In Hospitals With More Nurses Who Have Baccalaureate Degrees, Better Outcomes For Patients After Cardiac Arrest

Nursing students' expectations of group supervision while writing a bachelor thesis: A pre-post survey

BACKGROUND

Writing a bachelor thesis has a central role in nursing education. Nursing students require both information and academic literacy in order to write their theses, and there is an expectation that these skills will contribute to putting their knowledge into practice.

OBJECTIVES

To describe students' perceptions of the student and supervisor roles and to investigate students' experienced self-efficacy during the supervision of their bachelor thesis.

DESIGN

A cross-sectional pre-post design.

SETTINGS

Four universities were included. All four had bachelor thesis courses organized as a group supervision process, with a student active approach. Nursing students met together one hour prior to meeting with their supervisor, in order to discuss concerns, try to solve upcoming problems, and plan the agenda for the upcoming supervision session.

PARTICIPANTS

A total of 472 undergraduate nursing students were invited to participate.

METHODS

A web-based questionnaire was used, incorporating the Supervision of Thesis Questionnaire and the General Self-Efficacy Scale. Data were collected at two points: before and after the thesis course. Descriptive statistics and frequencies were calculated, and the independent t-test and Mann-Whitney U test were used for analytic analysis.

RESULTS

The response rate was 39 % (160/472) pre-course and 28 % (130/472) post-course. Nursing students had high expectations of supervision at both time points. Students reporting high self-efficacy had higher expectations of the supervisor's knowledge of the subject and the methods, compared to those reporting lower self-efficacy.

CONCLUSIONS

Nursing students reported high expectations for the supervision process, the supervisor, and themselves, both when entering and when ending the bachelor thesis course. Self-efficacy may contribute to these expectations. Active learning in a group (i.e., collaborative learning) may contribute to nursing students' commitment during the group supervision process in a bachelor thesis course. Further studies are warranted on the optimal group composition to support learning during bachelor thesis courses.

Evaluating associations between patient-to-nurse ratios and mortality, process of care events and vital sign documentation on paediatric wards: a secondary analysis of data from the EPOCH cluster-randomised trial

OBJECTIVE

To describe the associations between patient-to-nurse staffing ratios and rates of mortality, process of care events and vital sign documentation.

DESIGN

Secondary analysis of data from the evaluating processes of care and outcomes of children in hospital (EPOCH) cluster-randomised trial.

SETTING

22 hospitals caring for children in Canada, Europe and New Zealand.

PARTICIPANTS

Eligible hospitalised patients were aged>37 weeks and <18 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was all-cause hospital mortality. Secondary outcomes included five events reflecting the process of care, collected for all EPOCH patients; the frequency of documentation for each of eight vital signs on a random sample of patients; four measures describing nursing perceptions of care.

RESULTS

A total of 217 714 patient admissions accounting for 849 798 patient days over the course of the study were analysed. The overall mortality rate was 1.65/1000 patient discharges. The median (IQR) number of patients cared for by an individual nurse was 3.0 (2.8-3.6). Univariate Bayesian models estimating the rate ratio (RR) for the patient-to-nurse ratio and the probability that the RR was less than one found that a higher patient-to-nurse ratio was associated with fewer clinical deterioration events (RR=0.88, 95% credible interval (CrI) 0.77-1.03; P (RR<1)=95%) and late intensive care unit admissions (RR=0.76, 95% CrI 0.53-1.06; P (RR<1)=95%). In adjusted models, a higher patient-to-nurse ratio was associated with lower hospital mortality (OR=0.77, 95% CrI=0.57-1.00; P (OR<1)=98%). Nurses from hospitals with a higher patient-to-nurse ratio had lower ratings for their ability to influence care and reduced documentation of most individual vital signs and of the complete set of vital signs.

CONCLUSIONS

The data from this study challenge the assumption that lower patient-to-nurse ratios will improve the safety of paediatric care in contexts where ratios are low. The mechanism of these effects warrants further evaluation including factors, such as nursing skill mix, experience, education, work environment and physician staffing ratios.

TRIAL REGISTRATION NUMBER

EPOCH clinical trial registered on clinical trial.gov NCT01260831; post-results.

Relationship Between Unit Characteristics and Fall Incidence: A Cross-Sectional Survey Using Administrative Data in Japan

BACKGROUND

Falls are the most frequent accident experienced by inpatients in hospitals. As falls affect patient outcomes, high fall risk factors should be studied to prevent falls and improve patient safety. However, the relationship between hospital unit characteristics and fall risk has never been assessed.

PURPOSE

This study was designed to identify the unit characteristics significantly related to fall risk.

METHODS

A cross-sectional study was conducted on the medical records of patients hospitalized in a Japanese academic hospital between 2018 and 2019. This study quantified unit activities and utilized Diagnosis Procedure Combination data to examine unit characteristics related to falls based on unit day.

RESULTS

Data on 16,307 patients were included in the analysis, and 355 unit days were certified as fall events. Based on patient condition and medical treatment, the results identified antineoplastic injections, radiation therapy, aseptic treatment room, and functional status of partly assisted transfers, meals, and oral care as unit characteristics associated with increased fall events. Decreased nursing time per patient at night (odds ratio [OR] = 0.75, p = .04) and higher numbers of partially assisted transfer patients were also identified as unit characteristics associated with higher fall incidence rates (OR = 5.56, p = .01).

CONCLUSIONS

The results of this study are expected to assist nurses to predict falls based on unit characteristics; reducing nursing time in the units was found to be a factor associated with higher fall risk. Nurse managers must understand the unit-related fall risk factors, appropriately assign nurse staffing numbers, and demonstrate nursing leadership to prevent falls in their units.

Understanding of and attitudes towards nursing education reform at medical colleges in Kyrgyzstan: A mixed-method study

AIM

To determine teachers' understanding of and attitudes towards nursing education reform at four medical colleges in Kyrgyzstan.

