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Fijačko N, Masterson Creber R, Metličar Š, Gosak L, Štiglic G. Nurses' occupational physical activity and workload in a perioperative intensive care unit in Slovenia. Prev Med Rep 2024; 37:102543. [PMID: 38179440 PMCID: PMC10764244 DOI: 10.1016/j.pmedr.2023.102543] [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: 04/04/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
The field of nursing includes heavy occupational physical demands, including walking and standing for longer periods of time, in addition to moving and lifting. As such, in the context of a typical work shift, many nurses generally achieve the World Health Organization's recommended 10,000 steps per day. This study aimed at estimating the daily physical activity and workload of nurses in a perioperative intensive care unit. The data sources for this study included data from the hospital information system on various procedures and interventions, and the Silva Ex3 Plus pedometers for measuring steps, kilometers, calories, and activity time across various shifts in a perioperative intensive care unit. Twenty nurses from Slovenia volunteered to participate in this observational study. Over 13 weeks, a nurse working an 8-hour shift walked an average of 5,938 steps (4.4 km). However, nurses who worked a 12-hour weekend day shift came very close to the World Health Organization's recommendation with an average of 9,003 steps (6.5 km). A total of 227 patients were admitted and an average of 80 nursing interventions were performed per day and there was a positive relationship between physical activity, workload, and patient admissions in the perioperative intensive care unit (p = 0.001). Results of this study could help managers better understand nurses' physical activity and workload during various shifts in the perioperative intensive care unit.
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Affiliation(s)
- Nino Fijačko
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
- Maribor University Medical Centre, Maribor, Slovenia
| | | | - Špela Metličar
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
- Medical Dispatch Centre Maribor, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Lucija Gosak
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Gregor Štiglic
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Freguia F, Danielis M, Moreale R, Palese A. Nursing minimum data sets: Findings from an umbrella review. Health Informatics J 2022; 28:14604582221099826. [PMID: 35634983 DOI: 10.1177/14604582221099826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study explores the evidence available on Nursing Minimum Data Sets (NMDSs) by summarising: (a) the main methodological and reporting features of the reviews published in this field to date; (b) the recommendations developed and published in such reviews regarding the NMDSs, and (c) the categories and items that should be included in the NMDSs according to the available reviews. METHODS An Umbrella Review was performed. A search of secondary studies published up to November 2021 that were focused on NMDSs for adult hospitalised patients was conducted using MEDLINE (via PubMed), CINAHL and Scopus databases. The included studies were critically evaluated by using the Checklist for Systematic Review and Research Syntheses. The full review process was performed according to the Preferred Reporting Items for Systematic reviews and the Meta-Analyses statement. RESULTS From the initial 1311 studies that were retrieved, a total of eight reviews published from 1995 to 2018 were included. Their methodological quality was variable; these reviews offered four types of recommendations, namely at the overall, clinical, research and management levels. Additionally, seven NMDSs emerged with different purposes, elements, target populations and taxonomies. A list of categories and items that should be included in NMDSs have been summarised. CONCLUSIONS Nurses are daily involved in the nursing care documentation; however, which elements are recorded is mainly defined at the local levels and relies on paper and pencil. NMDS might provide a point of reference, specifically in the time of health digitalisation. Alongside other priorities as underlined in available recommendations, and the need to improve the quality of the reviews in this field, there is a need to develop a common NMDS by establishing its core elements, deciding on a standardised language and identifying linkages with other datasets.
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Affiliation(s)
- Francesca Freguia
- School of Nursing, Department of Medical Sciences, 9316University of Udine, Udine, Italy
| | - Matteo Danielis
- School of Nursing, Department of Medical Sciences, 9316University of Udine, Udine, Italy
| | - Renzo Moreale
- School of Nursing, Department of Medical Sciences, 9316University of Udine, Udine, Italy
| | - Alvisa Palese
- School of Nursing, Department of Medical Sciences, 9316University of Udine, Udine, Italy
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Ko Y, Park B, Lee H, Kim D. Developing and testing a Korean patient classification system for general wards based on nursing intensity. Nurs Open 2021; 8:1870-1878. [PMID: 33690973 PMCID: PMC8186681 DOI: 10.1002/nop2.845] [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: 01/04/2021] [Accepted: 02/14/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To develop a new general wards patient classification tool based on the nursing intensity level that reflects patients’ clinical characteristics and indirect nursing activities. Design A cross‐sectional design was adopted. This methodological study developed a patient classification system to sort general ward patients based on the intensity of their nursing needs and verified the validity and reliability of this classification system. Methods Thirteen experts verified the tools’ content validity. Data collectors and head nurses classified 150 patients from two hospitals with four general wards and various nurse staffing levels. Inter‐rater reliability was analysed. Staff nurses classified 846 patients following the Korean patient classification system on nursing intensity scores that reflected patients’ clinical status. Content validity was verified based on the classification results. Using K‐group cluster analysis, score ranges for four groups were identified. Results The developed tool includes 8 domains, (symptom management, infection control, nutrition and medication, personal hygiene and secretion, activity, sleep and rest, guidance in nursing/emotional support, nursing activity planning and coordination, indirect activity), 24 subdomains, 66 nursing activities and 124 criteria. Inter‐rater reliability showed high agreement.
