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Marrow RK, Cronin C, Ashby V, Currid T, Alexander M. A Patient and Public Engagement Project to Inform Dementia Care in a UK Hospital Trust. Health Expect 2024; 27:e70024. [PMID: 39254301 PMCID: PMC11386339 DOI: 10.1111/hex.70024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/23/2024] [Accepted: 08/25/2024] [Indexed: 09/11/2024] Open
Abstract
INTRODUCTION The increasing prevalence of dementia in the United Kingdom presents significant challenges for healthcare, with projections estimating over a million affected individuals by 2025, costing the NHS £6.3 billion annually. Hospital admissions among dementia patients are common, occupying about 25% of UK hospital beds and leading to prolonged stays and diminished health outcomes. METHOD This paper presents the opening stages, part of a larger project where Patient and Public Involvement and Engagement (PPIE) was employed to understand and navigate what it means for hospital care for a person living with dementia. To understand hospital care for dementia patients, focus groups were conducted through dementia cafés in Essex and Suffolk from February to July 2023 engaging patients, carers and family members. RESULTS Recognised processes for reporting PPIE and thematic analysis were used and identified six themes and 21 subthemes regarding hospital care: individualised care, role of carers, basic care, interpersonal communication, information sharing and staffing. DISCUSSION The results from the PPIE will be used to inform and work with stakeholders through the next phases of the project, which involves examining care processes in the hospital, identifying touchpoints and evaluating these areas. The project continues to be informed by stakeholders including people living with dementia, carers and staff. Additionally, the results may inform other service providers for care enhancements, processes and delivery. CONCLUSION Moving forward, the study emphasises the importance of building collaborative relationships with stakeholders involved in dementia care. Additionally, it provides insights to focus areas that are fundamental for acute care organisations when delivering care to people living with dementia. By incorporating insights from PPIE, this project seeks to identify inequalities in dementia care services, improve hospital care for people living with dementia, fostering a more inclusive and supportive healthcare environment. PATIENT OR PUBLIC CONTRIBUTION The purpose of the study was to explore the most important issues around hospital care for people with dementia, their carers and families. Persons living with dementia, carers and family members were involved in the study through community dementia cafés and recruited to take part in focus groups to discuss hospital care for patients with dementia. The design of questions and materials for the discussions was developed through consultation with the university department's service user lead and dementia specialist and reviewed by a service user member living with dementia. A pilot focus group was conducted with a group of carers. We worked with the dementia café managers to coordinate recruitment and a suitable environment to run the focus groups. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Rachel K Marrow
- School of Health and Social Care, University of Essex, Wivenhoe Park, Colchester, UK
| | - Camille Cronin
- School of Health and Social Care, University of Essex, Wivenhoe Park, Colchester, UK
- School of Health and Social Care, University of Essex, Elmer Approach, Southend-on-Sea, Essex
| | - Victor Ashby
- School of Health and Social Care, University of Essex, Wivenhoe Park, Colchester, UK
- School of Health and Social Care, University of Essex, Elmer Approach, Southend-on-Sea, Essex
| | - Thomas Currid
- School of Health and Social Care, University of Essex, Elmer Approach, Southend-on-Sea, Essex
| | - Marie Alexander
- East Suffolk and North Essex Foundation Trust (ESNEFT), Turner Road, Colchester, Essex, UK
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Vleminckx S, Van Bogaert P, De Meulenaere K, Willem L, Haegdorens F. Factors influencing the formation of balanced care teams: the organisation, performance, and perception of nursing care teams and the link with patient outcomes: a systematic scoping review. BMC Health Serv Res 2024; 24:1129. [PMID: 39334182 PMCID: PMC11429156 DOI: 10.1186/s12913-024-11625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/20/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The composition of care teams is crucial for delivering patient-centered healthcare, yet assembling a well-balanced team remains a challenge. This difficulty stems from the intricate dynamics of team capacity, culture, context, and the demands of the job. The current literature offers limited guidance for decision-makers on how to effectively navigate these dynamics to compose a balanced care team. METHODS We conducted a systematic scoping review of literature spanning from 2009 to 2022. The aim was to identify factors that significantly influence the work environment, team performance, nursing outcomes, and patient outcomes within healthcare settings. Our review focused on extracting and synthesizing evidence to uncover these influencing factors. RESULTS Our analysis identified 35 factors that play a significant role in shaping the work environment and influencing team performance, nursing outcomes, and patient outcomes. These factors were categorized into nine key domains: workload, leadership, team composition, stress and demands, professional relationships, safety, logistics and ergonomics, autonomy and responsibility, and transparency and task clearness. CONCLUSIONS To improve patient care and nursing job satisfaction, policymakers and decision-makers can consider these influencing factors in the design and management of care teams. The findings advocate for strategic adjustments in these domains to enhance a team's balance. Furthermore, our review underscores the need for further research to fill the identified gaps in knowledge, offering a directive for future studies into optimal care team composition. This systematic approach to team composition can significantly impact patient outcomes and nurse satisfaction, providing a roadmap for creating more effective and harmonious teams.
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Affiliation(s)
- Senne Vleminckx
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium.
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
| | - Kim De Meulenaere
- Faculty of Business and Economics - Management Department, University of Antwerp, Antwerp, Belgium
| | - Lander Willem
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium
| | - Filip Haegdorens
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
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Johnson C, Delaney KR, Cirpili A, Marriott S, O'Connor J. American Psychiatric Nurses Association Position: Staffing Inpatient Psychiatric Units. J Am Psychiatr Nurses Assoc 2024; 30:886-895. [PMID: 37698389 DOI: 10.1177/10783903231198247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVE An American Psychiatric Nurses Association (APNA) task force reviewed current staffing research to revise and update the 2011 APNA "Staffing inpatient psychiatric units" position paper and provide recommendations to the APNA Board of Directors on how psychiatric mental health (PMH) nurses might champion the staffing needs of inpatient psychiatric units. METHODS Current research on staffing and nursing practice in inpatient psychiatric units was reviewed as well as variables believed to influence staffing and nursing practice, such as consumer needs and workplace culture. Since current nurse staffing principles emphasize nursing value and how that value is connected to outcomes, the literature search included a focus on staffing and related patient outcomes. RESULTS PMH nurses are critical to the safety and quality of care in inpatient psychiatric units. However, there are little existing data on the relationship between staffing levels and even common adverse events such as staff injury and restraint of patients. Furthermore, there is scant research conducted on inpatient psychiatric units that informs optimal staffing models or establishes links between staffing and patient outcomes. CONCLUSIONS Consistent with current evidence, the universal use of a single method or model of determining staffing needs (e.g., nursing hours per, case mix index, or mandatory ratios) is not recommended. PMH nurses should champion systematic evaluation of staffing on their inpatient units against select patient, nurse, and system outcomes. A data repository of PMH nurse-sensitive outcomes is necessary to benchmark unit performance and staffing.
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Affiliation(s)
- Celeste Johnson
- Celeste Johnson, DNP, APRN, PMH CNS, CMJ Behavioral Health Consulting, LLC, Garland, TX, USA
| | - Kathleen R Delaney
- Kathleen R. Delaney, PhD, PMH-NP, FAAN, Rush University College of Nursing, Chicago, IL, USA
| | - Avni Cirpili
- Avni Cirpili, DNP, RN, Vanderbilt Psychiatric Hospital, Nashville, TN, USA
| | - Suzie Marriott
- Suzie Marriott, MS, RN, PMH-BC, Stony Brook Eastern Long Island Hospital, Port Jefferson Station, NY, USA
| | - Janette O'Connor
- Janette O'Connor, MS, BS, BSN, RN, PMH-BC, New York Presbyterian Hospital, White Plains, NY, USA
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Han K, Trinkoff AM, Baek H, Kim Y. A comparison of work characteristics and health status between Korean and US hospital nurses. Nurs Open 2024; 11:e70040. [PMID: 39286990 PMCID: PMC11406312 DOI: 10.1002/nop2.70040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/24/2024] [Accepted: 09/04/2024] [Indexed: 09/19/2024] Open
Abstract
AIM A rigorous examination of the occupational features across cultures helps draw policy recommendations for nurses' quality care practices and good health. This study aimed to explore the differences in work characteristics and health status between Korean and US hospital nurses. DESIGN For this comparative secondary data analysis study, we constructed a dataset with 304 pairs of nurses from Korea and the United States, matched by age and gender. METHODS We used the data from the 2020 Korean Hospital Nurses Health Behaviors and Health Status study, collected from May to July 2020, and the Nurse Worklife and Wellness Study (NWWS), conducted between November 2020 and February 2021. RESULTS Compared to nurses in the United States, Korean nurses rated their job-related conditions much lower, had lower intentions to stay in their current workplace and were less satisfied with their jobs. Korean nurses reported that organizational support and employee health resources were less prevalent and their levels of healthy behaviour practice and health status were lower than their US counterparts. Nurses in Korea require better practice environments and employee health support. Adequate workload and staffing levels are needed to improve job conditions for Korean nurses. Organizational support and employee health resources should always be accessible at nurses' workplaces.
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Affiliation(s)
- Kihye Han
- Chung‐Ang University College of NursingSeoulSouth Korea
| | | | - Hyang Baek
- University of Maryland School of NursingBaltimoreMarylandUSA
| | - Yeonhee Kim
- University of Ulsan Department of Clinical NursingSeoulSouth Korea
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Al‐Hammouri F, Hamdan KM, Haymour AM, Ibrahim MO, Malkawi A, Al‐Hiary SS, Albqoor MA, Shaheen AM. Quality of nursing care: Predictors of patient satisfaction in a national sample. Nurs Open 2024; 11:e2252. [PMID: 39166287 PMCID: PMC11336376 DOI: 10.1002/nop2.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 08/22/2024] Open
Abstract
AIM To assess patients' satisfaction with the quality of nursing care and the relationship between patients' characteristics and their level of satisfaction. DESIGN A descriptive correlational cross-sectional design was used in this study. METHODS Convenient sampling was utilized to include 1014 inpatients from six hospitals in Jordan: three private hospitals; two governmental hospitals; and one university-affiliated hospital. The data collection process occurred from September 2022 to January 2023. The data were collected using the Arabic version of the Patients' Satisfaction with Nursing Care Quality Questionnaire. The data were analysed using Pearson correlation, t-test, one-way ANOVA and multiple hierarchal regression. RESULTS The study included 1014 patients with an average age of 51.3 (SD = 18.6), and 59.9% were females. More than two thirds of the sample reported having health insurance, and 62.7% were unemployed. The mean total score of patients' satisfaction with nursing care quality (NCQ) was 68.2 (SD = 12.9), indicating high satisfaction. Higher-income levels (p < 0.001), higher education levels (p = 0.003), having health insurance (p < 0.001), being admitted to private hospitals (p < 0.001), being admitted to critical care units (p = 0.002), being in a single room (p = 0.001), excellent perceived health status (p < 0.001) and willingness to recommend the hospital to family and friends (p < 0.001) were significant predictors of patients' satisfaction with NCQ. CONCLUSIONS Patient and hospital environment characteristics affected patients' satisfaction with NCQ. Hospital management should consider these characteristics to improve patient satisfaction and outcomes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Policymakers and hospital management should consider improving the physical environment of their facilities to improve patients' satisfaction. Continuous professional development should emphasize nurses' communication skills to enhance their abilities to deliver information to their patients. IMPACT This study examined levels and predictors of patients' satisfaction with the quality of nursing care. The results indicated that improving patients' satisfaction can be achieved by focusing on areas of nurses' communication skills and explaining information to patients. REPORTING METHOD The study adhered to STORBE guidelines for reporting observational studies. PATIENT OR PUBLIC CONTRIBUTION Hospitalized patients contributed to the data of this study. Hospital administrators facilitated its implementation.