BACKGROUND

The quality of nursing education at undergraduate and postgraduate levels has a major impact on patient outcomes and the development of nursing as a profession and a science.

INTRODUCTION

Lower middle-income countries have sought to advance their nursing education by adopting the experiences of high-income countries.

METHODS

A mixed-method cross-sectional study design was used. The STROBE combined checklist was followed. A cohort of all faculty members at four colleges were included (N = 150). The questionnaire consisted of 10 groups of questions and statements. Both quantitative and qualitative data were collected.

FINDINGS

A total of 56.4% of respondents were familiar with the European approach to nurse education; 73.3% of respondents with a nursing education reported being familiar with the European approach, compared to 40.7% of respondents with a medical education. Qualitative written comments yielded 57 superscripts of codes, 14 subcategories, 5 categories and 2 themes as drivers and barriers of reform.

DISCUSSION

The survey revealed weak support for the nursing education reform. Respondents do not envisage nurse education being offered at all three levels of higher education (bachelor's, master's, and PhD), and even fewer recognise nurses as leaders of healthcare institutions.

IMPLICATION FOR NURSING

Teachers in nursing programmes should mostly be nurses with academic careers.

IMPLICATION FOR HEALTH POLICY

Nursing is still not recognised as an extremely important health profession that needs to be developed. This misunderstanding and negative attitude towards the role of nurses in the health care system are evident in both the quantitative and qualitative parts of the study.

Working on differentiated nursing practices in hospitals: A learning history on enacting new nursing roles

OBJECTIVE

This study aims to better understand how new future-oriented nursing roles are enacted in a general hospital.

DESIGN

A learning history, that is, a participatory action-oriented research design to explore and foster organizational learning.

METHODS

Data collection consisted of a (historical) document analysis, the shadowing of differentiated nursing practices (36 h), 22 open interviews, 4 oral history interviews, 2 focus groups and a podcast series (7 h) created with participants.

RESULTS

The data gathered revealed three important themes regarding enacting new nursing roles: (1) stretching the nature of nursing work, (2) using earlier experiences and (3) collectively tackling taboos.

CONCLUSIONS

Differentiated nursing practices and enacting new nursing roles have long and complex histories. Attempts to differentiate are often met with resistance from within the nursing profession. This study shows how the new role of nurse coordinator was negotiated in nursing teams. With a bottom-up approach focused on collective responsibilities. By acknowledging and reflecting on the past, spaces were enacted in which the role of nurse coordinator became one role, among others, in the delivery of patient care.

IMPACT

This study provides an innovative perspective on differentiated nursing practices by focusing on the past, the present and the future. We found that local, situated conditions can be taken as starting points when new nursing roles are enacted. In addition, shifting focus from individual nursing roles to nursing team development, emphasizing collective responsibilities, softens strong (historically) grown emotions and creates spaces in which new roles become negotiable.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Workload and short sickness absences in a cohort of Finnish hospital employees

This article used register data on day-to-day working hours of hospital employees combined with patient characteristics at work unit (wards) level to measure workload and its implications for short, self-certified sickness absences. We measured statistically the average nursing treatment burden of different patient mixes in hospital wards, and then analyzed the overall workload (intensity) of working days by comparing it to the actual available nursing workforce. We found that a significant part of the workload variation occurred between working days, and it was related to unexpected changes in the number of employees. In atypical situations a long work shift was associated with caring for patients with fewer resources. The high workload of a day increased the risk of short sickness absences along the following 3-week period. The results show that managing short-term workload variability should be a key aim from the perspective of well-being at work, and that combining different data sources can provide novel, important insights to the measurement of workload.

Multidisciplinary Consensus on Curricular Priorities for Pediatric Neurocritical Care Nursing Education: A Modified Delphi Study in the United States

BACKGROUND

Nurses are vital partners in the development of pediatric neurocritical care (PNCC) programs. Nursing expertise is acknowledged to be an integral component of high-quality specialty patient care in the field, but little guidance exists regarding educational requirements to build that expertise. We sought to obtain expert consensus from nursing professionals and physicians on curricular priorities for specialized PNCC nursing education in pediatric centers across the United States.

METHODS

We used a modified Delphi study technique surveying a multidisciplinary expert panel of nursing professionals and physicians. Online surveys were distributed to 44 panelists over three rounds to achieve consensus on curricular topics deemed essential for PNCC nursing education. During each round, panelists were asked to rate topics as essential or not essential, as well as given opportunities to provide feedback and suggest changes. Feedback was shared anonymously to the panelist group throughout the process.

RESULTS

From 70 initial individual topics, the consensus process yielded 19 refined topics that were confirmed to be essential for a PNCC nursing curriculum by the expert panel. Discrepancies existed regarding how universally to recommend topics of advanced neuromonitoring, such as brain tissue oxygenation; specialized neurological assessments, such as the serial neurological assessment in pediatrics or National Institutes of Health Stroke Scale; and some disease-based populations. Panelists remarked that not all centers see specific diseases, and not all centers currently employ advanced neuromonitoring technologies and skills.

CONCLUSIONS

We report 19 widely accepted curricular priorities that can serve as a standard educational base for PNCC nursing. Developing education for nurses in PNCC will complement PNCC programs with targeted nursing expertise that extends comprehensive specialty care to the bedside. Further work is necessary to effectively execute educational certification programs, implement nursing standards in the field, and evaluate the impact of nursing expertise on patient care and outcomes.

Perceived Barriers and Strategies to Increasing the BSN-Prepared Nursing Workforce

ABSTRACT

Care provided by Bachelor of Science in Nursing (BSN)-prepared Registered Nurses (RNs) has been shown to lead to more positive patient outcomes compared to care provided by non-BSN-prepared RNs. A Fall 2021 study explored barriers of requiring a BSN degree of staff nurses from the perspective of hospital and long-term care facility nurse leaders in Tennessee (N = 89), strategies to increase the number of nurses with BSNs, and association between leadership goals and the number of BSN-prepared nurses in the facilities. Seven barriers to requiring the BSN and nine strategies to increase BSNs were identified. Significant association was found between having plans to increase the number of BSN nurses and the percentage of nurses in the facility with BSN degrees.

