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Kaw N, Murray J, Lopez AJ, Mamdani MM. Nursing resource team capacity planning using forecasting and optimization methods: A case study. J Nurs Manag 2019; 28:229-238. [PMID: 31733153 DOI: 10.1111/jonm.12905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 11/29/2022]
Abstract
AIM To estimate the cost-minimizing size and skill mix of a nursing resource team (NRT). BACKGROUND Nurse absences can be filled by an NRT at lower hourly cost than staffing agencies or nurses working overtime, but an NRT must be appropriately sized to minimize total cost. METHODS Using all registered nurse (RN) absences at an academic teaching hospital from 1 October 2014 to 31 March 2018, we developed a generalized additive model (GAM) to forecast the weekly frequency of each of ten types of absence over 52 weeks. We used the forecasts in an optimization model to determine the cost-minimizing NRT composition. RESULTS The median weekly frequencies for the ten absence types ranged between 12 and 65.5. The root mean squared errors of the GAMs ranged between 4.55 and 9.07 on test data. The NRT dimensioned by the optimization model yields an estimated annual cost reduction of $277,683 (Canadian dollars) (7%). CONCLUSIONS The frequency of RN absences in a hospital can be forecasted with high accuracy, and the use of forecasting and optimization to dimension an NRT can substantially reduce the cost of filling RN absences. IMPLICATIONS FOR NURSING MANAGEMENT This methodology can be adapted by any hospital to optimize nurse staffing.
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Affiliation(s)
- Neal Kaw
- Unity Health Toronto, Toronto, ON, Canada.,Operations Research Center, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Joshua Murray
- Unity Health Toronto, Toronto, ON, Canada.,Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Art Jerome Lopez
- Unity Health Toronto, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Muhammad M Mamdani
- Unity Health Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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52
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Zuriguel-Pérez E, Falcó-Pegueroles A, Agustino-Rodríguez S, Gómez-Martín MDC, Roldán-Merino J, Lluch-Canut MT. Clinical nurses's critical thinking level according to sociodemographic and professional variables (Phase II): A correlational study. Nurse Educ Pract 2019; 41:102649. [PMID: 31698254 DOI: 10.1016/j.nepr.2019.102649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 07/10/2019] [Accepted: 10/22/2019] [Indexed: 11/18/2022]
Abstract
Critical thinking ability is one of the basic competencies of clinical nurse and is widely accepted as being associated with the provision of quality care, however, the few evidence-based data related to the relationship between level of critical thinking ability and nurses' sociodemographic and professional characteristics. The aim of this study was to identify the level of critical thinking among nurses in clinical practice according to sociodemographic and professional variables. Descriptive cross-sectional and correlational study was carried out in a sample of 339 nurses from medical, surgical and critical care units at a tertiary care hospital. This study is related to a previous publication that presents psychometric analysis. Data were compiled using the Nursing Critical Thinking in Clinical Practice Questionnaire and ad hoc form for the recording of sociodemographic and professional characteristics. The statistical analysis of the data was performed using frequency, Mann-Whitney U Test, Kruskal-Wallis Test, and Pearson's correlation coefficients. Nurses reported moderate levels of critical thinking. Older nurses, with 11-15 years of experience in the actual unit, with continuous shift work, a permanent contract and master's degree indicated a higher level of critical thinking. Critical thinking skills are related to certain socio-demographic and professional variables, particularly age, years of experience, shift work, type of contract and educational level.
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Affiliation(s)
| | - Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Spain(1)(2).
