Relationship between nurse staffing level and adult nursing-sensitive outcomes in tertiary hospitals of Korea: Retrospective observational study

BackgroundNurse staffing level is an important factor on nursing sensitive outcome. The relationships of nurse staffing level with nursing sensitive outcomes such as mortality, upper gastrointestinal bleeding and pressure ulcer have been explored in the United States, Canada, Australia, and New Zealand. Lower level of hospital nurse staffing seems associated with more adverse outcomes, especially mortality. However, there is insufficient evidence of the nurse staffing level-outcome relationship in other indicators.ObjectivesThis study was conducted to describe the status and prove the relationships of nurse staffing level with nursing sensitive outcome indicators for adult medical and surgical inpatients in Korea. Patient and hospital characteristics as covariates on nurse sensitive outcome were also explored.DesignThis was a retrospective observational study.SettingThe study setting was all 46 tertiary hospitals in Korea.ParticipantsWe selected all anonymized patients aged 19 years or older and admitted at tertiary hospitals for two years (2013–2014) using electronic reimbursement claims data.MethodMultiple logistic regression was used to examine relationships of nurse staffing level (accounted for full-time registered nurses in general ward only) with Nursing-sensitive outcomes (NSOs) adjusted for patient and hospital characteristics. NSOs included urinary tract infection, upper gastrointestinal tract bleeding, deep vein thrombosis, hospital-acquired pneumonia, pressure ulcer, sepsis, shock/cardiac arrest, CNS complication, in-hospital death, wound infection, physiologic/metabolic derangement and pulmonary failure.ResultsThe total number of patients in 46 tertiary hospitals in Korea for two years was 3,665,307. Among these, number of patients who had at least one nursing-sensitive outcome was 338,369 (9.23%). The significant relationships of nurse staffing level with six nursing-sensitive outcome rates (urinary tract infection, upper gastrointestinal tract bleeding, hospital-acquired pneumonia, shock/cardiac arrest, in-hospital death, and wound infection) were shown. These six nursing-sensitive outcomes showed an increasing trend as nurse staffing level degraded even after adjusting for patient and hospital characteristics. When the nursing-sensitive outcomes between those of group 1 (bed-to-nurse ratio < 2:1) and group 3 (between 2.5:1 and 3:1) were compared, the adjusted incidence rate of shock/cardiac arrest showed the highest difference (1.06%).ConclusionWe demonstrated strong evidence for the relationships of nurse staffing level with six nursing-sensitive outcomes. We can use this study to improve nursing quality and to inform patients of the nursing quality of hospitals so they can choose hospitals with better nursing quality. The nurse staffing level should be optimized for better outcomes.     

The introduction of a nursing guideline on depression at psychogeriatric nursing home wards: Effects on Certified Nurse Assistants

BackgroundTo improve care for residents with depression in dementia, an evidence based nursing guideline was developed. Using the guideline has already shown positive effects on depression in psychogeriatric nursing home residents.ObjectiveTo study the effects of the introduction of the nursing guideline ‘depression in dementia’ on perceived professional autonomy, workload and feelings of powerlessness and confidence in Certified Nurse Assistants.DesignA multi-center controlled intervention study with randomization at ward level, using pre-test, post-test and follow-up measurements.Setting18 psychogeriatric wards in 9 Dutch nursing homes.Participants: 193 Certified Nurse Assistants working on psychogeriatric nursing home wards for at least 20 h per week.MethodsAn evidence based guideline for nursing teams of psychogeriatric nursing home wards was introduced on nine experimental wards to reduce depression in residents diagnosed with depression in dementia. The guideline introduction consisted of team training and the installation of a promotion group. The nine control wards continued providing usual care. Primary outcomes are: (1) perceived professional autonomy and (2) experienced workload in Certified Nurse Assistants measured with the VBBA subscales ‘autonomy’ and ‘pace and amount of work’. Secondary outcomes are perceived powerlessness and confidence in caring for depressed and demented residents, using two self-developed scales.ResultsThe guideline introduction had a small, significant, positive effect on generally perceived professional autonomy in the Certified Nurse Assistants of the experimental wards. No short-term effects were found on generally experienced workload, or on confidence and powerlessness in caring for depressed residents with dementia.ConclusionThe introduction of the nursing guideline ‘depression in dementia’ has small, positive effects on perceived professional autonomy among the Certified Nurse Assistants. Long-term effects on experienced workload should be studied.     

