1
|
Kim J, Lee E, Jung Y, Kwon H, Lee S. Patient-level and organizational-level factors influencing in-hospital falls. J Adv Nurs 2022; 78:3641-3651. [PMID: 35441709 PMCID: PMC9790490 DOI: 10.1111/jan.15254] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/24/2022] [Accepted: 03/23/2022] [Indexed: 12/30/2022]
Abstract
AIM In-hospital fall is one key safety issue in a healthcare setting. Although healthcare providers apply several strategies for preventing falls, falls still occur in hospitals. The aim of this study was to investigate patient-level and organizational-level factors influencing in-hospital falls. DESIGN A multicentre retrospective observational study. METHODS This study used the national healthcare database and supplemented with organizational data obtained through a survey. Data extraction and survey were conducted between July and August 2020. A mixed-effect logistic regression model was used to analyse factors influencing in in-hospital falls. RESULTS A total of 43,286 patients admitted in 86 hospitals were included in this study. Fall rate was 0.85 per 1000 days. Length of stay was significantly longer for fall patients than for no-fall patients. Patient-level factors (including age, mobility impairment and surgery) and organizational-level factors (including nurse staffing and proportion of new nurses) were significant factors influencing in-hospital falls. CONCLUSION Since in-hospital falls increase economic burden to patients, we should consider various fall prevention strategies to reduce falls. For a strategy to be applied stably to patients, organizational factors must be supported. IMPACT Proactive fall management in acute settings is essential to ensure patient safety. Considering that the number of patients with fall risk is increasing due to ageing, organizational factors should be supported to provide quality nursing care for fall risk patients. Therefore, nurse leaders should primarily ensure an appropriate level of nurse staffing. They also need to make efforts to strengthen clinical competency of nurses.
Collapse
Affiliation(s)
- Jinhyun Kim
- College of NursingSeoul National UniversitySeoulSouth Korea
| | - Eunhee Lee
- School of Nursing/Research Institute of Nursing ScienceHallym UniversityChuncheonGangwon‐doSouth Korea
| | - Yoomi Jung
- Korea Armed Forces Nursing AcademyDaejeonSouth Korea
| | - Hyunjeong Kwon
- College of NursingSeoul National UniversitySeoulSouth Korea
| | - Sunmi Lee
- College of NursingSeoul National UniversitySeoulSouth Korea
| |
Collapse
|
2
|
Lee SH, Lee H, Yu S. Factors associated with nursing needs and nursing hours in acute care hospital settings: A cross-sectional study. J Nurs Manag 2022; 30:2005-2014. [PMID: 35420223 DOI: 10.1111/jonm.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
AIM To identify the patient and hospital characteristics related to nursing needs and nursing hours in acute hospital settings. BACKGROUND To determine appropriate staffing levels, accumulating empirical data through direct observation and surveys reflecting the actual situation is necessary. METHODS In this cross-sectional study, we conducted direct observations of nurses in acute care hospitals from May 1 to August 31, 2020. Twenty-six hospitals in five cities participated, and 747 nursing personnel collected 1,681 patients' data while performing nursing activities. The data of 1,605 individuals were analyzed using descriptive statistics, t-tests, analysis of variance, and linear regression. RESULTS Hospital size, admission day, patients' dependence level, high fall risk, and disease diagnoses were variables associated with nursing needs (F = 73.49, P < 0.001) and nursing hours (F = 57.7, P < 0.001). Comparing the correlates of nursing needs and nursing hours revealed that, unlike nursing needs, nursing hours were not significantly associated with surgery and certain diagnoses. CONCLUSION This study confirmed the variables associated with nursing needs and nursing hours in acute hospitals; based on this, determining appropriate staffing levels, which is an important step in improving inpatients' health outcomes, is necessary. IMPLICATIONS FOR NURSING MANAGEMENT In acute hospitals, an increased number of nurse staffing should be employed based on the number of newly hospitalized patients, patients with high dependence levels and specific diagnoses, and those at high risk of falling.
Collapse
Affiliation(s)
- Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Republic of Korea
| | - Hanju Lee
- Department of Nursing, Sangmyung University, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Soyoung Yu
- College of Nursing, CHA University, Pocheon, Gyeongghi-do, Republic of Korea
| |
Collapse
|
3
|
Olds D, Cramer E. Predictors of physical restraint use on critical care units: An observational structural equation modeling approach. Int J Nurs Stud 2021; 118:103925. [PMID: 33853022 DOI: 10.1016/j.ijnurstu.2021.103925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Modifiable unit characteristics, including nurse work environment, education, certification, and staffing have been shown to impact patient safety. Physical restraints are an important patient safety issue, however the relationships between these modifiable unit characteristics and physical restraint use on critical care units has not been explored. OBJECTIVES Our objective was to determine the role of nursing work environment, nurse education and certification, and nurse staffing on physical restraint use. DESIGN The study was a secondary analysis of 2017-2018 unit-level restraint rates from the National Database of Nursing Quality Indicators linked to Registered Nurse survey and hospital characteristics data. METHODS Work environment was examined at the unit-level using total Practice Environment Scale of the Nursing Work Index and subscale scores. Unit-level nurse expertise included the percent of nurses with at least a Bachelor of Science in Nursing degree and percent with certification. Nurse staffing was the unit-level Registered Nurse hours per patient day and skill mix. Analyses included descriptive statistics, bivariate correlations, and Structural Equation Modeling. We used a first order model to estimate predicted restraint use from the five subscales of the Practice Environment Scale of the Nursing Work Index. A higher order model predicted restraint use from a total work environment factor score. RESULTS The sample included 408 critical care units from 226 hospitals. Mean restraint rate was 15% (SD 12, range 0-53%). In the first-order model, the Collegial Nurse-Physician Relations subscale had a positive relationship with restraint use (β = 0.167, 95% confidence interval 0.010-0.333). In the higher order model, the total work environment score had a negative relationship with restraint use (β = -0.088, 95% confidence -0.178- -0.014). Registered Nurse hours per patient day had a negative relationship to restraint use in both the first order (β = -0.114, 95% confidence interval -0.222--0.025) and higher order models (β = -0.117, 95% confidence interval -0.223- -0.012). CONCLUSION We found that better nurse-physician relationships were associated with higher restraint use. This finding is supported by previous literature and may reflect physician trust in nursing judgement when using restraints. However, a better work environment overall was associated with lower restraint rates. Further, Registered Nurse hours per patient day, but not skill mix, was associated with lower restraint rates. We conclude that improving the overall nurse work environment and nurse staffing, as well as using interprofessional interventions, may be successful in decreasing restraint use on critical care units.
Collapse
Affiliation(s)
- Danielle Olds
- Research Assistant Professor, University of Kansas School of Nursing USA.
| | - Emily Cramer
- Research Associate Professor, University of Kansas School of Nursing USA
| |
Collapse
|
4
|
Bowers B. Improving practice and informing policy development: The impact of gerontological nursing research. Geriatr Nurs 2020; 41:32-37. [PMID: 32024595 DOI: 10.1016/j.gerinurse.2020.01.010] [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: 10/25/2022]
Abstract
Nurses have always approached the clinical care challenges they encounter with a combination of critical observation and a profound concern for human suffering. Beginning in earnest in the early 1980s, nurse researchers have pursued the answers to questions about the wellbeing of older adults, particularly those suffering from serious, chronic conditions. This paper offers three exemplars of nursing research domains that illustrate the creativity and commitment of nurse researchers seeking to understand and improve pervasive clinical problems experienced by older adults and to demonstrate the profound influence these activities have had on the evolution of the science and the quality of care for older adults. The impact of this work is reflected in practice protocols, institutional policies, government oversight, and improved outcomes for patients.