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Affiliation(s)
- Yukyung Ko
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, South Korea
| | - Bohyun Park
- Department of Nursing, Changwon National University, Changwon, South Korea
| | - Hanju Lee
- Department of Nursing, Sangmyung University, Cheonan, South Korea
| | - Donghwan Kim
- Health Insurance Review and Assessment Service, Wonju, South Korea
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Fennelly O, Grogan L, Reed A, Hardiker NR. Use of standardized terminologies in clinical practice: A scoping review. Int J Med Inform 2021; 149:104431. [PMID: 33713915 DOI: 10.1016/j.ijmedinf.2021.104431] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/20/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
AIM To explore the use and impact of standardized terminologies (STs) within nursing and midwifery practice. INTRODUCTION The standardization of clinical documentation creates a potential to optimize patient care and safety. Nurses and midwives, who represent the largest proportion of the healthcare workforce worldwide, have been using nursing-specific and multidisciplinary STs within electronic health records (EHRs) for decades. However, little is known regarding ST use and impact within clinical practice. METHODS A scoping review of the literature was conducted (2019) across PubMed, CINAHL, Embase and CENTRAL in collaboration with the Five Country Nursing and Midwifery Digital Leadership Group (DLG). Identified studies (n = 3547) were reviewed against a number of agreed criterion, and data were extracted from included studies. Studies were categorized and findings were reviewed by the DLG. RESULTS One hundred and eighty three studies met the inclusion criteria. These were conducted across 25 different countries and in various healthcare settings, utilising mainly nursing-specific (most commonly NANDA-I, NIC, NOC and the Omaha System) and less frequently local, multidisciplinary or medical STs (e.g., ICD). Within the studies, STs were evaluated in terms of Measurement properties, Usability, Documentation quality, Patient care, Knowledge generation, and Education (pre and post registration). As well as the ST content, the impact of the ST on practice depended on the healthcare setting, patient cohort, nursing experience, provision of education and support in using the ST, and usability of EHRs. CONCLUSION Employment of STs in clinical practice has the capability to improve communication, quality of care and interoperability, as well as facilitate value-based healthcare and knowledge generation. However, employment of several different STs and study heterogeneity renders it difficult to aggregate and generalize findings.
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Affiliation(s)
- Orna Fennelly
- Insight Centre for Data Analytics, University College Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - Loretto Grogan
- Office of the Nursing and Midwifery Services Director, Health Service Executive (HSE), Ireland.
| | - Angela Reed
- Northern Ireland Practice & Education Council for Nursing and Midwifery, Northern Ireland.
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Ko Y, Park B. Integrative literature review of patient classification tools for nursing intensity evaluation: Focusing on comparison of South Korean and international tools. Nurs Open 2021; 8:2105-2116. [PMID: 33389824 PMCID: PMC8363350 DOI: 10.1002/nop2.757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 10/06/2020] [Accepted: 11/05/2020] [Indexed: 11/11/2022] Open
Abstract
AIM This study aimed to review the literature on patient classification tools (PCTs) for assessing nursing strength and to compare South Korean and international tools. DESIGN Integrative literature review. METHODS We searched the relevant literature published from 2000-2017 in PubMed and two electronic databases in Korea in March 2017. Twenty-five published studies were reviewed. RESULTS In most Korean studies, patients were classified by PCT, which were tested to ensure validity and reliability, followed by measurement of nursing time and development of the conversion index. In international studies, PCTs used were simpler than those in Korean studies; the results of estimation for optimum nurse staffing were reported. Most studies insufficiently reflected indirect nursing needs and patients' non-clinical factors. The current PCTs used in Korean studies inadequately reflect the reality of nursing field. Therefore, development of new PCTs reflecting nursing intensity based on direct and indirect nursing activities is necessary.
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Affiliation(s)
- Yukyung Ko
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, South Korea
| | - Bohyun Park
- Department of Nursing, Changwon National University, Changwon, South Korea
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Ameel M, Leino H, Kontio R, van Achterberg T, Junttila K. Using the Nursing Interventions Classification to identify nursing interventions in free‐text nursing documentation in adult psychiatric outpatient care setting. J Clin Nurs 2020; 29:3435-3444. [DOI: 10.1111/jocn.15382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/05/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Ameel
- Helsinki University Hospital Helsinki Finland
- Department of Nursing Science University of Turku Turku Finland
- University of Helsinki Helsinki Finland
| | - Hanna Leino
- Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Raija Kontio
- Helsinki University Hospital Helsinki Finland
- Department of Nursing Science University of Turku Turku Finland
- University of Helsinki Helsinki Finland
| | - Theo van Achterberg
- Department of Public Health and Primary Care Academic Centre for Nursing and Midwifery KU Leuven Leuven Belgium
| | - Kristiina Junttila
- Helsinki University Hospital Helsinki Finland
- Department of Nursing Science University of Turku Turku Finland
- University of Helsinki Helsinki Finland
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van den Oetelaar WFJM, van Rhenen W, Stellato RK, Grolman W. Balancing workload of nurses: Linear mixed effects modelling to estimate required nursing time on surgical wards. Nurs Open 2020; 7:235-245. [PMID: 31871707 PMCID: PMC6917947 DOI: 10.1002/nop2.385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/14/2019] [Accepted: 09/02/2019] [Indexed: 11/08/2022] Open
Abstract
Aim Quantifying the relation between patient characteristics and care time and explaining differences in nursing time between wards. Design Academic hospital in the Netherlands. Six surgical wards, capacity 15-30 beds, 2012-2014. Methods Linear mixed effects model to study the relation between patient characteristics and care time. Estimated marginal means to estimate baseline care time and differences between wards. Results Nine patient characteristics significantly related to care time. Most required between 18 and 35 min extra, except "two or more IV/drip/drain" (8) and "one-on-one care" (156). Care time for minimum patient profile: 44-57 min and for average patient profile: 75-88 min. Sources of variation: nurse proficiency, patients, day-to-day variation within patients. The set of characteristics is short, simple and useful for planning and comparing workload. Explained variance up to 36%. Calculating estimated means per ward has not been done before. Nurse proficiency is an important factor.