The impact of the nursing hours per patient day (NHPPD) staffing method on patient outcomes: A retrospective analysis of patient and staffing data

Background

In March 2002 the Australian Industrial Relations Commission ordered the introduction of a new staffing method - nursing hours per patient day (NHPPD) - for implementation in Western Australia public hospitals. This method used a “bottom up” approach to classify each hospital ward into one of seven categories using characteristics such as patient complexity, intervention levels, the presence of high dependency beds, the emergency/elective patient mix and patient turnover. Once classified, NHPPD were allocated for each ward.

Objectives

The objective of this study was to determine the impact of implementing the NHPPD staffing method on 14 nursing-sensitive outcomes: central nervous system complications, wound infections, pulmonary failure, urinary tract infection, pressure ulcer, pneumonia, deep vein thrombosis, ulcer/gastritis/upper gastrointestinal bleed, sepsis, physiologic/metabolic derangement, shock/cardiac arrest, mortality, failure to rescue and length of stay.

Design and setting

The research design was an interrupted time series using retrospective analysis of patient and staffing administrative data from three adult tertiary hospitals in metropolitan Perth over a 4-year period.

Sample

All patient records (N = 236,454) and nurse staffing records (N = 150,925) from NHPPD wards were included.

Results

The study found significant decreases in the rates of nine nursing-sensitive outcomes when examining hospital-level data following implementation of NHPPD; mortality, central nervous system complications, pressure ulcers, deep vein thrombosis, sepsis, ulcer/gastritis/upper gastrointestinal bleed shock/cardiac arrest, pneumonia and average length of stay. At the ward level, significant decreases in the rates of five nursing-sensitive outcomes; mortality, shock/cardiac arrest, ulcer/gastritis/upper gastrointestinal bleed, length of stay and urinary tract infections occurred.

Conclusions

The findings provide evidence to support the continuation of the NHPPD staffing method. They also add to evidence about the importance of nurse staffing to patient safety; evidence that must influence policy. This study is one of the first to empirically review a specific nurse staffing method, based on an individual assessment of each ward to determine staffing requirements, rather than a “one-size-fits-all” approach.     

A 4-Bed Close-Observation Pod model of multidisciplinary care in hospital: A mixed methods study

Aims and objectivesTo examine activity, experiences, and outcomes of a 4-bed Close Observation Pod model of multidisciplinary care for patients, carers, and staff. This model provides additional surveillance by an assistant in nursing to support vulnerable older patients with cognitive or physical impairments at risk of hospital-acquired complications.DesignConcurrent mixed method design.MethodsData collection concluded in 2018 and entailed: (1) A retrospective cohort study of 12 months of patient outcome data; (2) Semi-structured interviews with manifest content analysis to describe the experiences of patients, carers, and staff, and (3) Cross-observational study with behavioural mapping to observe physical, social, and cognitive activity.ResultsPatients admitted to a 4-bed Close Observation Pod had significantly lower odds of falls than the control group; but were more than four times as likely to experience other adverse complications (pneumonia, delirium, pressure injuries, medical emergency team, personal threat) than those in the control group. The 4-bed Pod resulted in qualitatively perceived benefits of socialisation and monitoring for safety, but challenges of privacy, noise, staffing characteristics, and conflicting expectations. Patients were observed to have high levels of sedentary behaviour, spending on average only 34.7% of the observed time engaging in physical (18%), cognitive (5%), or social activity (15%).ConclusionComplex older patients provided with a close observation model of multidisciplinary care, where additional surveillance is provided by an assistant in nursing, were observed to experience lower odds of falls but higher rates of other potentially preventable complications, and high levels of sedentary behaviour.     

