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Kim SA, Cho SH. Trajectories of nursing hours over the course of hospitalization and estimated additional nurse staffing requirements to reduce the length of stay. J Nurs Scholarsh 2024. [PMID: 38745356 DOI: 10.1111/jnu.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/12/2024] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE The aims of this study are to examine the trajectories of nursing hours per patient day (NHPPD) over the course of hospitalization according to the patient's length of stay (LOS) and to estimate changes in the total nursing hours during hospitalization, average NHPPD, and the number of nurses additionally required when the LOS was reduced by 1 day. DESIGN This retrospective longitudinal study analyzed patient data collected from a tertiary university hospital located in Seoul, South Korea. The study sample included 11,316 inpatients who were discharged between September 1 and October 31, 2022. METHODS NHPPD over the course of each patient's hospitalization was estimated using the total score of the Korean Patient Classification System-1 (KPCS-1), which nurses evaluated and recorded every day from admission to discharge. The NHPPD trajectories were examined using linear mixed models to analyze repeated KPCS-1 measurements and control for the effects of patient characteristics. The changes in the average NHPPD when LOS was reduced by 1 day were estimated using maximum and minimum estimations. The impact of a 1-day reduction in LOS on staffing requirements was calculated as the number of nurses additionally required to work each shift and to be hired. FINDINGS The average LOS was 5.6 days, and the short (1-6 days) and medium (7-14 days) LOS groups accounted for 78.9% and 14.3% of patients, respectively. The NHPPD trajectories showed a "rise-peak-decline" pattern. Patients in the short LOS group received the most NHPPD on day 1 (day of admission) or day 2, whereas the NHPPD for patients in the medium LOS group peaked on days 3-6. After peaking, the NHPPD tended to decrease toward the end of hospitalization, with the least NHPPD on the day of discharge, followed by the day before discharge. When LOS was reduced by 1 day, the average NHPPD was estimated to increase by 7.7-50.0% in the maximum estimation, and 0.9-12.5% in the minimum estimation. In response to a 1-day reduction, 1.10-7.44 nurses were additionally required to care for 100 patients each shift and 5.28-35.70 additional nurses needed to be hired in the maximum estimation. In the minimum estimation, these values were 0.13-1.85 additional nurses per shift and 0.65-8.90 additional nurses to be hired, respectively. CONCLUSIONS Since NHPPD exhibited a "rise-peak-decline" trajectory, reducing the LOS by 1 day was estimated to increase the average NHPPD and lead to additional staffing requirements. The additional nurse requirement for a 1-day reduction was not constant; instead, it increased with each day subtracted from an already shorter LOS. CLINICAL RELEVANCE Sufficient nurse staffing is necessary to provide increased NHPPD as a result of shortened LOS. Changes in the LOS should be considered when determining nurse staffing requirements.
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Affiliation(s)
- Shin-Ae Kim
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Sung-Hyun Cho
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
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Womack DM, Miech EJ, Fox NJ, Silvey LC, Somerville AM, Eldredge DH, Steege LM. Coincidence Analysis: A Novel Approach to Modeling Nurses' Workplace Experience. Appl Clin Inform 2022; 13:794-802. [PMID: 36044917 PMCID: PMC9433166 DOI: 10.1055/s-0042-1756368] [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: 03/05/2022] [Accepted: 07/13/2022] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES The purpose of this study is to identify combinations of workplace conditions that uniquely differentiate high, medium, and low registered nurse (RN) ratings of appropriateness of patient assignment during daytime intensive care unit (ICU) work shifts. METHODS A collective case study design and coincidence analysis were employed to identify combinations of workplace conditions that link directly to high, medium, and low RN perception of appropriateness of patient assignment at a mid-shift time point. RN members of the study team hypothesized a set of 55 workplace conditions as potential difference makers through the application of theoretical and empirical knowledge. Conditions were derived from data exported from electronic systems commonly used in nursing care. RESULTS Analysis of 64 cases (25 high, 24 medium, and 15 low) produced three models, one for each level of the outcome. Each model contained multiple pathways to the same outcome. The model for "high" appropriateness was the simplest model with two paths to the outcome and a shared condition across pathways. The first path comprised of the absence of overtime and a before-noon patient discharge or transfer, and the second path comprised of the absence of overtime and RN assignment to a single ICU patient. CONCLUSION Specific combinations of workplace conditions uniquely distinguish RN perception of appropriateness of patient assignment at a mid-shift time point, and these difference-making conditions provide a foundation for enhanced observability of nurses' work experience during hospital work shifts. This study illuminates the complexity of assessing nursing work system status by revealing that multiple paths, comprised of multiple conditions, can lead to the same outcome. Operational decision support tools may best reflect the complex adaptive nature of the work systems they intend to support by utilizing methods that accommodate both causal complexity and equifinality.