| | | | | | - Juan Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada School of Nursing, Barcelona, Spain(2)
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Humairoh S, Yetti K, Rachmi SF. Whether Clinical Nurses (PK) III placement in the outpatient unit is in accordance with its functions and responsibilities? ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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54
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Sillero-Sillero A, Zabalegui A. Safety and satisfaction of patients with nurse's care in the perioperative. Rev Lat Am Enfermagem 2019; 27:e3142. [PMID: 31038636 PMCID: PMC6528624 DOI: 10.1590/1518-8345.2646.3142] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 01/27/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE to investigate the safety and satisfaction of patients and their relationship with nurse's care in the perioperative period. METHOD cross-sectional, multi-level, correlational study with 105 nurses in the surgical area and 150 patients operated in a Spanish tertiary hospital. For the nurses the sociodemographic variables, the perception of the work environment, the professional burnout and the satisfaction in the work were collected. For patients, the safety of adverse events and level of satisfaction, through the application of questionnaires. Univariate and multivariate analysis were used. RESULTS job satisfaction, professional commitment, and participation in hospital issues were negative predictors for adverse events related to the patient, while postoperative nurse care was a positive predictor. CONCLUSION there is an increase in adverse events when nurses are dissatisfied at work, less professional commitment and low availability to participate in the subjects of their unit. On the other hand, adverse events decrease when nurses perform the care in the postoperative period. Satisfaction was good and there was no association with the characteristics of nurses' attention. It is recommended to improve these predictors to increase the safety of surgical patients.
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Miller P, Waring L, Bolton G, Sloane C. Personnel flux and workplace anxiety: Personal and interpersonal consequences of understaffing in UK ultrasound departments. Radiography (Lond) 2019; 25:46-50. [DOI: 10.1016/j.radi.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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56
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Lee YJ, Hwang JI. Relationships of Nurse-Nurse Collaboration and Nurse-Physician Collaboration with the Occurrence of Medical Errors. ACTA ACUST UNITED AC 2019. [DOI: 10.11111/jkana.2019.25.2.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yeong-Ju Lee
- The Inje University Paik Hospital of Korea, Korea
| | - Jee-In Hwang
- College of Nursing Science, Kyung Hee University, Korea
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57
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Norman RM, Iversen HH, Sjetne IS. Development, adaptation and psychometric assessment of the extended brisbane practice environment measure for nursing homes (B-PEM-NH) for use in the Norwegian setting. Geriatr Nurs 2018; 40:302-313. [PMID: 30553554 DOI: 10.1016/j.gerinurse.2018.11.007] [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: 10/17/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022]
Abstract
Care workers' work environment is known to be associated with patient and nurse outcomes. To our knowledge no questionnaire is available for assessing this environment for all care workers in the Norwegian nursing-home setting. This paper describes the development, adaptation and assessment of such a questionnaire: the extended Norwegian version of the Brisbane Practice Environment Measure for Nursing Homes (B-PEM-NH). This version was developed and assessed using semistructured interviews, a reference group meeting, translation, adaptation, and pretesting, and psychometric assessment including exploratory and confirmatory factor analyses, and retest. We tested hypotheses to assess relations to other variables. The final factor solution comprised 41 items and 9 factors: interpersonal leadership, professional development, resources, professional leadership, input and acknowledgement, patient and next-of-kin focus, multidisciplinary collaboration, language misunderstandings, and feeling unsafe. The assessment showed that the B-PEM-NH had good psychometric properties, suggesting that the questionnaire is suitable for application in similar settings.
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Affiliation(s)
- Rebecka Maria Norman
- Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway; University of Oslo, Faculty of Medicine, Institute of Health and Society, Department of Health Management and Health Economics, PO Box 1130 Blindern, 0318 Oslo, Norway.
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58
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Baernholdt M, Hinton ID, Yan G, Xin W, Cramer E, Dunton N. Fall Rates in Urban and Rural Nursing Units: Does Location Matter? J Nurs Care Qual 2018; 33:326-333. [PMID: 29346186 PMCID: PMC6047925 DOI: 10.1097/ncq.0000000000000319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient falls remain a leading adverse event in hospitals. In a study of 65 rural hospitals with 222 nursing units and 560 urban hospitals with 4274 nursing units, we found that geographic region, unit type, and nurse staffing, education, experience, and outcomes were associated with fall rates. Implications include specific attention to fall prevention in rehabilitation units, creating better work environments that promote nurse retention, and provide RN-BSN educational opportunities.