Critical care nurses' experiences of caring challenges during post-resuscitation period: a qualitative content analysis

BACKGROUND

Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care.

AIM

This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period.

METHODS

A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis.

RESULTS

Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses' roles. Additionally, nurses expressed a negative attitude towards resuscitated patients.

CONCLUSION

Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses' roles in the post-resuscitation period and increasing support from nursing managers.

Examining online international health professions education: a mixed methods review of barriers, facilitators, and early outcomes★

BACKGROUND

Access to quality healthcare education across the world is disproportionate. This study explores the potential for Cardiovascular Perfusion education to be delivered online to reach international students.

METHODS

Exploratory mixed methods were used to identify the barriers, facilitators, and early outcomes of online international health professions education.

RESULTS

Qualitative analysis yielded four primary and nine subthemes. Multiple interventions were implemented in the planning of a novel online international Extracorporeal Science (ECS) program based on these themes. Quantitative data from the first semester of the new ECS program was collected along with data from the traditional entry-level program and historic data from previous entry-level cohorts. No significant correlations or differences were found between students. Student satisfaction surveys were determined to be equivalent for each group. Mixed data analysis revealed exceptional student satisfaction in areas where qualitative feedback was incorporated into the program design.

CONCLUSIONS

Online international education may be a viable option in the health professions. Barriers and facilitators to this mode of education were identified and utilized in designing one such program. Early outcomes from the novel ECS program reveal that student performance and satisfaction are equivalent to those of a traditional in-person training program.

The Effects of Organizational Characteristics, Individual Nurse Characteristics, and Occupational Fatigue on Missed Care at Night

BACKGROUND

Missed care is defined as the omission or delay of necessary patient care and is internationally reported by nurses as a significant safety risk. Nurses working at night also report high levels of occupational fatigue that, coupled with inadequate staffing and practice environment support, may impede a nurse's ability to carry out the nursing process and lead to more missed care.

OBJECTIVE

The study's objective was to examine the interrelationships among organizational and nurse characteristics, occupational fatigue, and missed care among nurses working at night.

METHODS

A cross-sectional design was used. Participants included registered nurses (RNs) who worked at night in New Jersey acute care hospitals. Multiple linear regression and simple moderation analyses were performed to examine the associations.

RESULTS

Nurses reported missing necessary care at night. Unsupportive practice environments, high RN workloads, high patient-RN ratios, high chronic fatigue levels, and low intershift recovery were individually associated with missed care at night. High patient-to-RN ratios and chronic fatigue were independently associated with missed care. However, patient-to-registered-staffing levels had the most considerable effect on missed care at night. Nurses' years of experience and the number of hours of sleep between shifts were significant moderators of the relationship between occupational fatigue states and missed care.

DISCUSSION

This study is the first to examine the interrelationship between occupational fatigue levels, organizational and nurse characteristics, and missed care at night. There is an urgent need to implement strategies in hospital organizations that foster work schedules and adequate staffing patterns that lessen nurses' occupational fatigue levels to ensure our workforce's and patients' safety.

Implementation and effectiveness of a nurse navigation programme based on noddings' care theory in first-year undergraduate nursing students for professional identity and career planning: A quasi-experimental study

AIMS

Development and evaluation of the effectiveness of a Nurse Navigation programme based on Noddings' Care theory on two dependent variables which were professional identity and career planning among first-year undergraduate nursing students.

BACKGROUND

First-year undergraduate nursing students generally have a low sense of professional identity and career planning, resulting in a loss of nursing power after graduation. Implemention of a Nurse Navigation program based on Noddings' Care theory may be potentially useful in cultivating their professional identity and career planning.

DESIGN

A quasi-experimental study.

METHODS

A convenience sample of 122 first-year undergraduate nursing students from two medical universities was recruited between September 2021 and June 2022. Students in the experimental group (n = 63) participated in the Nurse Navigation programme based on Noddings' Care theory, which contained four core components, spreading over 50 lessons. Those in the control group (n = 59) underwent a traditional training programme with five components across 44 lessons. The two groups were compared in terms of their level of professional identity by Professional identity questionnaire for nurse students (PIQNS) and career planning by Career planning questionnaire (CPQ) after the training using the t-test.

RESULTS

The mean score of professional identity in the experimental group increased significantly from 51.02 ± 8.46 at baseline to 58.02 ± 8.81 after the intervention (p < 0.001), with a large effect size (Cohen's d=0.810). Also, this post-intervention score was statistically significantly higher than that (52.86 ± 9.27) in the control group (p = 0.002), with a medium effect size (Cohen's d=0.571). The mean score of career planning in the experimental group increased significantly from 81.76 ± 9.86 at baseline to 94.52 ± 10.81 after the intervention (p < 0.001), with a large effect size (Cohen's d = 1.233). Also, this post-intervention score was statistically significantly higher than that (88.25 ± 9.30) in the control group (p < 0.001), with a medium effect size (Cohen's d=0.623).

CONCLUSIONS

The Nurse Navigation programme based on Noddings' Care theory showed effectiveness in enhancing professional identity and career planning among first-year undergraduate nursing students in China. Further rigorous studies are needed to examine its effectiveness and long-term impacts on these students.

RT education and COVID-19 pneumonia discharge quality

Background

There is a lack of data assessing the influence of respiratory therapist (RT) education on clinical outcomes. The primary objective of this study was to evaluate the impact of RTs holding advanced degrees or completing adult critical care competencies on discharge outcomes of patients with COVID-19 pneumonia.