Collapse
Affiliation(s)
- Barbara Bowers
- University of Wisconsin-Madison, School of Nursing, 5133 Signe Skott Cooper Hall, Madison, WI 53705, United States.
| |
Collapse
|
5
|
Bruyneel A, Tack J, Droguet M, Maes J, Wittebole X, Miranda DR, Pierdomenico LD. Measuring the nursing workload in intensive care with the Nursing Activities Score (NAS): A prospective study in 16 hospitals in Belgium. J Crit Care 2019; 54:205-211. [DOI: 10.1016/j.jcrc.2019.08.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/05/2019] [Accepted: 08/29/2019] [Indexed: 01/28/2023]
|
6
|
Bruyneel A, Guerra C, Tack J, Droguet M, Maes J, Miranda DR. Traduction sémantique en français et implémentation du Nursing Activities Score en Belgique. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : L’évaluation du temps de travail en soins infirmiers est une pratique courante aux soins intensifs. Elle permet de calculer un ratio infirmière/patient optimal qui est un enjeu majeur pour assurer la qualité des soins et maîtriser les coûts des soins de santé. Le Nursing Activities Score (NAS) permet de calculer ce ratio, mais l’outil n’a jamais été traduit en français et adapté à la Belgique.
Objectif : Traduire et adapter le NAS à la Belgique francophone.
Méthodes: L’échelle a été traduite par deux traducteurs indépendants de l’anglais vers le français. Ensuite, une traduction rétrograde du français à l’anglais a été réalisée. Une adaptation culturelle a été effectuée en réunissant un groupe de 13 infirmiers belges. Enfin, l’échelle traduite a été validée et implémentée dans deux unités de soins intensifs (USI) distinctes en Belgique francophone.
Résultats : La traduction rétrograde était similaire à la première traduction. La réunion avec le groupe d’experts a permis de trouver un consensus sur l’adaptation de l’échelle et le tutoriel adaptés au contexte des soins en Belgique. Pour la validation, le NAS a été encodé chez 113 patients et avec 981 NAS encodés dans deux USI, la médiane de NAS/patient était respectivement de 69 et 76 %. Le temps médian d’encodage du NAS était de trois minutes par patient. Nous avons observé une compliance élevée de l’encodage du NAS (respectivement 99 et 76 %).
Conclusions : Nous avons validé une échelle traduite en français conforme à la version originale et adaptée au contexte des soins en Belgique.
Collapse
|
7
|
|
8
|
Patrician PA, Loan LA, McCarthy MS, Swiger P, Breckenridge-Sproat S, Brosch LR, Jennings BM. Twenty years of staffing, practice environment, and outcomes research in military nursing. Nurs Outlook 2017; 65:S120-S129. [DOI: 10.1016/j.outlook.2017.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 12/12/2022]
|
9
|
Morita K, Matsui H, Fushimi K, Yasunaga H. Association between Nurse Staffing and In-Hospital Bone Fractures: A Retrospective Cohort Study. Health Serv Res 2017; 52:1005-1023. [PMID: 27453490 PMCID: PMC5441478 DOI: 10.1111/1475-6773.12529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals. DATA SOURCES/STUDY SETTING The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions. STUDY DESIGN We conducted a retrospective cohort study to examine the association of inpatient nurse-to-occupied bed ratio (NBR) with in-hospital fractures. Multivariable logistic regression with generalized estimating equations was performed, adjusting for patient characteristics and hospital characteristics. DATA COLLECTION/EXTRACTION METHODS We identified 770,373 patients aged 50 years or older who underwent planned major surgery for some forms of cancer or cardiovascular diseases. We used ICD-10 codes and postoperative procedure codes to identify patients with in-hospital fractures. Hospital characteristics were obtained from the "Survey of Medical Institutions and Hospital Report" and "Annual Report for Functions of Medical Institutions." PRINCIPAL FINDINGS Overall, 662 (0.09 percent) in-hospital fractures were identified. Logistic regression analysis showed that the proportion of in-hospital fractures in the group with the highest NBR was significantly lower than that in the group with the lowest NBR (adjusted odd ratios, 0.67; 95 percent confidence interval, 0.44-0.99; p = .048). CONCLUSIONS Sufficient nurse staffing may be important to reduce postsurgical in-hospital fractures in acute care hospitals.
Collapse
Affiliation(s)
- Kojiro Morita
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Kiyohide Fushimi
- Department of Health Policy and InformaticsGraduate School of MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
| |
Collapse
|
10
|
Ellenbecker CH, Edward J. Conducting Nursing Research to Advance and Inform Health Policy. Policy Polit Nurs Pract 2017; 17:208-217. [PMID: 28558601 DOI: 10.1177/1527154417700634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The primary roles of nurse scientists in conducting health policy research are to increase knowledge in the discipline and provide evidence for informing and advancing health policies with the goal of improving the health outcomes of society. Health policy research informs, characterizes, explains, or tests hypotheses by employing a variety of research designs. Health policy research focuses on improving the access to care, the quality and cost of care, and the efficiency with which care is delivered. In this article, we explain how nurses might envision their research in a policy process framework, describe research designs that nurse researchers might use to inform and advance health policies, and provide examples of research conducted by nurse researchers to explicate key concepts in the policy process framework. Health policies are well informed and advanced when nurse researchers have a good understanding of the political process. The policy process framework provides a context for improving the focus and design of research and better explicating the connection between research evidence and policy. Nurses should focus their research on addressing problems of importance that are on the healthcare agenda, work with interdisciplinary teams of researchers, synthesize, and widely disseminate results.
Collapse
Affiliation(s)
- Carol Hall Ellenbecker
- 1 Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, MA, USA
| | - Jean Edward
- 2 Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, KY, USA.,3 College of Nursing, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
11
|
Staggs VS, Olds DM, Cramer E, Shorr RI. Nursing Skill Mix, Nurse Staffing Level, and Physical Restraint Use in US Hospitals: a Longitudinal Study. J Gen Intern Med 2017; 32:35-41. [PMID: 27553206 PMCID: PMC5215153 DOI: 10.1007/s11606-016-3830-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/21/2016] [Accepted: 07/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although it is plausible that nurse staffing is associated with use of physical restraints in hospitals, this has not been well established. This may be due to limitations in previous cross-sectional analyses lacking adequate control for unmeasured differences in patient-level variables among nursing units. OBJECTIVE To conduct a longitudinal study, with units serving as their own control, examining whether nurse staffing relative to a unit's long-term average is associated with restraint use. DESIGN We analyzed 17 quarters of longitudinal data using mixed logistic regression, modeling quarterly odds of unit restraint use as a function of quarterly staffing relative to the unit's average staffing across study quarters. SUBJECTS 3101 medical, surgical, and medical-surgical units in US hospitals participating in the National Database of Nursing Quality Indicators during 2006-2010. Units had to report at least one quarter with restraint use and one quarter without. MAIN MEASURES We studied two nurse staffing variables: staffing level (total nursing hours per patient day) and nursing skill mix (proportion of nursing hours provided by RNs). Outcomes were any use of restraint, regardless of reason, and use of restraint for fall prevention. KEY RESULTS Nursing skill mix was inversely correlated with restraint use for fall prevention and for any reason. Compared to average quarters, odds of fall prevention restraint and of any restraint were respectively 16 % (95 % CI: 3-29 %) and 18 % (95 % CI: 8-29 %) higher for quarters with very low skill mix. CONCLUSIONS In this longitudinal study there was a strong negative correlation between nursing skill mix and physical restraint use. Ensuring that skill mix is consistently adequate should reduce use of restraint.
