gb/s OOK signal using 1.55-μm directly modulated laser and duobinary electrical equalizer

We demonstrate the transmission of 51.56-Gb/s on-off keying (OOK) signals generated by using a 1.55-μm directly modulated laser (DML) over 15-km long standard single-mode fiber. In this experiment, a duobinary electrical equalizer based on a finite-impulse-response filter is used at the receiver to increase the dispersion-limited transmission distance. We evaluate the performances of the 51.56-Gb/s OOK signals with respect to the transmission distance by using the frequency response analysis of the proposed system. This result is used to explain why it is effective to utilize the duobinary equalization (instead of binary equalization) for increasing the transmission distance.

Visual Analytics for Pattern Discovery in Home Care. Clinical Relevance for Quality Improvement

BACKGROUND

Visualization can reduce the cognitive load of information, allowing users to easily interpret and assess large amounts of data. The purpose of our study was to examine home health data using visual analysis techniques to discover clinically salient associations between patient characteristics with problem-oriented health outcomes of older adult home health patients during the home health service period.

METHODS

Knowledge, Behavior and Status ratings at discharge as well as change from admission to discharge that was coded using the Omaha System was collected from a dataset on 988 de-identified patient data from 15 home health agencies. SPSS Visualization Designer v1.0 was used to visually analyze patterns between independent and outcome variables using heat maps and histograms. Visualizations suggesting clinical salience were tested for significance using correlation analysis.

RESULTS

The mean age of the patients was 80 years, with the majority female (66%). Of the 150 visualizations, 69 potentially meaningful patterns were statistically evaluated through bivariate associations, revealing 21 significant associations. Further, 14 associations between episode length and Charlson co-morbidity index mainly with urinary related diagnoses and problems remained significant after adjustment analyses. Through visual analysis, the adverse association of the longer home health episode length and higher Charlson co-morbidity index with behavior or status outcomes for patients with impaired urinary function was revealed.

CONCLUSIONS

We have demonstrated the use of visual analysis to discover novel patterns that described high-needs subgroups among the older home health patient population. The effective presentation of these data patterns can allow clinicians to identify areas of patient improvement, and time periods that are most effective for implementing home health interventions to improve patient outcomes.

Determinants of Job Satisfaction and Turnover Intent in Home Health Workers

Based on the job demands–resources (JD-R) model, this study explored the impact of job demands (physical injury and racial/ethnic discrimination) and resources (self-confidence in job performance and recognition by supervisor/organization/society) on home health workers’ employee outcomes (job satisfaction and turnover intent). Using data from the National Home Health Aide Survey ( N = 3,354), multivariate models of job satisfaction and turnover intent were explored. In both models, the negative impact of demands (physical injury and racial/ethnic discrimination) and the positive impact of resources (self-confidence in job performance and recognition by supervisor and organization) were observed. The overall findings suggest that physical injury and discrimination should be prioritized in prevention and intervention efforts to improve home health workers’ safety and well-being. Attention also needs to be paid to ways to bolster work-related efficacy and to promote an organizational culture of appreciation and respect.

The Centers for Medicare & Medicaid Services Reimbursement Policy and Nursing-Sensitive Adverse Patient Outcomes

The Centers for Medicare & Medicaid Services (CMS) reimbursement policy identified 11 preventable adverse outcomes. Of these 11 patient outcomes, four (severe pressure ulcers, falls and trauma, catheter-associated urinary tract infections, and vascular catheter-associated infections) are considered nursing-sensitive quality outcomes that can be decreased with greater and better nursing care. A cross-sectional study examined the CMS reimbursement policy focusing on nursing-sensitive adverse patient outcomes. The percentage of Medicare patients served as a proxy for a measure of the CMS changes in reimbursement. The CMS reimbursement policy measured by the proxy variable was not related to a reduction of the four adverse outcomes.

Nurse practitioners' job satisfaction in rural versus nonrural areas

PURPOSE

The purpose of this study is to examine the nature of nurse practitioners' (NPs) job satisfaction and its relationship to work conditions in rural versus nonrural areas.