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Affiliation(s)
- Marianne Baernholdt
- Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, Richmond, Virginia
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Zuriguel-Pérez E, Lluch-Canut MT, Agustino-Rodríguez S, Gómez-Martín MDC, Roldán-Merino J, Falcó-Pegueroles A. Critical thinking: A comparative analysis between nurse managers and registered nurses. J Nurs Manag 2018; 26:1083-1090. [PMID: 30198624 DOI: 10.1111/jonm.12640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/26/2022]
Abstract
AIM To analyse the levels of critical thinking among nurse managers and registered nurses and to explore the association between these levels and socio-demographic and occupational factors. BACKGROUND Critical thinking is an essential skill in advanced clinical nursing. However, few studies to date have explored critical thinking levels in nurse managers or compared them with those recorded in registered nurses. METHODS A randomized sample of 44 nurse managers and 295 registered nurses from a tertiary hospital in Barcelona participated in this study. The Nursing Critical Thinking in Clinical Practice Questionnaire was used to measure the level of critical thinking. The data were analysed using multivariate analysis by logistic regression. RESULTS Levels of critical thinking were higher in nurse managers than in registered nurses. Age, work shift schedule and educational level were associated with a higher level of critical thinking in nurse managers and were predictor factors. CONCLUSIONS This study identified age, work shift schedule and educational level as factors that impact on the acquisition of critical thinking skills among nurse managers. IMPLICATIONS FOR NURSING MANAGEMENT This study provides substantive evidence of the levels of critical thinking among nurse managers. When introducing strategies to enhance these skills, the associated occupational factors should be taken into account.
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Affiliation(s)
- Esperanza Zuriguel-Pérez
- Department of Nursing Informatics and Knowledge Management, Hospital Vall d'Hebron, Barcelona, Spain.,Health Care Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - M Teresa Lluch-Canut
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Consolidated Research Group on Measurement Invariance and Analysis of Change (GEIMAC: 2014-1139), University of Barcelona, Barcelona, Spain
| | - Sandra Agustino-Rodríguez
- Department of Nursing Informatics and Knowledge Management, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Juan Roldán-Merino
- Consolidated Research Group on Measurement Invariance and Analysis of Change (GEIMAC: 2014-1139), University of Barcelona, Barcelona, Spain.,Sant Joan de Deu School of Nursing, University of Barcelona, Barcelona, Spain
| | - Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Consolidated Research Group on Advanced Techniques Applied Psychology (GTEAAP: 2014-326), University of Barcelona, Barcelona, Spain
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60
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Kouatly IA, Nassar N, Nizam M, Badr LK. Evidence on Nurse Staffing Ratios and Patient Outcomes in a Low-Income Country: Implications for Future Research and Practice. Worldviews Evid Based Nurs 2018; 15:353-360. [PMID: 30129163 DOI: 10.1111/wvn.12316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Conclusive evidence on the effect of nurse staffing ratios on nurse-sensitive outcomes (NSOs) has not yet been achieved worldwide. AIMS To describe the relationship between nurse staffing and NSOs at a Magnet designated, university hospital a low-income country. METHODS A 48-month prospective study assessed the relationship between nurse staffing and six patient outcomes or NSOs in medical-surgical units and critical care units (CCUs). Nurse staffing was measured by nursing hours per patient day (NHPPD) and skill mix, whereas NSOs were total falls and injury falls per 1,000 patient days, percent of surveyed patients with hospital-acquired pressure injuries (HAPI), catheter-associated urinary tract infections, ventilator-associated pneumonia, and central line-associated bloodstream infections (CLABSI) per 1,000 central line days. RESULTS The odds for total falls, injury falls, HAPI, and CLABSI in the medical-surgical units were higher with lower NHPPD ratios, OR = 4.67, p = .000; OR = 4.33, p = .001; OR = 3.77, p = .004 and OR = 2.61, p = .006, respectively. For the CCUs, lower rates of NHPPD increased the odds for total falls, OR = 6.25, p = .0007, HAPIs OR = 3.91, p = .001 and CLABSI, OR = 4.78, p = .000. Skill mix was associated with total falls, OR = 2.40, p = .005 and HAPIs OR = 2.07, p = .03 in the medical-surgical units but had no effect in any NSOs in the CCUs. LINKING EVIDENCE TO ACTION Higher rates of nurses per patient were effective in improving some NSOs but not others. Skill mix had no effect on any of the six NSOs in the CCUs. As such, the results remain inconclusive as the benefits of the higher nurse to patient ratios in this low-income country warranting further multisite studies in different settings and countries.