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Affiliation(s)
| | | | | | | | | | | | | | - Abeer M. Shaheen
- Community Health Nursing Department, School of NursingThe University of JordanAmmanJordan
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Broden EG, Eche-Ugwu IJ, DeCourcey DD, Wolfe J, Hinds PS, Snaman J. "At Least I Can Push this Morphine": PICU Nurses' Approaches to Suffering Among Dying Children. J Pain Symptom Manage 2024; 68:132-141.e2. [PMID: 38679304 DOI: 10.1016/j.jpainsymman.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
CONTEXT Parents of children who die in the pediatric intensive care unit (PICU) carry memories of their child's suffering throughout a lifelong grieving experience. Given their prolonged time at the bedside, PICU nurses are poised to attend to dying children's suffering. OBJECTIVES We aimed to explore how PICU nurses identify, assess, and attend to EOL suffering. METHODS Interpretive descriptive qualitative study with thematic analysis of virtual focus groups from a geographically diverse sample of PICU nurses. RESULTS Nurses participated in five focus groups (N = 19). Most identified as White (89%) females (95%) with a range of 1-24 years of PICU experience and involvement in >10 EOL care cases (89%). Nurses described approaches to suffering within five themes: 1) Identifying and easing perceptible elements; 2) Recognizing and responding to subtleties moment-to-moment; 3) Acclimating to family interdependence; 4) Synchronizing nurse in-the-room insight with systemic complexity; and 5) Accounting for ambiguity. Nurses detailed elements of suffering they could "fix" with straightforward, external interventions (e.g., pain medication). More complex tasks like optimizing care within familial and interprofessional team relationships while navigating psychosocial responses from children and families challenged nurses. Nurses attempted to minimize EOL suffering amidst ambiguity and complexity using internal processes including managing the environment and titrating moment-to-moment care. CONCLUSIONS While physical suffering may be remedied with direct nursing care, holistically attending to EOL suffering in the PICU requires both bolstering external processes and strengthening PICU nurses' internal resources. Improving psychosocial training and optimizing interprofessional care systems could better support dying children and their families.
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Affiliation(s)
- Elizabeth G Broden
- Department of Psychosocial Oncology and Palliative Care (E.G.B., J.S.), Dana-Farber Cancer Institute, Boston Massachussetts; National Clinician Scholars Program (E.G.B.), Yale Schools of Medicine and Public Health, New Haven, Connecticut.
| | - Ijeoma Julie Eche-Ugwu
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services(I.J.E.U.), Dana-Farber Cancer Institute, Boston, Massachussetts
| | - Danielle D DeCourcey
- Department of Pediatrics (D.D.D., J.W., J.S.), Harvard Medical School Boston, Massachussetts; Division of Medical Critical Care (D.D.D.), Boston Children's Hospital, Boston, Massachussetts
| | - Joanne Wolfe
- Department of Pediatrics (D.D.D., J.W., J.S.), Harvard Medical School Boston, Massachussetts; Department of Pediatrics (J.W.), Massachusetts General Hospital and Department of Pediatrics, Brigham and Women's Hospital, Boston, Massachussetts
| | - Pamela S Hinds
- Department of Nursing Science (P.H.), Professional Practice and Quality, Children's National Hospital, Washington, DC; Department of Pediatrics (P.H.), The George Washington University, Washington, DC
| | - Jennifer Snaman
- Department of Psychosocial Oncology and Palliative Care (E.G.B., J.S.), Dana-Farber Cancer Institute, Boston Massachussetts; Department of Pediatrics (D.D.D., J.W., J.S.), Harvard Medical School Boston, Massachussetts
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Caponnetto V, Dante A, El Aoufy K, Melis MR, Ottonello G, Napolitano F, Ferraiuolo F, Camero F, Cuoco A, Erba I, Rasero L, Sasso L, Bagnasco A, Alvaro R, Manara DF, Rocco G, Zega M, Cicolini G, Mazzoleni B, Lancia L. Community health services in European literature: A systematic review of their features, outcomes, and nursing contribution to care. Int Nurs Rev 2024. [PMID: 39073363 DOI: 10.1111/inr.13033] [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: 12/21/2023] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND To meet the population's needs, community care should be customized and continuous, adequately equipped, and monitored. INTRODUCTION Considering their fragmented and heterogeneous nature, a summary of community healthcare services described in European literature is needed. The aim of this study was to summarize their organizational models, outcomes, nursing contribution to care, and nursing-related determinants of outcomes. METHODS A systematic review was performed by searching PubMed, CINAHL, Scopus, and Embase in October 2022 and October 2023 (for updated results). Quantitative studies investigating the effects of community care, including nursing contribution, on patient outcomes were included and summarized. Reporting followed the PRISMA checklist. The review protocol was registered on PROSPERO (CRD42022383856). RESULTS Twenty-three studies describing six types of community care services were included, which are heterogeneous in terms of target population, country, interventions, organizational characteristics, and investigated outcomes. Heterogeneous services' effects were observed for access to emergency services, satisfaction, and compliance with treatment. Services revealed a potential to reduce rehospitalizations of people with long-term conditions, frail or older persons, children, and heart failure patients. Models are mainly multidisciplinary and, although staffing and workload may also have an impact on provided care, this was not enough investigated. DISCUSSION Community health services described in European literature in the last decade are in line with population needs and suggest different suitable models and settings according to different care needs. Community care should be strengthened in health systems, although the influence of staffing, workload, and work environment on nursing care should be investigated by developing new management models. CONCLUSIONS AND IMPLICATIONS FOR HEALTH POLICY Community care models are heterogeneous across Europe, and the optimum organizational structure is not clear yet. Future policies should consider the impact of community care on both health and economic outcomes and enhance nursing contributions to care.
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Affiliation(s)
- Valeria Caponnetto
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Angelo Dante
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Khadija El Aoufy
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Giulia Ottonello
- Department of Health Sciences, University of Genoa, Genova, Italy
- Ingram School of Nursing, McGill University, Montreal, Canada
- Direction of Health Professionals, "IRCCS Istituto Giannina Gaslini,", Genova, Italy
| | - Francesca Napolitano
- Department of Health Sciences, University of Genoa, Genova, Italy
- Department of Emergency and Admission, Policlinic Hospital "IRCSS San Martino,", Genova, Italy
| | - Fabio Ferraiuolo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Camero
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Angela Cuoco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Orthopedic and Traumatology Clinic, Orthopedic Institute "IRCSS Rizzoli,", Bologna, Italy
| | - Ilaria Erba
- Bachelor of Science in Nursing, Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Laura Rasero
- Department of Health Sciences, University of Florence, Florence, Italy
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genova, Italy
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
| | - Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Genova, Italy
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
| | - Duilio Fiorenzo Manara
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Gennaro Rocco
- Center of Excellence for Nursing Scholarship, Rome, Italy
- Faculty of Medicine, University "Our Lady of the Good Counsel", Tirana, Albania
| | - Maurizio Zega
- Center of Excellence for Nursing Scholarship, Rome, Italy
- FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
| | - Giancarlo Cicolini
- FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
- Section of Nursing and Midwifery, Department of Innovative Technologies in Medicine & Dentistry, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Beatrice Mazzoleni
- FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Loreto Lancia
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
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Mann C, Montoya L, Taylor J, Barton G. Measuring the PULSE of Nursing: Development of a Dashboard to Evaluate and Monitor Nursing Care Models. J Nurs Care Qual 2024; 39:273-278. [PMID: 38470854 DOI: 10.1097/ncq.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated into acute inpatient care settings. PROBLEM A mechanism to continuously monitor the impact of this staffing change was not available. APPROACH Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics. OUTCOMES The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators. CONCLUSION The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.
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Lai YL, Chen WY, Lee SS, Liaw YP. On the Association Between Demographic Structural Change and the Effectiveness of Nurse Staffing Policy for Inpatient Care: Evidence from Taiwan. Risk Manag Healthc Policy 2024; 17:1725-1743. [PMID: 38953037 PMCID: PMC11215666 DOI: 10.2147/rmhp.s468178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/14/2024] [Indexed: 07/03/2024] Open
Abstract
Purpose This study investigates the influence of demographic changes on the effectiveness of hospital nurse staffing policy, measured by the cumulative response of inpatient care quality to adjustments in hospital nurse staffing levels in Taiwan. Methods The research design utilized in this study aligns with the observational time-series methodology, and a total of 99 monthly time-series observations were collected from multiple databases administered by the Taiwan government over the period from January 2015 to March 2023. Specifically, the time-varying parameter vector autoregressive and autoregressive distributed lag models were employed to investigate the association between age distribution and nurse staffing policy effectiveness. Results The time-varying impulse responses of the unplanned 14-day readmission rate after discharge to changes in nurse staffing levels indicate a positive association between patient-to-nurse ratios and unplanned 14-day readmission rates across various types of hospitals. Nevertheless, the effectiveness of hospitals' nurse staffing policy is observed to diminish with population aging, particularly evident in medical centers and regional hospitals. Conclusion Policymakers should establish lower mandated patient-to-nurse ratios, grounded in practical nurse workforce planning, to address the needs of an aging society and enhance inpatient care quality through improved nurse staffing in hospitals.