Collapse
Affiliation(s)
- Vincent S. Staggs
- Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, 64108 MO USA
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108 USA
| | - Danielle M. Olds
- School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Emily Cramer
- School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Ronald I. Shorr
- Geriatric Research, Education and Clinical Center (GRECC), Malcom Randall Veterans Administration Medical Center, Gainesville, FL USA
- Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610 USA
| |
Collapse
|
12
|
Schneider PP, Geraedts M. Staffing and the incidence of pressure ulcers in German hospitals: A multicenter cross-sectional study. Nurs Health Sci 2016; 18:457-464. [DOI: 10.1111/nhs.12292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Paul Peter Schneider
- Institute for Health Services Research, School of Medicine, Faculty of Health; Witten/Herdecke University; Witten Germany
| | - Max Geraedts
- Institute for Health Services Research, School of Medicine, Faculty of Health; Witten/Herdecke University; Witten Germany
| |
Collapse
|
13
|
McKechnie D, Fisher MJ, Pryor J. The characteristics of falls in an inpatient traumatic brain injury rehabilitation setting. J Clin Nurs 2015; 25:213-22. [PMID: 26621788 DOI: 10.1111/jocn.13087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the nature of falls in an inpatient traumatic brain injury rehabilitation setting. BACKGROUND Falls are the most frequently recorded patient safety incident in the inpatient context. However, higher rates of falls are reported in rehabilitation settings compared to acute care settings. In the rehabilitation setting, patients with a traumatic brain injury have been identified as at a high risk of falling. However to date, research into the nature of falls involving this patient population is limited. DESIGN Five-year retrospective cohort study design. METHODS Falls data from an inpatient traumatic brain injury rehabilitation unit were retrieved from the NSW Ministry of Health Incident Information Management System and patient clinical notes; nursing shift data were retrieved from the local rostering system. RESULTS The fall rate was 5·18 per 1000 patient bed days. Over a 24-hour period falls (n = 103) occurred in a trimodal pattern. The median fall free period after admission was 14 days and 22% of traumatic brain injury patients had at least one fall. 53% of falls occurred in the patient's bedroom and 57% were attributed to loss of balance. At time of fall, 93% of fallers had impaired mobility and 85% required assistance for transfers. CONCLUSION Falls within inpatient traumatic brain injury rehabilitation are a significant and complex clinical issue. While many patients continued to be at risk of falling several months after admission, a repeat faller's first fall occurred earlier in their admission than a single faller's. RELEVANCE TO CLINICAL PRACTICE Generic falls prevention measures are insufficient for preventing falls in the brain injury rehabilitation population. Falls prevention initiatives should target times of high patient activity and situations where there is decreased nursing capacity to observe patients. Rehabilitation clinicians need to be mindful that a patient's risk of falling is not static and in fact, may increase over time.
Collapse
Affiliation(s)
- Duncan McKechnie
- Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.,Brain Injury Unit, Royal Rehab, Sydney, NSW, Australia
| | - Murray J Fisher
- Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.,Nursing Research & Development, Royal Rehab, Sydney, NSW, Australia
| | - Julie Pryor
- Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.,Nursing Research & Development, Royal Rehab, Sydney, NSW, Australia
| |
Collapse
|
14
|
Rochefort CM, Buckeridge DL, Abrahamowicz M. Improving patient safety by optimizing the use of nursing human resources. Implement Sci 2015; 10:89. [PMID: 26071752 PMCID: PMC4465738 DOI: 10.1186/s13012-015-0278-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/08/2015] [Indexed: 01/13/2023] Open
Abstract
Background Recent ecological studies have suggested that inadequate nurse staffing may contribute to the incidence of adverse events in acute care hospitals. However, longitudinal studies are needed to further examine these associations and to identify the staffing patterns that are of greatest risk. The aims of this study are to determine if (a) nurse staffing levels are associated with an increased risk of adverse events, (b) the risk of adverse events in relationship to nurse staffing levels is modified by the complexity of patient requirements, and (c) optimal nurse staffing levels can be established. Methods/design A dynamic cohort of all adult medical, surgical, and intensive care unit patients admitted between 2010 and 2015 to a Canadian academic health center will be followed during the inpatient and 7-day post-discharge period to assess the occurrence and frequency of adverse events in relationship to antecedent nurse staffing levels. Four potentially preventable adverse events will be measured: (a) hospital-acquired pneumonia, (b) ventilator-associated pneumonia, (c) venous thromboembolism, and (d) in-hospital fall. These events were selected for their high incidence, morbidity and mortality rates, and because they are hypothesized to be related to nurse staffing levels. Adverse events will be ascertained from electronic health record data using validated automated detection algorithms. Patient exposure to nurse staffing will be measured on every shift of the hospitalization using electronic payroll records. To examine the association between nurse staffing levels and the risk of adverse events, four Cox proportional hazards regression models will be used (one for each adverse event), while adjusting for patient characteristics and risk factors of adverse event occurrence. To determine if the association between nurse staffing levels and the occurrence of adverse events is modified by the complexity of patient requirements, interaction terms will be included in the regression models, and their significance assessed. To assess for the presence of optimal nurse staffing levels, flexible nonlinear spline functions will be fitted. Discussion This study will likely generate evidence-based information that will assist managers in making the most effective use of scarce nursing resources and in identifying staffing patterns that minimize the risk of adverse events. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0278-1) contains supplementary material, which is available to authorized users.
Collapse
|
15
|
Staggs VS, Mion LC, Shorr RI. Consistent differences in medical unit fall rates: implications for research and practice. J Am Geriatr Soc 2015; 63:983-7. [PMID: 25940548 DOI: 10.1111/jgs.13387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the proportion of variation in long-term fall rates attributable to variability between rather than within hospital units and to identify unit- and hospital-level characteristics associated with persistently low- and high-fall units. DESIGN Retrospective study of administrative data on inpatient falls. Eighty low-fall and 74 high-fall units were identified based on monthly rankings of fall rates. Unit- and hospital-level characteristics of these units were compared. SETTING U.S. general hospitals participating in the National Database of Nursing Quality Indicators. PARTICIPANTS Nonsubspecialty medical units (n=800) with 24 consecutive months of falls data. MEASUREMENTS Monthly self-reported unit fall rates (falls per 1,000 patient-days). RESULTS An estimated 87% of variation in 24-month fall rates was due to between-unit differences. With the exception of patient-days, a proxy for unit bed size, low- and high-fall units did not differ on nurse staffing or any other unit or hospital characteristic variable. CONCLUSION There are medical units with persistently low and persistently high fall rates. High-fall units had higher patient volume, suggesting patient turnover as a variable for further study. Understanding additional factors underlying variability in long-term fall rates could lead to sustainable interventions for reducing inpatient falls.
