Effects of Nurse Staffing on Resident Outcomes in Nursing Homes: A Systematic Review

ObjectivesTo evaluate the evidence on effects of nurse staffing in nursing homes on resident outcomes.DesignSystematic review.Setting and ParticipantsStudies evaluating the effects of nurse staffing levels, total staffing, or skill mix on pressure ulcers, nursing home associated infections, and pain outcomes for adult residents in US nursing homes.MethodsWe searched MEDLINE, Embase, CINAHL, and the Cochrane Database for English-language articles published between January 2000 and May 2021. We also searched for gray literature and sought expert referrals. Two reviewers participated in determination of eligibility, assessment of methodological quality, and abstraction of data. Abstracted data included study design; setting and population characteristics; and resident outcomes. We rated overall certainty of evidence (very low, low, moderate, and high) for each outcome using GRADE.ResultsOf 9152 unique citations, 378 articles underwent full-text review. We identified 22 eligible studies that addressed pressure ulcers (k = 15), COVID-19 cases and/or mortality (k = 4), other infections (k = 8), and moderate-severe pain among residents (k = 7); some examined multiple outcomes. Most studies (k = 17) were rated moderate or high quality. All studies were observational. Overall, registered nurse (RN) staffing was probably associated with fewer pressure ulcers (moderate certainty) and possibly fewer COVID-19 infections/mortality (low certainty), other infections (low certainty) and lower rates of moderate-severe pain (low certainty). Higher skill mix was probably associated with fewer pressure ulcers, higher resident COVID-19 infections, fewer other infections, and lower rates of moderate-severe pain (low certainty for all outcomes).Conclusions and ImplicationsHigher RN staffing and skill mix may be associated with better nursing home resident outcomes, while results were mixed for total staffing. Increasing RN staffing levels and skill mix are one of a variety of approaches to improve nursing home care.     

Staffing Shortages,Staffing Hours,and Resident Deaths in US Nursing Homes During the COVID-19 Pandemic

ObjectivesStaffing shortages at nursing homes during the COVID-19 pandemic may have impacted care providers' staffing hours and affected residents’ care and outcomes. This study examines the association of staffing shortages with staffing hours and resident deaths in nursing homes during the COVID-19 pandemic.DesignThis study measured staffing hours per resident using payroll data and measured weekly resident deaths and staffing shortages using the Centers for Disease Control and Prevention's National Healthcare Safety Network data. Multivariate linear regressions with facility and county-week fixed effects were used to investigate the association of staffing shortages with staffing hours and resident deaths.Setting and Participants15,212 nursing homes.MeasuresThe primary outcomes included staffing hours per resident of registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) and weekly total deaths per 100 residents.ResultsBetween May 31, 2020, and May 15, 2022, 18.4% to 33.3% of nursing homes reported staffing shortages during any week. Staffing shortages were associated with lower staffing hours per resident with a 0.009 decrease in RN hours per resident (95% CI 0.005-0.014), a 0.014 decrease in LPN hours per resident (95% CI 0.010-0.018), and a 0.050 decrease in CNA hours per resident (95% CI 0.043-0.057). These are equivalent to a 1.8%, 1.7%, and 2.4% decline, respectively. There was a positive association between staffing shortages and resident deaths with 0.068 (95% CI 0.048-0.088) total deaths per 100 residents. This was equivalent to an increase of 10.5%.Conclusion and ImplicationsOur results showed that self-reported staffing shortages were associated with a statistically significant decrease in staffing hours and with a statistically significant increase in resident deaths. These results suggest that addressing staffing shortages in nursing homes can save lives.     

Evidence on the Effects of the Federal COVID-19 Vaccine Mandate on Nursing Home Staffing Levels