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Affiliation(s)
- Iman Al Kouatly
- Nursing Director, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Nassar
- Nurse Quality Manager, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Nizam
- Executive Assistant, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Kurdahi Badr
- Professor, School of Nursing, Azusa Pacific University, Asuza, CA, USA
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Lee SE, Vincent C, Dahinten VS, Scott LD, Park CG, Dunn Lopez K. Effects of Individual Nurse and Hospital Characteristics on Patient Adverse Events and Quality of Care: A Multilevel Analysis. J Nurs Scholarsh 2018; 50:432-440. [PMID: 29902354 DOI: 10.1111/jnu.12396] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach. DESIGN This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada. METHODS Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care. FINDINGS Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital-level nurse education interacted with individual-level baccalaureate education. CONCLUSIONS This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. CLINICAL RELEVANCE Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality.
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Affiliation(s)
- Seung Eun Lee
- Assistant Professor, School of Nursing, University of Massachusetts, Lowell, MA, USA
| | - Catherine Vincent
- Associate Professor, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - V Susan Dahinten
- Associate Professor, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Linda D Scott
- Professor, School of Nursing, University of Wisconsin, Madison, WI, USA
| | - Chang Gi Park
- Research Assistant Professor, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Karen Dunn Lopez
- Assistant Professor, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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McFarlane DC, Doig AK, Agutter JA, Brewer LM, Syroid ND, Mittu R. Faster clinical response to the onset of adverse events: A wearable metacognitive attention aid for nurse triage of clinical alarms. PLoS One 2018; 13:e0197157. [PMID: 29768477 PMCID: PMC5955574 DOI: 10.1371/journal.pone.0197157] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/27/2018] [Indexed: 11/18/2022] Open
Abstract
Objective This study evaluates the potential for improving patient safety by introducing a metacognitive attention aid that enables clinicians to more easily access and use existing alarm/alert information. It is hypothesized that this introduction will enable clinicians to easily triage alarm/alert events and quickly recognize emergent opportunities to adapt care delivery. The resulting faster response to clinically important alarms/alerts has the potential to prevent adverse events and reduce healthcare costs. Materials and methods A randomized within-subjects single-factor clinical experiment was conducted in a high-fidelity 20-bed simulated acute care hospital unit. Sixteen registered nurses, four at a time, cared for five simulated patients each. A two-part highly realistic clinical scenario was used that included representative: tasking; information; and alarms/alerts. The treatment condition introduced an integrated wearable attention aid that leveraged metacognition methods from proven military systems. The primary metric was time for nurses to respond to important alarms/alerts. Results Use of the wearable attention aid resulted in a median relative within-subject improvement for individual nurses of 118% (W = 183, p = 0.006). The top quarter of relative improvement was 3,303% faster (mean; 17.76 minutes reduced to 1.33). For all unit sessions, there was an overall 148% median faster response time to important alarms (8.12 minutes reduced to 3.27; U = 2.401, p = 0.016), with 153% median improvement in consistency across nurses (F = 11.670, p = 0.001). Discussion and conclusion Existing device-centric alarm/alert notification solutions can require too much time and effort for nurses to access and understand. As a result, nurses may ignore alarms/alerts as they focus on other important work. There has been extensive research on reducing alarm frequency in healthcare. However, alarm safety remains a top problem. Empirical observations reported here highlight the potential of improving patient safety by supporting the meta-work of checking alarms.