Collapse
Affiliation(s)
- Vincent S Staggs
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.,Department of Pediatrics, University of Missouri- Kansas City, Kansas City, Missouri
| | - Lorraine C Mion
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Ronald I Shorr
- Department of Epidemiology, University of Florida, Gainesville, Florida.,Geriatric Research, Education and Clinical Center, Malcom Randall Veterans Administration Medical Center, Gainesville, Florida
| |
Collapse
|
16
|
Stalpers D, de Brouwer BJ, Kaljouw MJ, Schuurmans MJ. Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: A systematic review of literature. Int J Nurs Stud 2015; 52:817-35. [DOI: 10.1016/j.ijnurstu.2015.01.005] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 12/19/2014] [Accepted: 01/07/2015] [Indexed: 11/29/2022]
|
17
|
Schreuders LW, Bremner AP, Geelhoed E, Finn J. The relationship between nurse staffing and inpatient complications. J Adv Nurs 2014; 71:800-12. [PMID: 25414059 DOI: 10.1111/jan.12572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/29/2022]
Abstract
AIM To compare characteristics of hospitalizations with and without complications and examine the impact of nurse staffing on inpatient complications across different unit types. BACKGROUND Studies investigating the relationship between nurse staffing and inpatient complications have not shown consistent results. Methodological limitations have been cited as the basis for this lack of uniformity. Our study was designed to address some of these limitations. DESIGN Retrospective longitudinal hospitalization-level study. METHOD Adult hospitalizations to high intensity, general medical and general surgical units at three metropolitan tertiary hospitals were included. Data were sourced from Western Australian Department of Health administrative data collections from 2004-2008. We estimated the impact of nurse staffing on inpatient complications adjusted for patient and hospital characteristics and accounted for patients with multiple hospitalizations. RESULTS The study included 256,984 hospitalizations across 58 inpatient units. Hospitalizations with complications had significantly different demographic characteristics compared with those without. The direction of the association between nurse staffing and inpatient complications was not consistent for different inpatient complications, nurse skill mix groups or for hospitalizations with different unit movement patterns. CONCLUSION Our study design addressed limitations noted in the field, but our results did not support the widely held assumption that improved nurse staffing levels are associated with decreased patient complication rates. Despite a strong international focus on improving nurse staffing to reduce inpatient complications, our results suggest that adding more nurses is not a panacea for reducing inpatient complications to zero.
Collapse
Affiliation(s)
- Louise Winton Schreuders
- The University of Western Australia, School of Population Health, Perth, Western Australia, Australia
| | | | | | | |
Collapse
|
18
|
Differences in nursing practice environment among US acute care unit types: A descriptive study. Int J Nurs Stud 2014; 51:1441-9. [DOI: 10.1016/j.ijnurstu.2014.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 11/24/2022]
|
19
|
Aydin C, Donaldson N, Stotts NA, Fridman M, Brown DS. Modeling hospital-acquired pressure ulcer prevalence on medical-surgical units: nurse workload, expertise, and clinical processes of care. Health Serv Res 2014; 50:351-73. [PMID: 25290866 DOI: 10.1111/1475-6773.12244] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study modeled the predictive power of unit/patient characteristics, nurse workload, nurse expertise, and hospital-acquired pressure ulcer (HAPU) preventive clinical processes of care on unit-level prevalence of HAPUs. DATA SOURCES Seven hundred and eighty-nine medical-surgical units (215 hospitals) in 2009. STUDY DESIGN Using unit-level data, HAPUs were modeled with Poisson regression with zero-inflation (due to low prevalence of HAPUs) with significant covariates as predictors. DATA COLLECTION/EXTRACTION METHODS Hospitals submitted data on NQF endorsed ongoing performance measures to CALNOC registry. PRINCIPAL FINDINGS Fewer HAPUs were predicted by a combination of unit/patient characteristics (shorter length of stay, fewer patients at-risk, fewer male patients), RN workload (more hours of care, greater patient [bed] turnover), RN expertise (more years of experience, fewer contract staff hours), and processes of care (more risk assessment completed). CONCLUSIONS Unit/patient characteristics were potent HAPU predictors yet generally are not modifiable. RN workload, nurse expertise, and processes of care (risk assessment/interventions) are significant predictors that can be addressed to reduce HAPU. Support strategies may be needed for units where experienced full-time nurses are not available for HAPU prevention. Further research is warranted to test these finding in the context of higher HAPU prevalence.
Collapse
Affiliation(s)
- Carolyn Aydin
- Cedars-Sinai Medical Center and Burns and Allen Research Institute, 8700 Beverly Blvd., Los Angeles, CA; Collaborative Alliance for Nursing Outcomes, San Ramon, CA
| | | | | | | | | |
Collapse
|
20
|
Everhart D, Schumacher JR, Duncan RP, Hall AG, Neff DF, Shorr RI. Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics. Health Care Manage Rev 2014; 39:352-60. [PMID: 24566249 PMCID: PMC4277236 DOI: 10.1097/hmr.0000000000000013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time. PURPOSE The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups. METHODOLOGY/APPROACH We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression. FINDINGS A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group. PRACTICE IMPLICATIONS Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able to reduce fall rates by maintaining greater nurse staffing ratios as well as fostering an environment consistent with that of Magnet hospitals.
Collapse
Affiliation(s)
- Damian Everhart
- Damian Everhart, PhD, RN, is Assistant Professor, Brooks College of Health, University of North Florida, Jacksonville. E-mail: . Jessica R. Schumacher, PhD, MS, is Associate Director of Analytics, Department of Population Health Sciences, University of Wisconsin-Madison. R. Paul Duncan, PhD, MS, is Malcom and Christine Randall Professor and Chair, Department of Health Services Research, Management and Policy, University of Florida, Gainesville. Allyson G. Hall, PhD, MBA, MHS, is Associate Professor, Department of Health Services Research, Management and Policy, University of Florida, Gainesville. Donna F. Neff, PhD, RN, DSNAP, is Associate Professor, College of Nursing, University of Central Florida, Orlando. Ronald I. Shorr, MD, MS, is Professor, Department of Epidemiology, University of Florida, Gainesville
| | | | | | | | | | | |
Collapse
|
21
|
Choi J, Staggs VS. Comparability of nurse staffing measures in examining the relationship between RN staffing and unit-acquired pressure ulcers: A unit-level descriptive, correlational study. Int J Nurs Stud 2014; 51:1344-52. [DOI: 10.1016/j.ijnurstu.2014.02.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/09/2014] [Accepted: 02/13/2014] [Indexed: 11/29/2022]
|
22
|
Warshawsky N, Rayens MK, Stefaniak K, Rahman R. The effect of nurse manager turnover on patient fall and pressure ulcer rates. J Nurs Manag 2014; 21:725-32. [PMID: 23865925 DOI: 10.1111/jonm.12101] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 11/28/2022]
Abstract
AIMS The purpose of this study was to explore the effects of nurse manager turnover on the occurrence of adverse events. BACKGROUND Nurse managers create professional nurse practice environments to support the provision of quality patient outcomes. Inconsistent findings were reported in the literature testing the relationship between nurse managers and patient outcomes. All prior studies assumed stable nursing management. METHODS A longitudinal quasi-experimental study of 23 nursing units in two hospitals was used to determine whether unit characteristics, including nurse manager turnover, have an effect on patient falls or pressure ulcers. Statistical analyses included repeated measures and hierarchical modelling. RESULTS Patients in medical/surgical units experienced more falls than in intensive care units (F1,11 = 15.9, P = 0.002). Patients in units with a nurse manager turnover [odds ratio: 3.16; 95% confidence interval: 1.49-6.70] and intensive care units (odds ratio: 2.70; 95% confidence interval: 1.33-5.49) were more likely to develop pressure ulcers. CONCLUSIONS Nurse manager turnover and intensive care unit status were associated with more pressure ulcers. Medical/surgical unit status was associated with more falls. The study was limited by a small sample size. IMPLICATIONS FOR NURSE MANAGERS Nurse manager turnover may negatively impact patient outcomes. Stable nursing management, strategic interim management and long-term succession planning may reduce adverse patient events.
