The daily relationships between staffing,safety perceptions and personality in hospital nursing: A longitudinal on-line diary study

BackgroundThe association between poor staffing conditions and negative patient safety consequences is well established within hospital nursing. However, many studies have been limited to nurse population level associations, and have used routine data to examine relationships. As a result, it is less clear how these relationships might be manifested at the individual nurse level on a day-to-day basis. Furthermore, personality may have direct and moderating roles in terms of work environment and patient safety associations, but limited research has explored personality in this context.ObjectiveTo further our understanding of these associations, this paper takes a within-person approach to examine nurses’ daily perceptions of staffing and patient safety. In addition, we explore the potential role of personality factors as moderators of daily level associations.MethodWe recruited eighty-three hospital nurses from three acute NHS Trusts in the UK between March and July 2013. Nurses completed online end-of-shift diaries over three–five shifts which collected information on perceptions of staffing, patient–nurse ratio and patient safety (perceptions of patient safety, ability to act as a safe practitioner, and workplace cognitive failure). Personality was also assessed within a baseline questionnaire. Data were analysed using hierarchical linear modelling, and moderation effects of personality factors were examined using simple slopes analyses, which decomposed relationships at high and low levels of the moderator.ResultsOn days when lower patient–nurse ratios were indicated, nurses reported being more able to act as a safe practitioner (p = .011) and more favourable perceptions of patient safety (p = <.001). Additionally, when staffing was perceived more favourably, nurses reported being more able to act as a safe practitioner (p = <.001), more favourable perceptions of patient safety (p = <.001) and experienced less workplace cognitive failure (p = <.001). Conscientiousness and emotional stability emerged as key moderators of daily level associations between staffing and patient safety variables, with many relationships differing at high and low levels of these personality factors.ConclusionThe findings elucidate the potential mechanisms by which patient safety risks arise within hospital nursing, and suggest that nurses may not respond to staffing conditions in the same way, dependent upon personality. Further understanding of these relationships will enable staff to be supported in terms of work environment conditions on an individual basis.     

RN assessments of excellent quality of care and patient safety are associated with significantly lower odds of 30-day inpatient mortality: A national cross-sectional study of acute-care hospitals

BackgroundQuality and safety in health care has been increasingly in focus during the past 10–15 years. Stakeholders actively discuss ways to measure safety and quality of care to improve the health care system as a whole. Defining and measuring quality and safety, however, is complicated. One underutilized resource worthy of further exploration is the use of registered nurses (RNs) as informants of overall quality of care and patient safety. However, research is still scarce or lacking regarding RN assessments of patient safety and quality of care and their relationship to objective patient outcomes.ObjectiveTo investigate relationships between RN assessed quality of care and patient safety and 30-day inpatient mortality post-surgery in acute-care hospitals.DesignThis is a national cross-sectional study.Data sourcesA survey (n = >10,000 RNs); hospital organizational data (n = 67); hospital discharge registry data (n > 200,000 surgical patients).Data collection and analysisRN data derives from a national sample of RNs working directly with inpatient care in surgical/medical wards in acute-care hospitals in Sweden in 2010. Patient data are from the same hospitals in 2009–2010. Adjusted multivariate logistic regression models were used to estimate relationships between RN assessments and 30-day inpatient mortality.ResultsPatients cared for in hospitals where a high proportion of RNs reported excellent quality of care (the highest third of hospitals) had 23% lower odds of 30-day inpatient mortality compared to patients cared for in hospitals in the lowest third (OR 0.77, CI 0.65–0.91). Similarly, patients in hospitals where a high proportion of RNs reported excellent patient safety (highest third) had is 26% lower odds of death (OR 0.74, CI 0.60–0.91).ConclusionsRN assessed excellent patient safety and quality of care are related to significant reductions in odds of 30-day inpatient mortality, suggesting that positive RN reports of quality and safety can be valid indicators of these key variables.     

The development and testing of a nurse practitioner secondary prevention intervention for patients after acute myocardial infarction: A prospective cohort study