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Affiliation(s)
| | - Willem van Rhenen
- Center for Human Resource Organization and Management EffectivenessBusiness University NyenrodeBreukelenThe Netherlands
- Arbo UnieUtrechtThe Netherlands
| | - Rebecca K. Stellato
- University Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
| | - Wilko Grolman
- University Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
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The impact of an ageing population on the required hospital capacity: results from forecast analysis on administrative data. Eur Geriatr Med 2019; 10:697-705. [DOI: 10.1007/s41999-019-00219-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
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van den Oetelaar WFJM, van Stel HF, van Rhenen W, Stellato RK, Grolman W. Mapping nurses' activities in surgical hospital wards: A time study. PLoS One 2018; 13:e0191807. [PMID: 29689048 PMCID: PMC5916856 DOI: 10.1371/journal.pone.0191807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 01/11/2018] [Indexed: 11/18/2022] Open
Abstract
Background Balancing the number of nursing staff in relation to the number of patients is important for hospitals to remain efficient and optimizing the use of resources. One way to do this is to work with a workload management method. Many workload management methods use a time study to determine how nurses spend their time and to relate this to patient characteristics in order to predict nurse workload. Objective In our study, we aim to determine how nurses spend their working day and we will attempt to explain differences between specialized surgical wards. Setting The research took place in an academic hospital in the Netherlands. Six surgical wards were included, capacity 15 to 30 beds. Method We have used a work sampling methodology where trained observers registered activities of nurses and patient details every ten minutes during the day shift for a time period of three weeks. Results The work sampling showed that nurses spend between 40.1% and 55.8% of their time on direct patient care. In addition to this, nurses spend between 11.0% and 14.1% on collective patient care. In total, between 52.1% and 68% of time spent on tasks is directly patient related. We found significant differences between wards for 10 of the 21 activity groups. We also found that nurses spend on average 31% with the patient (bedside), which is lower than in another study (37%). However, we noticed a difference between departments. For regular surgical departments in our study this was on average 34% and for two departments that have additional responsibilities in training and education of nursing students, this was on average 25%. Conclusions We found a relatively low percentage of time spent on direct plus indirect care, and a lower percentage of time spent with the patient. We suspect that this is due to the academic setting of the study; in our hospital, there are more tasks related to education than in hospitals in other study settings. We also found differences between the wards in our study, which are mostly explained by differences in the patient mix, nurse staffing (proportion of nursing students), type of surgery and region of the body where the surgery was performed. However, we could not explain all differences. We made a first attempt in identifying and explaining differences in nurses’ activities between wards, however this domain needs more research in order to better explain the differences.
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Affiliation(s)
- W. F. J. M. van den Oetelaar
- Division of Internal Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - H. F. van Stel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - W. van Rhenen
- Center for Human Resource Organization and Management Effectiveness, Business University Nyenrode, Breukelen, the Netherlands
- ArboUnie Occupational Health Service, Utrecht, the Netherlands
| | - R. K. Stellato
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - W. Grolman
- Division of Surgical Specialties, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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González-Chordá VM. Variabilidad de los cuidados de enfermería según APR-GRD y severidad de la enfermedad en una muestra de nueve hospitales belgas. ENFERMERIA CLINICA 2017; 27:327-329. [DOI: 10.1016/j.enfcli.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 11/29/2022]
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van den Oetelaar WFJM, van Stel HF, van Rhenen W, Stellato RK, Grolman W. Balancing nurses' workload in hospital wards: study protocol of developing a method to manage workload. BMJ Open 2016; 6:e012148. [PMID: 28186931 PMCID: PMC5129129 DOI: 10.1136/bmjopen-2016-012148] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hospitals pursue different goals at the same time: excellent service to their patients, good quality care, operational excellence, retaining employees. This requires a good balance between patient needs and nursing staff. One way to ensure a proper fit between patient needs and nursing staff is to work with a workload management method. In our view, a nursing workload management method needs to have the following characteristics: easy to interpret; limited additional registration; applicable to different types of hospital wards; supported by nurses; covers all activities of nurses and suitable for prospective planning of nursing staff. At present, no such method is available. METHODS/ANALYSIS The research follows several steps to come to a workload management method for staff nurses. First, a list of patient characteristics relevant to care time will be composed by performing a Delphi study among staff nurses. Next, a time study of nurses' activities will be carried out. The 2 can be combined to estimate care time per patient group and estimate the time nurses spend on non-patient-related activities. These 2 estimates can be combined and compared with available nursing resources: this gives an estimate of nurses' workload. The research will take place in an academic hospital in the Netherlands. 6 surgical wards will be included, capacity 15-30 beds. ETHICAL CONSIDERATIONS The study protocol was submitted to the Medical Ethical Review Board of the University Medical Center (UMC) Utrecht and received a positive advice, protocol number 14-165/C. DISCUSSION This method will be developed in close cooperation with staff nurses and ward management. The strong involvement of the end users will contribute to a broader support of the results. The method we will develop may also be useful for planning purposes; this is a strong advantage compared with existing methods, which tend to focus on retrospective analysis.