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Affiliation(s)
- Yi-Ling Lai
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 402367, Taiwan
- Community Health Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, 427213, Taiwan
| | - Wen-Yi Chen
- Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, 403301, Taiwan
| | - Shiuan-Shinn Lee
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 402367, Taiwan
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 402367, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, 402367, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, 402367, Taiwan
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Tate K, Penconek T, Booth A, Harvey G, Flynn R, Lalleman P, Wolbers I, Hoben M, Estabrooks CA, Cummings GG. Contextually appropriate nurse staffing models: a realist review protocol. BMJ Open 2024; 14:e082883. [PMID: 38719308 PMCID: PMC11086385 DOI: 10.1136/bmjopen-2023-082883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Decisions about nurse staffing models are a concern for health systems globally due to workforce retention and well-being challenges. Nurse staffing models range from all Registered Nurse workforce to a mix of differentially educated nurses and aides (regulated and unregulated), such as Licensed Practical or Vocational Nurses and Health Care Aides. Systematic reviews have examined relationships between specific nurse staffing models and client, staff and health system outcomes (eg, mortality, adverse events, retention, healthcare costs), with inconclusive or contradictory results. No evidence has been synthesised and consolidated on how, why and under what contexts certain staffing models produce different outcomes. We aim to describe how we will (1) conduct a realist review to determine how nurse staffing models produce different client, staff and health system outcomes, in which contexts and through what mechanisms and (2) coproduce recommendations with decision-makers to guide future research and implementation of nurse staffing models. METHODS AND ANALYSIS Using an integrated knowledge translation approach with researchers and decision-makers as partners, we are conducting a three-phase realist review. In this protocol, we report on the final two phases of this realist review. We will use Citation tracking, tracing Lead authors, identifying Unpublished materials, Google Scholar searching, Theory tracking, ancestry searching for Early examples, and follow-up of Related projects (CLUSTER) searching, specifically designed for realist searches as the review progresses. We will search empirical evidence to test identified programme theories and engage stakeholders to contextualise findings, finalise programme theories document our search processes as per established realist review methods. ETHICS AND DISSEMINATION Ethical approval for this study was provided by the Health Research Ethics Board of the University of Alberta (Study ID Pro00100425). We will disseminate the findings through peer-reviewed publications, national and international conference presentations, regional briefing sessions, webinars and lay summary.
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Affiliation(s)
- Kaitlyn Tate
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Tatiana Penconek
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Booth
- School of Medicine and Population Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Flynn
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Inge Wolbers
- University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Matthias Hoben
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Carole A Estabrooks
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Greta G Cummings
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Behrendt CA, Heckenkamp J, Bergsträßer A, Billing A, Böckler D, Bücker A, Cotta L, Donas KP, Grözinger G, Heidecke CD, Hinterseher I, Horn S, Kaltwasser A, Kiefer A, Kirnich-Müller C, Kock L, Kölbel T, Czerny M, Kralewski C, Kurz S, Larena-Avellaneda A, Mutlak H, Oberhuber A, Oikonomou K, Pfeiffer M, Pfister K, Reeps C, Schäfer A, Schmitz-Rixen T, Steinbauer M, Steinbauer C, Strupp D, Stolecki D, Trenner M, Veit C, Verhoeven E, Waydhas C, Weber CF, Adili F. [Recommendations for the specialist further training of nursing personnel on intensive care units in the treatment of abdominal aortic aneurysms: results of a modified Delphi procedure with experts]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:395-405. [PMID: 38498123 PMCID: PMC11031449 DOI: 10.1007/s00104-024-02066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The medical development in the previous 15 years and the changes in treatment reality of the comprehensive elective treatment of abdominal aortic aneurysms necessitate a re-evaluation of the quality assurance guidelines of the Federal Joint Committee in Germany (QBAA-RL). In the current version this requires a specialist further training quota for nursing personnel in intensive care wards of 50%. The quota was determined in 2008 based on expert opinions, although a direct empirical evidence base for this does not exist. METHODS Representatives from the fields of patient representation, physicians, nursing personnel and other relevant interface areas were invited to participate in a modified Delphi procedure. Following a comprehensive narrative literature search, a survey and focus group discussions with national and international experts, a total of three anonymized online-based voting rounds were carried out for which previously determined key statements were assessed with a 4‑point Likert scale (totally disagree up to totally agree). In addition, the expert panel had also defined a recommendation for a minimum quota for the specialist training of nursing personnel on intensive care wards in the treatment of abdominal aortic aneurysms, whereby an a priori agreement of 80% of the participants was defined as the consensus limit. RESULTS Overall, 37 experts participated in the discussions and three successive voting rounds (participation rate 89%). The panel confirmed the necessity of a re-evaluation of the guideline recommendations and recommended the introduction of a shift-related minimum quota of 30% of the full-time equivalent of nursing personnel on intensive care wards and the introduction of structured promotional programs for long-term elevation of the quota. CONCLUSION In this national Delphi procedure with medical and nursing experts as well as representatives of patients, the fundamental benefits and needs of professional specialist qualifications in the field of intensive care medicine were confirmed. The corresponding minimum quota for specialist further training of intensive care nursing personnel should generally apply without limitations to specific groups. The expert panel stipulates a shift-related minimum quota for intensive care nursing personnel with specialist training of 30% of the nursing personnel on intensive care wards and the obligatory introduction of structured and transparent promotion programs for the long-term enhancement.
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Affiliation(s)
- Christian-Alexander Behrendt
- Deutsches Institut für Gefäßmedizinische Gesundheitsforschung gGmbH, Berlin, Deutschland.
- Abt. für Allgemeine und Endovaskuläre Gefäßchirurgie, Asklepios Klinik Wandsbek, Asklepios Medical School, Alphonsstr. 14, 22043, Hamburg, Deutschland.
| | | | | | - Arend Billing
- Kommission Krankenhausökonomie, Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin e. V., Berlin, Deutschland
| | - Dittmar Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Livia Cotta
- Deutsches Institut für Gefäßmedizinische Gesundheitsforschung gGmbH, Berlin, Deutschland
| | - Konstantinos P Donas
- Rhein Main Vascular Center, Klinik für vaskuläre und endovaskuläre Chirurgie, Asklepios Kliniken Langen, Paulinen Wiesbaden und Seligenstadt, Langen, Deutschland
| | - Gerd Grözinger
- Abt. für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Claus-Dieter Heidecke
- Institut für Qualität und Transparenz im Gesundheitswesen (IQTIG), Berlin, Deutschland
| | - Irene Hinterseher
- Klinik für Gefäßchirurgie, Universitätsklinikum Ruppin-Brandenburg, Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
| | - Silvio Horn
- Gefäßchirurgie, Alexianer St. Josefs Krankenhaus Potsdam, Potsdam, Deutschland
| | - Arnold Kaltwasser
- Sektion Pflegeforschung und Pflegequalität, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e. V., Berlin, Deutschland
| | - Andrea Kiefer
- Deutscher Berufsverband für Pflegeberufe (DBfK) Bundesverband e. V., Berlin, Deutschland
| | | | - Lars Kock
- Klinik für Gefäßchirurgie, Immanuel Albertinen Diakonie, Hamburg, Deutschland
| | - Tilo Kölbel
- Klinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Martin Czerny
- Abteilung für Herz- und Gefäßchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
- Medizinische Fakultät, Albert Ludwigs Universität Freiburg, Freiburg, Deutschland
| | - Christian Kralewski
- Kompetenz-Centrum Qualitätssicherung (KCQ), Medizinischer Dienst Baden-Württemberg, Tübingen, Deutschland
| | - Stephan Kurz
- Klinik für Herz‑, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum der Charité (DHZC), Berlin, Deutschland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Axel Larena-Avellaneda
- Abteilung für Gefäß- und endovaskuläre Chirurgie, Asklepios Klinik Altona, Asklepios Medical School, Hamburg, Deutschland
| | - Haitham Mutlak
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, SANA Klinikum Offenbach, Offenbach, Deutschland
| | - Alexander Oberhuber
- Klinik für Vaskuläre und Endovaskuläre Chirurgie, Uniklinik Münster, Münster, Deutschland
| | - Kyriakos Oikonomou
- Abteilung für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Manfred Pfeiffer
- Interessenvertretung Patienten-&-Versicherte, Sörgenloch, Deutschland
| | - Karin Pfister
- Universitäres Gefäßzentrum Ostbayern, Abteilung für Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Christian Reeps
- Bereich Gefäß- und Endovaskuläre Chirurgie, Uniklinikum Dresden, Dresden, Deutschland
| | - Andreas Schäfer
- Deutsche Gesellschaft für Pflegewissenschaft e. V., Duisburg, Deutschland
| | | | - Markus Steinbauer
- Klinik für Gefäßchirurgie, Gefäßzentrum, Barmherzige Brüder Regensburg, Regensburg, Deutschland
| | - Claudia Steinbauer
- Katholische Akademie für Berufe im Gesundheits- und Sozialwesen, Regensburg, Deutschland
| | - Daniel Strupp
- Intensivpflege, Asklepios Klinik Wandsbek, Hamburg, Deutschland
| | - Dietmar Stolecki
- Deutsche Gesellschaft für Fachkrankenpflege und Funktionsdienste e. V., Berlin, Deutschland
| | | | | | - Eric Verhoeven
- Klinikum Nürnberg und Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - Christian Waydhas
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e. V., Berlin, Deutschland
- Klinik Für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Christian F Weber
- Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, Asklepios Klinik Wandsbek, Hamburg, Deutschland
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Frankfurt, Frankfurt am Main, Deutschland
| | - Farzin Adili
- Klinik für Gefäßmedizin, Gefäßchirurgie und Endovaskuläre Chirurgie, Klinikum Darmstadt, Darmstadt, Deutschland
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Bachnick S, Unbeck M, Ahmadi Shad M, Falta K, Grossmann N, Holle D, Bartakova J, Musy SN, Hellberg S, Dillner P, Atoof F, Khorasanizadeh M, Kelly-Pettersson P, Simon M. TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) Project: Protocol for an International Longitudinal Multicenter Study. JMIR Res Protoc 2024; 13:e56262. [PMID: 38648083 PMCID: PMC11074892 DOI: 10.2196/56262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Nursing-sensitive events (NSEs) are common, accounting for up to 77% of adverse events in hospitalized patients (eg, fall-related harm, pressure ulcers, and health care-associated infections). NSEs lead to adverse patient outcomes and impose an economic burden on hospitals due to increased medical costs through a prolonged hospital stay and additional medical procedures. To reduce NSEs and ensure high-quality nursing care, appropriate nurse staffing levels are needed. Although the link between nurse staffing and NSEs has been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing patient-level exposure to nurse staffing during the hospital stay. Few studies have assessed nurse staffing and patient outcomes using a single-center longitudinal design, with limited generalizability. There is a need for multicenter longitudinal studies with improved potential for generalizing the association between individual nurse staffing levels and NSEs. OBJECTIVE This study aimed (1) to determine the prevalence, preventability, type, and severity of NSEs; (2) to describe individual patient-level nurse staffing exposure across hospitals; (3) to assess the effect of nurse staffing on NSEs in patients; and (4) to identify thresholds of safe nurse staffing levels and test them against NSEs in hospitalized patients. METHODS This international multicenter study uses a longitudinal and observational research design; it involves 4 countries (Switzerland, Sweden, Germany, and Iran), with participation from 14 hospitals and 61 medical, surgery, and mixed units. The 16-week observation period will collect NSEs using systematic retrospective record reviews. A total of 3680 patient admissions will be reviewed, with 60 randomly selected admissions per unit. To be included, patients must have been hospitalized for at least 48 hours. Nurse staffing data (ie, the number of nurses and their education level) will be collected daily for each shift to assess the association between NSEs and individual nurse staffing levels. Additionally, hospital data (ie, type, teaching status, and ownership) and unit data (ie, service line and number of beds) will be collected. RESULTS As of January 2024, the verification process for the plausibility and comprehensibility of patients' and nurse staffing data is underway across all 4 countries. Data analyses are planned to be completed by spring 2024, with the first results expected to be published in late 2024. CONCLUSIONS This study will provide comprehensive information on NSEs, including their prevalence, preventability, type, and severity, across countries. Moreover, it seeks to enhance understanding of NSE mechanisms and the potential impact of nurse staffing on these events. We will evaluate within- and between-hospital variability to identify productive strategies to ensure safe nurse staffing levels, thereby reducing NSEs in hospitalized patients. The TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) study will focus on the optimization of scarce staffing resources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56262.