ObjectiveTo assess the federal COVID-19 vaccine mandate's effects on nursing homes' nurse aide and licensed nurse staffing levels in states both with and without state-level vaccine mandates.DesignCross-sectional study using data from Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, and Economic Innovation Group. Including nursing home facility fixed effects provides evidence on the intertemporal effects of the federal vaccine mandate within nursing homes.Setting and ParticipantsThe sample contains 15,031 nursing homes, representing all US nursing homes with available data.MethodsOn January 13, 2022, the US Supreme Court upheld the federal COVID-19 vaccine mandate for health care workers in Medicare- and Medicaid-eligible facilities, with workers generally required to be vaccinated by March 20, 2022 (ie, the compliance date). We examined actual nursing home staffing levels in 3 time periods: (1) pre-Court decision; (2) precompliance date; and (3) postcompliance date. We separately examined staffing levels for nurse aides and licensed nursing staff. Because 28% of nursing homes were in states with state-imposed vaccine mandates that predated the Supreme Court's ruling, we divided the sample into 2 groups (nursing homes in mandate states vs nonmandate states) and performed all analyses separately.ResultsStaff vaccination rates and staffing levels were higher in mandate states than nonmandate states in all 3 time periods. After the Court's decision, staff vaccination rates increased 5% in nonmandate states and 1% in mandate states (on average). We find little evidence that the Court's vaccine mandate ruling materially affected nurse aide and licensed nurse staffing levels, or that nursing homes in mandate states and nonmandate states were differentially affected by the Court's ruling. Staffing levels over time were generally flat, with some evidence of a modestly greater increase for nurse aide staffing in mandate states than nonmandate states, and a modestly smaller decrease for licensed nurse staffing in mandate states than nonmandate states. Finally, regression results suggest that for both nurse aides and licensed nurses, staffing levels were lower in rural and for-profit nursing homes, and higher in Medicare-only, higher quality, and hospital-based nursing homes.Conclusions and ImplicationsResults suggest the federal COVID-19 vaccine mandate has not caused clinically material changes in nursing home's nurse aide and licensed nurse staffing levels, which continue to be primarily associated with factors that are well-known to researchers and practitioners.     

中小学饮食服务人员对学校营养工作的认识、态度和需求

目的 了解中小学饮食服务人员对学校营养工作的认识，态度和需求，方法 在6省市下属的12个市县有学生食堂的22所学校中，对71名中小学饮食服务人员进行访谈。结果 63.6%的学校按要求制定了“食堂卫生管理制度”，仅2所学校有“学校营养午餐配餐制度”。大部分学校饮食服务人员对学校营养工作的重要性有较充分的认识，但普遍认为教育行政部门和学校以及社会各界对学校营养工作重视不够，绝大多数人未接受过营养知识方面的专门培训，结论 学校饮食服务人员对营养工作的认识和态度，是学生健康成长的重环节，有关领导应重视和支持学校营养工作，坚持不懈地对学校饮食服务人员进行营养知识培训。     

护理人员在医院临床药学服务中的行为特征研究

目的 探究护理人员在医院临床药学服务中的行为特征.方法 分层抽取全国240例在职护理人员,通过问卷调查方式分析其临床药学认知、用药相关行为特征及倾向.结果 护理人员对临床药学服务有点了解的人群占51.67％,显著高于了解和不了解的人群（P＜0.05）;护理人员主要从自己和国内其他医院了解临床药学服务（86.08％）,显著高于其他途径（P＜0.05）.护理人员了解药物信息主要通过药物使用说明书（81.67％）,明显高于其他渠道（P＜0.05）.所有护理人员均认为药师提供药物知识很有必要;希望药师参与临床用药指导占94.17％;认为药师或护理人员需要专业化培训的占87.5％.结论 护理人员对临床药学服务有一定的了解,但仍需进一步提高药师专业水平,加强药师与护理人员的配合,促进临床药学服务工作的深入开展.     

Identification and Critical Appraisal of Food Service Satisfaction Questionnaires for Use in Nursing Homes: A Systematic Review

BackgroundFood service provision in nursing homes is a complex, adaptive system through which multiple stakeholders interface. Organizational stakeholders include staff involved in preparing and delivering meals. Consumer stakeholders are the end users including residents and family. Questionnaires can be an economical and efficient method of measuring food service satisfaction in nursing homes and a powerful quality improvement tool.Objective(1) To identify questionnaires that measure food service satisfaction of various stakeholders in a nursing homes and (2) to critically appraise the psychometric properties of identified questionnaires.MethodsFive electronic databases were searched (Cumulative Index to Nursing and Allied Health Literature, Medline, ProQuest, Scopus, and Cochrane) in April 2020. Data from the eligible studies were extracted, and the psychometric properties were critically appraised using the Consensus-Based Standards for the Selection of Health Measurement Instruments.ResultsThis review identified 129 studies that used a questionnaire to measure food service satisfaction in nursing homes. Of those, 107 studies representing 75 unique general nursing home satisfaction questionnaires were excluded for failing to adequately explore aspects related to food service. From the remaining 22 studies, 7 food service satisfaction questionnaires were identified; 5 intended for consumers (residents) and 2 intended for organizational stakeholders (staff). Using the Consensus-Based Standards for the Selection of Health Measurement Instruments quality criteria, most questionnaires had flaws in content validity and construct validity, primarily due to small sample sizes. No questionnaires explored food service satisfaction from the family perspective.ConclusionsNursing homes collect satisfaction information for accreditation, marketing, benchmarking, and quality improvement. Although questionnaires are easy to administer, the quality of the data they collect is impacted by the validity and reliability of the questionnaires used. Using unreliable satisfaction data may mean that nursing homes are not accurately able to understand the impact of changes in the system on stakeholder satisfaction.     

