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Gormley E, Connolly M, Ryder M. The development of nursing-sensitive indicators: A critical discussion. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100227. [PMID: 39188551 PMCID: PMC11345314 DOI: 10.1016/j.ijnsa.2024.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/17/2024] [Accepted: 07/20/2024] [Indexed: 08/28/2024] Open
Abstract
Discussion arguments In a science-based profession, nurses must continuously monitor and evaluate the effectiveness of their care. However, data on what constitutes nursing care in practice and the delivery process is lacking. Insufficient evidence on how nurses contribute to patient care hampers the evaluation of nursing practice.We discuss nursing-sensitive indicators, their origins, current applications, and challenges related to their use in evaluating the quality of nursing care. We analyse nursing-sensitive indicators in the context of criticisms levelled at the profession related to the lack of evidence to support their value in the larger healthcare environment. Conclusions We have a disjointed approach to evaluating nursing care. Current systems designed to monitor nursing care, such as metrics and data sets, are not adequate or effective for comprehensively evaluating nursing care, considering the fundamentals and values of the nursing profession.
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Affiliation(s)
- Edel Gormley
- University College Dublin (UCD) School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Michael Connolly
- University College Dublin (UCD) School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Education & Research Centre Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Mary Ryder
- University College Dublin (UCD) School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Ngune I, Myers H, Cole A, Palamara P, Redknap R, Roche M, Twigg D. Developing nurse-sensitive outcomes in acute inpatient mental health settings-A systematic review. J Clin Nurs 2023; 32:6254-6267. [PMID: 36915223 DOI: 10.1111/jocn.16679] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/14/2022] [Accepted: 01/30/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND While nurse-sensitive outcomes (NSOs) are well established in numerous health settings, to date there is no indicator suite of NSOs for inpatient mental health settings. AIM To assess the relationship between nursing variables and patient outcomes in acute inpatient mental health settings to determine which outcomes can be used as indicators of the quality of nursing care. METHODS Databases accessed were CINAHL, MEDLINE, PsycINFO and EMBASE, last searched in May 2022. The review followed the 2020 PRISMA checklist for systematic reviews. Papers published between 1995 and 2022, conducted in acute mental health care units were included. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. A meta-analysis was not possible because of the large number of variables and measurement inconsistencies. RESULTS A total of 57 studies were reviewed. Studies were categorised according to whether they found a significant or non-significant relationship between nurse variables and patient outcomes. Seven outcomes-aggression, seclusion, restraint, absconding, pro-re-nata medications, special observations and self-harm-were identified. For each outcome, there were significant findings for several nurse variables indicating that all included outcomes could be used as NSOs. However, evidence for aggression, seclusion and restraint use as suitable NSOs was more robust than the evidence for self-harm, absconding, pro-re-nata medications and special observations. CONCLUSION All the seven outcomes can all be used to develop an NSO indicator suite in mental health inpatient settings. More work is needed to establish high-quality studies to clearly demonstrate the relationship between these outcome measures and changes in nurse variables such as nurse staffing, skill mix, work environment, nurse education and nurse experience. PATIENT AND PUBLIC CONTRIBUTION Patient or public contribution was not possible because of the type of the variables being explored.
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Affiliation(s)
- Irene Ngune
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Helen Myers
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Amanda Cole
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Peter Palamara
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robina Redknap
- Western Australia Department of Health, Perth, Western Australia, Australia
| | - Michael Roche
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Diane Twigg
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Li L, Wu HH, Huang CH, Zou Y, Li XY. Key drivers of promoting patient safety culture from the perspective of medical staff at a tertiary hospital in China. TQM JOURNAL 2022. [DOI: 10.1108/tqm-02-2022-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PurposeUnderstanding the antecedents of patient safety culture among medical staff is essential if hospital managers are to promote explicit patient safety policies and strategies. The factors that influence patient safety culture have received little attention. The authors aim to investigate the antecedents of patient safety culture (safety climate) in relation to medical staff to develop a comprehensive approach to improve patient safety and the quality of medical care in China.Design/methodology/approachThe Chinese version of the Safety Attitudes Questionnaire (CSAQ) was used to examine the attitudes toward patient safety among physicians and nurses. This medical staff was asked to submit the intra-organizational online survey via email. A total of 1780 questionnaires were issued. The final useable questionnaires were 256, yielding a response rate of 14.38%. One-way analysis of variance (ANOVA) was employed to test if different sex, supervisor/manager, age, working experience, and education result in different perceptions. Confirmatory factor analysis (CFA) was used to verify the structure of the data. Then linear regression with forward selection was performed to obtain the essential dimension(s) that affect the safety culture (safety climate).FindingsThe CFA results showed that 26 CSAQ items measured 6 safety-related dimensions. The linear regression results indicated that working conditions, teamwork climate, and job satisfaction had significant positive effects on safety culture (safety climate).Practical implicationsHospital managers should put increased effort into essential elements of patient-oriented safety culture, such as working conditions, teamwork climate, and job satisfaction to develop appropriate avenues to improve the quality of delivered medical services as well as the safety of patients.Originality/valueThis study focused on the contribution that the antecedents of patient safety culture (safety climate) make with reference to the perspective of medical staff in a tertiary hospital in China.