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Affiliation(s)
- Stefanie Bachnick
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Maryam Ahmadi Shad
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Katja Falta
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Nicole Grossmann
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Daniela Holle
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Jana Bartakova
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
| | - Sarah N Musy
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sarah Hellberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Stockholm, Sweden
| | - Pernilla Dillner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Fatemeh Atoof
- Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Paula Kelly-Pettersson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Stockholm, Sweden
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
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Doyle BR, Smith LM, Marshall JL, Carlisle BA, Perera AC. Consistently Exploring Nurse Staffing and Neurocritical Care Unit Turnover. J Neurosci Nurs 2024; 56:54-59. [PMID: 38232239 DOI: 10.1097/jnn.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
ABSTRACT BACKGROUND: Staffing models within nursing units have long been a hot topic of discussion. The COVID-19 pandemic exacerbated this discussion by straining the national nursing environment and workforce. Before the pandemic, the neuroscience intensive care unit (NSICU) primarily used an acuity-adjusted staffing model and aimed for a nurse-to-patient ratio of 1:1.5. During and after the pandemic, the NSICU was forced to primarily use a centralized staffing model because of the increased turnover in the hospital at large and a rise in patient census. METHODS : Unit census data in an NSICU were tracked before, during, and after the pandemic alongside utilization of a centralized staffing model in the hospital at large. RESULTS : During this time, the NSICU saw a statistically significant increase in average nurse-to-patient ratio and incidences of both floating and tripled assignments. The NSICU simultaneously saw a 180% increase in nursing turnover. CONCLUSION : Although we cannot prove that a centralized staffing model is directly responsible for higher nursing turnover, its utilization led to greater incidence of poor staffing-reflected in deviation from the nurse-to-patient ratio goal of the unit. Nurse staffing concerns play a large role in nurse satisfaction in the workforce: staffing shortages have been described both as a precursor to and as a consequence of increased nursing turnover.
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Minten L, Dubois C, Desmet W, Bennett J. Economical aspects of coronary angiography for diagnostic purposes: a Belgian perspective. Acta Cardiol 2024; 79:41-45. [PMID: 37962299 DOI: 10.1080/00015385.2023.2281105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023]
Abstract
Coronary angiography (CA) is an increasing diagnostic procedure in Belgium. The aim of this analysis was to look at the financial aspects of CA in a large tertiary Belgium hospital to establish if current reimbursement is appropriate. For the analysis of costs we considered the use of the catheterisation laboratory, personnel costs and material costs during multiple weekly periods in the spring of 2023. We calculated that one cathlab needs to perform 8.21 CA's to equal incomes with costs. To allow for a small positive income (200€) for the hospital/cardiologist 9 procedures per cathlab day are required. Our hospital performs a 7 (mean) ± 0.75 (standard deviation) of CA's per cathlab day and therefore does not reach this financial break-even point. Our calculations are on the safe side, since coronary physiological interrogation with fractional flow reserve (FFR) was excluded from this analysis. Nevertheless, this is a cost-effective technique for which no extra reimbursement is foreseen in the current Belgium system.
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Affiliation(s)
- Lennert Minten
- Department of Cardiovascular Sciences, Kaholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, University Hospitals Leuven (UZ Leuven), Leuven Belgium
| | - Christophe Dubois
- Department of Cardiovascular Sciences, Kaholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, University Hospitals Leuven (UZ Leuven), Leuven Belgium
| | - Walter Desmet
- Department of Cardiovascular Sciences, Kaholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, University Hospitals Leuven (UZ Leuven), Leuven Belgium
| | - Johan Bennett
- Department of Cardiovascular Sciences, Kaholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, University Hospitals Leuven (UZ Leuven), Leuven Belgium
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15
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Polancich S, Miltner R, Montgomery A, Dick T, Poe T, Brown D, Patrician PA. Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes. J Healthc Manag 2023; 68:174-186. [PMID: 37159016 DOI: 10.1097/jhm-d-22-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
GOAL The purpose of this study was to examine nurse staffing while describing the relationships that exist in staffing and quality associated with nursing care during the COVID-19 pandemic, a significantly challenging time for nurse staffing. We examined the relationship between permanent registered nurse (RN) and travel RN staffing during the pandemic and the nursing-sensitive outcomes of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), falls, and hospital-acquired pressure injuries (HAPIs) and length of stay and compared the cost of CAUTIs, CLABSIs, falls, and HAPIs in fiscal years 2021 and 2022. METHODS We used a descriptive, observational design to retrospectively examine permanent nurse staffing volume and CAUTI, CLABSI, HAPI, and fall counts from October 1, 2019, to February 28, 2022, and travel nurse volume for the most current 12 months, April 1, 2021, to March 31, 2022. Descriptive statistics, Pearson correlation, and statistical process control analyses were completed. PRINCIPAL FINDINGS Pearson correlation showed a statistically significant, moderately strong negative correlation (r = -0.568, p = .001) between the active registered nurse full-time equivalents (RN FTEs) and average length of stay (ALOS), and a moderately strong positive correlation (r = 0.688, p = .013) between the travel RN FTEs and ALOS. Pearson correlations were not statistically significant, with low to moderate negative correlations for CAUTIs (r = -0.052, p = .786), CLABSIs (r = -0.207, p = .273), and falls (r = -0.056, p = .769). Pearson correlation for active RN and HAPI showed a moderately strong, statistically significant positive correlation (r = 0.499, p = .003). We observed common cause variation in CAUTIs and CLABSIs, with HAPIs and falls showing special cause variation via statistical process control. PRACTICAL APPLICATIONS Despite the challenges associated with the lack of available nurse staffing accompanied by increasing responsibilities including unlicensed tasks, positive clinical outcomes can be maintained by staff adherence to evidence-based quality improvement.
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Affiliation(s)
- Shea Polancich
- University of Alabama at Birmingham School of Nursing and University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | | | | | - Tracey Dick
- University of Alabama at Birmingham School of Nursing
| | - Terri Poe
- University of Alabama at Birmingham Hospital
| | - Daran Brown
- University of Alabama at Birmingham Hospital
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Wang Y, Zhang Y, Han J, Chen Y, Li L, Wei X, Fu G. Diabetes knowledge and training needs among non-endocrinology nurses. Heliyon 2023; 9:e15985. [PMID: 37215767 PMCID: PMC10196786 DOI: 10.1016/j.heliyon.2023.e15985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
Background It is necessary to determine the diabetes knowledge level among non-endocrinology nurses in primary care hospitals to develop continuing education strategies. Method A questionnaire survey was conducted among 6819 non-endocrinology nurses in 70 primary hospitals in the Guangxi Zhuang Autonomous Region to assess their diabetes knowledge level and training needs. Factors affecting knowledge level were analyzed using multiple linear regression models. Results Diabetes knowledge was low, particularly for diabetes monitoring. Knowledge was higher in nurses who had in-service education and training in diabetes; most believed that training was necessary and hoped to improve their ability to care for diabetic patients. The most suitable training method was considered to be each nurse was taught by an assigned person after centralized specialized education and training. Conclusion Non-endocrinology nurses in primary care hospitals lack knowledge of diabetes and have a strong need for training. Systematic training is required to ensure that patients receive high-quality and comprehensive care.
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Affiliation(s)
- Yudong Wang
- School of Nursing, Youjiang Medical University for Nationalities, Baise, China
- Department of Nursing, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Department of Nursing, Liaocheng People's Hospital, Liaocheng, China
| | - Yanping Zhang
- Department of Geriatric Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jiaxia Han
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yongfeng Chen
- Department of Nursing, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Lirong Li
- Clinical Tumor Center, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xiaohui Wei
- School of Nursing, Youjiang Medical University for Nationalities, Baise, China
- Department of Nursing, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Guifen Fu
- Department of Nursing, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Krüger L, Mannebach T, Zittermann A, Wefer F, von Dossow V, Rojas Hernandez S, Gummert J, Langer G. Patientinnen- und patientenbezogene Auswirkungen von prozessverantwortlicher Pflege. Med Klin Intensivmed Notfmed 2023; 118:257-262. [PMID: 36971803 PMCID: PMC10160145 DOI: 10.1007/s00063-023-00998-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/08/2023] [Indexed: 03/29/2023]
Abstract
Abstract
Background
Since January 2022, a primary nursing system called process-responsible nursing (PP) has substituted the standard room care system in an intensive care unit (ICU) at our institution. The process of the development and implementation of PP is already being evaluated in a separate study as an actual analysis prior to implementation, as well as after 6 and 12 months.
Aim
This pilot randomized controlled trial (RCT) aims to test the feasibility of an RCT. For this purpose, the duration of delirium, among other things, will be compared in the project ICU with the results of standard care in another ICU at the university hospital. As secondary aims, the incidence of delirium, anxiety, the satisfaction of relatives, and the effects of PP on nurses will be assessed.
Methods
It is planned to recruit about 400–500 patients over a period of one year. They will be allocated to PP or standard care. Delirium will be assessed using the Confusion Assessment Method for Intensive Care Units by specifically trained nurses three times a day. Anxiety in patients, the satisfaction of relatives, and the effects of PP on nurses will be evaluated using the numeric rating scale, a standardized questionnaire, and a focus group interview, respectively.
Expected results
The primary hypothesis is that compared to usual care PP reduces the duration of delirium by at least 8 h. Additional hypotheses are that PP reduces anxiety in patients and increases the satisfaction of relatives.
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Affiliation(s)
- Lars Krüger
- Project and Knowledge Management/Care Development intensive care, Care Directorate, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Thomas Mannebach
- Surgical Intensive Care Unit E 0.1, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Franziska Wefer
- Care Development, Care Directorate, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
- Institute for Nursing Science, Medical Faculty and University Hospital Cologne, University of Cologne, Gleueler Straße 176–178, 50935 Cologne, Germany
| | - Vera von Dossow
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Sebastian Rojas Hernandez
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Gero Langer
- Institute of Health and Nursing Sciences, German Center for Evidence-based Nursing, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
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Gonçalves I, Mendes DA, Caldeira S, Jesus É, Nunes E. The Primary Nursing Care Model and Inpatients' Nursing-Sensitive Outcomes: A Systematic Review and Narrative Synthesis of Quantitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2391. [PMID: 36767759 PMCID: PMC9915435 DOI: 10.3390/ijerph20032391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The delivery of quality, safe, and patient-centered care is foundational for professional practice. The primary nursing model allows nurses to have excellent knowledge about patients and families and to plan and coordinate care from admission to discharge, with better management of health situations. Nurses play a crucial role in improving patients' outcomes, namely those sensitive to nursing care. The knowledge of the relationship between the primary nursing model and the nursing-sensitive outcomes provides new scientific evidence that strengthens the relevance of this nursing care organization model in the inpatients' health outcomes. This systematic review describes the relationship between nurse-sensitive inpatients' outcomes and the primary nursing care model. METHODS A systematic review was conducted with a narrative synthesis, and the following databases were searched: MEDLINE, CINAHL, Web of Science, Nursing & Allied Health Collection, SciELO Collections, and Cochrane. RESULTS A total of 22 full texts were assessed, of which five were included in the study according to the selection criteria. The analysis results indicated that the primary nursing care model was related to nursing-sensitive patient safety outcomes. Patients' experience was also considered a nursing-sensitive outcome, namely in the satisfaction with nursing care. CONCLUSION The negative outcomes are clearly related to the primary nursing care model. There is scarce research that relates primary nursing to positive outcomes, such as patients' functional status and self-care abilities, and more studies are needed.