Assessment of Food Safety Knowledge,Attitudes and Practices of Food Service Staff in Bangladeshi Hospitals: A Cross-Sectional Study

Food safety knowledge, attitudes and practices among hospital food service staff are crucial in the prevention of foodborne disease outbreaks, as hospitalized patients are more vulnerable to potential hazards. This study, therefore, sought to assess the food safety knowledge, attitudes and practices of food service staff in Bangladeshi hospitals. A cross-sectional study was conducted among 191 food service staff from seven different hospitals in Dhaka and Chattogram from October 2021 to March 2022 using pretested questionnaires. Multiple linear regression was used to identify the factors associated with the food safety knowledge, attitudes and practices. The findings showed moderate knowledge but high levels of attitudes and practices of food safety among hospital food handlers. Food safety knowledge was significantly higher among males, participants from private hospitals and participants working in a hospital that had a food service supervisor and dietitian in charge of food service operations. Moreover, participants from private hospitals and participants working in a hospital that had a food service supervisor and dietitian in charge of food service operations had more positive attitudes and better practices regarding food safety. Hospital management should consider these factors for enhancing food handlers’ knowledge and increase training and supervision on food safety practices to reduce foodborne diseases and outbreaks.     

Leadership,Staff Empowerment,and the Retention of Nursing Assistants: Findings From a Survey of U.S. Nursing Homes

ObjectivesWe examined the relationship between nursing assistant (NA) retention and a measure capturing nursing home leadership and staff empowerment.DesignCross-sectional study using nationally representative survey data.Setting and ParticipantsData from the Nursing Home Culture Change 2016-2017 Survey with nursing home administrator respondents (N = 1386) were merged with facility-level indicators.MethodsThe leadership and staff empowerment practice score is an index derived from responses to 23 survey items and categorized as low, medium, and high. Multinomial logistic regression weighted for sample design and to address culture-change selection bias identified factors associated with 4 categories of 1-year NA retention: 0% to 50%, 51% to 75%, 76% to 90%, and 91% to 100%.ResultsIn an adjusted model, greater leadership and staff empowerment levels were consistently associated with high (76%-90% and 91%-100%) relative to low (0%-50%) NA retention. Occupancy rate, chain status, licensed practical nurse and certified nursing assistant hours per day per resident, nursing home administrator turnover, and the presence of a union were also significantly associated with higher categories of retention (vs low retention).Conclusions and ImplicationsModifiable leadership and staff empowerment practices are associated with NA retention. Associations are most significant when examining the highest practice scores and retention categories. Nursing homes seeking to improve NA retention might look to leadership and staff empowerment practice changes common to culture change.     

军队医院人员门急诊社会化保障初探

本文结合远离军队医疗机构人员门急诊社会化保障的实践,提出以下思考：①社会化保障实质是运行机制的变革,必须改变管理思路,按市场法则运作。②必须制定制度法规,健全调控约束机制,做到有法可依,按章办事。③要签定一个规范的协议,建立一套有效的管理办法和监督体系,加强经费管理。④实行社会化保障不能削弱自身保障功能,充分发挥二者的互补作用,综合提高保障能力。     

Effects of Statins for Secondary Prevention on Functioning and Other Outcomes Among Nursing Home Residents

