Association of hospital nursing and postsurgical sepsis

Hospital nurse staffing variation and Covid-19 deaths: A cross-sectional study

BACKGROUND

During the Covid-19 pandemic, Covid-19 mortality varied depending on the hospital where patients were admitted, but it is unknown what aspects of hospitals were important for mitigating preventable deaths.

OBJECTIVE

To determine whether hospital differences in pre-pandemic and during pandemic nursing resources-average patient-to-registered nurse (RN) staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition-explain differences in risk-adjusted Covid-19 mortality; and to estimate how many deaths may have been prevented if nurses were better resourced prior to and during the pandemic.

METHODS

This is a cross-sectional study of 87,936 Medicare beneficiaries (65-99 years old) hospitalized with Covid-19 and discharged (or died) between April 1 and December 31, 2020, in 237 general acute care hospitals in New York and Illinois. Measures of hospital nursing resources (i.e. patient-to-RN staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition) in the pre-pandemic period (December 2019 to February 2020) and during (April to June 2021) were used to predict in-hospital and 30-day mortality using adjusted logistic regression models.

RESULTS

The mean age of patients was 78 years (8.6 SD); 51 % were male (n = 44,998). 23 % of patients admitted to the hospital with Covid-19 died during the hospitalization (n = 20,243); 31.5 % died within 30-days of admission (n = 27,719). Patients admitted with Covid-19 to hospitals with better nursing resources pre-pandemic and during the pandemic were statistically significantly less likely to die. For example, each additional patient in the average nurses' workload pre-pandemic was associated with 20 % higher odds of in-hospital mortality (OR 1.20, 95 % CI [1.12-1.28], p < 0.001) and 15 % higher odds of 30-day mortality (OR 1.15, 95 % CI [1.09-1.21], p < 0.001). Hospitals with greater proportions of BSN-qualified RNs, better quality nurse work environments, and Magnet recognition offered similar protective benefits to patients during the pandemic. If all hospitals in the study had superior nursing resources prior to or during the pandemic, models estimate many thousands of deaths among patients hospitalized with Covid-19 could have been avoided.

CONCLUSIONS

Patients with Covid-19 admitted to hospitals with adequate numbers of RNs caring for patients, a workforce rich in BSN-qualified RNs, and high-quality nurse work environments (both prior to and during the Covid-19 pandemic) were more likely to survive the hospitalization. Bolstering these hospital nursing resources during ordinary times is necessary to ensure better patient outcomes and emergency-preparedness of hospitals for future public health emergencies.

Mortality Among the Dementia Population in Not-For-Profit Hospitals with Better Nursing Resources

The dementia population has higher rates of mortality during hospital stays than those without dementia. The aim of this study is to examine the relationship between ownership status (i.e. for-profit vs. not-for-profit) and nursing resources (i.e. nurse work environment, nurse-to-patient staffing, and nurse education) on 30-day mortality among post-surgical older adults with dementia. A cross-sectional analysis of linked American Hospital Association, Medicare claims, and nurse survey data was conducted using multi-level logistic regression models. We examined these models to assess the relationship between ownership status and 30-day mortality after adjusting patient and hospital characteristics. We also analyzed the relationship between the hospital ownership status and the 30-day mortality, after considering the three nursing resources. Older adults with dementia who received care in hospitals with not-for-profit status were less likely to die within 30 days of admission following surgery compared to those treated in hospitals with for-profit hospital status (i.e. odds ratio 0.82, 95% confidence interval 0.73-0.92, p = <.001). In addition, the odds ratios estimating the association between ownership and mortality were similar across the different models of the three nursing resources with and without those controls (i.e. 0.88 vs. 0.83 vs. 0.82). Surgical patients with dementia had better outcomes when cared for in not-for-profit hospitals, particularly with greater levels of nurse education and nurse staffing. The relationship between profit status and mortality was partly explained by the lower levels of nurse staffing and education in for-profit vs. not-for-profit hospitals.

Therapeutic Effect of Continuous Blood Purification Combined with Humanized Nursing in Patients with Severe Sepsis

This work aimed to explore the effect of humanized nursing on the patients' recovery from severe sepsis based on continuous blood purification (CBP). 90 patients with severe sepsis were randomly and equally divided into a control group (basic intensive nursing + CBP) and a therapy group (humanized nursing + CBP). Before treatment and on the 7th and 14th days after treatment, indicators of patients were compared, including white blood cell (WBC), tumor necrosis factor (TNF-α), hepatic and renal function, C-reactive protein (CRP), brain natriuretic peptide (BNP), procalcitonin (PCT), and erythrocyte sedimentation rate (ESR). The mortality and nursing satisfaction were compared. After treatment, the saturation of pulse oxygen (SPO₂) in the therapy group (85 ± 20 and 91 ± 9) was higher than that in the control group (78 ± 28 and 82 ± 18, respectively), and the lactic acid level (LAL) was greatly lower (2.8 ± 2.4 and 1.6 ± 0.9 vs. 4.3 ± 2.3 and 2.3 ± 2.7). The Acute Physiology and Chronic Health Evaluation II (APACHE-II) score after treatment was lower (13.67 ± 4.28 and 8.45 ± 5.12 vs. 17.34 ± 6.4 and 11.46 ± 4.23). The BNP, blood urea nitrogen (BUN), and CRP levels were decreased, and so did inflammatory indicators. The survival rate reached 71% and 47% in the therapy group and control group, respectively; and the nursing satisfaction was 97.80% and 26.67%, respectively. Humanized nursing combined with CBP could improve the therapeutic effect and speed up the recovery from severe sepsis.