DATA SOURCES

A secondary analysis of data extracted from the 2012 National Sample Survey of Nurse Practitioners. NPs in active practice in clinical settings were included in this study. The final analytic sample consisted of 9010 NPs.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Overall, NPs were satisfied with their positions (satisfied to very satisfied). Both rural and nonrural NPs were most satisfied with the proportion of their time spent in patient care, their level of autonomy, and the respect that they received from other colleagues. Nonrural NPs who said or stated that they performed to the fullest extent of their states' legal scope of practice were more satisfied than nonrural NPs who did not. When nonrural NPs fully utilized their NP skills, their job satisfaction increased. For rural NPs, a similar pattern was found regarding full use of their NP skills. The evidence found in this study reminds us that given the increasing demands for NPs' healthcare services, continuous effort should be made to recruit and retain rural NPs.

Korean Immigrant Women’s Health Care Utilization in the United States

A systematic literature review was performed to review empirical evidence, published between 1946 and 2015, regarding Korean immigrant women’s health care utilization and factors affecting their health care utilization in the United States. Andersen’s behavioral model of health services utilization was used as a framework and was expanded to analyze the pattern of health services utilization and to identify characteristics of access to health care. A total of 32 reports were included. Variables were categorized into 1 of 5 individual determinants: cultural, enabling, predisposing, need, and reinforcing factor. A total of 423 relationships were found between individual determinants and health care utilization. All reinforcing variables were effective in increasing Korean immigrant women’s health care utilization in a positive way. Interventions targeting multiple factors were strongly effective in encouraging Korean immigrant women to utilize health services for cancer screening. However, these studies yielded inconsistent findings related to outcome measures due to the variability of measurement criteria.

Crosstalk analysis in homogeneous multi-core two-mode fiber under bent condition

We analyze the inter-core crosstalk in homogeneous multi-core two-mode fibers (MC-TMFs) under bent condition by using the coupled-mode equations. In particular, we investigate the effects of the intra-core mode coupling on the inter-core crosstalk for two different types of MC-TMFs at various bending radii. The results show that the inter-core homo-mode crosstalk of LP(11) mode is dominant under the gentle fiber bending condition due to its large effective area. However, as the fiber bending becomes tight, the intra-core mode coupling is significantly enhanced and consequently makes all the inter-core crosstalk levels comparable to each other regardless of the mode. A similar tendency is observed at a reduced bending radius when the difference in the propagation constants between modes is large and core pitch is small.

Use of temporary nursing staff and nosocomial infections in intensive care units

AIMS AND OBJECTIVES

To examine the nature and prevalence of the use of temporary nursing staff in intensive care units and relationships between the use of temporary nursing staff and the occurrence of nosocomial infections (central line-associated blood stream infections and ventilator-associated pneumonia).

BACKGROUND

Hiring temporary nurses raises controversial issues with respect to nurse staffing, care processes and patient outcomes, yet empirical findings regarding the use of temporary nurses are mixed. Whether adverse patient outcomes in intensive care units are related to the use of temporary nursing staff remains unexamined.

DESIGN

A retrospective longitudinal design was used.

METHODS

Data were collected monthly from 12 intensive care units at six hospitals; 144 ICU-month data points were used for the analysis. Chi-square, anova and logit regression models were used to examine the research questions.

RESULTS

The intensive care units used higher levels of temporary nursing staff, but the use of temporary nursing staff was not significantly associated with nosocomial infections. Nurses' perceptions regarding staffing and resource adequacy were significantly associated with nosocomial infections.

CONCLUSIONS

No evidence was found to link the use of temporary nursing staff and nosocomial infections. Instead, nurses' perceptions of staffing adequacy were related to nosocomial infections.

RELEVANCE TO CLINICAL PRACTICE

Given the greater use of temporary nursing staff in intensive care units, nurse managers in intensive care units need to monitor the levels of temporary nurse staffing and develop a systematic approach for hospitals to assist in these nurses' adjustment, which can reduce the burden of both temporary and permanent intensive care unit nurses. In addition to quantitative measures of nurse staffing, nurses' perceptions regarding staffing adequacy can be used to measure nurse staffing in relation to adverse patient outcomes.

Impact of states' nurse work hour regulations on overtime practices and work hours among registered nurses

OBJECTIVES

To examine the degree to which states' work hour regulations for nurses-policies regarding mandatory overtime and consecutive work hours-decrease mandatory overtime practice and hours of work among registered nurses.

METHODS

We analyzed a nationally representative sample of registered nurses from the National Sample Survey of Registered Nurses for years 2004 and 2008. We obtained difference-in-differences estimates of the effect of the nurse work hour policies on the likelihood of working mandatory overtime, working more than 40 hours per week, and working more than 60 hours per week for all staff nurses working in hospitals and nursing homes.