Study Design and Methods

This retrospective, cross-sectional study included adults with confirmed COVID-19 admitted to the hospital for at least three days between March-May 2020. The academic degree held by each RT was considered advanced (baccalaureate or higher) or associate degree. Discharge outcomes were considered good, compromised, or poor when subjects' hospital discharge was directly to home, long-term care facility/rehabilitation center, or hospice/died, respectively. A time-to-event multi-state regression model was used to determine the impact of RT academic degree and adult critical care competencies on discharge outcomes using α=0.05.

Results

A total of 260 subjects (median age 59 y; 166 males) received clinical care from 132 RTs. RT median professional experience was six y (IQR 3-11), 70.8% had an advanced degree, and 70.8% completed adult critical care competencies. The time-to-event multi-state regression model showed that patients with >85% exposure to RTs with advanced degrees transitioned 3.72 times more frequently to good outcomes than RTs without advanced degrees (p=.001). Similarly, patients with >85% exposure to RTs with adult critical care competencies transitioned 5.10 times more frequently to good outcomes than RTs without adult critical care competencies (p<.001).

Conclusion

Patients with COVID-19 pneumonia who received greater than 85% of their care by RTs who earned advanced degrees or completed adult critical care competencies had improved discharge outcomes. This preliminary work suggests that advancing education for the respiratory therapist workforce may improve the discharge quality of patients with acute respiratory failure and should be further explored.

Standards for evaluating the quality of undergraduate nursing e-learning programme in low- and middle-income countries: a modified Delphi study

BACKGROUND

The lack of standards for evaluating the quality of undergraduate nursing programmes hampers the evaluation of e-learning programmes in low- and middle-income countries. Fragmented approaches to evaluation coupled with a lack of uniform criteria have been a major deterrent to the growth of e-learning. Adopting standards from high-income countries has contextual challenges in low- and middle-income countries (LMICs). Holistic approaches coupled with uniform standards provide information to stakeholders hence the quality of the programmes is measurable. The e-learning situation in low-and middle-income countries provided an impetus to develop and validate these standards.

DESIGN

A modified Delphi technique.

REVIEW METHODS

Fourteen experts with experience and expertise in e-learning and regulation of undergraduate nursing from fourteen countries from LMICs participated in three rounds of the modified Delphi process. A pre-described set of standards was shared electronically for independent and blinded ratings. An 80% threshold was set for consensus decisions. The standards were modified based on experts' comments, and two subsequent rounds were used to refine the standards and criteria.

RESULTS

At the end of round one, the expert consensus was to keep 67, modify 39 and remove three criteria. At the end of the second round, the consensus was to modify 38 and remove one criteria. In the third round, experts agreed that the standards were feasible, usable, and practical in LMICs. A total of six broad standards with 104 criteria were developed.

CONCLUSION

The Technological bloom permeating all spheres of society, including education is an essential component in the development of e-learning programmes. E-learning in nursing education requires critical evaluation to ensure quality in undergraduate nursing programmes. The intricacies of the Low and middle-income context were taken into consideration in developing the standards to offer sustainable evaluation of the quality of e-learning in LMICs, and local solutions to local problems.

Seamless Academic Progression in Nursing Education: A Qualitative Descriptive Study

AIM

The aim of this study was to investigate programs throughout the United States for seamless academic progression from associate degree nursing (ADN) to baccalaureate degree nursing programs (BSN).

BACKGROUND

Seamless academic progression has been shown to have a positive effect on increasing the proportion of BSN nurses. Goals to increase the number of BSN-prepared nurses have not been met.

METHOD

A qualitative descriptive study was conducted to assess how nurse administrators of ADN programs move toward seamless academic progression for students.

RESULTS

Three themes that described the current state of seamless progression emerged from the data: a) ongoing communication between program leaders, students, and stakeholders; b) development of pathways that enable seamless academic progression; and c) stakeholder influence on academic progression.

CONCLUSION

Administrators who participated in this study shared that their progression programs were in the early developmental stages.

'No more heroes': The ILC Oxford Statement on fundamental care in times of crises

AIM

To outline the International Learning Collaborative (ILC) Oxford Statement, explicating our commitment to ensuring health and care systems are equipped to meet patients' fundamental care needs during times of unprecedented crisis.

DESIGN/METHOD

Discussion paper. The content was developed via a co-design process with participants during the ILC's international conference.

KEY ARGUMENTS

We, the ILC, outline what we do and do not want to see within our health and care systems when faced with the challenges of caring for patients during global pandemics and other crises. Specifically, we want fundamental care delivery to be seen as the minimum standard rather than the exception across our health and care systems. We want nursing leaders to call out and stand up for the importance of building fundamental care into systems, processes and funding priorities. We do not want to see the voices of nursing leaders quashed or minimized in favour of other agendas. In turn, what we want to see is greater recognition of fundamental care work and greater respect for the people who do it. We expect nurses to have a 'seat at the table' where the key health and care decisions that impact patients and staff are made.

CONCLUSION

To achieve our goals we must (1) ensure that fundamental care is embedded in all health and care systems, at all levels; (2) build on and strengthen the leadership skills of the nursing workforce by clearly advocating for person-centred fundamental care; (3) co-design systems that care for and support our staff's well-being and which foster collective resilience rather than overly rely on individual resilience; (4) improve the science and methodologies around reporting and measuring fundamental care to show the positive impact of this care delivery and (5) leverage the COVID pandemic crisis as an opportunity for transformational change in fundamental care delivery.