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Affiliation(s)
| | - H F van Stel
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - W van Rhenen
- Center for Human Resource Organization and Management Effectiveness, Business University Nyenrode, Breukelen, The Netherlands
- ArboNed Occupational Health Service, Utrecht, The Netherlands
| | - R K Stellato
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Grolman
- University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
There is no consistent, standardized, concise method for nurses to record information about their patients and clients that is conducive to store, retrieve, and use in patient and client care; to improve professional self-development; and to use in collaboration with patients and clients, their families, other nurses, doctors, hospitals, and health systems. Nurses gauge the health status of their patients and clients every day and are now in a position both to record their impressions for their own use and to share them with colleagues who care for the same patients and clients. What is now needed is a way to record these clinical impressions within an authoritative format that is related to the depth and breadth of the clinical literature related to nursing and the needs of the patients and clients nurses serve. The International Council of Nurses' Nurse-Patient Summary is proposed here to fill the gulf between narrative nurses' notes, proprietary and widely varying electronic health record systems, and information from nurses about their patiens and clients human needs. The International Council of Nurses' Nurse-Patient Summary could replace nursing diagnosis items in the Nursing Minimum Data Set and serve as a substitute for the World Health Organization's International Classification of Function, Disability and Health, a seldom used instrument derived from the International Council of Nurses' Basic Principles of Nursing Care.
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Ranegger R, Hackl WO, Ammenwerth E. Implementation of the Austrian Nursing Minimum Data Set (NMDS-AT): A Feasibility Study. BMC Med Inform Decis Mak 2015; 15:75. [PMID: 26384111 PMCID: PMC4574574 DOI: 10.1186/s12911-015-0198-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/08/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND An Austrian Nursing Minimum Data Set (NMDS-AT) has been developed to describe the diversity of patient populations and variability of nursing care based on nursing diagnoses, nursing interventions, and nursing outcomes. The aim of this study is to test the feasibility of using this NMDS-AT by assessing the availability of data needed for the NMDS-AT in routine nursing documentation, and to assess its reliability and usefulness. METHODS Data were collected in a general hospital from patient records of 20 patients representing 457 patient days. Availability of needed data was assessed by two raters in a chart review based on an NMDS-AT form. The interrater reliability (n=20) and intrarater reliability (n=5) was assessed using Cohen's kappa coefficient and intraclass correlation coefficient (ICC). Usefulness was assessed by verifying whether typical analysis questions can be answered by the documented NMDS-AT data. RESULTS In the 20 patient records, thirteen nursing diagnoses, 50 nursing interventions, and five nursing outcomes occurred, representing 68 (58.6%) of the overall 116 data elements of the NMDS-AT. The data were found at different data sources (e.g., electronic nursing record or paper-based fever chart) and in various forms (e.g., standardized or free text). The interrater reliability of the thirteen nursing diagnoses showed kappa values (percentage of agreement) ranging from 0.35 (85%) to 1.00 (100%). The 50 nursing interventions showed ICCs ranging from 0.03 to 1.00. All nursing outcomes showed an ICC of 1.00. The intrarater reliability showed 100% agreement. Performing typical analysis questions showed that the extracted NMDS-AT data are able to answer questions of clinical management, of policy makers, and of nursing science. CONCLUSIONS The NMDS-AT was found to be feasible: needed data was available in the analysed patient records, data extraction showed good reliability, and typical analysis could be performed and showed interesting results. Before the NMDS-AT can be introduced in healthcare institutions, the following challenges need to be addressed: 1. improve the quality of nursing documentation; 2. reduce fragmentation of documentation; 3. use a standardized nursing classification system; and 4. establish mappings between nursing classification systems and the NMDS-AT.
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Affiliation(s)
- Renate Ranegger
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Management/Pflege, Stiftingtalstraße 4-6, 8010 Graz, Austria
| | - Werner O. Hackl
- UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Biomedical Informatics, Eduard Wallnöfer-Zentrum I, 6060 Hall in Tirol, Austria
| | - Elske Ammenwerth
- UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Biomedical Informatics, Eduard Wallnöfer-Zentrum I, 6060 Hall in Tirol, Austria
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Outcome detection using hospital activity data: Implications for development of nursing-sensitive quality monitoring and reporting in Australia (Commentary on Schreuders et al., Int. J. Nurs. Stud. 51 (3) (2014) 470–478). Int J Nurs Stud 2015; 52:487-90. [DOI: 10.1016/j.ijnurstu.2014.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/01/2014] [Accepted: 04/07/2014] [Indexed: 11/17/2022]
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van Oostveen CJ, Ubbink DT, Huis in het Veld JG, Bakker PJ, Vermeulen H. Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review. PLoS One 2014; 9:e98102. [PMID: 24878506 PMCID: PMC4039449 DOI: 10.1371/journal.pone.0098102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 04/28/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care and inherent costs. The aim of this study was to ascertain which patient-related characteristics or models can predict the need for medical and nursing care in general hospital settings. METHODS We systematically searched MEDLINE, Embase, Business Source Premier and CINAHL. Pre-defined eligibility criteria were used to detect studies that explored patient characteristics and health status parameters associated to the use of hospital care services for hospitalized patients. Two reviewers independently assessed study relevance, quality with the STROBE instrument, and performed data analysis. RESULTS From 2,168 potentially relevant articles, 17 met our eligibility criteria. These showed a large variety of factors associated with the use of hospital care services; models were found in only three studies. Age, gender, medical and nursing diagnoses, severity of illness, patient acuity, comorbidity, and complications were the characteristics found the most. Patient acuity and medical and nursing diagnoses were the most influencing characteristics. Models including medical or nursing diagnoses and patient acuity explain the variance in the use of hospital care services for at least 56.2%, and up to 78.7% when organizational factors were added. CONCLUSIONS A larger variety of factors were found to be associated with the use of hospital care services. Models that explain the extent to which hospital care services are used should contain patient characteristics, including patient acuity, medical or nursing diagnoses, and organizational and staffing characteristics, e.g., hospital size, organization of care, and the size and skill mix of staff. This would enable healthcare managers at different levels to evaluate hospital care services and organize or reorganize patient care.