Collapse
Affiliation(s)
- Nora Warshawsky
- College of Nursing, University of Kentucky, Lexington, KY 40503-0232, USA.
| | | | | | | |
Collapse
|
23
|
Sving E, Idvall E, Högberg H, Gunningberg L. Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study. Int J Nurs Stud 2014; 51:717-25. [DOI: 10.1016/j.ijnurstu.2013.09.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 08/13/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
|
24
|
Carmona-Monge FJ, Uranga IU, Gómez SG, Herranz CQ, Bengoetxea MB, Unanue GE, Martin AI, Hernando ME, Saralegui EB, Irazoqui MA. [Usage analysis of the Nursing Activities Score in two Spanish ICUS]. Rev Esc Enferm USP 2014; 47:1108-16. [PMID: 24346450 DOI: 10.1590/s0080-623420130000500014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 06/13/2013] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to analyze the discourse of health managers on aspects related to delay in tuberculosis diagnosis. This was a qualitative research study, conducted with 16 Family Health Unit managers. The empirical data were obtained through semi-structured interviews. The analysis was based on the theoretical framework of the French school of discourse analysis. According to the managers' statements, the delay in tuberculosis diagnosis is related to patient and health service aspects. As for patient aspects, managers report fear, prejudice and lack of information as factors that may promote a delayed diagnosis. Regarding health service aspects, structural problems and lack of professional skills were reported. The discourse of managers should be considered to qualify tuberculosis control actions and to prevent delays in diagnosis.
Collapse
Affiliation(s)
| | | | - Sonia García Gómez
- Critical Care Unit, University Hospital Alcorcón Foundation, Madrid, Spain
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Staggs VS, Dunton N. Associations between rates of unassisted inpatient falls and levels of registered and non-registered nurse staffing. Int J Qual Health Care 2013; 26:87-92. [PMID: 24225270 PMCID: PMC3914564 DOI: 10.1093/intqhc/mzt080] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To enhance understanding of how nurse staffing relates to unassisted falls by exploring non-linear associations between unassisted fall rates and levels of registered nurse (RN) and non-RN staffing on 5 nursing unit types, thereby enabling managers to improve patient safety by making better-informed decisions about staffing. DESIGN Cross-sectional analysis of routinely collected data using hierarchical negative binomial regression. SETTING 8069 nursing units in 1361 U.S. hospitals participating in the National Database of Nursing Quality Indicators(®). Main outcome measure Rate of unassisted falls per inpatient day. RESULTS Associations between unassisted fall rates and nurse staffing varied by unit type. For medical-surgical units, higher RN staffing was weakly associated with lower fall rates. On step-down and medical units, the association between RN staffing and fall rates depended on the level of staffing: At lower staffing levels, the fall rate increased as staffing increased, but at moderate and high staffing levels, the fall rate decreased as staffing increased. Higher levels of non-RN staffing were generally associated with higher fall rates.. CONCLUSIONS Increasing non-RN staffing seems ineffective at preventing unassisted falls. Increasing RN staffing may be effective, depending on the unit type and the current level of staffing.
Collapse
Affiliation(s)
- Vincent S Staggs
- Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3060, Kansas City, KS 66160, USA.
| | | |
Collapse
|
26
|
Abstract
Although nursing care hours (NCH) is commonly used to examine factors related to adverse events among inpatients, the reliability of the NCH measure has rarely been examined. This study assessed the reliability of NCH data from the National Database of Nursing Quality Indicators® by estimating intraclass correlation coefficients (ICCs) with data from the California Office for Statewide Health Planning and Development. Hospital-level aggregated NCH data for critical care units were linked from each of the databases for 48 California hospitals matched in the two databases. Estimated ICCs were .96 for registered nurse (RN) hours and .72 for non-RN hours. Findings provide evidence that NCH data of the national database were substantially reliable for use in national comparable benchmarking reports for hospitals' quality improvement activities and research.
Collapse
Affiliation(s)
- JiSun Choi
- 1University of Kansas School of Nursing, Kansas City, USA
| | | | | |
Collapse
|
27
|
Evaluation of the nursing workload through the nine equivalents for nursing manpower use scale and the nursing activities score: A prospective correlation study. Intensive Crit Care Nurs 2013; 29:228-33. [DOI: 10.1016/j.iccn.2013.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 03/08/2013] [Accepted: 03/13/2013] [Indexed: 01/09/2023]
|
28
|
Abstract
Over a decade of research on the relationship between nurse staffing and patient outcomes has demonstrated the important role of nurses in the provision of high-quality, safe care, yet currently, no evidence-based nurse staffing guidelines exist. A systematic review of reviews was conducted to explore reasons why this is the case and recommend directions for future research to improve upon this gap. Authors of the 29 included reviews reported variability in methods and measurement approaches, lack of incorporation of nurse processes and system factors that potentially affect relationships among variables, and overall inconsistencies in results across primary studies. We propose use of an Integrated Framework for a Systems Approach to Nurse Staffing Research to inform the development of applicable conceptual models. Future studies that use a systems approach and focus on establishing causal relationships among variables will potentially strengthen the evidence and advance the science in this area.
Collapse
Affiliation(s)
- Caitlin W. Brennan
- VA Boston Healthcare System, MA, USA
- Case Western Reserve University, Cleveland, OH, USA
- Veterans Affairs National Quality Scholars Program, Louis Stokes Cleveland VA Medical Center, OH, USA
| | | | | |
Collapse
|
29
|
Choi J, Bergquist-Beringer S, Staggs VS. Linking RN workgroup job satisfaction to pressure ulcers among older adults on acute care hospital units. Res Nurs Health 2013; 36:181-90. [PMID: 23408439 DOI: 10.1002/nur.21531] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2013] [Indexed: 11/09/2022]
Abstract
We examined the relationship between registered nurse (RN) workgroup job satisfaction and hospital-acquired pressure ulcers (HAPUs) among older adults on six types of acute care units. Random-intercept logistic regression analyses were performed using 2009 unit-level data from the National Database of Nursing Quality Indicators® (NDNQI®) and the NDNQI RN Survey. Overall, RN workgroup job satisfaction was negatively associated with HAPU rates, although the relationship varied by unit type. RN workgroup satisfaction was significantly associated with HAPU rates on critical care, medical, and rehabilitation units. No significant association was found on step-down, surgical, and medical-surgical units. Findings provide evidence that higher RN workgroup job satisfaction is related to lower HAPU rates among older adult patients in acute care hospitals.