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Affiliation(s)
- Isabel Gonçalves
- Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Palma de Cima, 1649-023 Lisbon, Portugal
- Hospital da Luz Lisboa, Avenida Lusíada, 100, 1500-650 Lisbon, Portugal
| | - Diana Arvelos Mendes
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, NURSE’IN-UIESI, Estefanilha, 2910-761 Setúbal, Portugal
| | - Sílvia Caldeira
- Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Palma de Cima, 1649-023 Lisbon, Portugal
| | - Élvio Jesus
- Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Palma de Cima, 1649-023 Lisbon, Portugal
| | - Elisabete Nunes
- Escola Superior de Enfermagem de Lisboa, Nursing Research, Innovation and Development Centre of Lisbon, 1600-190 Lisbon, Portugal
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Ota Y, Nomura K, Hirayama J, Maeda E, Komatsu J, Nakamura M, Yamada R, Ishikawa H, Kobayashi T, Shirakawa H, Aisaka K, Ono M, Hiraike H, Hiraike O, Okinaga H. Relationship between somatic symptoms with menstruation and intention to leave work among university hospital nurses in Japan: a cross-sectional study. Int Arch Occup Environ Health 2023; 96:155-166. [PMID: 35913561 DOI: 10.1007/s00420-022-01905-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/23/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE This study investigated the association between menstrual symptoms and the intention to leave work among female nurses in Japan. METHODS This cross-sectional study investigated female nurses (n = 317) at two university hospitals. The items measured were their characteristics (e.g., age, body mass index), "intention to leave" work, somatic symptoms related with menstruation, self-reported menstrual characteristics (e.g., pain), physical workloads (e.g., working hours and night shifts) and psychological workloads, measured with the Copenhagen Burnout Inventory (CBI), and the Job Content Questionnaire (JCQ). Participants with at least four somatic symptoms (e.g., cold, fatigue) which are present during their menstrual cycles were considered to have "somatic symptoms associated with menstruation." We also measured serum ovarian and gonadotropin-releasing hormones. RESULTS Approximately 40% of women answered "intention to leave" work, and 17% had "somatic symptoms associated with menstruation." Multiple logistic regression analysis suggested that nurses reporting "somatic symptoms associated with menstruation" were more likely to have "intention to leave" work: the adjusted odds ratios (AOR, 95% confidence interval [CI]) were 2.15 (1.12-4.11) in the personal-burnout model, 2.23 (1.16-4.31) in the work-related burnout model, 2.91 (1.52-5.56) in the client-related burnout model; 2.96 (1.50-5.82) in the JCQ model. There was no association between serum and gonadotropin hormones and the intention to leave. CONCLUSION Somatic symptoms with menstruation were associated with intention to leave work among female Japanese nurses. Intervention for somatic symptoms with menstruation might support nurses to continue work.
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Affiliation(s)
- Yu Ota
- School of Medicine, Akita University, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Junko Hirayama
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Eri Maeda
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Junko Komatsu
- Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Mio Nakamura
- Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Rouko Yamada
- Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Hitomi Ishikawa
- Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Teiko Kobayashi
- Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Hideko Shirakawa
- Akita Nursing Station, 6-6 Sensyukubotamachi, Akita, 010-0874, Japan
| | - Kozo Aisaka
- Hamada Hospital, 2-5, Kandasurugadai, Chiyoda, Tokyo, 101-0062, Japan
| | - Mariko Ono
- School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Haruko Hiraike
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan
| | - Osamu Hiraike
- Department of Obstetrics and Gynecology, Tokyo University School of Medicine, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Hiroko Okinaga
- Support Center for Women Physicians and Researchers, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan
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Liu S, Wang C, Jiang Y, Ren H, Yu T, Cun W, Yang Z. Nurse scheduling in COVID-19-designated hospitals in China: A nationwide cross-sectional survey. J Nurs Manag 2022; 30:4024-4033. [PMID: 36191302 PMCID: PMC9874521 DOI: 10.1111/jonm.13832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/03/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023]
Abstract
AIM This study aimed to investigate scheduling in COVID-19-designated hospitals, including working hours, rest days, adverse nursing outcomes and their relationship. BACKGROUND Hospitals are at the forefront of COVID-19 prevention and control, and nurses are the main force on the frontline of the epidemic. Nursing shift is one of the most relevant and pressing issues for frontline nurses. However, there is a lack of national, large-sample surveys on scheduling and adverse nursing outcomes in COVID-19-designated hospitals. METHODS Using a cross-sectional online survey, we used nurse-reported data to measure the characteristics of the work setting, samples and work schedule. A descriptive analysis was performed to assess the shift status and adverse outcomes of designated hospitals and frontline nurses. Logistic regression analysis was performed to determine the association between them. RESULTS Basic data were collected from 217 departments of 69 COVID-19-designated hospitals in 31 provinces in China. Nurses in the severe isolation ward worked mainly for 4 h per shift, whereas those in the fever clinic and observation ward worked mainly for 6-8 h. Half of the nurses had only 1 day of rest per week. Long working hours, lack of adequate rest time and overtime can seriously affect the quality and safety of nurses' work, resulting in adverse outcomes. Frontline nurses hope that scheduling guarantees the time to rest while ensuring fairness. CONCLUSIONS The current evidence showed that frontline nurses were faced with long working hours, insufficient rest and overtime, which has a negative impact on nurse satisfaction, physical and mental health and quality of care. The government, hospitals and administrators still face many problems to overcome in their nursing schedules. IMPLICATIONS FOR NURSING MANAGEMENT Governments and hospitals should take these factors, such as the work setting characteristics and demographic features of the frontline nurses, into account when selecting nurses to fight COVID-19. Nurses have different working hours in different types of coronavirus unit; therefore, nursing managers should consider the working environment and nursing schedule needs, and in the future, we should pay attention to the fairness of nurses while ensuring their rest.
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Affiliation(s)
- Shanshan Liu
- Evidence‐based Nursing Center, West China Hospital/West China School of NursingSichuan UniversityChengduChina
| | - Cong Wang
- Evidence‐based Nursing Center, West China Hospital/West China School of NursingSichuan UniversityChengduChina
| | - Yan Jiang
- Department of Nursing, West China Hospital/West China School of NursingSichuan UniversityChengduChina
| | - Hongfei Ren
- Department of Nursing, West China Hospital/West China School of NursingSichuan UniversityChengduChina
| | - Ting Yu
- Evidence‐based Nursing Center, West China Hospital/West China School of NursingSichuan UniversityChengduChina
| | - Wei Cun
- Evidence‐based Nursing Center, West China Hospital/West China School of NursingSichuan UniversityChengduChina
| | - Zhibo Yang
- Evidence‐based Nursing Center, West China Hospital/West China School of NursingSichuan UniversityChengduChina
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Imam A, Gathara D, Aluvaala J, Maina M, English M. Evaluating the effects of supplementing ward nurses on quality of newborn care in Kenyan neonatal units: protocol for a prospective workforce intervention study. BMC Health Serv Res 2022; 22:1230. [PMID: 36195863 PMCID: PMC9530438 DOI: 10.1186/s12913-022-08597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data from High Income Countries have now linked low nurse staff to patient ratios to poor quality patient care. Adequately staffing hospitals is however still a challenge in resource-constrained Low-middle income countries (LMICs) and poor staff-to-patient ratios are largely taken as a norm. This in part relates to limited evidence on the relationship between staffing and quality of patient care in these settings and also an absence of research on benefits that might occur from improving hospital staff numbers in LMICs. This study will determine the effect on the quality of patient care of prospectively adding extra nursing staff to newborn units in a resource constrained LMIC setting and describe the relationship between staffing and quality of care. METHODS This prospective workforce intervention study will involve a multi-method approach. We will conduct a before and after study in newborn units of 4 intervention hospitals and a single time-point comparison in 4 non-intervention hospitals to determine if there is a change in the level of missed nursing care, a process measure of the quality of patient care. We will also determine the effect of our intervention on routinely collected quality indicators using interrupted time series analysis. Using three nurse staffing metrics (Total nursing hours, nursing hours per patient day and nursing hours per patient per shift), we will describe the relationship between staffing and the quality of patient care. DISCUSSION There is an urgent need for the implementation of staffing policies in resource constrained LMICs that are guided by relevant contextual data. To the best of our knowledge, this is the first study to evaluate the prospective addition of nursing staff in resource-constrained care settings. Our findings are likely to provide the much-needed evidence for better staffing in these settings. TRIAL REGISTRATION This study was retrospectively registered in the Pan African Clinical Trial Registry ( https://pactr.samrc.ac.za/Default.aspx?Logout=True ) database on the 10th of June 2022 with a unique identification number-PACTR202206477083141.
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Affiliation(s)
- Abdulazeez Imam
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - David Gathara
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Jalemba Aluvaala
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Michuki Maina
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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22
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Kutz A, Koch D, Haubitz S, Conca A, Baechli C, Regez K, Gregoriano C, Ebrahimi F, Bassetti S, Eckstein J, Beer J, Egloff M, Kaeppeli A, Ehmann T, Hoess C, Schaad H, Wharam JF, Lieberherr A, Wagner U, de Geest S, Schuetz P, Mueller B. Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e2233667. [PMID: 36169957 PMCID: PMC9520366 DOI: 10.1001/jamanetworkopen.2022.33667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Whether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial. OBJECTIVE To evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in Switzerland. It was conducted from February 2017 through January 2019. Data analysis was conducted from March 2021 to July 2022. INTERVENTION After a 12-month preintervention phase (February 2017 through January 2018), an electronic interprofessional-led discharge planning tool was implemented in February 2018 in 7 intervention hospitals in addition to standard discharge planning. MAIN OUTCOMES AND MEASURES Mixed-effects segmented regression analyses were used to compare monthly changes in trends of length of stay, hospital readmission, in-hospital mortality, and facility discharge after the implementation of the tool with changes in trends among control hospitals. RESULTS There were 54 695 hospitalizations at intervention hospitals, with 27 219 in the preintervention period (median [IQR] age, 72 [59-82] years; 14 400 [52.9%] men) and 27 476 in the intervention phase (median [IQR] age, 72 [59-82] years; 14 448 [52.6%] men) and 438 791 at control hospitals, with 216 261 in the preintervention period (median [IQR] age, 74 [60-83] years; 109 770 [50.8%] men) and 222 530 in the intervention phase (median [IQR] age, 74 [60-83] years; 113 053 [50.8%] men). The mean (SD) length of stay in the preintervention phase was 7.6 (7.1) days for intervention hospitals and 7.5 (7.4) days for control hospitals. During the preintervention phase, population-averaged length of stay decreased by -0.344 hr/mo (95% CI, -0.599 to -0.090 hr/mo) in control hospitals; however, no change in trend was observed among intervention hospitals (-0.034 hr/mo; 95% CI, -0.646 to 0.714 hr/mo; difference in slopes, P = .09). Over the intervention phase (February 2018 through January 2019), length of stay remained unchanged in control hospitals (slope, -0.011 hr/mo; 95% CI, -0.281 to 0.260 hr/mo; change in slope, P = .03), but decreased steadily among intervention hospitals by -0.879 hr/mo (95% CI, -1.607 to -0.150 hr/mo; change in slope, P = .04, difference in slopes, P = .03). Safety analyses showed no change in trends of hospital readmission, in-hospital mortality, or facility discharge over the whole study time. CONCLUSIONS AND RELEVANCE In this nonrandomized controlled trial, the implementation of an electronic interprofessional-led discharge planning tool was associated with a decline in length of stay without an increase in hospital readmission, in-hospital mortality, or facility discharge. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN83274049.