PRINCIPAL FINDINGS

The mandatory overtime and consecutive work hour regulations were significantly associated with 3.9 percentage-point decreases in the likelihood of working overtime mandatorily and 11.5 percentage-point decreases in the likelihood of working more than 40 hours per week, respectively.

CONCLUSIONS

State mandatory overtime and consecutive work hour policies are effective in reducing nurse work hours. The consecutive work hour policy appears to be a better regulatory tool for reducing long work hours for nurses.

Incidence of venous thromboembolism following major surgery in Korea: from the Health Insurance Review and Assessment Service database

BACKGROUND

Data on the incidence of venous thromboembolism (VTE) following major surgery in Asian populations are limited.

METHODS

Using the Korean Health Insurance Review and Assessment Service database, we performed a nationwide population-based epidemiologic study to estimate the incidence of VTE after major orthopedic, cancer, and benign surgeries. VTE cases were identified from all patients undergoing major surgery between 2007 and 2011 using both diagnostic and drug codes as treatment evidence of VTE within 5 weeks of surgery. We also calculated the relative risk of VTE in major orthopedic and cancer surgery compared to benign surgery.

RESULTS

The overall rates of postoperative VTE were 1.24%, 0.67%, and 0.05% for major orthopedic, cancer, and benign surgeries, respectively. Hip fracture (1.60%) and colorectal cancer surgeries (1.67%) were associated with the highest rates of VTE, and the rates steadily increased during the study period. Advanced age, female sex, and general anesthesia were independent risk factors for VTE. Patients undergoing surgery for colorectal, pancreatic, ovarian, and esophageal cancer, and major orthopedic surgery had a > 20-fold higher risk of VTE than those undergoing benign surgery.

CONCLUSIONS

This is the largest epidemiologic study to investigate the incidence of VTE after major surgery in Asia, demonstrating that the rates of postoperative VTE are lower than in Caucasian populations. This study contributes to a better understanding of the differences in postoperative VTE development between Korean and Caucasian populations; the data also suggest that perioperative prophylactic strategies in Asians should be based on studies of such populations.

Factors associated with hospital staff nurses working on-call hours: a pilot study

When nurses work on-call hours, they have limited ability to control the hours they work. Nurses may be required to work extra hours and, if they are unable to detach from work during break time, can experience fatigue and sleep disturbances. Previous studies have not examined factors associated with on-call work. In this pilot study, the authors examined state regulatory, organizational, and personal factors related to nurse on-call hours. Data were collected from registered nurses working in hospitals in two states; the final analytic sample consisted of 219 nurses. The authors found that four variables (teaching hospital employment, patient-to-nurse ratio, race/ethnicity of the nurse, and living with children) were significantly related to working on-call hours. Additional research is needed to understand nurse on-call hours and develop agency policies to promote nurses' health and well-being.

Presence of nurse mandatory overtime regulations and nurse and patient outcomes

Working overtime among nurses is a prevalent practice used to control chronic understaffing and a common method used to handle normal variations in the patient census. The underlining mechanism of the relationship of nurse overtime to nurse injuries and adverse patient events is that when nurses work overtime or long hours, it contributes to nurses' fatigue and sleep so their alertness and vigilance are impaired in both their regular shift and overtime shift. The associations between mandatory overtime regulations and nurse and patient outcomes were examined among a sample of 173 nurses in North Carolina and West Virginia. Findings indicated mandatory nurse overtime regulation did not have any association with nurse injuries. There were statistically significant associations found between the regulations and adverse patient events. However, these associations should be interpreted with caution because the regulations were not related to nurse overtime or long work hours.

A study on knowledge and attitude toward brain death and organ retrieval among health care professionals in Korea

PURPOSE

The practice of retrieving vital organs from brain-dead donors is legally and medically accepted in Korea, but health care professionals' beliefs and opinions regarding these matters have not been sufficiently explored. The purpose of this study was to evaluate the knowledge and attitudes of health care professionals to the concepts of brain death and organ retrieval.

METHODS

Data were collected using a 41-item questionnaire during a week in June 2011. Sixty-one doctors and 109 nurses from five hospitals with more than 2000 beds in Seoul, Korea, participated in the survey. The data was analyzed using SPSS version 17.0 (SPSS Inc. Chicago, Illinois, USA).