Collapse
Affiliation(s)
- Jisun Choi
- National Database of Nursing Quality Indicators, University of Kansas School of Nursing, 3901 Rainbow Blvd, Kansas City, KS, USA
| | | | | |
Collapse
|
30
|
Staggs VS. Nurse staffing, RN mix, and assault rates on psychiatric units. Res Nurs Health 2012; 36:26-37. [PMID: 23007694 DOI: 10.1002/nur.21511] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2012] [Indexed: 11/06/2022]
Abstract
The association between nurse staffing and patient violence on psychiatric units is unclear, and the association between nursing skill mix and violence has not been studied. Monthly data on physical/sexual assaults by patients against others were obtained for 351 adult psychiatric units. Total and injury assault rates were modeled as dependent variables using hierarchical Poisson regression, with total staffing and registered nurse (RN) mix as predictors. Assault rates were 12% higher per additional nursing hour per patient day but 6% lower per 5-point increase in percent of hours provided by RNs. In cubic spline models fit to explore nonlinear staffing-violence associations, assault rates increased with staffing through most of its range but began to decline at very high levels.
Collapse
Affiliation(s)
- Vincent S Staggs
- Department of Biostatistics and School of Nursing, University of Kansas Medical Center, Kansas City, KS 66160, USA
| |
Collapse
|
31
|
Esparza SJ, Zoller JS, White AW, Highfield MEF. Nurse staffing and skill mix patterns: Are there differences in outcomes? J Healthc Risk Manag 2012; 31:14-23. [PMID: 22359259 DOI: 10.1002/jhrm.20092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this study was to examine the impact on patient outcomes of nurse staffing and registered nurse (RN) skill mix patterns used by medical-surgical units in California hospitals after enactment of nurse-to-patient staffing ratio laws, and determine if there are differences in patient outcomes for conditions that are considered sensitive to nursing care. Results from this study demonstrated an association between total nursing hours per patient day (NHPPD) and two outcomes: urinary tract infections (UTI) and length of stay (LOS). A stronger association was observed between the RN proportions of the total nursing hours of care and the same outcomes. The higher the total NHPPD and RN proportion, the lower the LOS and the lower the odds of hospitalized patients' developing UTI.
Collapse
|
32
|
UNRUH LYNNY, NOONEY JENNIFER. Newly licensed registered nurses’ perceptions of job difficulties, demands and control: individual and organizational predictors. J Nurs Manag 2011; 19:572-84. [DOI: 10.1111/j.1365-2834.2011.01239.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
|
34
|
Breckenridge-Sproat S, Johantgen M, Patrician P. Influence of unit-level staffing on medication errors and falls in military hospitals. West J Nurs Res 2011; 34:455-74. [PMID: 21540354 DOI: 10.1177/0193945911407090] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined unit-level associations of nurse staffing and workload, and the effect of the practice environment on adverse patient events. A secondary analysis was conducted of a longitudinal data set of 23 Army inpatient units from the Military Nursing Outcomes Database. Generalized Linear Mixed Modeling accommodated nested, nonparametric data. Staff category was found to be a significant predictor of medication errors and patient falls, but the relationship varied by unit type. Patient census had no effect on either outcome; however, a higher patient acuity was associated with an increase in both adverse events. The nursing practice environment mediated medication errors but not falls, in all unit types. Skill mix is important; however, additional components of staffing need consideration in producing positive patient outcomes.
Collapse
|
35
|
Abstract
Use of outsourced nurses is often a stop-gap measure for unplanned vacancies in smaller healthcare facilities such as long-term acute-care hospitals (LTACHs). However, the relationship of utilization levels (low, medium, or high percentages) of nonemployees covering staff schedules often is perceived to have negative relationships with quality outcomes. To assess this issue, the authors discuss the outcomes of their national study of LTACH hospitals that indicated no relationship existed between variations in percentage of staffing by contracted nurses and selected outcomes in this post-acute-care setting.
Collapse
|
36
|
|
37
|
Brown DS, Donaldson N, Burnes Bolton L, Aydin CE. Nursing-sensitive benchmarks for hospitals to gauge high-reliability performance. J Healthc Qual 2011; 32:9-17. [PMID: 20946421 DOI: 10.1111/j.1945-1474.2010.00083.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Benchmarking expedites the quest for best practices and is crucial to hospitals' effective, reliable, and superior performance. Comparative performance data are used by accrediting and regulatory bodies to evaluate performance and by consumers in making decisions on where to seek healthcare. Nursing-sensitive quality measures affirmed by the National Quality Forum are now used in public reporting and pay-for-performance in addition to traditional medical outcome metrics. This report provides hospital nursing-sensitive benchmarks from medical/surgical, critical care, and step-down units drawn from 196 hospitals during six quarters in 2007 and 2008. Outcome measures include pressure ulcer prevalence rates and fall/falls with injury rates. Additional indicators that describe nursing care (nurse staffing care hours, skill mix, nurse/patient ratios, workload intensity, voluntary turnover, and use of sitters) and patient descriptors (age, gender, and diagnosis description) were also included. Specific benchmarks are provided using the 10th and the 90th percentiles, as well as quartiles to allow hospitals an opportunity to understand comparative performance with specificity. The purpose of this article is to provide hospitals not currently participating in comparative benchmarking databases with nursing-sensitive data from the Collaborative Alliance for Nursing Outcomes for use in performance improvement processes.
Collapse
|
38
|
Lake ET, Shang J, Klaus S, Dunton NE. Patient falls: Association with hospital Magnet status and nursing unit staffing. Res Nurs Health 2010; 33:413-25. [PMID: 20824686 DOI: 10.1002/nur.20399] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The relationships between hospital Magnet® status, nursing unit staffing, and patient falls were examined in a cross-sectional study using 2004 National Database of Nursing Quality Indicators (NDNQI®) data from 5,388 units in 108 Magnet and 528 non-Magnet hospitals. In multivariate models, the fall rate was 5% lower in Magnet than non-Magnet hospitals. An additional registered nurse (RN) hour per patient day was associated with a 3% lower fall rate in ICUs. An additional licensed practical nurse (LPN) or nursing assistant (NA) hour was associated with a 2-4% higher fall rate in non-ICUs. Patient safety may be improved by creating environments consistent with Magnet hospital standards.