Effect of online communication skills training on effective communication and self-efficacy and self-regulated learning skills of nursing students: A randomized controlled study

AimThe aim of this study was to determine the effect of online communication skills training conducted for first-year nursing students on effective communication and self-efficacy and self-regulated learning skills.BackgroundCommunication skills are an important part of nursing care.MethodsThis research was designed as a pre-test–post-test randomized controlled experimental study. The study population comprised first-year undergraduate nursing students of a state university in Turkey. A total of 60 students included in the study were divided into the two following groups: experimental (n = 30) and control (n = 30) groups. The research data were collected between 1 December 2020 and 1 March 2021. Pre-test and post-test forms were simultaneously provided to the groups. Post-tests were repeated 1 month after the pre-test was completed. A 2-day (a total of 12 h) communication skills training was conducted online for the students in the experimental group after the pre-test forms were filled. Information form, Effective Communication Skills Scale (ECSS), General Self-efficacy Scale (GSE) and Self-regulated Learning Skills Scale (SRLSS) were used to collect the data.ResultsThe effective communication and SRLSS mean scores of the nursing students were high and the GSE scores were below average. On comparing the groups, the post-test mean scores of the communication skills and GSE were found to decrease in both the groups compared with the pre-test ones. This decrease was significant only in the “ego-enhancing language” subdimension of ECSS (p < 0.05). The post-test mean scores of the SRLSS increased in both the groups, but this increase was not significant (p > 0.05).ConclusionAlthough the SRLSS scores of the students increased in the post-test, the study results show that communication skills training did not have a significant effect on effective communication and self-efficacy and self-regulated learning skills. The results of this study are important in terms of guiding research and trainings that examine the effects of communication skills.     

The effects of nurse staffing on adverse events,morbidity, mortality,and medical costs

BACKGROUND: Nurse staffing levels are an important working condition issue for nurses and believed to be a determinant of the quality of nursing care and patient outcomes. OBJECTIVES: To examine the effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. METHODS: Using two existing databases, the study sample included 232 acute care California hospitals and 124,204 patients in 20 surgical diagnosis-related groups. The adverse events included patient fall/injury, pressure ulcer, adverse drug event, pneumonia, urinary tract infection, wound infection, and sepsis. Multilevel analysis was employed to examine, simultaneously, the effects of nurse staffing and patient and hospital characteristics on patient outcomes. RESULTS: Three statistically significant relationships were found between nurse staffing and adverse events. An increase of 1 hour worked by registered nurses (RN) per patient day was associated with an 8.9% decrease in the odds of pneumonia. Similarly, a 10% increase in RN Proportion was associated with a 9.5% decrease in the odds of pneumonia. Providing a greater number of nursing hours per patient day was associated with a higher probability of pressure ulcers. The occurrence of each adverse event was associated with a significantly prolonged length of stay and increased medical costs. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization. CONCLUSION: Patients are experiencing adverse events during hospitalization. Care systems to reduce adverse events and their consequences are needed. Having appropriate nurse staffing is a significant consideration in some cases.     

Perceived adverse patient outcomes correlated to nurses’ workload in medical and surgical wards of selected hospitals in Kuwait