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Affiliation(s)
- Dana M. Womack
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | | | - Nicholas J. Fox
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Linus C. Silvey
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Anna M. Somerville
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Deborah H. Eldredge
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Linsey M. Steege
- School of Nursing, University of Wisconsin–Madison, Madison, Wisconsin, United States
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Maceri J. Positive outcomes of a surgical progressive care unit for patients following head and neck cancer surgery. Nurs Manag (Harrow) 2021; 52:34-40. [PMID: 34723884 DOI: 10.1097/01.numa.0000795608.76624.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jocelyn Maceri
- Jocelyn Maceri is a nursing administrator at Henry Ford Hospital in Detroit, Mich
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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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Predicting healthcare-associated infections, length of stay, and mortality with the nursing intensity of care index. Infect Control Hosp Epidemiol 2021; 43:298-305. [PMID: 33858546 DOI: 10.1017/ice.2021.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objectives of this study were (1) to develop and validate a simulation model to estimate daily probabilities of healthcare-associated infections (HAIs), length of stay (LOS), and mortality using time varying patient- and unit-level factors including staffing adequacy and (2) to examine whether HAI incidence varies with staffing adequacy. SETTING The study was conducted at 2 tertiary- and quaternary-care hospitals, a pediatric acute care hospital, and a community hospital within a single New York City healthcare network. PATIENTS All patients discharged from 2012 through 2016 (N = 562,435). METHODS We developed a non-Markovian simulation to estimate daily conditional probabilities of bloodstream, urinary tract, surgical site, and Clostridioides difficile infection, pneumonia, length of stay, and mortality. Staffing adequacy was modeled based on total nurse staffing (care supply) and the Nursing Intensity of Care Index (care demand). We compared model performance with logistic regression, and we generated case studies to illustrate daily changes in infection risk. We also described infection incidence by unit-level staffing and patient care demand on the day of infection. RESULTS Most model estimates fell within 95% confidence intervals of actual outcomes. The predictive power of the simulation model exceeded that of logistic regression (area under the curve [AUC], 0.852 and 0.816, respectively). HAI incidence was greatest when staffing was lowest and nursing care intensity was highest. CONCLUSIONS This model has potential clinical utility for identifying modifiable conditions in real time, such as low staffing coupled with high care demand.