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Affiliation(s)
| | - Dirk T. Ubbink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Quality Assurance & Process Innovation Academic Medical Center, Amsterdam, The Netherlands
| | - Judith G. Huis in het Veld
- Department of Quality Assurance & Process Innovation Academic Medical Center, Amsterdam, The Netherlands
| | - Piet J. Bakker
- Department of Quality Assurance & Process Innovation Academic Medical Center, Amsterdam, The Netherlands
| | - Hester Vermeulen
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Quality Assurance & Process Innovation Academic Medical Center, Amsterdam, The Netherlands
- Amsterdam School of Health Professions, University of Amsterdam, Amsterdam, The Netherlands
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Juvé-Udina ME, Pérez EZ, Padrés NF, Samartino MG, García MR, Creus MC, Batllori NV, Calvo CM. Basic nursing care: retrospective evaluation of communication and psychosocial interventions documented by nurses in the acute care setting. J Nurs Scholarsh 2013; 46:65-72. [PMID: 24354414 DOI: 10.1111/jnu.12062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to evaluate the frequency of psychosocial aspects of basic nursing care, as e-charted by nurses, when using an interface terminology. METHODS An observational, multicentre study was conducted in acute wards. The main outcome measure was the frequency of use of the psychosocial interventions in the electronic nursing care plans, analysed over a 12 month retrospective review. FINDINGS Overall, 150,494 electronic care plans were studied. Most of the intervention concepts from the interface terminology were used by registered nurses to illustrate the psychosocial aspects of fundamentals of care in the electronic care plans. CONCLUSIONS AND IMPLICATIONS The results presented help to demonstrate that the interventions of this interface terminology may be useful to inform psychosocial aspects of basic and advanced nursing care. CLINICAL RELEVANCE The identification of psychosocial elements of basic nursing care in the nursing documentation may lead to obtain a deeper understanding of those caring interventions nurses consider essential to represent nurse-patient interactions. The frequency of psychosocial interventions may contribute to delineate basic and advanced nursing care.
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Affiliation(s)
- Maria-Eulàlia Juvé-Udina
- IDIBELL Institute of Research, Nurse coordinator, Catalan Institute of Health. Associate professor, University of Barcelona School of Nursing - Health Universitat de Barcelona Campus, Barcelona, Catalonia, Spain
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Burston S, Chaboyer W, Gillespie B. Nurse-sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues. J Clin Nurs 2013; 23:1785-95. [DOI: 10.1111/jocn.12337] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Sarah Burston
- School of Nursing and Midwifery; Griffith University; Gold Coast QLD Australia
| | - Wendy Chaboyer
- NHMRC National Centre for Research Excellence in Nursing (NCREN); Research Centre for Clinical and Community Practice Innovation; Griffith University; Gold Coast QLD Australia
| | - Brigid Gillespie
- NHMRC National Centre for Research Excellence in Nursing (NCREN); C/School of Nursing and Midwifery; Griffith University; Gold Coast QLD Australia
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Milani A, Mauri S, Gandini S, Magon G. Oncology Nursing Minimum Data Set (ONMDS): can we hypothesize a set of prevalent Nursing Sensitive Outcomes (NSO) in cancer patients? Ecancermedicalscience 2013; 7:345. [PMID: 24009644 PMCID: PMC3757958 DOI: 10.3332/ecancer.2013.345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Indexed: 11/14/2022] Open
Abstract
Background The nursing minimum data set (NMDS) was created in 1977 in the United States to collect uniform standardised data that could be comparable among different nursing areas or patients. So far, in the literature, an NMDS in an oncology setting has not yet been described. Considering an oncology nursing minimum data set (ONMDS), which data could be chosen to define this tool regarding cancer patient care? Material and methods At the European Institute of Oncology (IEO), 20 experienced oncology nurses representing surgical, medical, and critical areas participated in a nursing record working group. All nurses followed an educational course on NMDS, and they shared clinical experiences to find which data common among different areas could be useful to care. To identify these data, nurses considered three issues: what is nursing care for nurses in the IEO? What is the nurses’ responsibility in the IEO? What is the organisational nursing model in the IEO? Nurses in the IEO are autonomous in decision making and recognised by patients and by a multi-professional team; the organisational nursing model is primary nursing with patient-centred care. Nursing data must therefore show the quality and results of this care. With this in mind, the working group decided to orient the ONMDS toward nursing-sensitive outcomes (NSOs), meeting also with psychologists, physiotherapists, and dieticians. Nurses analysed Oncology Nursing Society outcomes, and through focus groups, experiential meetings, role playing, and case studies, they integrated them with other NSOs. Results The ONMDS is composed of 49 NSOs recognised as the most common and frequent oncologic outcomes regardless of the treatment that the patient undergoes. These outcomes were clustered into 15 categories. The categories are: gastrointestinal outcomes, genitourinary outcomes, respiratory outcomes, skin outcomes, fluid and electrolyte balance outcomes, neurological outcomes, security, functional status, vascular access outcomes, nutritional status, pain, psychosocial discomfort, activities of daily living (ADL), instrumental activities daily living (IADL), and self-care outcomes. Conclusions Efforts to identify an ONMDS based on NSOs allow us to develop an tool that can standardise language, assessment, and intervention, but overall could be used to measure nursing care. To evaluate these potentialities, the ONMDS was introduced into nursing records, and it was tested with a pre–post research study.