Aim. This study was carried out to identify the perceived adverse patient outcomes as related to nurses’ workload. It also assessed nurses’ perception of variables contributing to the workload and adverse patient outcomes. Background. Several studies have been published on adverse patient outcomes in which a correlation was found between nurses’ workload and some adverse patient outcomes. Design. A cross‐sectional survey was conducted between registered nurses (n = 780) working in medical and surgical wards of five general governmental hospitals in Kuwait. Data collection instruments. Data were collected using a self‐administered questionnaire consisting of three sections to elicit information about the sample characteristics, perception of workload and perceived adverse patient outcomes during the last shift and last working week. Results. The three major perceived adverse outcomes reported by the nurses while on duty during their last shift were: complaints from patients and families (2%), patients received a late dose or missed a dose of medication (1·8%) and occurrences of pressure ulcer (1·5%). Similarly, the reported adverse outcomes over the past week were complaints from patients and families (5%), patients received a late dose or missed a dose of medication (5·3%) and discovery of a urinary tract infection (3·7%). Increases in nurse‐patient load, bed occupancy rate, unstable patients’ condition, extra ordinary life support efforts and non‐nursing tasks; all correlated positively with perceived adverse patient outcomes. Conclusion. This study sheds light on an important issue affecting patient safety and quality of care as perceived by the nurses themselves as caregivers. Relevance to clinical practice. Nurses’ perception of variables contributing to adverse patient outcomes and their workload could significantly affect the provided nursing care and nursing care recipients. The findings could help in policy formulation and planning strategies to decrease adverse patient outcomes in many countries with a health care structure similar to that of Kuwait.     

妇科院内感染的危险因素与护理对策

目的：调查和分析妇科院内感染发生状况，以制定相应的护理措施来控制和降低医院感染的发生率。方法：采用回顾性调查方法，对2007年1-12月3820例妇科出院患者进行院内感染的调查、统计和分析。结果：发生院内感染114例，感染发生率为2.98％，其中高龄患者、化疗患者是医院感染的高危人群；此外，住院时间越长，感染发生率越高。常见感染部位依次为呼吸道、泌尿道、胃肠道等。结论：严格执行无菌操作，加强病房管理、基础护理和健康教育，缩短留置尿管时间和住院时间，可以降低院内感染发生率。     

Identifying nurse-sensitive indicators for stand-alone high acuity areas: A systematic review

Background

Nurse-sensitive patient outcomes that are suitable for general medical and surgical settings are well developed. Indicators developed for general ward settings may not be suitable for stand-alone high acuity areas; therefore, a different set of indicators is required.

How does the length of day shift affect patient care on older people's wards? A mixed method study

BackgroundInternationally, studies have focused on whether shift length impacts on patient care. There are also ongoing concerns about patient care for older people in hospital. The study aim was to investigate how length of day shift affects patient care in older people’s hospital wards.Objectives1) To explore how length of day shift affects patient care in older people’s wards; 2) To explore how length of day shift affects the quality of communication between nursing staff and patients/families on older people’s wardsDesignA mixed method case study.SettingsThe study was based on two older people’s wards in an acute hospital in England. One ward was piloting two, overlapping 8 h day shifts for 6 months while the other ward continued with 12 h day shifts.Participants and methodsQualitative interviews were conducted with 22 purposively recruited nursing staff (17 registered nurses; 5 nursing assistants). An analysis of patient discharge survey data was conducted (n = 279). Twenty hours of observation of nursing staff’s interactions with patients and families was conducted, using an adapted version of the Quality of Interaction Schedule (301 interactions observed), with open fieldnotes recorded, to contextualise the observations.ResultsThere were no statistically significant differences in patient survey results, or quality of interactions, between the two wards. There were three overall themes: Effects of day shift length on patient care; Effects of day shift length on continuity of care and relationships; Effects of day shift length on communication with patients and families. Nursing staff believed that tiredness could affect care and communication but had varied views about which shift pattern was most tiring. They considered continuity of care was important, especially for older people, but had mixed views about which shift pattern best promoted care continuity. The difficulties in staffing a ward with an 8 h day shift pattern, in a hospital that had a 12 h day shift pattern were highlighted. Other factors that could affect patient care were noted including: ward leadership, ward acuity, use of temporary staff and their characteristics, number of consecutive shifts, skillmix and staff experience.ConclusionsThere was no conclusive evidence that length of day shift affected patient care or nursing staff communication with patients and families. Nursing staff held varied views about the effects of day shift length on patient care. There were many other factors identified that could affect patient care in older people’s wards.     