ObjectivesStudies examining the effects of statins after acute myocardial infarction (AMI) excluded frail older adults, especially nursing home (NH) residents, and few examined functional outcomes. Older NH residents may benefit less from statins and be particularly susceptible to adverse drug events like myopathy-related functional decline. We evaluated the effects of statins on 1-year functional decline, rehospitalization, and death in NH residents.DesignWe conducted a retrospective cohort study using 2007-2010 linked national data from Minimum Data Set (MDS) assessments, Medicare claims, and Online Survey Certification and Reporting System records.Setting and ParticipantsWe included US NH residents 65 years and older who were statin nonusers, were hospitalized for AMI between May 2007 and March 2010, and returned to the NH.MeasuresOutcomes were functional decline, death, and rehospitalization in the first year after post-AMI NH admission. New statin users were 1:1 propensity-score matched to nonusers to adjust for 92 characteristics. We estimated hazard ratios (HRs) and restricted mean survival time differences with 95% confidence intervals (CIs) comparing individuals who did vs did not initiate statin therapy after AMI hospitalization.ResultsPropensity-score matching yielded a cohort of 5440 residents. Mean age was 83 years and 69% were female. Statin use was associated with a reduction in mortality (HR 0.80, 95% CI 0.73-0.87), corresponding to a mean of 15.9 (95% CI 9.9-22.0) days of extended life expectancy. No overall differences in rehospitalization (HR 1.06, 95% CI 0.98-1.14) or functional decline (HR 1.00, 95% CI 0.88-1.14) were observed.Conclusions and ImplicationsStatins may reduce 1-year mortality by 20% without affecting function among older NH residents who wish to live longer after AMI. During shared decision making with these patients or their representatives, clinicians should consider communicating that the average benefit of statins is 16 days of additional survival over 1 year.     

Effects of Horticulture on Frail and Prefrail Nursing Home Residents: A Randomized Controlled Trial

Objective

Frail nursing home residents face multiple health challenges as a result of their frail status. The aim of this study was to examine the effects of HT on the psychosocial well-being of frail and prefrail nursing home residents.

The Impact of Modifying Food Service Practices in Secondary Schools Providing a Routine Meal Service on Student’s Food Behaviours,Health and Dining Experience: A Systematic Review and Meta-Analysis

The education sector is recognised as an ideal platform to promote good nutrition and decision making around food and eating. Examining adolescents in this setting is important because of the unique features of adolescence compared to younger childhood. This systematic review and meta-analysis examine interventions in secondary schools that provide a routine meal service and the impact on adolescents’ food behaviours, health and dining experience in this setting. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist and Cochrane Handbook recommendations. Studies published in English searched in four databases and a hand search yielded 42 interventions in 35 studies. Risk of bias was assessed independently by two reviewers. Interventions were classified using the NOURISHING framework, and their impact analysed using meta-analysis, vote-counting synthesis or narrative summary. The meta-analysis showed an improvement in students selecting vegetables (odds ratio (OR): 1.39; 1.12 to 1.23; p = 0.002), fruit serves selected (mean difference (MD): 0.09; 0.09 to 0.09; p < 0.001) and consumed (MD: 0.10; 0.04 to 0.15; p < 0.001), and vegetable serves consumed (MD: 0.06; 0.01 to 0.10; p = 0.024). Vote-counting showed a positive impact for most interventions that measured selection (15 of 25; 41% to 77%; p = 0.002) and consumption (14 of 24; 39% to 76%; p = 0.013) of a meal component. Interventions that integrate improving menu quality, assess palatability, accessibility of healthier options, and student engagement can enhance success. These results should be interpreted with caution as most studies were not methodologically strong and at higher risk of bias. There is a need for higher quality pragmatic trials, strategies to build and measure sustained change, and evaluation of end-user attitudes and perceptions towards intervention components and implementation for greater insight into intervention success and future directions (PROSPERO registration: CRD42020167133).     

2006年郑州市某电厂员工健康行为、认知与需求调查

[目的]调查电厂员工健康相关行为、认知状况和卫生服务需求,为开展工作场所健康促进,实施干预措施提供基线资料。[方法]2006年,对郑州市某电厂员工进行调查。[结果]调查738人,急救常识、预防胃病知识知晓率,具有不吸烟、不饮酒、锻炼身体和洗手等健康相关行为者所占比例,对常见病的自我治疗方法、改善劳动环境条件、增加福利待遇、增加医疗费、定期体检有需求者所占比例,需求办培训班、现场座谈咨询、发放宣传资料健康教育形式者所占比例,不同工种间的差异均有统计学意义（P〈0.01或P〈0.05）;工作时穿工作服和使用防护用品者所占比例各个工种均在88%以上,有病时就医者所占比例各个工种均不超过50%;对职业病的病因、有害物质进入机体的主要途径、女工保健的方法、刺激性气体的危害均为化学组知晓率最高,对粉尘危害的知晓率锅炉/燃料运行组最高,对噪声危害的知晓率汽机运行组最高。[结论]某电厂员工对健康教育和职业卫生服务的需求率较高,不同工种员工的健康卫生行为与健康知识知晓率有一定差异。     