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Ricci de Araújo T, Papathanassoglou E, Gonçalves Menegueti M, Grespan Bonacim CA, Lessa do Valle Dallora ME, de Carvalho Jericó M, Basile-Filho A, Laus AM. Critical care nursing service costs: Comparison of the top-down versus bottom-up micro-costing approach in Brazil. J Nurs Manag 2021; 29:1778-1784. [PMID: 33772914 DOI: 10.1111/jonm.13313] [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: 06/14/2020] [Revised: 02/23/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
AIM To estimate the nursing service costs using a top-down micro-costing approach and to compare it with a bottom-up micro-costing approach. BACKGROUND Accurate data of nursing cost can contribute to reliable resource management. METHOD We employed a retrospective cohort design in an adult intensive care unit in São Paulo. A total of 286 patient records were included. Micro-costing analysis was conducted in two stages: a top-down approach, whereby nursing costs were allocated to patients through apportionment, and a bottom-up approach, considering actual nursing care hours estimated by the Nursing Activities Score (NAS). RESULTS The total mean cost by the top-down approach was US$1,640.4 ± 1,484.2/patient. The bottom-up approach based on a total mean NAS of 833 ± 776 points (equivalent to 200 ± 86 hr of nursing care) yielded a mean cost of US$1,487.2 ± 1,385.7/patient. In the 268 patients for whom the top-down approach estimated higher costs than the bottom-up approach, the total cost discrepancy was US$4,427.3, while for those costed higher based on NAS, the total discrepancy was US$436.9. The top-down methodology overestimated costs for patients requiring lower intensity of care, while it underestimated costs for patients requiring higher intensity of care (NAS >100). CONCLUSIONS The top-down approach may yield higher estimated ICU costs compared with a NAS-based bottom-up approach. IMPLICATIONS FOR NURSING MANAGEMENT These findings can contribute to an evidence-based approach to budgeting through reliable costing methods based on actual nursing workload, and to efficient resource allocation and cost management.
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Affiliation(s)
- Thamiris Ricci de Araújo
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Mayra Gonçalves Menegueti
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | - Anibal Basile-Filho
- Department of Surgery and Anatomy of Medical School, Division of Intensive Medicine of Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Maria Laus
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
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Evaluation of Electronic Health Record-Generated Work Intensity Scores and Nurse Perceptions of Workload Appropriateness. Comput Inform Nurs 2020; 39:306-311. [PMID: 33346996 DOI: 10.1097/cin.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Electronic health record-generated work intensity scores represent state-of-the art functionality for dynamic nursing workload estimation in the hospital setting. In contrast to traditional stand-alone patient classification and acuity tools, electronic health record-based tools eliminate the need for dedicated data entry, and scores are automatically updated as new information is entered into patient records. This paper summarizes the method and results of evaluation of electronic health record-generated work intensity scores on six hospital patient care units in a single academic medical center. The correlation between beginning-of-shift work intensity scores and self-reported registered nurse rating of appropriateness of patient assignment was assessed using Spearman rank correlation. A weak negative correlation (-0.09 to -0.23) was observed on all study units, indicating that nurse appropriateness ratings decrease as work intensity scores increase. Electronic health record-generated work intensity scores provide useful information that can augment existing data sources used by charge nurses to create equitable nurse-patient assignments. Additional research is needed to explain observed variation in nurses' appropriateness ratings across similar work intensity point ranges.
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Juvé-Udina ME, González-Samartino M, López-Jiménez MM, Planas-Canals M, Rodríguez-Fernández H, Batuecas Duelt IJ, Tapia-Pérez M, Pons Prats M, Jiménez-Martínez E, Barberà Llorca MÀ, Asensio-Flores S, Berbis-Morelló C, Zuriguel-Pérez E, Delgado-Hito P, Rey Luque Ó, Zabalegui A, Fabrellas N, Adamuz J. Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster-unit-level descriptive comparison. J Nurs Manag 2020; 28:2216-2229. [PMID: 32384199 PMCID: PMC7754324 DOI: 10.1111/jonm.13040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/20/2020] [Accepted: 05/02/2020] [Indexed: 12/23/2022]
Abstract
AIM To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters. BACKGROUND Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood. METHOD Descriptive design with data from four unit-clusters: medical, surgical, combined and step-down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse-sensitive outcomes. RESULTS Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters. CONCLUSION Patient acuity is similar among unit-clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit-clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.