Work environment characteristics associated with quality of care in Dutch nursing homes: A cross-sectional study

BackgroundA lack of relationship between direct care staffing levels and quality of care, as found in prior studies, underscores the importance of considering the quality of the work environment instead of only considering staff ratios. Only a few studies, however, have combined direct care staffing with work environment characteristics when assessing the relationship with quality of care in nursing homes.ObjectivesTo examine the relationship between direct care staffing levels, work environment characteristics and perceived quality of care in Dutch nursing homes.DesignCross-sectional, observational study in cooperation with the Dutch Prevalence Measurement of Care Problems.Settings: Twenty-four somatic and 31 psychogeriatric wards from 21 nursing homes in the Netherlands.Participants: Forty-one ward managers and 274 staff members (registered nurses or certified nurse assistants) from the 55 participating wards.MethodsWard rosters were discussed with managers to obtain an insight into direct care staffing levels (i.e, total direct care staff hours per resident per day). Participating staff members completed a questionnaire on work environment characteristics (i.e., ward culture, team climate, communication and coordination, role model availability, and multidisciplinary collaboration) and they rated the quality of care in their ward.Data were analyzed using multilevel linear regression analyses (random intercept). Separate analyses were conducted for somatic and psychogeriatric wards.ResultsIn general, staff members were satisfied with the quality of care in their wards. Staff members from psychogeriatric wards scored higher on the statement ‘In the event that a family member had to be admitted to a nursing home now, I would recommend this ward’. A better team climate was related to better perceived quality of care in both ward types (p ≤ 0.020). In somatic wards, there was a positive association between multidisciplinary collaboration and agreement by staff of ward recommendation for a family member (p = 0.028). In psychogeriatric wards, a lower score on market culture (p = 0.019), better communication/coordination (p = 0.018) and a higher rating for multidisciplinary collaboration (p = 0.003) were significantly associated with a higher grade for overall quality of care. Total direct care staffing, adhocracy culture, hierarchy culture, as well as role model availability were not significantly related to quality of care.ConclusionsOur findings suggest that team climate may be an important factor to consider when trying to improve quality of care. Generating more evidence on which work environment characteristics actually lead to better quality of care is needed.     

UK ward design: patient dependency, nursing workload, staffing and quality-an observational study

BACKGROUND: There are important relationships between ward design, patient welfare and staff activity in the literature but studies seem not to have tested all the variables. Whether ward designs influence nursing structures, processes and outcomes, therefore, has not been fully answered. While studies provide helpful guidance, nursing efficiency and effectiveness implications are speculative. OBJECTIVES: To improve nursing efficiency and effectiveness by capitalizing on the best ward design features. SETTING: A database consisting of 375 UK wards, constructed for other research and development purposes, was revisited and reconfigured for the present study. The database was updated between 2003 and 2004. PARTICIPANTS: Of 390 wards approached, 375 generated usable data. METHOD: Patient dependency, nursing activity, workload, nursing quality and staffing data in the original database were obtained using mainly non-participation observation methods. Later, wards were classified in eight ways and differences between ward types examined. RESULTS: Patient dependency did not stand out in any ward type but as the literature predicted, direct patient care was higher in Nightingale wards. Racetrack ward nursing activity was also close to idyllic. Bay wards, owing to their greater occupancy peaks and troughs, had a propensity to generate heavier workloads. Time-out and down-time were not excessive in any ward type, and it is likely that ward leadership may be compensating for some variables' negative effects. Racetrack wards were considerably less-well staffed and grade-mix dilute and consequently the cheapest. Quality scores were higher in Nightingale wards-nurses' greater observation capability was a significant factor. Wards' central-core configurations also influenced nursing efficiency and effectiveness. CONCLUSIONS: Racetrack wards have an edge over other ward designs. However, replicating Nightingale conditions by, for example, equalising occupancy, throughput and staffing and maximising nurses' substations, could engender similar outcomes elsewhere.     