Is nurse staffing associated with critical deterioration events on acute and critical care pediatric wards? A literature review

Pediatric and neonatal patients admitted to acute and critical care wards may experience critical deterioration events that may lead to unexpected deaths if unrecognized and untreated promptly. Adequate levels and skill-mix of nurse staffing are essential for the quality of patient monitoring and response to deteriorating patients. Insufficient staffing may have an impact on the occurrence of missed care and consequently on critical deterioration events, increasing the risk of mortality and failure-to-rescue. To review the literature to explore the association between nurse staffing levels or skill-mix and pediatric and neonatal critical deterioration events, such as mortality, pediatric intensive care unit (PICU)/neonatal intensive care unit (NICU) unplanned admissions, cardiac arrests, and failure-to-rescue. A structured narrative literature review was performed. Pubmed, Cinhal, and Web of Science were searched from January 2010 to September 2022. Four independent reviewers conducted the study screening and data extraction. The quality of the studies included was evaluated using the Joanna Briggs Institute critical appraisal tools. Out of a total of 2319 studies, 15 met the inclusion criteria. A total of seven studies were performed in PICU, six in NICU, and two in general pediatric wards. Nurse staffing measures and outcomes definitions used were heterogeneous. Most studies suggested nursing skill-mix, increased working experience, or higher nursing degrees were associated with increased survival in PICU. Decreased nursing staffing levels were associated with increased mortality in NICU and mechanically ventilated patients in PICU.

CONCLUSION

Evidence on the association of nurse staffing and critical deterioration events in PICU and NICU is limited, while there is no evidence reported for pediatric wards. Future research is needed to determine adequate levels of nurse/patient ratios and proportion of registered nurses in the skill-mix for pediatric acute and critical care nursing to improve outcomes on in-patient wards.

WHAT IS KNOWN

• Adult nursing skill-mix, staffing ratios, and level of education are associated with patient mortality and failure to rescue. • In children, nurse staffing levels are associated with clinical outcomes.

WHAT IS NEW

• Evidence on the association of nurse staffing levels or skill-mix with pediatric or neonatal mortality is limited. • There is some evidence regarding the association of nursing work experience, certification, higher level degree with in-hospital survival in PICU.

Nurse Education and Hospital Readmissions for Children With and Without a Mental Health Condition

OBJECTIVES

In adults, receiving care in a hospital with more baccalaureate-prepared nurses improves outcomes. This relationship is magnified in adults with serious mental illness or cognitive impairment. Whether the same is true in children with and without a mental health condition is unknown. The study purposes were to determine 1) whether the proportion of baccalaureate-prepared nurses affected the odds of readmission in children; and 2) whether this relationship differed for children with a mental health condition.

PATIENTS AND METHODS

We linked cross-sectional data from the 2016 Healthcare Cost and Utilization Project State Inpatient Databases, the RN4CAST-US nurse survey in Florida, and the American Hospital Association. Inclusion criteria were ages 3 to 21 years. Mental health conditions were defined as psychiatric or developmental/behavioral diagnoses. These were identified using the Child and Adolescent Mental Health Disorders Classification System. We used multivariable, hierarchical logistic regression models to assess the relationship between nurse training and readmissions.

RESULTS

In 35 081 patients admitted to 122 hospitals with 4440 nurses, 21.0% of patients had a mental health condition and 4.2% had a 7-day readmission. For individuals without a mental health condition, each 10% increase in the proportion of baccalaureate-prepared nurses was associated with 8.0% lower odds of readmission (odds ratio = 0.92, 95% confidence interval = 0.87-0.97). For those with a mental health condition, each 10% increase in the proportion of baccalaureate-prepared nurses was associated with 16.0% lower odds of readmission (odds ratio = 0.84, 95% confidence interval = 0.78-0.91).

CONCLUSIONS

A higher proportion of baccalaureate-educated nurses is associated with lower odds of readmission for pediatric patients. This association has a larger magnitude in patients with a mental health condition.

Concept Analysis of Systems Thinking in the Context of Interprofessional Practice and Improved Patient Outcomes

AIM

The purpose of this study was to explore the definition and application of systems thinking (ST) in interprofessional practice and improved patient outcomes.

BACKGROUND

Nurse educators need a universal definition of ST to implement in curricula to foster quality and safety while enhancing outcomes for nursing students.

METHOD

The QSEN RN-BSN Task Force used the hybrid model of concept analysis to identify the process of fostering ST in clinical and didactic learning experiences and how ST changed over time from the perspective of educators.

RESULTS

The definition of ST in the context of interprofessional practice and outcomes was "a dynamic, analytical process that looks at complex patterns, relationships, and connections within elements and structures, resulting in the ability to recognize the whole picture."

CONCLUSION

The concept of ST in the context of interprofessional practice and improved patient outcomes may be integrated within nursing curricula.

A Pediatric-Specific View on Improved Nurse-Sensitive Indicators Related to Increased BSN or Higher Rates Over Time

BACKGROUND

Nurses obtaining higher levels of education has been recommended nationally for more than a decade to support improved patient outcomes.

LOCAL PROBLEM

Organizational strategies were implemented to achieve a highly educated workforce at the project site over 14 years. However, there was no evaluation of relationship with increasing education levels and pediatric patient outcomes.

METHODS

A quality improvement project explored the relationship of Bachelor of Science in Nursing (BSN) or higher prepared nurses with 9 different nurse-sensitive indicators (NSIs). Educational preparation and NSI data were retrieved retrospectively from hospital databases from up to 14 years.

RESULTS

Moderate to moderately strong correlations were noted between the proportion of BSN or higher prepared nurses and 2 NSIs (central line-associated bloodstream infections, r = -0.55 and surgical site infections, r = -0.71). Four of the 9 indicators were approaching moderate correlation.

CONCLUSIONS

Increasing the proportion of highly educated nurses at the project site correlated with improvements in select NSI outcomes.