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Affiliation(s)
- Daniel C. McFarlane
- Patient Care & Monitoring Solutions, Innovation Office, Royal Philips, Andover, Massachusetts, United States of America
- * E-mail:
| | - Alexa K. Doig
- College of Nursing, University of Utah, Salt Lake City, Utah, United States of America
| | - James A. Agutter
- College of Architecture & Planning, University of Utah, Salt Lake City, Utah, United States of America
- Applied Medical Visualizations (Medvis), Salt Lake City, Utah, United States of America
| | - Lara M. Brewer
- Department of Anesthesiology, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
| | - Noah D. Syroid
- Applied Medical Visualizations (Medvis), Salt Lake City, Utah, United States of America
- Anesthesiology Center for Patient Simulation, University of Utah, Salt Lake City, Utah, United States of America
| | - Ranjeev Mittu
- Information Technology Division, Information Management and Decision Architectures Branch, United States Naval Research Laboratory, Washington, District of Columbia, United States of America
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Kapaale CC. Understanding Value as a Key Concept in Sustaining the Perioperative Nursing Workforce. AORN J 2018; 107:345-354. [DOI: 10.1002/aorn.12074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Azevedo Filho FMD, Rodrigues MCS, Cimiotti JP. Ambiente da prática de enfermagem em unidades de terapia intensiva. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
Resumo Objetivo Analisar o ambiente da prática de enfermagem em unidades de terapia intensiva. Métodos Estudo descritivo, de abordagem quantitativa, realizado com 209 profissionais de enfermagem de três hospitais de ensino brasileiros. O ambiente da prática de enfermagem foi avaliado através da Practice Environment Scale. Os dados foram analisados descritivamente, assumindo nível de significância de 5% (p<0,05). O coeficiente Alfa de Cronbach foi utilizado para examinar a consistência interna dos construtos. Resultados Os profissionais de enfermagem consideraram desfavoráveis quatro das cinco dimensões do ambiente da prática profissional: participação dos enfermeiros na discussão dos assuntos hospitalares; fundamentos de enfermagem voltados para a qualidade do cuidado, habilidade, liderança e suporte dos coordenadores/supervisores de enfermagem aos enfermeiros/equipe de enfermagem; e adequação da equipe e de recursos. Apenas a dimensão relações colegiais entre profissionais de enfermagem e médicos apresentou avaliação positiva. Enfermeiros reconheceram mais fortemente atributos desfavoráveis no ambiente de prática do que técnicos de enfermagem. Conclusão O ambiente mostrou-se desfavorável para a prática dos profissionais de enfermagem. Esforços são necessários para tornar o ambiente de prática mais atrativo aos profissionais de enfermagem, e assim estimular melhorias na qualidade e na segurança da assistência prestada.
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Brühl A, Planer K, Hagel A. Variation of Care Time Between Nursing Units in Classification-Based Nurse-to-Resident Ratios: A Multilevel Analysis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018755242. [PMID: 29442533 PMCID: PMC5815415 DOI: 10.1177/0046958018755242] [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
A validity test was conducted to determine how care level-based nurse-to-resident ratios compare with actual daily care times per resident in Germany. Stability across different long-term care facilities was tested. Care level-based nurse-to-resident ratios were compared with the standard minimum nurse-to-resident ratios. Levels of care are determined by classification authorities in long-term care insurance programs and are used to distribute resources. Care levels are a powerful tool for classifying authorities in long-term care insurance. We used observer-based measurement of assignable direct and indirect care time in 68 nursing units for 2028 residents across 2 working days. Organizational data were collected at the end of the quarter in which the observation was made. Data were collected from January to March, 2012. We used a null multilevel model with random intercepts and multilevel models with fixed and random slopes to analyze data at both the organization and resident levels. A total of 14% of the variance in total care time per day was explained by membership in nursing units. The impact of care levels on care time differed significantly between nursing units. Forty percent of residents at the lowest care level received less than the standard minimum registered nursing time per day. For facilities that have been significantly disadvantaged in the current staffing system, a higher minimum standard will function more effectively than a complex classification system without scientific controls.