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Affiliation(s)
- Maria-Eulàlia Juvé-Udina
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.,Catalan Institute of Health, Barcelona, Spain
| | - Maribel González-Samartino
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.,Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Magdalena López-Jiménez
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Irene Joana Batuecas Duelt
- Multidisciplinary Nursing Research Group, VHIR Vall d'Hebron Institute of Research, Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marta Tapia-Pérez
- Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Emilio Jiménez-Martínez
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Susana Asensio-Flores
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Carme Berbis-Morelló
- Joan XXIII University Hospital, Tarragona, Spain.,School of Nursing, Rovira i Virgili University, Tarragona, Spain
| | - Esperanza Zuriguel-Pérez
- Multidisciplinary Nursing Research Group, VHIR Vall d'Hebron Institute of Research, Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pilar Delgado-Hito
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain
| | - Óscar Rey Luque
- Nursing School, University of La Laguna, Tenerife, Spain.,Nuestra Señora de la Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Adelaida Zabalegui
- Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.,IDIBAPS, August Pi i Sunyer Biomedical Research Institute, Hospital Clínic, Barcelona, Spain
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.,IDIBAPS, August Pi i Sunyer Biomedical Research Institute, Hospital Clínic, Barcelona, Spain
| | - Jordi Adamuz
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.,Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
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Capo‐Lugo CE, Shumock K, Young DL, Klein L, Cassell A, Cvach M, Lavezza A, Friedman M, Bhatia E, Brotman DJ, Hoyer EH. Association between ambulatory status and call bell use in hospitalized patients—A retrospective cohort study. J Nurs Manag 2019; 28:54-62. [DOI: 10.1111/jonm.12888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Carmen E. Capo‐Lugo
- Department of Physical Therapy School of Health Professions University of Alabama at Birmingham Birmingham Alabama
- Department of Physical Medicine and Rehabilitation School of Medicine Johns Hopkins University Baltimore Maryland
| | | | - Daniel L. Young
- Department of Physical Medicine and Rehabilitation School of Medicine Johns Hopkins University Baltimore Maryland
- Department of Physical Therapy University of Nevada, Las Vegas Las Vegas Nevada
| | - Lisa Klein
- Johns Hopkins Hospital Baltimore Maryland
| | - Andre Cassell
- Department of Physical Medicine and Rehabilitation Johns Hopkins Hospital Baltimore Maryland
| | - Maria Cvach
- Johns Hopkins Health System Baltimore Maryland
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation Johns Hopkins Hospital Baltimore Maryland
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation Johns Hopkins Hospital Baltimore Maryland
| | - Elys Bhatia
- Johns Hopkins Health System Baltimore Maryland
| | | | - Erik H. Hoyer
- Department of Physical Medicine and Rehabilitation School of Medicine Johns Hopkins University Baltimore Maryland
- Department of Physical Medicine and Rehabilitation Johns Hopkins Hospital Baltimore Maryland
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Womack DM, Vuckovic NN, Steege LM, Eldredge DH, Hribar MR, Gorman PN. Subtle cues: Qualitative elicitation of signs of capacity strain in the hospital workplace. APPLIED ERGONOMICS 2019; 81:102893. [PMID: 31422247 PMCID: PMC6834115 DOI: 10.1016/j.apergo.2019.102893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 06/20/2019] [Accepted: 07/03/2019] [Indexed: 06/10/2023]
Abstract
Through everyday care experiences, nurses develop expertise in recognition of capacity strain in hospital workplaces. Through qualitative interview, experienced nurses identify common activity changes and adaptive work strategies that may signal an imbalance between patient demand and service supply at the bedside. Activity change examples include nurse helping behaviors across patient assignments, increased volume of nurse calls from patient rooms, and decreased presence of staff at the nurses' station. Adaptive work strategies encompass actions taken to recruit resources, move work in time, reduce work demands, or reduce thoroughness of task performance. Nurses' knowledge of perceptible signs of strain provides a foundation for future exploration and development of real-time indicators of capacity strain in hospital-based work systems.