The Association between Nursing Skill Mix and Patient Outcomes in a Mental Health Setting: Protocol for an Observational Feasibility Study

International research on nursing skill mix has focused primarily on medical and surgical patient populations. The association between nursing skill mix and clinical outcomes for psychiatric inpatients has not been explored. The aim of this study is to establish the feasibility of extracting and linking nurse and inpatient data from hospital administrative data sources. This is an observational study. Data will be extracted from hospital administrative sources and linked together. Patient information will include duration and number of psychiatric hospital admissions. We will extract information on the educational preparation of nurses working in the participating hospitals to enable us to calculate estimates of the nursing skill mix. The study will be conducted in two psychiatric inpatient services in Australia. Our study will test the feasibility of extracting and linking nursing skill mix and patient data in a mental health setting and will inform the methodological development of an appropriately powered observational study. Australian and New Zealand clinical trial registry: ACTRN12619001337167p.

Critical Care Unit Organizational and Personnel Factors Impact Cardiac Arrest Prevention and Rescue in the Pediatric Cardiac Population

OBJECTIVES

Patient-level factors related to cardiac arrest in the pediatric cardiac population are well understood but may be unmodifiable. The impact of cardiac ICU organizational and personnel factors on cardiac arrest rates and outcomes remains unknown. We sought to better understand the association between these potentially modifiable organizational and personnel factors on cardiac arrest prevention and rescue.

DESIGN

Retrospective analysis of the Pediatric Cardiac Critical Care Consortium registry.

SETTING

Pediatric cardiac ICUs.

PATIENTS

All cardiac ICU admissions were evaluated for cardiac arrest and survival outcomes.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Successful prevention was defined as the proportion of admissions with no cardiac arrest (inverse of cardiac arrest incidence). Rescue was the proportion of patients surviving to cardiac ICU discharge after cardiac arrest. Cardiac ICU organizational and personnel factors were captured via site questionnaires. The associations between organizational and personnel factors and prevention/rescue were analyzed using Fine-Gray and multinomial regression, respectively, accounting for clustering within hospitals. We analyzed 54,521 cardiac ICU admissions (29 hospitals) with 1,398 cardiac arrest events (2.5%) between August 1, 2014, and March 5, 2019. For both surgical and medical admissions, lower average daily cardiac ICU occupancy was associated with better cardiac arrest prevention. Better rescue for medical admissions was observed for higher registered nursing hours per patient day and lower proportions of "part time" cardiac ICU physician staff (< 6 service weeks/yr). Increased registered nurse experience was associated with better rescue for surgical admissions. Increased proportion of critical care certified nurses, full-time intensivists with critical care fellowship training, dedicated respiratory therapists, quality/safety resources, and annual cardiac ICU admission volume were not associated with improved prevention or rescue.

CONCLUSIONS

Our multi-institutional analysis identified cardiac ICU bed occupancy, registered nurse experience, and physician staffing as potentially important factors associated with cardiac arrest prevention and rescue. Recognizing the limitations of measuring these variables cross-sectionally, additional studies are needed to further investigate these organizational and personnel factors, their interrelationships, and how hospitals can modify structure to improve cardiac arrest outcomes.

Developing trends of initial nursing education in China from 2006 to 2017: A descriptive analysis based on national-level data

INTRODUCTION

There is currently a global nurse shortage. Initial nursing education is the primary preparation for a robust nursing workforce that must be strengthened.

OBJECTIVES

To describe the developing trends of initial nursing education in China from 2006 to 2017 and to analyze related characteristics and issues.

DESIGN

A descriptive study with secondary data analysis.

METHODS

The numbers, educational-level composition and regional distribution (i.e., East, Central, West, and Northeast regions) of students recruited into initial nursing education programs from 2006 to 2017 were analyzed. Changes in the numbers of the nursing workforce from 2006 to 2020 were compared with the changes in education sector to facilitate an interpretation of the development trend of initial nursing education.

RESULTS

The number of recruits into initial nursing education programs has increased from 0.38 million in 2006 to 0.44 million in 2008, and maintained between 0.5 million and 0.54 million during 2009 to 2017. Students recruited to secondary diploma, advanced diploma, and baccalaureate degree programs accounted for 50.55% (71.46% in 2009), 39.36% and 10.09% of the total in 2017, respectively. There were 3.34 nurses per 1000 population in 2020, a substantial increase from 1.09 in 2006. The regional distribution of recruits was imbalanced, with more recruits per 1000 population in the West (0.49), Central (0.40), Northeast (0.34) and the least in the East (0.26) in 2017. The distribution of nurses was relatively balanced among the four regions.

CONCLUSIONS

The development in initial nursing education in China is significant from 2006 to 2017. The education sector recruited and graduated about 0.5 million nursing students respectively per year in recent years. If simply considering the number of recruits, it could meet the workforce demands, however, to further upgrade nurses' educational preparation, the recruits into advanced diploma and baccalaureate degree programs need to be increased. A maldistribution of recruits among regions persists, while the distribution of nurses is relatively balanced. Multiple strategies should be adopted to achieve a balance between the supply and demand of nurses, with providing more higher-educated nurses in all regions across mainland China.

The Impact of Nurse Staffing on Falls Performance within a Healthcare System: A Descriptive Study

AIM

The purpose of this study was to examine the impact of nurse staffing on inpatient falls performance across a multi-hospital system.

BACKGROUND

Evidence to support which staffing variables influence fall performance so that healthcare organizations can better allocate resources is lacking.

METHOD

A descriptive study design was used to analyze the impact of nurse staffing and falls performance, with units dichotomized as either high or low performing based on national benchmarking data. The impact was evaluated using 10 nurse staffing variables.

RESULTS

A total of 9 units were included (5 high and 4 low performing). Higher performing units showed less use of sitters and travelers, had fewer nurses working overtime hours, and employed more expert-level clinical nurses and combined nursing assistant/health unit coordinator positions, than lower performing units.

CONCLUSION

Findings provide evidence of how staffing variables affect a unit's falls performance. While significant relationships were found, further evaluation is needed to explore the relationship of staffing variables and quality outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers may consider trying to reduce use of sitters and travelers, and utilize innovative staffing models, such as using combined nursing assistant/health unit coordinator positions, to help improve their falls performance.