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Affiliation(s)
- A Milani
- European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
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Blecker S, Austrian JS, Shine D, Braithwaite RS, Radford MJ, Gourevitch MN. Monitoring the pulse of hospital activity: electronic health record utilization as a measure of care intensity. J Hosp Med 2013; 8:513-8. [PMID: 23908140 DOI: 10.1002/jhm.2068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/09/2013] [Accepted: 05/30/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hospital care on weekends has been associated with reduced quality and poor clinical outcomes, suggesting that decreases in overall intensity of care may have important clinical effects. We describe a new measure of hospital intensity of care based on utilization of the electronic health record (EHR). METHODS We measured global intensity of care at our academic medical center by monitoring the use of the EHR in 2011. Our primary measure, termed EHR interactions, was the number of accessions of a patient's electronic record by a clinician, adjusted for hospital census, per unit of time. Our secondary measure was percent of total available central processing unit (CPU) power used to access EHR servers at a given time. RESULTS EHR interactions were lower on weekend days as compared to weekdays at every hour (P < 0.0001), and the daytime peak in intensity noted each weekday was blunted on weekends. The relative rate and 95% confidence interval (CI) of census-adjusted record accessions per patient on weekdays compared with weekends were: 1.76 (95% CI: 1.74-1.77), 1.52 (95% CI: 1.50-1.55), and 1.14 (95% CI: 1.12-1.17) for day, morning/evening, and night hours, respectively. Percent CPU usage correlated closely with EHR interactions (r = 0.90). CONCLUSIONS EHR usage is a valid and easily reproducible measure of intensity of care in the hospital. Using this measure we identified large, hour-specific differences between weekend and weekday intensity. EHR interactions may serve as a useful measure for tracking and improving temporal variations in care that are common, and potentially deleterious, in hospital systems.
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Affiliation(s)
- Saul Blecker
- Department of Population Health, New York University School of Medicine, New York, New York; Department of Medicine, New York University Langone Medical Center, New York, New York
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Myny D, De Bacquer D, Van Hecke A, Beeckman D, Verhaeghe S, Van Goubergen D. Validation of standard times and influencing factors during the development of the Workload Indicator for Nursing. J Adv Nurs 2013; 70:674-86. [PMID: 23980560 DOI: 10.1111/jan.12232] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND A tool to assist in optimal allocation of available nursing resources is of paramount importance. AIMS The goals of this study were as follows: (1) to determine whether the standard time values of the Belgian Nursing Minimum Dataset are a valid basis for the development of a Workload Indicator for Nursing; (2) to quantify the impact of factors that most influence nursing workload; and (3) to examine the cross-impact of items of the Belgian Nursing Minimum Dataset. DESIGN This research project is a prospective observational study with exploratory aspects. METHODS The data for this prospective study were collected during September 2010 from a convenience sample of 23 nursing units in four hospitals in Belgium. The data collection included three parts: (1) the registration of the items of the Belgian Nursing Minimum Dataset; (2) the amount of time committed to direct patient care; and (3) analysis of variables, which influence the nursing workload at patient and unit level. RESULTS The correlation coefficients for the sum of Direct and Indirect Patient Care and the Workload Indicator for Nursing-score of the surgical, internal medicine and intensive care units were 0·85, 0·88 and 0·89 respectively. Significant differences in standard time utilization for nursing activities at the patient level are directly related to the level of mobility assistance required. Units needing significantly more time for Direct and Indirect Patient Care than predicted by the Workload Indicator for Nursing-score had a higher mean number of complex nursing activities per patient. CONCLUSIONS The high correlation coefficients between the total time utilized for direct patient care and the WiN-score indicate that the standard time values of the Belgian Nursing Minimum Dataset are valid.
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Affiliation(s)
- Dries Myny
- Department of Nursing, Ghent University and Staff member, Ghent University Hospital, Belgium
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Juvé-Udina ME. What patients' problems do nurses e-chart? Longitudinal study to evaluate the usability of an interface terminology. Int J Nurs Stud 2013; 50:1698-710. [PMID: 23684394 DOI: 10.1016/j.ijnurstu.2013.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 04/08/2013] [Accepted: 04/16/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The nurses' ability to document patient's status, problems and progress is an important issue in patients' safety. Nursing terminologies are intended to support nursing practice but as any other clinical tool, they should be evaluated to assure quality and warrant effective written communication among clinicians. OBJECTIVES This study was aimed to evaluate the usability of the diagnosis axis of an interface terminology by assessing its completeness and the frequency of use of its concepts. DESIGN Observational, longitudinal, multicentre study. SETTING A total of 8 hospitals representing 162 acute medical-surgical, obstetric and mental health nursing wards, step-down units and home in-patient units were included. PARTICIPANTS Overall, 246,400 electronic care plans were studied; 53.5% from male patients; 14.6% paediatrics and 33.7% from patients elder than 70 years old. Most were admitted due to cardiocirculatory, respiratory, digestive or musculoskeletal conditions (50.5%), other acute medical or surgical disorders (29.8%) and obstetrics (19.3%). METHODS The main outcome measures were: the use of nursing diagnoses from the interface terminology evaluated and their accumulated frequency, analysed over a 3-year retrospective review of the electronic nursing care plans. The analysis of data included descriptive statistics with a confidence level of 95% for confidence intervals. RESULTS Most of the diagnostic concepts from the interface terminology were used (92.3%) by nurses to illustrate patients' problems in the electronic care plans. Their frequency of use widely varied, from some very frequent diagnoses like Risk for haemorrhage (51.4%; CI 95%: 51.25-51.65) or Acute pain (49.6%; CI: 49.49-49.88) to others used only in exceptional cases like Faecal impaction or Extravasation. The first nursing diagnosis related to family or caregiver emerges in the 32nd place of the ranking. CONCLUSIONS Results for outcome measures oriented that the diagnosis axis of this interface terminology meets the usability criterion of completeness when assessing for the use of its concepts in the acute care setting.