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Affiliation(s)
- Albert Brühl
- 1 Vallendar University of Philosophy and Theology (PTHV), Germany
| | | | - Anja Hagel
- 3 Rhineland-Palatinate and Saarland, Trier, Germany
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A National Study Links Nurses’ Physical and Mental Health to Medical Errors and Perceived Worksite Wellness. J Occup Environ Med 2018; 60:126-131. [DOI: 10.1097/jom.0000000000001198] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cho E, Park J, Choi M, Lee HS, Kim EY. Associations of Nurse Staffing and Education With the Length of Stay of Surgical Patients. J Nurs Scholarsh 2017; 50:210-218. [PMID: 29266711 DOI: 10.1111/jnu.12366] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE To examine the association of nurse staffing and education with the length of stay of surgical patients in acute care hospitals in South Korea. DESIGN A cross-sectional survey design was used for a nurse survey in acute hospitals collected between 2008 and 2009. The survey data (N = 1,665) were linked with patient discharge data (N = 113,438) and hospital facility data from 58 hospitals with 100 or more beds in South Korea. METHODS The dependent variable was the length of stay, that is, the number of days a patient remained in the hospital. The independent variables were nurse staffing (number of patients per nurse) and nurses' education level (percentage of nurses with a bachelor of science in nursing [BSN] degree). A multilevel analysis was used to analyze the associations of nurse staffing and education level with the length of stay by controlling for both hospital and patient characteristics. FINDINGS The average proportion of nurses with a BSN in all the hospitals was 30.86%, while the average number of patients per nurse was 14.31. The median length of hospital stay for patients was about 7 days. The multilevel analysis showed that nurse staffing and nurse education level were significantly associated with the length of stay of surgical patients in acute care hospitals. A 10% increase in the average number of patients per nurse increased the length of stay by 0.284 days (p = .037). When the number of nurses with a BSN was increased by 1%, the length of stay decreased by 0.42 days (p = .025). CONCLUSIONS Nurse staffing and nurses' education levels were significantly associated with the length of stay of surgical patients in South Korean hospitals. The findings from this study suggest that the South Korea healthcare system should develop appropriate strategies to improve the nurse staffing and education levels to ensure high-quality patient care in hospitals. CLINICAL RELEVANCE Healthcare policymakers and nurse managers need to modify adequate nurse staffing and education levels in order to reduce the length of stay of patients.
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Affiliation(s)
- Eunhee Cho
- Professor, Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | - Jeongyoung Park
- Assistant Professor, The George Washington University School of Nursing, Washington, DC, USA
| | - Miyoung Choi
- Associate Research Fellow, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, South Korea
| | - Hye Sun Lee
- Postdoctoral Researcher, Biostatistician, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun-Young Kim
- Professor, Dong-A University, Department of Nursing, Busan, South Korea
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Hwang JI, Park HA. Nurses’ systems thinking competency, medical error reporting, and the occurrence of adverse events: a cross-sectional study. Contemp Nurse 2017; 53:622-632. [DOI: 10.1080/10376178.2017.1409081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jee-In Hwang
- Department of Nursing, College of Nursing Science, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul 02447, South Korea
| | - Hyeoun-Ae Park
- Department of Biostatistics and Health Informatics, School of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
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Swiger PA, Patrician PA, Miltner RS(S, Raju D, Breckenridge-Sproat S, Loan LA. The Practice Environment Scale of the Nursing Work Index: An updated review and recommendations for use. Int J Nurs Stud 2017. [DOI: 10.1016/j.ijnurstu.2017.06.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tvedt C, Sjetne IS, Helgeland J, Løwer HL, Bukholm G. Nurses' reports of staffing adequacy and surgical site infections: A cross-sectional multi-centre study. Int J Nurs Stud 2017; 75:58-64. [PMID: 28735246 DOI: 10.1016/j.ijnurstu.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/04/2017] [Accepted: 07/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is indicated that healthcare personnel's perceptions of the work environment may reflect the clinical outcomes for the patients they care for. However, the body of evidence is inconsistent when it comes to the association between work environment and surgical site infection. OBJECTIVES The aim of this study is to examine the associations between nurse-reported characteristics of the work environment and incidence of surgical site infections after total hip arthroplasty. DESIGN AND SETTINGS This is a cross-sectional multicentre study conducted in 16 Norwegian hospitals. PARTICIPANTS Clinical outcomes for 2885 patients >18years that underwent total hip arthroplasty are combined with work environment descriptions from 320 nurses. MATERIALS AND METHODS We combine data about surgical site infections from The Norwegian Surveillance System for Antibiotic Consumption and Healthcare-Associated Infections and hospital characteristics such as overall survival probability (from administrative patient data) and nurses' reports of characteristics of the work environment (from a multicentre survey among nurses in Norwegian hospitals). Stepwise mixed-effects logistic regression model was performed to examine the associations between characteristics of the work environment and surgical site infections. RESULTS The incidence of surgical site infection among 2885 patients undergoing total hip arthroplasty in 16 Norwegian hospitals was 2.6%. Older age, elective procedures and high scores for staffing adequacy were associated with risk for surgical site infection. The association between high scores for adequate staffing and low risk for surgical site infections was present for patients that were admitted for an elective procedure, but not for patients admitted for a non-elective procedure. CONCLUSION Our results show that the risk of surgical site infections after elective total hip arthroplasty was lower in hospitals where nurses assessed staffing as adequate. Our findings add to the existing literature that examines the linkage between work environment and clinical outcomes.