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Afaneh T, Abu-Moghli F, Ahmad M. Nursing-sensitive indicators: a concept analysis. Nurs Manag (Harrow) 2021; 28:28-33. [PMID: 33829713 DOI: 10.7748/nm.2021.e1982] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/09/2022]
Abstract
Nursing-sensitive indicators (NSIs) are the criteria for changes in a person's health status that nursing care can directly affect, and they form the foundation for monitoring the quality of nursing care. For example, they can assist in establishing a common ground for benchmarking and in providing evidence of the cost-effectiveness of nursing care. However, despite the considerable influence of nursing interventions on the quality of healthcare, measuring the quality of nursing care and its effects on patient outcomes and healthcare systems remains challenging. There is also little consensus on what constitutes an NSI, resulting in inconsistent conceptualisations for measuring the quality of nursing care and the use of several different terms to describe indicators that are sensitive to nursing interventions. This article describes a literature review and concept analysis, which enabled the authors to develop a concept model for NSIs, with the intention of improving the concept of NSIs.
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Affiliation(s)
- Tareq Afaneh
- King Hamad University Hospital, Muharraq, Bahrain
| | - Fathieh Abu-Moghli
- Professor of Nursing Administration, Department of Community Health Nursing, University of Jordan, Amman, Jordan
| | - Muayyad Ahmad
- Professor of Adult Nursing, Department of Clinical Nursing, University of Jordan, Amman, Jordan
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Sharplin G, Adelson P, Kennedy K, Williams N, Hewlett R, Wood J, Bonner R, Dabars E, Eckert M. Establishing and Sustaining a Culture of Evidence-Based Practice: An Evaluation of Barriers and Facilitators to Implementing the Best Practice Spotlight Organization Program in the Australian Healthcare Context. Healthcare (Basel) 2019; 7:healthcare7040142. [PMID: 31726668 PMCID: PMC6956050 DOI: 10.3390/healthcare7040142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/22/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Nurses and midwives are central to the implementation and delivery of quality care through evidence-based practice (EBP). However, implementation of EBP in nursing and midwifery is under-researched with few examples of systematic and sustained change. The Registered Nurses Association of Ontario’s Best-Practice Spotlight Organization (BPSO) Program was adopted in South Australia as a framework to systematically implement EBP in two diverse and complex healthcare settings. Methods: The study was a post-implementation, mixed-method evaluation conducted at two healthcare settings in Adelaide, South Australia utilizing qualitative and quantitative data. Proctor’s implementation evaluation framework guided the evaluation design. Information sources included; interviews, focus groups, questionnaires, and document review. Results: Clinical and executive staff (n = 109 participants) from a broad range of stakeholder groups participated in the interviews, focus groups, and returned questionnaires. A number of facilitators directly affecting program implementation were identified; these pertained to embedding continuity into the program’s implementation and delivery, a robust governance structure, and executive sponsorship. Barriers to implementation were also identified. These barriers pertained to organizational or workforce challenges; staff turnover and movement (e.g., secondment), insufficient staff to allow people to attend training, and a lack of organizational commitment to the program, especially at an executive level. As a result of successful implementation, it was observed that over three years, the BPSO program positively influenced the uptake and implementation of EBP by clinicians and the organizations into which they were introduced. Conclusions: The BPSO model can be translocated to new healthcare systems and has the potential to act as a mechanism for establishing and sustaining EBP change. This study was the first to apply an implementation evaluation framework to the BPSO program, which allowed for structured analysis of facilitating or impeding factors that affected implementation success. The findings have important implications for other health systems looking to translocate the same or similar EBP programs, as well as contributing to the growing body of implementation evaluation literature.
