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Factors Associated with In-Hospital Mortality in Acute Care Hospital Settings: A Prospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217951. [PMID: 33138169 PMCID: PMC7663007 DOI: 10.3390/ijerph17217951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/25/2022]
Abstract
Background: In-hospital mortality is a key indicator of the quality of care. Studies so far have demonstrated the influence of patient and hospital-related factors on in-hospital mortality. Currently, new variables, such as nursing workload or the level of dependency, are being incorporated. We aimed to identify which individual, clinical and hospital characteristics are related to hospital mortality. Methods: A multicentre prospective observational study design was used. Sampling was conducted between February 2015 and October 2017. Patients over 16 years, admitted to medical or surgical units at 11 public hospitals in Andalusia (Spain), with a foreseeable stay of at least 48 h were included. Multivariate regression analyses were performed to analyse the data. Results: The sample consisted of 3821 assessments conducted in 1004 patients. The mean profile was that of a male (52%), mean age of 64.5 years old, admitted to a medical unit (56.5%), with an informal caregiver (60%). In-hospital mortality was 4%. The INICIARE (Inventario del Nivel de Cuidados Mediante Indicadores de Clasificación de Resultados de Enfermería) scale yielded an adjusted odds ratio [AOR] of 0.987 (95% confidence interval [CI]: 0.97–0.99) and the nurse staffing level (NSL) yielded an AOR of 1.197 (95% CI: 1.02–1.4). Conclusion: Nursing care dependency measured by INICIARE and nurse staffing level was associated with in-hospital mortality.
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Bruyneel A, Gallani MC, Tack J, d'Hondt A, Canipel S, Franck S, Reper P, Pirson M. Impact of COVID-19 on nursing time in intensive care units in Belgium. Intensive Crit Care Nurs 2020; 62:102967. [PMID: 33162312 PMCID: PMC7598359 DOI: 10.1016/j.iccn.2020.102967] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. OBJECTIVE To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DESIGN This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SETTING Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. MEASUREMENTS AND MAIN RESULTS The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6-6.4). CONCLUSIONS Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.
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Affiliation(s)
- Arnaud Bruyneel
- Soins intensifs - Centre Hospitalier Universitaire Tivoli, Belgium; SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | | | - Jérôme Tack
- SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Soins intensifs - Cliniques Universitaire de Bruxelles - Hôpital Erasme, Belgium
| | - Alain d'Hondt
- Soins intensifs - Centre Hospitalier Universitaire Ambroise Paré, Belgium
| | - Sebastien Canipel
- SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Soins intensifs - Centre Hospitalier Universitaire Ambroise Paré, Belgium
| | - Stéphane Franck
- Soins intensifs - Centre Hospitalier Universitaire Tivoli, Belgium
| | - Pascal Reper
- Soins intensifs - Centre Hospitalier de la Haute Senne, le Tilleriau, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
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Hammar LM, Alam M, Olsen M, Swall A, Boström AM. Being Treated With Respect and Dignity?-Perceptions of Home Care Service Among Persons With Dementia. J Am Med Dir Assoc 2020; 22:656-662. [PMID: 32839126 DOI: 10.1016/j.jamda.2020.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Studies on the quality of home care services (HCS) offered to persons with dementia (PwDs) reveal the prevalence of unmet needs and dissatisfaction related to encounters and a lack of relationships with staff. The objective of this study was to enhance knowledge of the perceptions of PwDs regarding their treatment with dignity and respect in HCS over time. DESIGN A mixed longitudinal cohort study was designed to study trends in the period between 2016 and 2018 and compare the results between PwDs (cases) and persons without dementia (controls) living at home with HCS. SETTING AND PARTICIPANTS Persons aged 65 years and older with HCS in Sweden. METHODS Data from an existing yearly HCS survey by the Swedish National Board of Health and Welfare (NBHW) was used. The focus was on questions concerning dignity and respect. NBHW data sets on diagnoses, medications, HCS hours, and demographic information were also used. We applied GEE logistic and cumulative logit regression models to estimate effects and trends of interest after controlling for the effects of age, gender, self-rated health, and number of HCS hours. RESULTS Over the study period, 271,915 (PwDs = 8.1%) respondents completed the survey. The results showed that PwDs were significantly less likely (3%-10% lower odds and cumulative odds) than controls to indicate that they were satisfied in response to questions related to dignity and respect. Both groups experienced a decrease in satisfaction from 2016 to 2018. Females, individuals with poor self-rated health, and individuals granted more HCS hours were found to be more dissatisfied. CONCLUSIONS AND IMPLICATIONS The HCS organization needs to shift from a task-oriented system to a person-centered approach, where dignity and respect are of the utmost importance. The HCS organizations need to be developed to focus on competence in person-centered care, and leadership to support staff.