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Affiliation(s)
- Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Koch
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Antoinette Conca
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Ciril Baechli
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Katharina Regez
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Claudia Gregoriano
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Fahim Ebrahimi
- Division of Gastroenterology, University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jens Eckstein
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Juerg Beer
- Department of Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Michael Egloff
- Department of Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | | | - Tobias Ehmann
- Department of Medicine, Hospital Zofingen, Zofingen, Switzerland
| | - Claus Hoess
- Department of Medicine, Cantonal Hospital Muensterlingen, Muensterlingen, Switzerland
| | - Heinz Schaad
- Department of Medicine, Hospital Interlaken, Hospitals Frutigen Meiringen Interlaken, Interlaken, Switzerland
| | - James Frank Wharam
- Department of Medicine, Duke University and Duke-Margolis Center for Health Policy, Durham, North Carolina
| | | | - Ulrich Wagner
- National Institute for Cancer Epidemiology and Registration, National Agency for Cancer Registration, University of Zurich, Switzerland
| | - Sabina de Geest
- Nursing Science, Department of Public Health of Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Barghi Shirazi F, Moslehi S, Rasouli MR, Masoumi G. A Systematic Literature Review Identifying the Dimensions and Components of Simulation of the Hospital Emergency Department During Emergencies and Disasters. Med J Islam Repub Iran 2022; 36:82. [PMID: 36128272 PMCID: PMC9448461 DOI: 10.47176/mjiri.36.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 07/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The use of simulation in medical education is evolving widely around the world. Hospital emergency services in the event of accidents and disasters affect the quality of health care. It is critical to determine the fundamental features for developing a hospital emergency department simulation to improve emergency services. In this regard, the current study conducted a comprehensive assessment of studies with the determinations and components of hospital emergency department simulation during accidents and disasters. Methods: In this systematic literature review, all studies between January 2010 and July 2021 were searched in MEDLINE/PubMed, EMBASE, ProQuest, Scopus, Web of Science, Iran medex Google Scholar, and Scientific Information Database (SID), MagIran databases and were analyzed with the thematic analysis approach and results were expressed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The quality of the included studies was assessed using related checklists. Results: The findings of this study were divided into 3 main categories and 10 subcategories, including factors related to manpower (manpower arrangement, performance-awareness-skills, safety, and communication), factors related to medical services (triage, time, and transfer of the injured), and factors related to resource management and support (physical environment, equipment, and the information system). Conclusion: Through systematic planning, simulation allows for the identification of emergency department difficulties during accidents and disasters. Identifying dimensions and components, such as resource management and support, manpower, and medical services, is effective in designing the simulation of the hospital emergency department during accidents and disasters. Therefore, it is recommended to conduct future studies with a qualitative approach and focus on the factors affecting the simulation of the hospital emergency department during disasters, which has been done by the same researchers.
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Affiliation(s)
- Fahimeh Barghi Shirazi
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shandiz Moslehi
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Rasouli
- Department of Industrial Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Gholamreza Masoumi
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran,Corresponding author: Dr Gholamreza Masoumi,
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Liu S, Li X, Yin X, Wang L. Analysis of the Effect of Rational Emotional Intervention Combined with Hierarchical Management Mode on Improving the Psychological Stress of Emergency Nurses and Trainee Nurses. Emerg Med Int 2022; 2022:2038018. [PMID: 35721256 PMCID: PMC9205731 DOI: 10.1155/2022/2038018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To explore the effect of rational emotional intervention combined with hierarchical management mode on improving the psychological stress of emergency nurses and trainee nurses. Methods 50 emergency nurses who worked or practiced in our hospital from June 2019 to May 2021 were selected as the research object. From June 2019 to May 2020, our hospital adopted the traditional management mode. From June 2020 to May 2021, our hospital adopted the rational emotional intervention combined with hierarchical management mode. The psychological state, work stress, stress response, job burnout, and sleep quality of emergency nurses were compared before and after intervention. Results Compared with before intervention, the scores of self-rating anxiety scale and self-rating depression scale, the work stress scores, the Maslach burnout inventory score, the Pittsburgh sleep quality index score of emergency nurses decreased after intervention (P < 0.05). Compared with before intervention, the stress coping scores of emergency nurses increased after intervention (P < 0.05). Conclusion The rational emotional intervention combined with hierarchical management mode can improve the psychological pressure of emergency nurses and trainee nurses, reduce job burnout, improve stress coping ability, and improve sleep quality.
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Affiliation(s)
- Shirui Liu
- College of Educational Science, Hengyang Normal University, Hengyang 421002, Hunan, China
| | - Xiangsu Li
- Health School of Nuclear Industry, Hengyang 421002, Hunan, China
| | - Xianghong Yin
- Health School of Nuclear Industry, Hengyang 421002, Hunan, China
| | - Liqun Wang
- The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang 421002, Hunan, China
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25
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Lee E, De Gagne JC. The impact of resilience on turnover among newly graduated nurses: A 1‐year‐follow up study. J Nurs Manag 2022; 30:1295-1302. [DOI: 10.1111/jonm.13613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Eunhee Lee
- Hallym University School of Nursing/Research Institute of Nursing Science Chuncheon Gangwon‐do Korea
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Wieczorek-Wójcik B, Gaworska-Krzemińska A, Owczarek A, Wójcik M, Orzechowska M, Kilańska D. The Influence of Nurse Education Level on Hospital Readmissions-A Cost-Effectiveness Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074177. [PMID: 35409859 PMCID: PMC8998689 DOI: 10.3390/ijerph19074177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022]
Abstract
Background: Readmissions are adverse, costly, and potentially preventable. The study aimed to evaluate the cost-effectiveness of reducing readmissions resulting from missed care, depending on the level of education of nurses, from the perspective of the service provider. Methods: We calculated missed care resulting in additional readmissions based on the longitudinal study conducted between 2012 and 2014, as well as readmissions that could have been potentially prevented by adding a 10% increase in hours of nursing care provided by BSN/MSc nurses for 2014. The cost-effectiveness analysis (CEA) was performed to calculate the cost-effectiveness of preventing one hospitalization in non-surgical and surgical wards by increasing the number of nursing hours provided by BSN/MSc nurses. Cost−benefit analysis (CBA) was performed, and the CBR (cost−benefit ratio) and BCR (benefit−cost ratio) were calculated. Results: Increasing the number of hours of nursing care (RN) by 10% decreased the chance for an unplanned readmission by 11%; (OR = 0.89; 95% CI: 0.78−1.01; p = 0.08) in non-surgical wards and 43% (OR = 0.57; 95% CI: 0.49−0.67; p < 0.001) in surgical wards. In non-surgical wards, the number of readmissions that were preventable with extra hours provided by BSN/MSc nurses was 52, and the cost-effectiveness ratio (CER) was USD 226.1. The number of preventable readmissions in surgical wards was 172, and the CER was USD 54.96. In non-surgical wards, the CBR was USD 0.07, while the BCR was USD 1.4. In surgical wards, the CBR was USD 0.02, and the BCR was USD 4.4. Conclusions: The results of these studies broaden the understanding of the relationship among nursing education, patient readmission, and the economic outcomes of hospital care. According to the authors, the proposed intervention has an economic justification. Hence, the authors recommend it for approval by the service provider.
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Affiliation(s)
- Beata Wieczorek-Wójcik
- Department of Nursing and Medical Rescue, Pomeranian University in Slupsk, 76-200 Slupsk, Poland;
| | - Aleksandra Gaworska-Krzemińska
- Institute of Nursing and Midwifery, Medical University of Gdansk, 80-210 Gdansk, Poland
- Correspondence: ; Tel.: +48-601632088
| | - Aleksander Owczarek
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Michał Wójcik
- Rehazentrum Walenstadtberg, Chnoblisbüel 1, CH-8881 Walenstadtberg, Switzerland; (M.W.); (M.O.)
| | - Monika Orzechowska
- Rehazentrum Walenstadtberg, Chnoblisbüel 1, CH-8881 Walenstadtberg, Switzerland; (M.W.); (M.O.)
| | - Dorota Kilańska
- Department of Coordinated Care, Medical University of Lodz, 90-419 Lodz, Poland;
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Hosseini FA, Parvan K, Shaygan M, Thomson B. Male Nursing Students' Perception of Gender Barriers in Nursing Curricula in an Iranian University of Medical Sciences. INVESTIGACION Y EDUCACION EN ENFERMERIA 2022; 40:e03. [PMID: 35485616 PMCID: PMC9052718 DOI: 10.17533/udea.iee.v40n1e03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The present study aimed to determine male nursing students' perception of gender barriers in nursing curricula. METHODS This descriptive study was conducted on 150 B.Sc. and M.Sc. nursing students at Tabriz School of Nursing and Midwifery, Tabriz university of medical sciences, Tabriz, Iran that were selected through convenience sampling. The study data were collected using Inventory of Male Friendliness in Nursing Programs-Short (IMFNP-S). This scale has 17 items for investigating male nursing students' perception of gender barriers in nursing curricula. Each item is a 5-point Likert-type scale scored from 0 to 4; total scale score could range from 0 to 68, higher scores representing male nursing students' perception of less gender barriers in nursing curricula. RESULTS The total mean score of gender barriers was 35.11+6.15. The most important barriers included different requirements/limitations in obstetrics apprenticeship (Median=1), and need for proving oneself because of people's expectation of nurses to be female (Median=2). On the other hand, the least important barriers were lack of important people's support on one's career decisions (Median=3), and lack of opportunity to work with other male nurses (Median=3). The scale score was not associated with the socio-demographic characteristics studied. CONCLUSIONS The most male nursing students feel various gender issues in the nursing curriculum in a medium level that may negatively impact on their learning, professional performance and motivation and tendency to nursing. Furthermore, this vicious cycle can lead to lack of professional development, leaving the job and burnout. Thus, creating a gender-neutral environment can make nursing programs more male friendly.