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Affiliation(s)
- Dana M Womack
- Oregon Health & Science University, Department of Medical Informatics & Clinical Epidemiology, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239-3098, USA.
| | - Nancy N Vuckovic
- Cambia Health Solutions, 100 SW Market St, Portland, OR, 97201, USA
| | - Linsey M Steege
- University of Wisconsin - Madison, School of Nursing, 701 Highland Avenue, Madison, WI, 53705, USA
| | - Deborah H Eldredge
- Oregon Health & Science University Hospital, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239-3098, USA
| | - Michelle R Hribar
- Oregon Health & Science University, Department of Medical Informatics & Clinical Epidemiology, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239-3098, USA
| | - Paul N Gorman
- Oregon Health & Science University, Department of Medical Informatics & Clinical Epidemiology, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239-3098, USA; Oregon Health & Science University Hospital, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239-3098, USA
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Juvé-Udina ME, Adamuz J, López-Jimenez MM, Tapia-Pérez M, Fabrellas N, Matud-Calvo C, González-Samartino M. Predicting patient acuity according to their main problem. J Nurs Manag 2019; 27:1845-1858. [PMID: 31584733 PMCID: PMC7328732 DOI: 10.1111/jonm.12885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/11/2019] [Accepted: 09/30/2019] [Indexed: 12/01/2022]
Abstract
AIM To assess the ability of the patient main problem to predict acuity in adults admitted to hospital wards and step-down units. BACKGROUND Acuity refers to the categorization of patients based on their required nursing intensity. The relationship between acuity and nurses' clinical judgment on the patient problems, including their prioritization, is an underexplored issue. METHOD Cross-sectional, multi-centre study in a sample of 200,000 adults. Multivariate analysis of main problems potentially associated with acuity levels higher than acute was performed. Distribution of patients and outcome differences among acuity clusters were evaluated. RESULTS The main problems identified are strongly associated with patient acuity. The model exhibits remarkable ability to predict acuity (AUC, 0.814; 95% CI, 0.81-0.816). Most patients (64.8%) match higher than acute categories. Significant differences in terms of mortality, hospital readmission and other outcomes are observed (p < .005). CONCLUSION The patient main problem predicts acuity. Most inpatients require more intensive than acute nursing care and their outcomes are adversely affected. IMPLICATIONS FOR NURSING MANAGEMENT Prospective measurement of acuity, considering nurses' clinical judgments on the patient main problem, is feasible and may contribute to support nurse management workforce planning and staffing decision-making, and to optimize patients, nurses and organizational outcomes.
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Affiliation(s)
- Maria-Eulàlia Juvé-Udina
- Nursing Executive Department, Catalan Institute of Health, Barcelona, Catalonia, Spain.,Nursing Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.,Fundamental and Medical-Surgical Nursing, Medicine and Health Sciences Faculty, Nursing School, University of Barcelona, Barcelona, Catalonia, Spain
| | - Jordi Adamuz
- Nursing Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.,Fundamental and Medical-Surgical Nursing, Medicine and Health Sciences Faculty, Nursing School, University of Barcelona, Barcelona, Catalonia, Spain.,Nursing Knowledge and Information Systems Department, Bellvitge University Hospital, Barcelona, Catalonia, Spain
| | - Maria-Magdalena López-Jimenez
- Nursing Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.,Fundamental and Medical-Surgical Nursing, Medicine and Health Sciences Faculty, Nursing School, University of Barcelona, Barcelona, Catalonia, Spain
| | - Marta Tapia-Pérez
- Nursing Knowledge and Information Systems Department, Bellvitge University Hospital, Barcelona, Catalonia, Spain
| | - Núria Fabrellas
- Fundamental and Medical-Surgical Nursing, Medicine and Health Sciences Faculty, Nursing School, University of Barcelona, Barcelona, Catalonia, Spain.,Nursing Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain
| | - Cristina Matud-Calvo
- Nursing Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.,Nursing Knowledge and Information Systems Department, Bellvitge University Hospital, Barcelona, Catalonia, Spain
| | - Maribel González-Samartino
- Nursing Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.,Fundamental and Medical-Surgical Nursing, Medicine and Health Sciences Faculty, Nursing School, University of Barcelona, Barcelona, Catalonia, Spain.,Nursing Knowledge and Information Systems Department, Bellvitge University Hospital, Barcelona, Catalonia, Spain
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