Using observational simulation teaching methods in professional development to address patient safety

BackgroundFramed within the National Quality Health Service Standards and using immersive simulation approaches, a series of videos responding to accreditation audit findings were created and used as teaching artefacts for mandatory professional development at a regional hospital in Australia. The scenarios captured a patient's hospital journey and targeted quality standards for medication administration, infection control, patient identification, documentation and preventing falls.AimTo improve patient safety and quality health outcomes.MethodsMixed methods comprising of quality audit data, surveys and interviews were used to evaluate the effectiveness of the simulation video artefacts and to measure the impact of the professional development initiative using simulation artefacts on patient outcomes.FindingsFindings showed high levels of satisfaction with the new education programme, improved understanding of documentation, improved risk management and a significant reduction in the incidence of falls with injury (73%), medication incidents (34%), and infection (61%).ConclusionThis project promoted a culture of safety and learning and demonstrated that using simulation videos in mandatory professional development can positively impact safety and health outcomes.     

The effect of the SAFE or SORRY? programme on patient safety knowledge of nurses in hospitals and nursing homes: A cluster randomised trial

Background

Patients in hospitals and nursing homes are at risk for the development of often preventable adverse events. Guidelines for the prevention of many types of adverse events are available, however compliance with these guidelines appears to be lacking. As a result many patients do not receive appropriate care. We developed a patient safety program that allows organisations to implement multiple guidelines simultaneously and therefore facilitates guideline use to improve patient safety. This program was developed for three frequently occurring nursing care related adverse events: pressure ulcers, urinary tract infections and falls. For the implementation of this program we developed educational activities for nurses as a main implementation strategy.

Objectives

The aim of this study is to describe the effect of interactive and tailored education on the knowledge levels of nurses.

Design

A cluster randomised trial was conducted between September 2006 and July 2008.

Settings

Ten hospital wards and ten nursing home wards participated in this study. Prior to baseline, randomisation of the wards to an intervention or control group was stratified for centre and type of ward.

Participants

All nurses from participating wards.

Methods

A knowledge test measured nurses’ knowledge on the prevention of pressure ulcers, urinary tract infections and falls, during baseline en follow-up. The results were analysed for hospitals and nursing homes separately.

Results

After correction for baseline, the mean difference between the intervention and the control group on hospital nurses’ knowledge on the prevention of the three adverse events was 0.19 points on a zero to ten scale (95% CI: −0.03 to 0.42), in favour of the intervention group. There was a statistically significant effect on knowledge of pressure ulcers, with an improved mean mark of 0.45 points (95% CI: 0.10-0.81). For the other two topics there was no statistically significant effect. Nursing home nurses’ knowledge did neither improve (0 points, CI: −0.35 to 0.35) overall, nor for the separate subjects.

Conclusion

The educational intervention improved hospital nurses’ knowledge on the prevention of pressure ulcers only. More research on long term improvement of knowledge is needed.

Trial registration

ClinicalTrials.gov ID [NCT00365430].     

The effect of a brief mindfulness-based stress reduction program on strengthening awareness of medical errors and risks among nursing students

InformationHealthcare professionals' awareness of medical errors and risks results in effective medical error reporting and patient safety. Mindfulness has positive effects on strengthening attention and awareness. However, little is known about the use of mindfulness in patient safety education among nursing students. This study aimed to examine if a brief mindfulness-based stress reduction program would have a beneficial impact on (a) medical error attitudes, (b) the number of medical errors and risks in a simulation environment, and (c) self-confidence and satisfaction among nursing students.MethodsA quasi-experimental design with a control group was conducted with 78 third-year nursing students at a private, accredited, nursing program in Istanbul, Türkiye.ResultsThere was a statistically significant improvement in the intervention group between the pre-test and post-test for medical error attitudes (p < 0.001), and the number of medical errors and risks in a simulation environment (p < 0.001). There was no statistical difference in the intervention and control groups for self-confidence and satisfaction (p > 0.05).ConclusionThese results suggest that a brief mindfulness-based stress reduction program positively strengthens nursing students' awareness of medical errors and risks.     