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Lascano D, Lai R, Stringel G, Stewart FD. Weekend Admissions Associated with Increased Length of Stay for Children Undergoing Cholecystectomy. JSLS 2021; 25:JSLS.2021.00047. [PMID: 34949908 PMCID: PMC8678762 DOI: 10.4293/jsls.2021.00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Prior research shows an association between increased length of stay (LOS) and weekend surgical admissions, but none have looked at this relationship in children undergoing nonelective cholecystectomy for benign noncongenital biliary disease. We investigated whether weekend admissions lead to a longer LOS in this patient population. Methods: The Statewide Planning and Research Cooperative System database was queried for children ≤ 17 years undergoing cholecystectomy in New York State between January 1, 2009 and December 31, 2012. Parametric and nonparametric statistical testing was used for univariate analysis; multivariable binary logistic regression and linear regression models were used for multivariable analysis. Statistical significance was < 0.05. Results: A total of 1066 pediatric patients underwent nonelective cholecystectomy for gallstone pancreatitis (9.7%) and other benign biliary noncongenital diseases (90.3%), of which 22.1% of all patients were admitted over the weekend. Most cases (97.2%) were treated laparoscopically with an overall 3-day median LOS. Weekend admission was associated with an increased LOS of 4 days as opposed to 3 days during the weekday (p < 0.001). On a multivariable binary logistic regression model controlling for hospital factors, indication for surgery, and comorbidities, weekend admission was associated with 1.92 odds of increased length of stay (adjusted odds ratio of 1.924, 95% confidence interval: 1.386–2.673). Conclusion: Weekend admissions were associated with increased LOS and charges for children requiring nonelective cholecystectomy, despite the wide use of laparoscopic surgery.
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Affiliation(s)
- Danny Lascano
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Rachel Lai
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Gustavo Stringel
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - F Dylan Stewart
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY
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Cocchieri A, Magon G, Cavalletti M, Cristofori E, Zega M. Exploring hospital compliance with the primary nursing care model: validating an inventory using the Delphi method. BMC Nurs 2021; 20:188. [PMID: 34607579 PMCID: PMC8491371 DOI: 10.1186/s12912-021-00712-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background The primary nursing care model is considered a personalized model of care delivery based on care continuity and on the relationship between the nurse and patient. Primary nursing checklists are not often mentioned in the literature; however, they represent a valid instrument to develop, implement, and evaluate primary nursing. The aim of this study was to create a structured checklist to explore hospital compliance in primary nursing. Methods The Delphi method was used to develop and validate a checklist. The preliminary version was created and sent to three experts for their opinions. Their comments were ultimately used in the first version, which included four components with 19 items regarding primary nursing characteristics. A two-round Delphi process was used to generate consensus items. The Delphi panel consisted of six experts working in primary nursing contexts and/or teaching or studying primary nursing. Data were collected using a structured questionnaire from July 2020 to January 2021. These experts were asked to rate each element for relevance using a 4-point Likert-type scale. Furthermore, the consensus among the panel of experts was set at ≥78%, with selected items being voted “quite relevant” and “highly relevant”. Content validity index (I-CVI) and modified kappa statistic were also calculated. Following expert evaluation, the first version of the checklist was modified, and the new version, constituting 17 items, was sent to the same experts. Results The first version of the checklist demonstrated a main relevance score of 3.34 (SD = 0.83; range = 1.3–4; mean I-CVI = 0.84; range: 0.83–1), but three items did not receive an adequate I-CVI score, that is, lower than 0.78. After the second round, the I-CVIs improved. The main score of relevance was 3.61 (SD: 0.35; range = 2.83–4; mean = I-CVI: 0.93). The S-CVI/UA was 0.58, and the S-CVI/Ave was 0.93. Conclusion Measuring primary nursing compliance should be implemented to provide continuous feedback to nurses. Moreover, utilizing valid checklists could permit comparing different results from others’ research. Future research should be conducted to compare the results from the checklist with nursing outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00712-1.
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Affiliation(s)
- Antonello Cocchieri
- Fondazione Policlinico A. Gemelli IRCCS, 00168, Rome, Italy. .,Section of Hygiene, Woman and Child Health and Public health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Giorgio Magon
- European Institute of Oncology, Via Ripamonti, 435, Milan, Italy
| | | | - Elena Cristofori
- Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Maurizio Zega
- Fondazione Policlinico A. Gemelli IRCCS, 00168, Rome, Italy
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Siddique SM, Tipton K, Leas B, Greysen SR, Mull NK, Lane-Fall M, McShea K, Tsou AY. Interventions to Reduce Hospital Length of Stay in High-risk Populations: A Systematic Review. JAMA Netw Open 2021; 4:e2125846. [PMID: 34542615 PMCID: PMC8453321 DOI: 10.1001/jamanetworkopen.2021.25846] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Many strategies to reduce hospital length of stay (LOS) have been implemented, but few studies have evaluated hospital-led interventions focused on high-risk populations. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study to further evaluate system-level interventions for LOS reduction. OBJECTIVE To identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS. EVIDENCE REVIEW Multiple databases, including MEDLINE and Embase, were searched for English-language systematic reviews from January 1, 2010, through September 30, 2020, with updated searches through January 19, 2021. The scope of the protocol was determined with input from AHRQ Key Informants. Systematic reviews were included if they reported on hospital-led interventions intended to decrease LOS for high-risk populations, defined as those with high-risk medical conditions or socioeconomically vulnerable populations (eg, patients with high levels of socioeconomic risk, who are medically uninsured or underinsured, with limited English proficiency, or who are hospitalized at a safety-net, tertiary, or quaternary care institution). Exclusion criteria included interventions that were conducted outside of the hospital setting, including community health programs. Data extraction was conducted independently, with extraction of strength of evidence (SOE) ratings provided by systematic reviews; if unavailable, SOE was assessed using the AHRQ Evidence-Based Practice Center methods guide. FINDINGS Our searches yielded 4432 potential studies. We included 19 systematic reviews reported in 20 articles. The reviews described 8 strategies for reducing LOS in high-risk populations: discharge planning, geriatric assessment, medication management, clinical pathways, interdisciplinary or multidisciplinary care, case management, hospitalist services, and telehealth. Interventions were most frequently designed for older patients, often those who were frail (9 studies), or patients with heart failure. There were notable evidence gaps, as there were no systematic reviews studying interventions for patients with socioeconomic risk. For patients with medically complex conditions, discharge planning, medication management, and interdisciplinary care teams were associated with inconsistent outcomes (LOS, readmissions, mortality) across populations. For patients with heart failure, clinical pathways and case management were associated with reduced length of stay (clinical pathways: mean difference reduction, 1.89 [95% CI, 1.33 to 2.44] days; case management: mean difference reduction, 1.28 [95% CI, 0.52 to 2.04] days). CONCLUSIONS AND RELEVANCE This systematic review found inconsistent results across all high-risk populations on the effectiveness associated with interventions, such as discharge planning, that are often widely used by health systems. This systematic review highlights important evidence gaps, such as the lack of existing systematic reviews focused on patients with socioeconomic risk factors, and the need for further research.
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Affiliation(s)
- Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
| | - Kelley Tipton
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Brian Leas
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
| | - S. Ryan Greysen
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Nikhil K. Mull
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Meghan Lane-Fall
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia
| | - Kristina McShea
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Amy Y. Tsou
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
- Division of Neurology, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Porcel‐Gálvez AM, Fernández‐García E, Rafferty AM, Gil‐García E, Romero‐Sánchez JM, Barrientos‐Trigo S. Factors That Influence Nurse Staffing Levels in Acute Care Hospital Settings. J Nurs Scholarsh 2021; 53:468-478. [PMID: 33876892 PMCID: PMC8360162 DOI: 10.1111/jnu.12649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/02/2020] [Accepted: 01/15/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To identify which patient and hospital characteristics are related to nurse staffing levels in acute care hospital settings. DESIGN A cross-sectional design was used for this study. METHODS The sample comprised 1,004 patients across 10 hospitals in the Andalucian Health Care System (southern Spain) in 2015. The sampling was carried out in a stratified, consecutive manner on the basis of (a) hospital size by geographical location, (b) type of hospital unit, and (c) patients' sex and age group. Random criteria were used to select patients based on their user identification in the electronic health record system. The variables were grouped into two categories, patient and hospital characteristics. Multilevel linear regression models (MLMs) with random intercepts were used. Two models were fitted: the first was the null model, which contained no explanatory variables except the intercepts (fixed and random), and the second (explanatory) model included selected independent variables. Independent variables were allowed to enter the explanatory model if their univariate association with the nurse staffing level in the MLM was significant at p < .05. RESULTS Two hierarchical levels were established to control variance (patients and hospital). The model variables explained 63.4% of the variance at level 1 (patients) and 71.8% at level 2 (hospital). Statistically significant factors were the type of hospital unit (p = .002), shift (p < .001), and season (p < .001). None of the variables associated with patient characteristics obtained statistical significance in the model. CONCLUSIONS Nurse staffing levels were associated with hospital characteristics rather than patient characteristics. CLINICAL RELEVANCE This study provides evidence about factors that impact on nurse staffing levels in the settings studied. Further studies should determine the influence of patient characteristics in determining optimal nurse staffing levels.
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Affiliation(s)
- Ana María Porcel‐Gálvez
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
| | - Elena Fernández‐García
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
| | - Anne Marie Rafferty
- Professor of Nursing PolicyAdult Nursing DepartmentFlorence Nightingale School of Nursing and Midwifery, King’s CollegeLondonUK
| | - Eugenia Gil‐García
- Associate Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
| | - José Manuel Romero‐Sánchez
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, Seville, Spain, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1019 “Nursing methods and standardized languages (MELES)”Universidad de CádizCádizSpain
| | - Sergio Barrientos‐Trigo
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
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Zhou H, Wang X, Du R, Cheng X, Zheng K, Dong S, Henri J, Chen C, Wang T. The Work Experience of Newly Recruited Male Nurses during COVID-19: A Qualitative Study. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:203-209. [PMID: 34033973 PMCID: PMC8142026 DOI: 10.1016/j.anr.2021.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose This study was to investigate the work experience of newly recruited male nurses during the COVID-19 pandemic. Methods With a phenomenological approach, this qualitative study was adopted semistructured interviews by phone or video calls. A total of 9 male nurses newly recruited for the COVID-19 wards in Chinese hospitals were interviewed for this study. And Colaizzi's method was applied for evaluation in the data analysis. Results Based on our findings, three themes were extracted. First, the newly recruited male nurses showed negative emotions at the beginning of COVID-19 epidemic, which was caused by changes in working conditions and content, but also prompted the nurses to change the way of coping with the crisis. Second, they gradually mastered the working skills and psychological training to cope with COVID-19 and developed a positive attitude toward life and a high sense of professional responsibility. Finally, we learned about their needs to respond to public health emergencies such as the COVID-19 pandemic. Conclusion COVID-19 is a disaster for all of humanity. The newly recruited male nurses are an important force in emergency rescue. Although they suffered from short-term negative emotions, they quickly adapted to the crisis. In order to better prepare for future emergencies, the disaster response capacity of newly recruited male nurses needs to be further improved. In addition, newly recruited male nurses have a strong demand for timely and personalized career development guidance.