Collapse
Affiliation(s)
- Eileen T Lake
- Center for Health Outcomes & Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
39
|
Charalambous A, Katajisto J, Välimäki M, Leino-Kilpi H, Suhonen R. Individualised care and the professional practice environment: nurses' perceptions. Int Nurs Rev 2010; 57:500-7. [PMID: 21050203 DOI: 10.1111/j.1466-7657.2010.00831.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To describe individualised care and the professional practice environment from nurses' point of view and to explore the associations between them. BACKGROUND There is an increasing emphasis on individualised nursing care within the literature and the health-care context. Preliminary evidence suggests that the implementation of individualised care is associated with the practice style of care, work organization and the practice environment. METHODS An exploratory correlational survey was used. Data were collected using the Individualised Care Scale and Revised Professional Practice Environment instruments from nurses and nurse managers (n=207, response rate 59%) working in in-patient wards of three acute hospitals' 13 different units in Finland in 2008. Data were analysed based on descriptive statistics and Spearman's rho correlations. FINDINGS Nurses perceived that they generally support patient individuality and that the care they provided was individualised. Nurses' perceptions about the support of individuality and views on individuality of care provided were associated with handling conflict, work motivation, control over practice, leadership and autonomy, relationships with physicians and cultural sensitivity. DISCUSSION The findings support the perception that individualised care and the professional practice environment are associated. There is a need for further studies to examine these associations more closely. Manipulating aspects of the environment may possibly be used to increase the ability of the nurses to provide individualised care. Patient perspectives should be included in future studies. Because of the national data, the results are indicative only. CONCLUSIONS The recognition of the associations between individualised care and professional practice environment elements may help to develop individualised clinical nursing care.
Collapse
Affiliation(s)
- A Charalambous
- Department of Nursing Studies, Cyprus University of Technology, Nicosia, Cyprus
| | | | | | | | | |
Collapse
|
40
|
Simon M, Hausner E, Klaus SF, Dunton NE. Identifying nurse staffing research in Medline: development and testing of empirically derived search strategies with the PubMed interface. BMC Med Res Methodol 2010; 10:76. [PMID: 20731858 PMCID: PMC2936389 DOI: 10.1186/1471-2288-10-76] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 08/23/2010] [Indexed: 11/10/2022] Open
Abstract
Background The identification of health services research in databases such as PubMed/Medline is a cumbersome task. This task becomes even more difficult if the field of interest involves the use of diverse methods and data sources, as is the case with nurse staffing research. This type of research investigates the association between nurse staffing parameters and nursing and patient outcomes. A comprehensively developed search strategy may help identify nurse staffing research in PubMed/Medline. Methods A set of relevant references in PubMed/Medline was identified by means of three systematic reviews. This development set was used to detect candidate free-text and MeSH terms. The frequency of these terms was compared to a random sample from PubMed/Medline in order to identify terms specific to nurse staffing research, which were then used to develop a sensitive, precise and balanced search strategy. To determine their precision, the newly developed search strategies were tested against a) the pool of relevant references extracted from the systematic reviews, b) a reference set identified from an electronic journal screening, and c) a sample from PubMed/Medline. Finally, all newly developed strategies were compared to PubMed's Health Services Research Queries (PubMed's HSR Queries). Results The sensitivities of the newly developed search strategies were almost 100% in all of the three test sets applied; precision ranged from 6.1% to 32.0%. PubMed's HSR queries were less sensitive (83.3% to 88.2%) than the new search strategies. Only minor differences in precision were found (5.0% to 32.0%). Conclusions As with other literature on health services research, nurse staffing studies are difficult to identify in PubMed/Medline. Depending on the purpose of the search, researchers can choose between high sensitivity and retrieval of a large number of references or high precision, i.e. and an increased risk of missing relevant references, respectively. More standardized terminology (e.g. by consistent use of the term "nurse staffing") could improve the precision of future searches in this field. Empirically selected search terms can help to develop effective search strategies. The high consistency between all test sets confirmed the validity of our approach.
Collapse
Affiliation(s)
- Michael Simon
- School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, Kansas 66160, USA.
| | | | | | | |
Collapse
|
41
|
Lopez KD, Gerling GJ, Cary MP, Kanak MF. Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting. J Am Med Inform Assoc 2010; 17:313-21. [PMID: 20442150 DOI: 10.1136/jamia.2009.000422] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis. DESIGN A mix of qualitative and quantitative methods were used to identify work constraints imposed on nurses, which may underlie patient falls. MEASUREMENTS Data collection was done on a neurology unit staffed by 27 registered nurses and utilized field observations, focus groups, time-motion studies and written surveys (AHRQ Hospital Survey on Patient Culture, NASA-TLX, and custom Nursing Knowledge of Fall Prevention Subscale). RESULTS Four major constraints were identified that inhibit nurses' ability to prevent patient falls. All constraints relate to work processes and the physical work environment, opposed to safety culture or nursing knowledge, as currently emphasized. The constraints were: cognitive 'head data', temporal workload, inconsistencies in written and verbal transfer of patient data, and limitations in the physical environment. To deal with these constraints, the nurses tend to employ four workarounds: written and mental chunking schemas, bed alarms, informal querying of the previous care nurse, and informal video and audio surveillance. These workarounds reflect systemic design flaws and may only be minimally effective in decreasing risk to patients. CONCLUSION Cognitive engineering techniques helped identify seemingly hidden constraints in the work domain that impact the problem of patient falls. System redesign strategies aimed at improving work processes and environmental limitations hold promise for decreasing the incidence of falls in inpatient nursing units.
Collapse
Affiliation(s)
- Karen Dunn Lopez
- Department of Health Systems Science, College of Nursing, The University of Illinois Chicago, Chicago, Illinois, USA
| | | | | | | |
Collapse
|
42
|
Aiken LH, Sloane DM, Cimiotti JP, Clarke SP, Flynn L, Seago JA, Spetz J, Smith HL. Implications of the California nurse staffing mandate for other states. Health Serv Res 2010; 45:904-21. [PMID: 20403061 PMCID: PMC2908200 DOI: 10.1111/j.1475-6773.2010.01114.x] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To determine whether nurse staffing in California hospitals, where state-mandated minimum nurse-to-patient ratios are in effect, differs from two states without legislation and whether those differences are associated with nurse and patient outcomes. DATA SOURCES Primary survey data from 22,336 hospital staff nurses in California, Pennsylvania, and New Jersey in 2006 and state hospital discharge databases. STUDY DESIGN Nurse workloads are compared across the three states and we examine how nurse and patient outcomes, including patient mortality and failure-to-rescue, are affected by the differences in nurse workloads across the hospitals in these states. PRINCIPAL FINDINGS California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units. Lower ratios are associated with significantly lower mortality. When nurses' workloads were in line with California-mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care. CONCLUSIONS Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur.
Collapse
Affiliation(s)
- Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104-4217, USA.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Wagner LM, Damianakis T, Mafrici N, Robinson-Holt K. Falls Communication Patterns Among Nursing Staff Working in Long-Term Care Settings. Clin Nurs Res 2010; 19:311-26. [DOI: 10.1177/1054773810370995] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effective fall-risk communication both among staff and between staff and family members is vital for ensuring the safety of residents in long-term care (LTC) settings. This study uses focus group methodology to investigate how information about falls is identified, communicated, and responded to by licensed staff (registered nurses/registered practical nurses) and unlicensed staff (personal support workers) in four LTC facilities. The authors report on the major themes that emerged throughout the focus groups relating to falls management and report on similarities and differences in the communication processes between the two sampled groups. Results highlight communication of the resident’s fall risk, reporting procedures to staff and family members, care plan communication and adherence information, a falls quality improvement knowledge deficit, and barriers to falls quality improvement. Recommendations toward improved communication networks among diverse LTC staff to enhance fall-reduction efforts in LTC settings are provided.