Variations in nursing baccalaureate education and 30-day inpatient surgical mortality

BACKGROUND

In 2010, the IOM recommended an increase in the proportion of bachelor's-prepared (BSN) nurses to 80% by 2020. This goal was largely based on evidence linking hospitals with higher proportions of BSN nurses to better patient outcomes. Though, evidence is lacking on whether outcomes differ by a hospital's composition of initial BSN and transitional RN-to-BSN nurses.

PURPOSE

The purpose of this study is to determine whether risk-adjusted odds of surgical mortality are associated with a hospital's proportion of initial BSN and transitional RN-to-BSN nurses.

METHODS

Logistic regression models were used to analyze cross-sectional data of general surgical patients, nurses, and hospitals in four large states in 2015 to 2016.

FINDINGS

Higher hospital proportions of BSN nurses, regardless of educational pathway, are associated with lower odds of 30-day inpatient surgical mortality.

DISCUSSION

Findings support promoting multiple BSN educational pathways to reach the IOM's recommendation of at least an 80% BSN workforce.

The effects in assistance indicators of changes on a nursing team

Introduction: This article discusses the path of healthcare associated infections (HAI) indicators in the intensive care unit (ICU) of a public teaching hospital in Belo Horizonte, Minas Gerais, Brazil, after certain change in its nursing staff: pair of nursing caregivers. The model of a pair of caregivers consists in assigning one nurse and one nursing technician for every three patients. The indicators analyzed were infection related to central venous catheters (CVCs), the risk of HAI, turnover, and absenteeism. Objective: The objective of this paper is to understand the impact of the restructuring of the nursing staff in Human Resources and on the rate of infection in the ICU. Methods: As for methods, it is a qualitative and descriptive research carried out as a case study. Results: The results have shown that the risk of HAIs significantly increased after the change in staffing, but the density of vascular access infection associated with CVCs was drastically reduced. The results of turnover of nursing technics decreased and the turnover of nurses increased while the absenteeism of the nursing team decreased after the change. The interviews revealed that there was a gain at the care due to the change. Conclusion: As a conclusion, the results of the study have shown that the proposed nursing model caused a care gain, once the interviews exposed that and indicator directly related to nursing team care (infection associated with CVCs) decreased.

An Innovative Model Integrating an Academic-Practice Partnership in an RN-BSN Program

Research demonstrates a higher concentration of bachelor of science in nursing (BSN)-prepared registered nurses improves patient care outcomes. To increase the BSN workforce, one academic institution, in collaboration with a practice partner, formed an academic-practice partnership. Strategic actions included the development of the integration model for the RN-BSN program as a framework for program expansion, curricular revision, nurse leader faculty integration, and student clinical placement. Partnership outcomes included the acceptance of all qualified applicants for admission, clinical placement secured for all students, excellent course evaluation ratings for faculty, and development of a sustainable and transferrable model.

Value of Nurse Practitioner Inpatient Hospital Staffing

BACKGROUND

Evidence indicates hospitals with better registered nurse (RN) staffing have better patient outcomes. Whether involving more nurse practitioners (NPs) in inpatient care produces better outcomes is largely unknown.

OBJECTIVE

The objective of this study was to determine whether the presence of more NPs produces better inpatient outcomes net of RN staffing.

RESEARCH DESIGN

This was a 2015-2016 cross-sectional data on 579 hospitals linked from: (1) RN4CAST-US nurse surveys; (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; (3) surgical patient discharge abstracts; (4) Medicare Spending per Beneficiary (MSPB) reports; (5) American Hospital Association (AHA) Annual Survey. Hospitals were grouped according to their NP/beds ratios [<1 NP/100 beds (N=132), 1-2.99 NPs/100 beds (N=279), and 3+ NPs/100 beds (N=168)].

SUBJECTS

RNs randomly sampled nurses from licensure lists yielded 22,273 RNs in study hospitals; discharge data for 1.4 million surgical patients; HCAHPS data for 86% of study hospitals.

MEASURES

Mortality, readmissions, lengths of stay, MSPB, patient experience, and quality reported by patients and nurses.

RESULTS

After adjustments, patients in hospitals with 3+ NPs/100 beds had lower odds than patients in hospitals with <1 NP/100 beds of 30-day mortality [odds ratio (OR)2=0.76; 95% confidence interval (CI)=0.67-0.82; P<0.001] and 7-day readmissions (OR2=0.90; 95% CI=0.86-0.96; P<0.001), shorter average length of stay (incident rate ratio2=0.92; 95% CI=0.88-0.96; P<0.001) and 5.4% lower average MSPB (95% CI=3.8%-7.1%). Patients and nurses in the hospitals with higher NP/bed ratios were significantly more likely to report better care quality and safety, and nurses reported lower burnout, higher job satisfaction, greater intentions of staying in their jobs.

CONCLUSIONS

Having more NPs in hospitals has favorable effects on patients, staff nurse satisfaction, and efficiency. NPs add value to existing labor resources.

Practice environment, independence, and roles among DNP- and MSN-prepared primary care nurse practitioners

BACKGROUND

Many nursing schools are adopting the Doctor of Nursing Practice (DNP) as the preferred model of nurse practitioner (NP) education and eliminating Master of Science in Nursing (MSN) programs. To date, no studies have explored the relationship between DNP preparation and NP practice environment, independence, and roles.

PURPOSE

The purpos of this study is to compare practice environment, independence, and roles among DNP- and MSN-prepared primary care NPs.

METHODS

This study used a cross-sectional design and observational regression analysis of survey data.

FINDINGS

DNP-prepared NPs reported: 1) more favorable NP-Physician Relationships, 2) fewer clinical hours, and 3) more practice leadership. These differences were, however, small and not significant at 0.05 level.