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Affiliation(s)
- Huiyue Zhou
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, China
| | - Xin Wang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, China
| | - Ruofei Du
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, China
| | - Xiang Cheng
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, China
| | - Kexin Zheng
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, China
| | - Shiqi Dong
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, China
| | - Justin Henri
- School of Medicine Deakin University, Geelong, Victoria, Australia
| | - Changying Chen
- Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Tao Wang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, China; Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Australia; The People's Hospital of Hebi, Henan, China.
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Saaiman T, Filmalter CJ, Heyns T. Important factors for planning nurse staffing in the emergency department: A consensus study. Int Emerg Nurs 2021; 56:100979. [PMID: 33706044 DOI: 10.1016/j.ienj.2021.100979] [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: 10/13/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Planning adequate nurse staffing in the emergency department (ED) is challenging. Although there are models to determine nurse staffing in EDs, these models do not consider all the factors. Inadequate nurse staffing causes overcrowding, poor quality of patient care, increased hospital costs, poor patient outcomes and high levels of burnout amongst nurses. In this paper, we report stakeholders' perceptions of important factors to be considered when planning ED nursing ratios. METHODS We applied a consensus research design. The data was generated from modified nominal group techniques followed by an e-Delphi with two rounds. The factors were generated during two nominal groups by 19 stakeholders which included management and healthcare professionals working in EDs. The generated factors were then put on a survey format for use in an e-Delphi. Using purposive and snowball sampling the survey was distributed to 74 national and international experts for consensus. RESULTS Ultimately, 43 experts agreed (a validity index of ≥ 80%) on four categories namely: hospital, staff, patient and additional categories which included 17 related factors. CONCLUSION Ideal nurse staffing ratios are influenced by the complexity of the environment and interactions between multiple factors. The categories and factors identified emphasised the need for extensive further research to ensure a financially viable model that will be accepted by both staff and patient, and thus promote optimal outcomes.
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Affiliation(s)
- Tania Saaiman
- University of Pretoria, Department of Nursing, South Africa
| | | | - Tanya Heyns
- University of Pretoria, Department of Nursing, South Africa
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Omondi GB, Murphy GAV, Jackson D, Brownie S, English M, Gathara D. Informal task-sharing practices in inpatient newborn settings in a low-income setting-A task analysis approach. Nurs Open 2020; 7:869-878. [PMID: 32257274 PMCID: PMC7113512 DOI: 10.1002/nop2.463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/10/2020] [Accepted: 02/03/2020] [Indexed: 11/20/2022] Open
Abstract
Aim To describe the complexity and criticality of neonatal nursing tasks and existing task-sharing practices to identify tasks that might be safely shared in inpatient neonatal settings. Design We conducted a cross-sectional study in a large geographically dispersed sample using the STROBE guidelines. Methods We used a task analysis approach to describe the complexity/criticality of neonatal nursing tasks and to explore the nature of task sharing using data from structured, self-administered questionnaires. Data was collected between 26th April and 22nd August 2017. Results Thirty-two facilities were surveyed between 26th April and 22nd August, 2017. Nearly half (42%, 6/14) of the "moderately critical" and "not critical" (41%, 5/11) tasks were ranked as consuming most of the nurses' time and reported as shared with mothers respectively. Most tasks were reported as shared in the public sector than in the private-not-for-profit facilities. This may largely be a response to inadequate nurse staffing, as such, there may be space for considering the future role of health care assistants.
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Affiliation(s)
| | - Georgina A. V. Murphy
- KEMRI‐Wellcome Trust Research ProgrammeNairobiKenya
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Debra Jackson
- Faculty of HealthUniversity of TechnologySydneyNSWAustralia
| | - Sharon Brownie
- School of MedicineGriffith UniversityNathanQldAustralia
- PRAXIS ForumGreen Templeton CollegeUniversity of OxfordOxfordUK
| | - Mike English
- KEMRI‐Wellcome Trust Research ProgrammeNairobiKenya
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - David Gathara
- KEMRI‐Wellcome Trust Research ProgrammeNairobiKenya
- Aga Khan University HospitalNairobiKenya
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Darling EK, Babe G, Sorbara C, Perez R. Trends in very early discharge from hospital for newborns under midwifery care in Ontario from 2003 to 2017: a retrospective cohort study. CMAJ Open 2020; 8:E462-E468. [PMID: 32586788 PMCID: PMC7850229 DOI: 10.9778/cmajo.20190165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Very early discharge from hospital is an element of Ontario midwifery care. Our aim in the present study was to describe the frequency of very early hospital discharge for newborns in Ontario midwifery care over time. METHODS We conducted a retrospective population-based cohort study, including all midwife-attended singleton term cephalic newborns delivered by spontaneous vaginal birth at Ontario hospitals between April 2003 and February 2017. Our primary outcome was very early hospital discharge (< 6 h after birth) for newborns. Secondary outcomes were pediatric consultation before hospital discharge, phototherapy before hospital discharge and readmission for treatment of jaundice. We used generalized linear mixed models to estimate the relation between maternal, neonatal and hospital factors and very early discharge, while accounting for clustering by hospital. RESULTS The study cohort included 101 852 newborns born at 89 hospitals. Between 2003/04 and 2016/17, the unadjusted rate of very early discharge decreased from 34.3% to 30.7%. This trend was not significant after adjustment for covariates (odds ratio 1.0, 95% confidence interval 0.99-1.0). Unadjusted rates of pediatric consultation, phototherapy and readmission for jaundice all rose slightly over the study period. Hospital-specific risk-adjusted frequencies of very early discharge ranged from 5% (n = 1479) to 83% (n = 3459) across the 75 Ontario hospitals with at least 100 newborns included in the study cohort. INTERPRETATION Hospital-level factors contributed to the observed decrease in crude rates of very early discharge for midwifery clients. Wide variation in these rates across Ontario hospitals points to room for improvement to make more efficient use of health care resources by promoting optimal levels of very early discharge.
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Affiliation(s)
- Elizabeth K Darling
- Department of Obstetrics & Gynecology (Darling) McMaster University; McMaster Midwifery Research Centre (Darling), McMaster University, Hamilton, Ont.; ICES (Babe, Perez), Hamilton, Ont.; Midwifery Education Program (Sorbara), Ryerson University; Institute of Health Policy, Management and Evaluation (Sorbara), University of Toronto, Toronto, Ont.
| | - Glenda Babe
- Department of Obstetrics & Gynecology (Darling) McMaster University; McMaster Midwifery Research Centre (Darling), McMaster University, Hamilton, Ont.; ICES (Babe, Perez), Hamilton, Ont.; Midwifery Education Program (Sorbara), Ryerson University; Institute of Health Policy, Management and Evaluation (Sorbara), University of Toronto, Toronto, Ont
| | - Carla Sorbara
- Department of Obstetrics & Gynecology (Darling) McMaster University; McMaster Midwifery Research Centre (Darling), McMaster University, Hamilton, Ont.; ICES (Babe, Perez), Hamilton, Ont.; Midwifery Education Program (Sorbara), Ryerson University; Institute of Health Policy, Management and Evaluation (Sorbara), University of Toronto, Toronto, Ont
| | - Richard Perez
- Department of Obstetrics & Gynecology (Darling) McMaster University; McMaster Midwifery Research Centre (Darling), McMaster University, Hamilton, Ont.; ICES (Babe, Perez), Hamilton, Ont.; Midwifery Education Program (Sorbara), Ryerson University; Institute of Health Policy, Management and Evaluation (Sorbara), University of Toronto, Toronto, Ont
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Assaye AM, Wiechula R, Schultz TJ, Feo R. Nurse staffing models in medical-surgical units of acute care settings: A cross-sectional study. Int J Nurs Pract 2019; 26:e12812. [PMID: 31840875 DOI: 10.1111/ijn.12812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/21/2019] [Accepted: 11/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nurse staffing models have been developed across different countries to address nursing shortages and improve quality of nursing care. However, there is no published study that describes nurse staffing models in Ethiopian hospitals. AIMS To describe the existing staffing models for nursing practice in acute care units of two hospitals (one public and one private) in Ethiopia. METHODS A cross-sectional study was conducted from July to December 2018. A self-administered questionnaire was used to collect data such as shift patterns, hours worked, and number of patients cared for per shift. Unit-level data on nurse staffing were collected using a checklist developed specifically for this study. RESULTS Fifty-nine percent (59.9%) of participants reported that they worked six or seven days per week. On average, they worked 50 hours per week and 12% working over 60 hours per week. The number of patients they provided care for during their last shift ranged from four to 45 with an average of 13 patients. CONCLUSION This study demonstrates that nurses working in acute care settings in Ethiopia are typically working more than 40 hours per week and caring for many patients per shift, which has the potential to impact patient safety.
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Affiliation(s)
- Ashagre Molla Assaye
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Richard Wiechula
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia.,Centre for Evidence-Based Practice South Australia, Joanna Briggs Institute, North Adelaide, South Australia, Australia
| | - Timothy J Schultz
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia.,Centre for Evidence-Based Practice South Australia, Joanna Briggs Institute, North Adelaide, South Australia, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Abstract
OBJECTIVE The purpose of this review is to comment on the association between hospital nursing personnel staffing and patient outcomes, including the avoidance of errors and complications. METHODS A literature search was carried out in the Medline database on publications from the last 10 years on nursing personnel staffing. RESULTS Only overviews and observational studies on the topic were available and no controlled or prospective surveys. Most investigators assumed that there was an inverse relationship between low nursing staff levels of hospital wards and intensive care and adverse outcomes, including higher mortality rates; however, there is no clear significance for this assumption and evidence-based definitive lower limits for nursing staff cannot be given due to a lack of randomized trials. The causes for unfavorable results in the case of inadequate nursing personnel staffing include hygiene deficiencies, orders not followed and unfulfilled nursing and monitoring measures. Furthermore, staff overload leads to staff dissatisfaction and burnout, which also has a negative impact on the results. Most studies required a maximum patient to nurse ratio of 2:1 for the intensive care unit and an average ratio of not more than 8:1 for surgical wards. With respect to these requirements, changing personnel needs must be considered depending on the current state of the patients being cared for, which enabled all investigators to require a flexible roster design; approval for fixed statutory lower limits for nursing staff was low. The level of education of the nursing staff also played an essential role as qualified nursing staff cannot be replaced at will by less qualified assistant staff. CONCLUSION The level of training and the number of the nursing personnel influence hospital mortality and adverse outcomes; however, there are no evidence-based lower levels for nursing staff for inpatient care and perhaps this cannot be the case due to the changing complexity of the patients admitted, the comorbidities and possible treatment complications. There is a considerable need for research.
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