基于三圈理论的“互联网+护理服务”政策分析:成效、问题与对策

目的:优化"互联网+护理服务"政策,为破解医疗护理资源短缺、护理服务缺乏针对性等问题提供对策建议。方法:利用"三圈理论"从价值、能力和支持三个角度对政策实施过程中的成效和问题进行探索与分析。结果:当前政策虽提高了护理服务质量、避免了医疗资源的不必要浪费,但存在城乡公平性价值不突出、财政投入不明确、互联网平台不完善等问题。结论:为最大程度地发挥政策效果,进一步优化政策公平性价值导向,拓展人、财、物等资源投入能力,扩大互联网平台等利益相关者可谓势在必行。     

Children’s Community Nutrition Environment,Food and Drink Purchases and Consumption on Journeys between Home and School: A Wearable Camera Study

Children’s community nutrition environments are an important contributor to childhood obesity rates worldwide. This study aimed to measure the type of food outlets on children’s journeys to or from school, children’s food purchasing and consumption, and to determine differences by ethnicity and socioeconomic status. In this New Zealand study, we analysed photographic images of the journey to or from school from a sample of 147 children aged 11–13 years who wore an Autographer camera which recorded images every 7 s. A total of 444 journeys to or from school were included in the analysis. Camera images captured food outlets in 48% of journeys that had a component of active travel and 20% of journeys by vehicle. Children who used active travel modes had greater odds of exposure to unhealthy food outlets than children who used motorised modes; odds ratio 4.2 (95% CI 1.2–14.4). There were 82 instances of food purchases recorded, 84.1% of which were for discretionary foods. Of the 73 food and drink consumption occasions, 94.5% were for discretionary food or drink. Children on their journeys to or from school are frequently exposed to unhealthy food outlets. Policy interventions are recommended to limit the availability of unhealthy food outlets on school routes.     

Evaluating Rehabilitation Medicine: Effects on Survival,Function, and Home Care

ABSTRACT

The goal of this study was to measure the clinical impact of rehabilitation on adults diagnosed with a disabling disorder in four major diagnostic groups (nervous, circulatory, musculoskeletal, and injury). To summarize the current knowledge in this area, a meta-analysis of rehabilitation studies was also completed. Specific objectives of the clinical trial were to determine the effects of inpatient rehabilitation on: (1) survival, (2) function, (3) home care, and related variables such as family function and use of health care resources. Patients hospitalized for the first time with a disabling condition (n = 85) were randomly assigned to inpatient rehabilitation (n = 43) or to outpatient follow-up (n = 42) in which the usual medical services were provided but no scheduled rehabilitative therapies were offered. To compare the two groups, analyses of covariance were conducted for functional ability, health care use, survival, health status, personal adjustment and family function. The between subjects factor was inpatient rehabilitation versus the control group. The within subjects factor was time of assessment (index, six months, and 1 year).

No significant treatment effect was found at six months or one year for any of the variables under study using analyses of covariance. There were also no differences between groups in their use of nursing homes, length of hospital stay, survival, or in the number of hospital readmissions or clinic visits during the first year after hospital discharge. Rehabilitation did cost significantly more than medical care, primarily due to the cost of inpatient services.

Some clinical trials have noted a treatment effect on functional ability but not on mortality, need for skilled care, or mental health status. The current study is consistent with these previous findings except for the lack of impact on physical function. This exception may be due to the fact that prior studies looked only at homogeneous groups, whereas the current study utilized heterogeneous grouping across four major diagnostic categories. Any apparent benefit may not be detectable across disability groups and may require more specialized scrutiny, or even tailored rehabilitative care, to detect a difference. It is recommended that health care systems evaluate the benefits of subacute rehabilitative care and consider outpatient programs that can be provided at home for implementation.