Implantación de la Guía de buenas prácticas: valoración del ictus mediante la atención continuada en pacientes hospitalizados

IntroductionStroke is an important cause of morbidity and mortality in adults and implies high social and healthcare costs due to the consequences it causes. To minimize these, it is important to apply best practice guidelines that ensure evidence-based care and reduce clinical variability. The objective of the study is to evaluate the results of implantation of the Ictus Best Practice Guideline for attending in-hospital stroke patients.MethodQuasi-experimental pre-post intervention study. Over 18 years of age admitted to the University Hospital Complex of Albacete and Hospital Complex of Navarra with a diagnosis of stroke. Process variables: Neurological assessment (Canadian Scale and the National Institute of Health Stroke Scale), dysphagia assessment (Water Test and the Volume-Viscosity Clinical Exploration Method), risk falls (Downton Scale), pain detection (Numerical Scale), pressure injury risk (Braden Scale), health education. Outcome variables: Aspiration pneumonia, falls, independence of daily life activities (modified Barthel and Rankin index), pressure injuries and pain intensity.Results1270 patients were evaluated in CHUA and 627 in CHN, most were men and the average age was over 69 years, with a higher incidence of ischaemic strokes. In CHUA 16 pressure sores, 17 falls and 20 cases of aspiration pneumonia were recorded and 15 cases of pressure sores were identified in CHN. An increase of cases could be attributed to the greater number of patients evaluated and the increased nursing awareness about recording adverse events.ConclusionsApplication of guideline recommendations improved statistically significantly throughout the implementation time. Some possibilities for improvement are detected, so it is necessary to continue working on both the quality of care provided and the health outcomes of patients.     

综合性医院妇产科医院感染的危险因素分析与护理对策

目的调查和分析综合性医院妇产科医院感染发生状况,并制定相应的护理措施来控制和降低医院感染的发生率。方法采用回顾性调查方法,对2005年1月至12月3150侧妇产科出院患者（妇科1910例;产科1240例）进行院内感染的调查、统计和分析。培果妇科发生院内感染57例,感染率为2．98％。妇科病房中高龄患者、化疗患者是医院感染的高危人群;住院时间越长感染率越高。常见感染部位依次为呼吸道、泌尿道、胃肠道等。产科发生院内感染10例。感染率为0．81％。妊娠合并并发症的患者是高危人群,常见感染部位依次为呼吸道,泌尿道,宫腔等。结论严格执行无菌操作。加强病房管理、基础护理和健康教育,缩短留置尿管时间和住院天数。可以降低妇产科的医院感染。     

The relationship between nurse staffing and patient outcomes: a case study

Background

Research has shown a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with lower patient to nurse ratios (i.e. less patients per nurse) associated with better outcomes.

Objectives

To explore the relationship between nurse staffing characteristics (the nursing hours worked by permanent and temporary staff and nurse hours per patient day) and patient outcomes: pressure sores, patient falls, upper gastrointestinal bleed, pneumonia, sepsis, shock and deep vein thrombosis.

Design

A case study using retrospective hospital data, at ward level.

Setting

A tertiary cardio-respiratory NHS Trust in England, comprising two hospitals.

Participants

All patients, including day cases, who were admitted to either hospital as an in-patient over 12 months.

Methods

Data were extracted from corporate hospital systems. The clinical areas were categorised as lower dependency, i.e. wards, or critical care which included ICU and high dependency units. The relationship between nurse staffing characteristics and patient outcomes was assessed using either a Poisson or negative binomial regression model as appropriate. We sought to establish whether the outcomes were affected by the nurse hours per patient day, the permanent nurse hours worked as a percentage of the total hours, and the permanent nurse hours worked as a percentage of the permanent and bank hours combined.

Results

In the lower dependency category wards there was only a weak association demonstrated between nurse staffing and the majority of the outcomes. The results from the high dependency critical care areas showed few significant results with only the rate of sepsis being significantly reduced as the ratio of permanent staff hours increased.

Conclusions

The study demonstrated the possibility of using existing hospital data to examine the relationship between nurse staffing and patient outcomes, however the associations found were weak and did not replicate reliably the findings from previous work.