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Affiliation(s)
- Christine Tvedt
- Lovisenberg Diaconal University College, Lovisenberggata 15b, 0456 Oslo, Norway.
| | | | - Jon Helgeland
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Hege Line Løwer
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Geir Bukholm
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway; Norwegian University of Life Sciences, PO Box 5003, 1432 Ås, Norway
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71
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Rommel A, Kottner J, Suhr R, Lahmann N. [Frequency of falls among clients of home care services : The importance of care-related and social risk factors]. Z Gerontol Geriatr 2017; 52:3-9. [PMID: 28332012 DOI: 10.1007/s00391-017-1215-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 12/21/2016] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Among the elderly falls frequently result in injuries, increase the need for long-term care and pose a challenge for the quality assurance in nursing care. We describe the frequency and risk factors of falls among care-dependent persons using home care services in Germany. METHODS The participants of the study "Nursing-related health problems in home care" (n = 880) were recruited based on a list of the officially accredited nursing services. Data collection followed a standardized study protocol. Proportions were calculated and adjusted odds ratios and predicted probabilities were estimated using binary logistic regression. RESULTS Falls are a frequent occurrence among care-dependent persons who are cared for by home care services: Almost every tenth care-dependent person suffers from a fall within a period of 2 weeks. Falls are mainly associated with social and care-related factors. Besides a low educational status this comprises certain living and care arrangements: People living alone or having infrequent contact to their nursing service as well as clients that, according to their carers, should receive more support have a significantly higher chance of falling. Multimorbidity is a medical risk factor while neurological diseases as well as polypharmacy present increased risks only in interaction with living and care arrangements. CONCLUSION Nursing staff and physicians should maintain an overview of the social and health conditions of people in need of long-term care. If care-dependent persons live alone or are infrequently cared for, additional medical problems considerably increase the risk for falling; therefore, preventive interventions and follow-up assessments of actual need levels should be promptly considered if health conditions or living arrangements change.
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Affiliation(s)
- A Rommel
- Abteilung 2: Epidemiologie und Gesundheitsmonitoring, Robert-Koch-Institut, Postfach 65 02 61, 13302, Berlin, Deutschland.
| | - J Kottner
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - R Suhr
- Stiftung ZQP, Zentrum für Qualität in der Pflege, Berlin, Deutschland
| | - N Lahmann
- Forschungsgruppe Geriatrie, AG Pflegeforschung, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Abstract
This study investigated the relationships between seven workload factors and patient and nurse outcomes. (1) Background: Health systems researchers are beginning to address nurses’ workload demands at different unit, job and task levels; and the types of administrative interventions needed for specific workload demands. (2) Methods: This was a cross-sectional correlational study of 472 acute care nurses from British Columbia, Canada. The workload factors included nurse reports of unit-level RN staffing levels and patient acuity and patient dependency; job-level nurse perceptions of heavy workloads, nursing tasks left undone and compromised standards; and task-level interruptions to work flow. Patient outcomes were nurse-reported frequencies of medication errors, patient falls and urinary tract infections; and nurse outcomes were emotional exhaustion and job satisfaction. (3) Results: Job-level perceptions of heavy workloads and task-level interruptions had significant direct effects on patient and nurse outcomes. Tasks left undone mediated the relationships between heavy workloads and nurse and patient outcomes; and between interruptions and nurse and patient outcomes. Compromised professional nursing standards mediated the relationships between heavy workloads and nurse outcomes; and between interruptions and nurse outcomes. (4) Conclusion: Administrators should work collaboratively with nurses to identify work environment strategies that ameliorate workload demands at different levels.
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The Association of Nursing Workloads, Organizational, and Individual Factors with Adverse Patient Outcome. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.43444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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