DISCUSSION

We found no major differences in practice environment, independence, and roles among DNP- and MSN-prepared primary care NPs. As more nursing schools establish DNP programs and more DNP-prepared NPs enter the field, it is especially important to continue to study the impact of DNP preparation on the NP workforce.

Changes in proportion of bachelor's nurses associated with improvements in patient outcomes

This study uses data from two cross-sections in time (2006, 2016) to determine whether changes over time in hospital employment of bachelor's of science in nursing (BSN) nurses is associated with changes in patient outcomes. Data sources include nurse survey data, American Hospital Association Annual Survey data, and patient administrative claims data from state agencies in California, Florida, New Jersey, and Pennsylvania. The study sample included general surgical patients aged 18-99 years admitted to one of the 519 study hospitals. Multilevel logistic regression and truncated negative binomial models were used to estimate the cross-sectional and longitudinal effects of the proportion of hospital BSN nurses on patient outcomes (i.e., in-hospital mortality, 7- and 30-day readmissions, length of stay). Between 2006 and 2016, the average proportion of BSN nurses in hospitals increased from 41% to 56%. Patients in hospitals that increased their proportion of BSN nurses over time had significantly reduced odds of risk-adjusted mortality (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), 7-day readmission (OR: 0.96, 95% CI: 0.94-0.99) and 30-day readmission (OR: 0.98, 95% CI: 0.95-1.00), and shorter lengths of stay (incident rate ratio [IRR]: 0.98, 95% CI: 0.97-0.99). Longitudinal findings of an association between increased proportions of BSN nurses and improvements in patient outcomes corroborate previous cross-sectional research, suggesting that a better educated nurse workforce may add value to hospitals and patients.

Nurse staffing legislation: Empirical evidence and policy analysis

Unsafe nurse staffing conditions in hospitals have been shown to increase the risk of adverse patient events, including mortality. Consequently, United States and international professional nursing organizations often advocate for safer staffing conditions. There are a variety of factors to consider when staffing nurses for patient safety, such as the number of patients per nurse, nurse preparation, patient acuity, and nurse autonomy. The complex issue of staffing nurses often is compounded by cost issues and can become politicized. When nurse organizations' recommendations for safe staffing measures are disregarded by hospital administrations, nurse lobbyists and interest groups often pursue legislative action to protect patients and nurses from unsafe staffing conditions. This article presents a narrative review of safe nurse staffing factors and an analysis of nurse staffing legislation. Using a patient-centric lens, three state-level nurse staffing policies (mandated nurse-to-patient ratios, public reporting of staffing plans, and nurse staffing committees) were evaluated by empirical evidence, cost to hospitals and state governments, political feasibility, and potential to affect patient populations. Although nurse staffing policy analysis can be conducted in several ways, it is crucial that nurses consider empirical evidence related to staffing policies as well as evaluations of implemented policies and political influences.

Professional Identity in Graduating Nursing Students

BACKGROUND

This research examines the meaning of nursing professional identity development from the perspectives of both associate degree nursing students and baccalaureate degree nursing students in their final semester. It provides insight into the student's understanding of nursing professional identity and the factors students identified as supporting or detracting from it.

METHOD

Participants were guided through individual interviews using semistructured interview questions and later invited to focus groups with other students to clarify and elaborate on previous comments.

RESULTS

Results demonstrated both groups shared many descriptions of what it means to be a nursing professional, including knowledge, caring, team-work, and integrity. Good communication, confidence, competence, critical thinking, advocacy, and leadership were concepts the participants frequently used to describe the professional nurse.

CONCLUSION

This research helps to further the understanding of this significant topic in nursing education and to serve as a basis for student activities that help foster nursing professional identity formation. [J Nurs Educ. 2021;60(2):74-80.].

Rural-urban differences in educational attainment among registered nurses: Implications for achieving an 80% BSN workforce

BACKGROUND

Multiple professional organizations and institutes recommend the Bachelor of Science in Nursing (BSN) degree as a minimum standard for registered nurse practice. Achieving this standard may be particularly challenging in rural areas, which tend to be more economically disadvantaged and have fewer opportunities for higher educational attainment compared to urban areas.

PURPOSE

Our primary objective was to provide updated information on rural-urban differences in educational attainment. We also examined rural-urban differences in employment type, salary, and demographics among registered nurses in different practice settings.

METHODS

Data were obtained from the 2011-2015 American Community Survey (ACS) Public Use Microdata Sample (PUMS). The sample included registered nurses (RN) between the ages of 18-64 years (n = 34,104) from all 50 states. Chi-square tests, t-tests, and multivariable logistic regression were used to examine the relationship between rurality and BSN preparedness and salary across practice settings.

RESULTS

Urban nurses were more likely to have a BSN degree than rural nurses (57.9% versus 46.1%, respectively; p < 0.0001), and BSN preparedness varied by state. In adjusted analysis, factors in addition to residence associated with BSN preparation included age, race, and region of the country. Differences in wages were experienced by nurses across practice settings with urban nurses generally earning significantly higher salaries across practice settings (p < 0.0001).

CONCLUSIONS

Strategies to advance nursing workforce education are needed in rural areas and may contribute to improved care quality and health outcomes.

Community and family nurse: Present keys, future challenges

It is the mission of the Community and Family Nurse through an integral and holistic approach to accompany people from cradle to death in developing their health potential, and promote different family, work and social environments to facilitate this development. Throughout history, various international, European and national organizations have regulated the figure of the Community and Family Nurse, and now their functions, powers and professional performance are fully regulated. The Community and Family Nurse can respond to the needs of a changing population and take on new responsibilities in management and research. Their extensive basic and advanced skills gathered under a rigorous training programme, benefit the health system, the nursing profession, citizenry and its communities. Many challenges remain for the Health Departments of each Autonomous Region to make it possible for this specialty to develop its full potential for improving care.

Better Cardiac Arrest Outcomes in Hospitals with More Nurses with BSNs

According to this study.