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Affiliation(s)
- Greg Sharplin
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
- Correspondence: ; Tel.: +61-8-8302-2846
| | - Pam Adelson
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
| | - Nicola Williams
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Roslyn Hewlett
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Jackie Wood
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Rob Bonner
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Elizabeth Dabars
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
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Giles M, Graham L, Ball J, Watts W, King J, Bantawa K, Paul M, Harris A, Paul O'Brien A, Parker V. Variations in indwelling urinary catheter use in four Australian acute care hospitals. J Clin Nurs 2019; 28:4572-4581. [PMID: 31469471 DOI: 10.1111/jocn.15048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/25/2019] [Accepted: 08/18/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify the point prevalence of indwelling urinary catheters (IDCs) in adult inpatients in acute care hospitals, and to describe the indications for IDC insertion based on patient age, gender, specialty and hospital. BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are preventable healthcare-associated infections. IDC duration is the strongest predictor of CAUTI, and little is known about characteristics of patients who receive an IDC. DESIGN Two single-day point prevalence surveys collected baseline patient data as part of a larger pre-post control-intervention study. METHODS Surveys were conducted at four acute care hospitals in NSW, Australia, for all adult patients. Data collection included IDC presence, insertion details and urine culture collection. Point prevalence data were linked with electronically extracted patient demographic data. This study is presented in line with STROBE checklist (See Supplementary File 1). RESULT Data from 1,630 patients were analysed, with 196 patients (12%) identified as having an IDC on the survey dates. IDC prevalence rates were higher in males (13%) than in females (11%). Critical care had the highest rate of patients with IDCs (42%). Urine cultures were collected in 70 patients with an IDC (43%). CONCLUSIONS Findings indicated similar rates of IDC use in males and females, and there was no significant difference in age between patients with or without an IDC. However, indication for IDC varied by patient age and gender. High rates of urine culture collection may represent routine collection. RELEVANCE TO CLINICAL PRACTICE IDC use is found across genders, all age groups and specialties. Nurses should be aware that any of their patients may have an IDC and be particularly aware of certain indications based on patient age and gender. Routine urine culture collection is not advised, and instead, nurses should be guided by clinical decision-making tools.
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Affiliation(s)
- Michelle Giles
- Hunter New England Local Health District, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Laura Graham
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Jean Ball
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Wendy Watts
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Jennie King
- University of Newcastle, Newcastle, New South Wales, Australia.,Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Kamana Bantawa
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Michelle Paul
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Alison Harris
- Central Coast Local Health District, Gosford, New South Wales, Australia
| | | | - Vicki Parker
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
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Takashima M, Burmeister E, Ossenberg C, Henderson A. Assessment of the clinical performance of nursing students in the workplace: Exploring the role of benchmarking using the Australian Nursing Standards Assessment Tool (ANSAT). Collegian 2019. [DOI: 10.1016/j.colegn.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sturm H, Rieger MA, Martus P, Ueding E, Wagner A, Holderried M, Maschmann J. Do perceived working conditions and patient safety culture correlate with objective workload and patient outcomes: A cross-sectional explorative study from a German university hospital. PLoS One 2019; 14:e0209487. [PMID: 30608945 PMCID: PMC6319813 DOI: 10.1371/journal.pone.0209487] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/06/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Workload and demands on hospital staff have been growing over recent years. To ensure patient and occupational safety, hospitals increasingly survey staff about perceived working conditions and safety culture. At the same time, routine data are used to manage resources and performance. This study aims to understand the relation between survey-derived measures of how staff perceive their work-related stress and strain and patient safety on the one hand, and routine data measures of workload and quality of care (patient safety) on the other. METHODS We administered a written questionnaire to all physicians and nurses in the inpatient units at a German university hospital. The questionnaire was an amalgam of the Copenhagen Psychosocial Questionnaire (COPSOQ), the Copenhagen Burnout Inventory (CBI) scale to assess patient-related burnout of and portions of the Hospital Survey on