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Affiliation(s)
- Maria Eulàlia Juvé-Udina
- Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Health Universitat de Barcelona Campus, School of Nursing, Barcelona, Spain.
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van Oostveen CJ, Vermeulen H, Gouma DJ, Bakker PJ, Ubbink DT. Explaining the amount of care needed by hospitalised surgical patients: a prospective time and motion study. BMC Health Serv Res 2013; 13:42. [PMID: 23379756 PMCID: PMC3599528 DOI: 10.1186/1472-6963-13-42] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 01/31/2013] [Indexed: 01/17/2023] Open
Abstract
Background Hospitals provide care for patients with a variety of diseases, co-morbidities and complications. The actual amount of care these patients need is unclear. Given the recent developments such as ageing, multi-morbidity and budgetary restraints, a practical explanatory model would avail healthcare professionals and managers in determining the demand and costs for clinical care. Methods Six surgical wards in a Dutch university hospital participated in this prospective time and motion study. Surgeons, nurses and paramedics recorded the time spent on patient care 24/7 by means of PDAs. The investigators extracted possible determining characteristics from a previous systematic review and expert focus group. Total amount of care needed by the patients was expressed as costs involved in medical and nursing time, surgical interventions and diagnostics. Afterwards the investigators applied linear regression analysis to detect significant independent characteristics. Results 174 Surgical patients were monitored during their hospital stay. Characteristics significantly influencing the consumed amount of care were: medication during hospitalisation, complications, co-morbidity, medical specialty, age, as well as undergoing surgery and length of stay. Median costs for care were €8.446 per patient admission. Conclusions The investigators developed a model that explains the total demand and costs of care needed for surgical patients in a university hospital. The input for this instrument can be derived from readily available data in hospital databases. This makes it a relatively easy instrument to help healthcare professionals and managers appreciate the amount of care needed on (surgical) wards and may be used to appreciate trends in time.
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Affiliation(s)
- Catharina J van Oostveen
- Department of Quality Assurance & Process Innovation, Academic Medical Centre, room A3-503, P,O box 22700, Amsterdam, DE, 1100, The Netherlands
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Rauta S, Salanterä S, Nivalainen J, Junttila K. Validation of the core elements of perioperative nursing. J Clin Nurs 2012. [DOI: 10.1111/j.1365-2702.2012.04220.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nuevos métodos de cálculo de plantilla ajustado a las necesidades de cada servicio: ¿una alternativa posible? ENFERMERIA CLINICA 2012; 22:275-7. [DOI: 10.1016/j.enfcli.2012.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 07/04/2012] [Indexed: 11/20/2022]
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Klaus SF, Dunton N, Gajewski B, Potter C. Reliability of the nursing care hour measure: a descriptive study. Int J Nurs Stud 2012; 50:924-32. [PMID: 22874589 DOI: 10.1016/j.ijnurstu.2012.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 07/12/2012] [Accepted: 07/15/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The nursing care hour has become an international standard unit of measure in research where nurse staffing is a key variable. Until now, there have been no studies verifying whether nursing care hours obtained from hospital data sources can be collected reliably. OBJECTIVES To examine the processes used by hospitals to generate nursing care hour data and to evaluate inter-rater reliability and guideline compliance with standards of the National Database of Nursing Quality Indicators(®) (NDNQI(®)) and the National Quality Forum. DESIGN AND SETTING Two-phase descriptive study of all NDNQI hospitals that submitted data in third quarter of 2007. METHODS Data for phase I came from an online survey created by the authors to ascertain the processes used by hospitals to collect nursing care hours and their compliance with standardized data collection guidelines. In phase II, inter-rater reliability was measured using intra-class correlations between nursing care hours generated from clock hour files submitted to the study team by participants' payroll/accounting departments and aggregated data submitted previously. RESULTS Phase I data were obtained from a total of 714 respondents. Nearly half (48%) of all sites use payroll records to obtain nursing care hour data and 70% use one of the standardized methods for converting the bi-weekly hours into months. Unit secretaries were reportedly included in NCH by 17.4% of respondents and only 26.2% of sites could accurately identify the point at which newly hired nurses should be included. The phase II findings (n=11) support the ability of two independent raters to obtain similar results when calculating total nursing care hours according to standard guidelines (ICC=0.76-0.99). CONCLUSIONS Although barriers exist, this study found support for hospitals' abilities to collect reliable nursing care hour data.
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Affiliation(s)
- Susan F Klaus
- University of Kansas Hospital, University of Kansas School of Nursing, 3901 Rainbow Blvd., Kansas City, KS 66160, United States.