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Affiliation(s)
- Lena Marmstål Hammar
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | - Moudud Alam
- School of Technology and Business Studies/Statistics, Dalarna University, Falun, Sweden
| | - Marie Olsen
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Anna Swall
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Theme Ageing, Karolinska University Hospital, Huddinge, Sweden; Stockholms Sjukhem, R&D Unit, Stockholm, Sweden
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Foli KJ, Reddick B, Zhang L, Krcelich K. Nurses' psychological trauma: "They leave me lying awake at night". Arch Psychiatr Nurs 2020; 34:86-95. [PMID: 32513472 DOI: 10.1016/j.apnu.2020.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe nurses' personal and professional psychological trauma. METHODS A content analysis of 372 responses surrounding personal and professional trauma was performed. RESULTS Five themes emerged. A new type of trauma was uncovered, heretofore undescribed in the literature: insufficient resource trauma caused by a lack of resources and staff needed to render quality, safe care. CONCLUSION Nurses' reports were vivid, frequently indicating they were still recovering from traumatic experiences. Professional sources of trauma were categorized as inherent in the role of the nurse and those that could be mitigated through organizational policy, adequate resources, and oversight.
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Affiliation(s)
- Karen J Foli
- Purdue University School of Nursing, West Lafayette, IN, United States of America.
| | - Blake Reddick
- Purdue University School of Nursing, West Lafayette, IN, United States of America
| | - Lingsong Zhang
- Department of Statistics, Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Kathryn Krcelich
- Purdue University School of Nursing, West Lafayette, IN, United States of America
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Higaonna M, Morimoto T, Ueda S. Association between nursing care delivery models and patients' health outcomes in a university hospital: A retrospective cohort study based on the Diagnostic Procedure Combination database. Jpn J Nurs Sci 2020; 17:e12319. [PMID: 32239665 DOI: 10.1111/jjns.12319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/20/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022]
Abstract
AIM This study aims to examine the association between nursing delivery models (fixed-team nursing model and Partnership Nursing System® [PNS®]) and patients' health outcomes (30-day in-hospital mortality and functional decline, indicated by a decline in Barthel Index or in-hospital mortality). METHODS This study used a retrospective cohort design based on the data from the Diagnostic Procedure Combination database, which included routinely collected health data for Japanese administrative claims. Participants were inpatients aged 20-99 years admitted between July 2010 and August 2012 (fixed-team nursing period) and July 2014 and August 2017 (PNS® period) to an academic teaching hospital in Japan. Odds ratios and 95% confidence intervals were estimated using multivariable logistic models. RESULTS We included 24,108 and 23,872 patients for the analyses of 30-day in-hospital mortality and functional decline, respectively (median age: 62 years; 52% women). The 30-day mortalities in both fixed-team nursing and PNS® groups were 0.5%. There was no significant association between the nursing delivery models and 30-day in-hospital mortality (adjusted odds ratio = 1.15, 95% confidence interval = 0.78-1.70). However, the PNS® group was found to have a higher proportion of patients with functional decline (2.7%) than the fixed-team nursing group (2.2%; p = .030). The adjusted odds ratio of declined function in the PNS® group, compared to the fixed-team nursing group, was 1.40 (95% confidence interval = 1.17-1.68, p < .001). CONCLUSIONS Further studies are needed to examine how the PNS® model influences patient outcomes, especially nurse-sensitive patient outcomes.