Patient Safety Culture (HSPSC). Indicators from administrative data used to assess workload and patient-related work-strain were: amount of overtime worked, work intensity recording of nurses, cost weight, occupancy rate and DRG-related length of stay. Quality of care was assessed using readmission rates and disease-related length of stay. Univariate associations were tested with Pearson correlations. RESULTS Response rate were 37% (224) for physicians and 39% (351) for nurses. Physicians' overtime correlated strongly with perceived quantitative demands (.706, 95% CI: 0.634 to 0.766), emotional demands (.765; 95% CI: 0.705 to 0.814), and perceived role conflicts (.655, 95% CI: 0.573 to 0.724). Nurses' work-intensity measures were associated with decreasing physician job satisfaction and with less favorable perceptions of the appropriateness of staffing (-.527, 95% CI:-0.856 to 0.107). Both professional groups showed medium to strong associations between the morbidity measure (cost weight) and role conflicts; between occupancy rates and role clarity (-.482, 95% CI: -0.782 to -0.02) and predictability of work (-.62, 95% CI: -0.848 to -0.199); and between length of stay and internal team functioning (-.555, 95% CI: -0.818 to -0.101). Higher readmission rates were associated with lower perceived patient safety (-.476, 95% CI: -0.779 to 0.006), inadequate staffing (-.702, 95% CI: -0.884 to -0.334), and worse team functioning (-.520, 95% CI: -0.801 to -0.052). Shorter disease-related length of stay was associated with better teamwork within units (-.555, 95% CI: -0.818 to -0.101) and a lower risk of physician burnout (-.588, 95% CI: -0.846 to -0.108). CONCLUSION Perceptions of hospital personnel regarding sub-optimal workplace safety and teamwork issues correlated with worse patient outcome measures. Furthermore, objective measures of overtime work as well as objective measures of workload correlated clearly with subjective work-related stress and strain. This suggests that objective workload measures (such as overtime worked) could be used to indirectly monitor job-related psychosocial strain on employees and, thus, improve not only staff wellbeing but also patient outcomes. On the other hand, listening to their personnel could help hospitals to improve patient (and employee) safety.
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Affiliation(s)
- Heidrun Sturm
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße, Tübingen, Germany
- Institute of General Practice and Interprofessional Care, University Hospital of Tübingen, Osianderstr, Tübingen, Germany
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital of Tübingen, Silcherstraße, Tübingen, Germany
| | - Esther Ueding
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße, Tübingen, Germany
| | - Anke Wagner
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße, Tübingen, Germany
| | - Martin Holderried
- Department of Quality Management, Medical and Business Development, University Hospital of Tübingen, Hoppe-Seyler-Str, Tübingen, Germany
| | - Jens Maschmann
- University Hospital Jena, Medical Director, Bachstrasse, Jena, Germany
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Gray E, Currey J, Considine J. Hospital in the home nurses’ assessment decision making: an integrative review of the literature. Contemp Nurse 2018; 54:603-616. [DOI: 10.1080/10376178.2018.1532802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Erika Gray
- School of Nursing and Midwifery, Deakin University, Geelong, VIC 3125, Australia
- Eastern Health, Arnold St, Box Hill, VIC 3128, Australia
| | - Judy Currey
- School of Nursing and Midwifery, Deakin University, Geelong, VIC 3125, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3125, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, VIC 3125, Australia
- Eastern Health, Arnold St, Box Hill, VIC 3128, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3125, Australia
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Myers H, Pugh JD, Twigg DE. Identifying nurse-sensitive indicators for stand-alone high acuity areas: A systematic review. Collegian 2018. [DOI: 10.1016/j.colegn.2017.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sim J, Crookes P, Walsh K, Halcomb E. Measuring the outcomes of nursing practice: A Delphi study. J Clin Nurs 2017; 27:e368-e378. [DOI: 10.1111/jocn.13971] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jenny Sim
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Patrick Crookes
- School of Nursing, Midwifery & Paramedicine; Australian Catholic University; North Sydney NSW Australia
| | - Kenneth Walsh
- School of Health Sciences; University of Tasmania; Hobart TAS Australia
| | - Elizabeth Halcomb
- School of Nursing; University of Wollongong; Wollongong NSW Australia
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Twigg DE, Myers H, Duffield C, Pugh JD, Gelder L, Roche M. The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data. Int J Nurs Stud 2016; 63:189-200. [DOI: 10.1016/j.ijnurstu.2016.09.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 09/06/2016] [Accepted: 09/09/2016] [Indexed: 10/21/2022]
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Bail K, Grealish L. ‘Failure to Maintain’: A theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital. Int J Nurs Stud 2016; 63:146-161. [DOI: 10.1016/j.ijnurstu.2016.08.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 01/20/2023]
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