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Determining a set of measurable and relevant factors affecting nursing workload in the acute care hospital setting: a cross-sectional study. Int J Nurs Stud 2011; 49:427-36. [PMID: 22030021 DOI: 10.1016/j.ijnurstu.2011.10.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 09/18/2011] [Accepted: 10/03/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND While there has been great interest in the effect of nurse staffing levels have on the quality of care in hospitals, less attention has been given to determining the factors that affect the nursing workload. There are no existing studies that help define measurable factors that have a clear relation to nursing workload. OBJECTIVES The aim of this study was to determine the most important and measurable factors, other than patient acuity, that influence nursing workload. DESIGN A cross-sectional design. SETTINGS Hospitals within the acute hospital care setting. PARTICIPANTS Persons with a nursing educational background, working in Belgian acute care hospitals. METHODS A self-administered questionnaire was developed based on the results of an integrative review, the use of focus groups and a survey on measurability and relevance of the included factors. The questionnaire listed relevant and measurable factors related to nursing workload. Weight and frequency of each factor was assessed. RESULTS The initial list consisted of 94 factors. These factors were regrouped and organised into a questionnaire of 28 measurable and sufficiently relevant factors affecting the nursing workload. More than half of the initial factors seemed to be relevant, but hard to measure on a daily basis. Based on the impact of each factor, the number of work interruptions was the most important factor related to nursing workload. CONCLUSIONS It is unlikely that a workload instrument will ever be able to take into account all possible factors affecting the nursing workload. Nevertheless, the number of work interruptions, the patient turnover rate and the number of mandatory registrations should be included in the development or revision of a workload measurement tool.
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Diya L, Van den Heede K, Sermeus W, Lesaffre E. The relationship between in-hospital mortality, readmission into the intensive care nursing unit and/or operating theatre and nurse staffing levels. J Adv Nurs 2011; 68:1073-81. [DOI: 10.1111/j.1365-2648.2011.05812.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Establishing the relationship between nurse staffing and hospital mortality using a clustered discrete-time logistic model. Stat Med 2010; 29:778-85. [DOI: 10.1002/sim.3756] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Van den Heede K, Michiels D, Thonon O, Sermeus W. Using Nursing Interventions Classification as a Framework to Revise the Belgian Nursing Minimum Data Set. ACTA ACUST UNITED AC 2009; 20:122-31. [DOI: 10.1111/j.1744-618x.2009.01124.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: analysis of administrative data. Int J Nurs Stud 2009; 46:796-803. [PMID: 19201407 DOI: 10.1016/j.ijnurstu.2008.12.018] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 12/23/2008] [Accepted: 12/30/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND In most multicenter studies that examine the relationship between nurse staffing and patient safety, nurse-staffing levels are measured per hospital. This can obscure relationships between staffing and outcomes at the unit level and lead to invalid inferences. OBJECTIVE In the present study, we examined the association between nurse-staffing levels in nursing units that treat postoperative cardiac surgery patients and the in-hospital mortality of these patients. DESIGN-SETTING-PARTICIPANTS: We illustrated our approach by using administrative databases (Year 2003) representing all Belgian cardiac centers (n=28), which included data from 58 intensive care and 75 general nursing units and 9054 patients. METHODS We used multilevel logistic regression models and controlled for differences in patient characteristics, nursing care intensity, and cardiac procedural volume. RESULTS Increased nurse staffing in postoperative general nursing units was significantly associated with decreased mortality. Nurse staffing in postoperative intensive care units was not significantly associated with in-hospital mortality possibly due to lack of variation in ICU staffing across hospitals. CONCLUSION This study, together with the international body of evidence, suggests that nurse staffing is one of several variables influencing patient safety. These findings further suggest the need to study the impact of nurse-staffing levels on in-hospital mortality using nursing-unit-level specific data.
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Van den Heede K, Sermeus W, Diya L, Clarke SP, Lesaffre E, Vleugels A, Aiken LH. Nurse staffing and patient outcomes in Belgian acute hospitals: cross-sectional analysis of administrative data. Int J Nurs Stud 2008; 46:928-39. [PMID: 18656875 DOI: 10.1016/j.ijnurstu.2008.05.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 05/03/2008] [Accepted: 05/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Studies have linked nurse staffing levels (number and skill mix) to several nurse-sensitive patient outcomes. However, evidence from European countries has been limited. OBJECTIVES This study examines the association between nurse staffing levels (i.e. acuity-adjusted Nursing Hours per Patient Day, the proportion of registered nurses with a Bachelor's degree) and 10 different patient outcomes potentially sensitive to nursing care. DESIGN-SETTING-PARTICIPANTS: Cross-sectional analyses of linked data from the Belgian Nursing Minimum Dataset (general acute care and intensive care nursing units: n=1403) and Belgian Hospital Discharge Dataset (general, orthopedic and vascular surgery patients: n=260,923) of the year 2003 from all acute hospitals (n=115). METHODS Logistic regression analyses, estimated by using a Generalized Estimation Equation Model, were used to study the association between nurse staffing and patient outcomes. RESULTS The mean acuity-adjusted Nursing Hours per Patient Day in Belgian hospitals was 2.62 (S.D.=0.29). The variability in patient outcome rates between hospitals is considerable. The inter-quartile ranges for the 10 patient outcomes go from 0.35 for Deep Venous Thrombosis to 3.77 for failure-to-rescue. No significant association was found between the acuity-adjusted Nursing Hours per Patient Day, proportion of registered nurses with a Bachelor's degree and the selected patient outcomes. CONCLUSION The absence of associations between hospital-level nurse staffing measures and patient outcomes should not be inferred as implying that nurse staffing does not have an impact on patient outcomes in Belgian hospitals. To better understand the dynamics of the nurse staffing and patient outcomes relationship in acute hospitals, further analyses (i.e. nursing unit level analyses) of these and other outcomes are recommended, in addition to inclusion of other study variables, including data about nursing practice environments in hospitals.
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Affiliation(s)
- Koen Van den Heede
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, Leuven B-3000, Belgium.
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