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Affiliation(s)
- Miki Higaonna
- Gerontological Nursing, School of Health Sciences, Faculty of Medicine, University of the Ryukyu, Okinawa, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology & Therapeutics, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Eekholm S, Ahlström G, Kristensson J, Lindhardt T. Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia: a descriptive cross-sectional study. BMC Infect Dis 2020; 20:73. [PMID: 31973742 PMCID: PMC6979078 DOI: 10.1186/s12879-019-4742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 12/27/2019] [Indexed: 02/03/2023] Open
Abstract
Background Community acquired pneumonia (CAP) remains a significant cause of morbidity and in-hospital mortality, and readmission rates are rising for older persons (> 65 years). Optimized treatment and nursing care will benefit patients and the health economy. Hence, there is a need to describe gaps between current clinical practice and recommendations in evidence-based guidelines for diagnostic procedures, medical treatment and nursing interventions for older patients with CAP. Methods Structured observations, individual ad hoc interviews and audits of patient records were carried out in an emergency department and three medical units. Data were analysed by manifest content analysis and descriptive statistics. Results Thirty patients (median age 74 years) admitted with CAP and 86 physicians, nurses, physiotherapists were included. The median length of stay (LOS) was 6.5 days, in-hospital mortality was10 and 40.7% were readmitted within one month. The severity assessment tool (CURB-65) was used in 16.7% of the patients, correct antibiotic treatment prescribed for 13.3% and chest radiography (≤6 weeks post-discharge) prescribed for 22.2%. Fluid therapy, nutrition support and mobilisation plans were found to be developed sporadically, and interventions to be performed unsystematically and sparingly. Positive Expiratory Pressure therapy and oral care were the nursing interventions with lowest adherence, ranging from 18.2 to 55.6%. Conclusions Adherence to recommendations was low for several central treatment and nursing care interventions for patients with CAP with possible consequences for patients and the use of resources. Thus, there is an urgent need to identify and remove barriers to adherence to recommendations in the neglected areas in view of the potential to improve patient outcomes.
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Affiliation(s)
- Signe Eekholm
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden. .,Research Unit for Clinical Nursing, Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Tove Lindhardt
- Research Unit for Clinical Nursing, Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, 2730, Herlev, Denmark
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Needleman J, Stone PW. Nurses and nursing support matter: interpreting the evidence. BMJ Qual Saf 2020; 30:bmjqs-2020-010830. [PMID: 31919094 DOI: 10.1136/bmjqs-2020-010830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Jack Needleman
- Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York City, New York, USA
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Information system use antecedents of nursing employee turnover in a hospital setting. Health Care Manage Rev 2020; 47:78-85. [PMID: 33399352 DOI: 10.1097/hmr.0000000000000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Voluntary turnover (VTO) of nursing employees is expensive for hospital systems and is often associated with lower levels of patient satisfaction, as well as adverse patient outcomes such as falls and medication errors. PURPOSE The aim of this study was to establish nurses' electronic medical record (EMR) use patterns and test if they can be used to predict VTO. METHODOLOGY/APPROACH The study followed 1,836 hospital nurses via the collection of EMR metadata through two 1-month time periods that were 1 year apart. Machine learning algorithms were then used to derive patterns of EMR utilization using VTO as a key variable for classification. Post hoc analysis of the most predictive variables was conducted. RESULTS The predictive model was effective in identifying which nurses would turnover 73.4% of the time and which nurses would not turnover 84.1% of the time. PRACTICE APPLICATIONS The ability to accurately predict nurses' intentions to leave is critical to reducing turnover. Early identification can lead to specific interventions to mitigate factors that are adversely impacting the nursing experience. Post hoc analysis and the key informant interviews indicated that many nurses do not appear to have good EMR navigation skills and spend significant effort in search of patient information.
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Affiliation(s)
- Cindy L. Munro
- Cindy L. Munro is coeditor in chief of the American Journal of Critical Care. She is dean and professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Aluko A. Hope
- Aluko A. Hope is coeditor in chief of the American Journal of Critical Care. He is an associate professor at Albert Einstein College of Medicine and an intensivist and assistant bioethics consultant at Montefiore Medical Center, both in New York City
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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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