RESULTS

There were statistically significant differences in the scores on knowledge according to marital status (P = .001) education level (P = .019), whether the participants were informed about organ donation from a brain-dead donor (P = .002), and the participant's experience managing potential brain-dead patients (P = .037). There were statistically significant differences in the scores on the attitude according to gender (P < .001), age (P < .001), marital status (P < .001), education level (P = .003), job position (P < .001), and the participant's experience referring brain-dead patients to the hospital-based organ procurement organization (P = .001). Significantly, attitude's positively correlated with knowledge about brain-dead organ donation (P < .001).

CONCLUSION

Compared with previous studies, the knowledge and attitudes of health care professionals' regarding brain death and organ retrieval were not improved. There are passive attitudes to brain death and organ retrieval. More research must be performed to promote knowledge and understanding toward brain death and organ retrieval among health care professionals.

Nurse overtime, working conditions, and the presence of mandatory nurse overtime regulations

Although more states have regulated mandatory nurse overtime, limited research has examined the impact of these regulations on the actual time nurses work and their working conditions. The purpose of this study was to compare nurse overtime and working conditions between states with and states without regulations limiting mandatory nurse overtime. Data were collected from registered nurses working in hospitals located in states with and without mandatory nurse overtime regulations; the final sample consisted of 219 nurses. No difference was found in overtime worked between nurses who worked in states with regulations or without. Those nurses working in states with regulations cared for more patients per shift and experienced more chronic nursing shortages on their nursing units than those working in states without regulation. Continuous efforts are needed to improve the implementation of regulations to reduce nurse mandatory overtime and long work hours.

Nurse Overtime, Working Conditions, and the Presence of Mandatory Nurse Overtime Regulations

Although more states have regulated mandatory nurse overtime, limited research has examined the impact of these regulations on the actual time nurses work and their working conditions. The purpose of this study was to compare nurse overtime and working conditions between states with and states without regulations limiting mandatory nurse overtime. Data were collected from registered nurses working in hospitals located in states with and without mandatory nurse overtime regulations; the final sample consisted of 219 nurses. No difference was found in overtime worked between nurses who worked in states with regulations or without. Those nurses working in states with regulations cared for more patients per shift and experienced more chronic nursing shortages on their nursing units than those working in states without regulation. Continuous efforts are needed to improve the implementation of regulations to reduce nurse mandatory overtime and long work hours.

Nursing overtime: why, how much, and under what working conditions?

To provide the best care to patients, the physical wellness of nursing staff is essential. Current evidence indicates long work hours can lead to adverse nurse and patient outcomes. To provide quality and safe patient care, both staff nurses and nurse managers need to recognize the adverse effects of overtime, whether it is mandatory or voluntary. Results of this study showed overtime was not used more when there was an increase in nursing shortages. Further, overtime was not used to control shortages; rather, understaffing was an underlying condition of the nursing practice, at least in the study sample. Thus, efforts must be made not only to prevent nurses from working long hours, but also to resolve the problem of understaffing in order to retain qualified nurses in hospitals.

Pharmacokinetics of sildenafil and its metabolite, N-desmethylsildenafil, in rats with liver cirrhosis and diabetes mellitus, alone and in combination

Pharmacokinetics of sildenafil and its metabolite, N-desmethylsildenafil, in humans and rats with liver cirrhosis (LC) and diabetes mellitus (DM), alone and in combination (LCD) did not seem to be reported. Sildenafil was administered intravenously (10 mg/kg) and orally (20 mg/kg) to control, LC, DM, and LCD rats. Expression of intestinal CYP isozymes in those rats was also measured. In LC, DM, and LCD rats, the areas under the curve (AUCs) of intravenous sildenafil were significantly greater (by 195%, 54.2%, and 127%, respectively) than controls. In LC and LCD rats, AUCs of oral sildenafil were significantly greater (3010% and 2030%, respectively) than controls. In LC, DM, and LCD rats, significantly greater AUCs of intravenous sildenafil were due to the slower hepatic extraction of sildenafil (because of decrease in the protein expression of hepatic CYP2C11 and 3A subfamily in LC and LCD rats, and CYP2C11 in DM rats). In LC and LCD rats, greater magnitude of increase in AUCs of oral sildenafil than those after the intravenous administration could be mainly due to the decrease in the intestinal extraction of sildenafil (because of decrease in the protein expression of intestinal CYP2C11 in LC and LCD rats).