Collapse
Affiliation(s)
- Laura M. Wagner
- Baycrest Geriatric Health Care System, Toronto, Ontario, Canada, , University of Toronto, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
44
|
Harrison BE, Ferrari M, Campbell C, Maddens M, Whall AL. Evaluating the Relationship Between Inattention and Impulsivity-Related Falls in Hospitalized Older Adults. Geriatr Nurs 2010; 31:8-16. [DOI: 10.1016/j.gerinurse.2009.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 09/17/2009] [Accepted: 09/18/2009] [Indexed: 12/17/2022]
|
45
|
Abstract
OBJECTIVE To successfully educate, integrate, and empower nonlicensed personnel in the surgical intensive care unit in the use of a skin care protocol to maintain and improve skin integrity. DESIGN Observational intervention study. SETTING Surgical intensive care unit. PATIENTS Data related to alterations in skin integrity were collected over 4 months, representing approximately 2000 patient-days. A total of 97 specific events representing 121 "areas of concern" were identified by nonlicensed personnel. INTERVENTIONS Nonlicensed staff members' knowledge in 6 key areas related to pressure ulcer (PrU) development was surveyed before and after implementation of an interventional patient hygiene (IPH) program incorporating comprehensive bathing and incontinence protocols. A unique point-of-use skin inspection tool was used by nonlicensed personnel to communicate areas of concern to licensed personnel (registered nurses [RNs]). MAIN OUTCOME MEASURES Reduction in PrUs and improvement in nonlicensed staff knowledge of facility protocols. MAIN RESULTS Incidence of new PrUs decreased from 7.14% at baseline to 0% at the end of the study. Nonlicensed staff knowledge increased to 100% in all 6 knowledge areas. CONCLUSION Implementation of an IPH program incorporating comprehensive bathing and incontinence management resulted in enhanced communication between nonlicensed staff and RNs as well as improved patient outcomes.
Collapse
|
46
|
Schubert M, Clarke SP, Glass TR, Schaffert-Witvliet B, De Geest S. Identifying thresholds for relationships between impacts of rationing of nursing care and nurse- and patient-reported outcomes in Swiss hospitals: a correlational study. Int J Nurs Stud 2008; 46:884-93. [PMID: 19111306 DOI: 10.1016/j.ijnurstu.2008.10.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 10/14/2008] [Accepted: 10/14/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the Rationing of Nursing Care in Switzerland Study, implicit rationing of care was the only factor consistently significantly associated with all six studied patient outcomes. These results highlight the importance of rationing as a new system factor regarding patient safety and quality of care. Since at least some rationing of care appears inevitable, it is important to identify the thresholds of its influences in order to minimize its negative effects on patient outcomes. OBJECTIVES To describe the levels of implicit rationing of nursing care in a sample of Swiss acute care hospitals and to identify clinically meaningful thresholds of rationing. DESIGN Descriptive cross-sectional multi-center study. SETTINGS Five Swiss-German and three Swiss-French acute care hospitals. PARTICIPANTS 1338 nurses and 779 patients. METHODS Implicit rationing of nursing care was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Other variables were measured using survey items from the International Hospital Outcomes Study battery. Data were summarized using appropriate descriptive measures, and logistic regression models were used to define a clinically meaningful rationing threshold level. RESULTS For the studied patient outcomes, identified rationing threshold levels varied from 0.5 (i.e., between 0 ('never') and 1 ('rarely') to 2 ('sometimes')). Three of the identified patient outcomes (nosocomial infections, pressure ulcers, and patient satisfaction) were particularly sensitive to rationing, showing negative consequences anywhere it was consistently reported (i.e., average BERNCA scores of 0.5 or above). In other cases, increases in negative outcomes were first observed from the level of 1 (average ratings of rarely). CONCLUSIONS Rationing scores generated using the BERNCA instrument provide a clinically meaningful method for tracking the correlates of low resources or difficulties in resource allocation on patient outcomes. Thresholds identified here provide parameters for administrators to respond to whenever rationing reports exceed the determined level of '0.5' or '1'. Since even very low levels of rationing had negative consequences on three of the six studied outcomes, it is advisable to treat consistent evidence of any rationing as a significant threat to patient safety and quality of care.
Collapse
Affiliation(s)
- Maria Schubert
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | | | | | | | | |
Collapse
|
47
|
Unruh L, Russo CA, Jiang HJ, Stocks C. Can state databases be used to develop a national, standardized hospital nurse staffing database? West J Nurs Res 2008; 31:66-88. [PMID: 18667627 DOI: 10.1177/0193945908319992] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study evaluates the feasibility of building a national, standardized hospital nurse staffing database from state data collections in order to improve the availability of valid, reliable nursing staffing measures and to allow linkage to other databases. A state-by-state review of public and private reporting systems reveals that 25 states collect some form of nurse staffing data. Out of those, 12 states make complete, usable data available, and 5 additionally meet data quality and specificity criteria. Our review finds that there is little consistency in the content of the RN measure, which makes it difficult to conduct multistate research on nurse staffing topics. We recommend the long-term development of two types of nurse staffing databases: a state-by-state collection, and a standardized, multistate database with uniform data elements across states. This mixed approach will provide a comprehensive source of nurse staffing data to researchers with diverse analytic needs.
Collapse
|
48
|
Burnes Bolton L, Aydin CE, Donaldson N, Brown DS, Sandhu M, Fridman M, Aronow HU. Mandated nurse staffing ratios in California: a comparison of staffing and nursing-sensitive outcomes pre- and postregulation. Policy Polit Nurs Pract 2008; 8:238-50. [PMID: 18337430 DOI: 10.1177/1527154407312737] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article examines the impact of mandated nursing ratios in California on key measures of nursing quality among adults in acute care hospitals. This study is a follow-up and extension of our first analysis exploring nurse staffing and nursing-sensitive outcomes comparing 2002 pre-ratios regulation data to 2004 postratios regulation data. For the current study we used postregulation ratios data from 2004 and 2006 to assess trends in staffing and outcomes. Findings for nurse staffing affirmed the trends noted in 2005 and indicated that changes in nurse staffing were consistent with expected increases in the proportion of licensed staff per patient. This report includes an exploratory examination of the relationship between staffing and nursing-sensitive patient outcomes. However anticipated improvements in nursing-sensitive patient outcomes were not observed. This report contributes to the growing understanding of the impacts of regulatory staffing mandates on hospital operations and patient outcomes.
Collapse
|
49
|
Exploring Organizational Context and Structure as Predictors of Medication Errors and Patient Falls. J Patient Saf 2008. [DOI: 10.1097/pts.0b013e3181695671] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
50
|
Abstract
Because there's no scientific evidence to support specific nurse-patient ratios, and in order to assess the impact of hospital nurse staffing levels on given patient, nurse, and financial outcomes, the author conducted a literature review. The evidence shows that adequate staffing and balanced workloads are central to achieving good outcomes, and the author offers recommendations for ensuring appropriate nurse staffing and for further research.
Collapse
|