BackgroundPatients with acute myocardial infarction (AMI) are at high risk for reinfarction and death. Therapies that have been shown to reduce these risks (secondary prevention) continue to be underutilized. Nurse practitioners are well positioned to provide secondary prevention during and following hospitalization.ObjectivesThe purpose of this study was to evaluate the effects of NP care on the rate of provider implementation and patient achievement of evidence-based secondary prevention target goals.DesignA prospective cohort design was used, which compared achievement of target goals between patients who received secondary prevention care from an NP to those who received usual care.ParticipantsThe sample consisted of 65 patients with AMI, admitted to a large community hospital. Patients meeting eligibility criteria were recruited consecutively.MethodsThe intervention was delivered by the NP before discharge from hospital and one week, two weeks, six weeks and 3 months after discharge. Data on patients’ achievement of goals were obtained before discharge from hospital and 3 months after discharge from both groups.ResultsThis study's results provide preliminary evidence that an NP delivered secondary prevention intervention can significantly improve achievement of the following target goals when compared to usual care: smoking cessation (OR 5), blood pressure (OR 15), attendance at cardiac rehabilitation (OR 7), physical activity five days a week (OR 17), physical activity ≥ five days a week (OR 34), achieving a glycated haemoglobin < 7% in those with diabetes (OR 10), triglyceride levels (p = .02), statin use at follow-up (p = .05), and number of weeks to cardiac rehabilitation (p = .05).ConclusionNP-led interventions such as this warrant duplication to evaluate reproducibility of the intervention and to determine if short-term improvements in secondary prevention goals translate into morbidity and mortality benefits.     

Post-operative mortality,missed care and nurse staffing in nine countries: A cross-sectional study

BackgroundVariation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery.AimExamine if missed nursing care mediates the observed association between nurse staffing levels and mortality.MethodData from the RN4CAST study (2009–2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses’ staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation.ResultsNurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse’s workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031–1.106) and 16% (OR 1.159 95% CI 1.039–1.294) increase in the odds of a patient dying within 30 days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality.ConclusionMissed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an ‘early warning’ indicator of higher risk for poor patient outcomes.     

Mobbing among care workers in nursing homes: A cross-sectional secondary analysis of the Swiss Nursing Homes Human Resources Project

BackgroundAs a category of bullying, mobbing is a form of violence in the workplace that damages the employing organization as well as the targeted employee. In Europe, the overall prevalence of mobbing in healthcare is estimated at 4%. However, few studies have explored mobbing among long-term care workers.ObjectivesThis study aims to examine the frequency of mobbing in Swiss nursing homes and its relationships with care workers’ (i.e. registered nurse, licensed practical nurse, assistant nurse, nurse aide) health status, job satisfaction, and intention to leave, and to explore the work environment as a contributing factor to mobbing.DesignA cross-sectional, multi-center sub-study of the Swiss Nursing Homes Human Resource Project (SHURP).SettingNursing homes in Switzerland’s three language regions.ParticipantsA total of 162 randomly selected nursing homes with 20 or more beds, including 5311 care workers with various educational levels.MethodControlling for facility and care worker characteristics, generalized estimation equations were used to assess the relationships between mobbing and care workers’ health status, job satisfaction, and intention to leave as well as the association of work environment factors with mobbing.ResultsIn Swiss nursing homes, 4.6% of surveyed care workers (n = 242) reported mobbing experiences in the last 6 months. Compared to untargeted persons, those directly affected by mobbing had higher odds of health complaints (Odds Ratios (OR): 7.81, 95% CI 5.56–10.96) and intention to leave (OR: 5.12, 95% CI 3.81–6.88), and lower odds of high job satisfaction (OR: 0.19, 95% CI 0.14–0.26). Odds of mobbing occurrences increased with declining teamwork and safety climate (OR: 0.41, 95% CI 0.30–0.58), less supportive leadership (OR: 0.42, 95% CI 0.30–0.58), and higher perceived inadequacy of staffing resources (OR: 0.66, 95% CI 0.48–0.92).ConclusionsMobbing experiences in Swiss nursing homes are relatively rare. Alongside teamwork and safety climate, risk factors are strongly associated with superiors’ leadership skills. Targeted training is necessary to sensitize managers to mobbing’s indicators, effects and potential influencing factors.     

How do nurse practitioners work in primary health care settings? A scoping review

ObjectivesThis scoping review explores the work of nurse practitioners in primary health care settings in developed countries and critiques their contribution to improved health outcomes.DesignA scoping review design was employed and included development of a research question, identification of potentially relevant studies, selection of relevant studies, charting data, collating, summarising and reporting findings. An additional step was added to evaluate the methodological rigor of each study.DataData sources included literature identified by a search of electronic databases conducted in September 2015 (CINAHL, Informit, Web of Science, Scopus and Medline) and repeated in July 2016. Additional studies were located through hand searching and authors’ knowledge of other relevant studies.Results74 articles from eight countries were identified, with the majority emanating from the United States of America. Nurse practitioners working in communities provided care mostly in primary care centres (n = 42), but also in community centres (n = 6), outpatient departments (n = 6), homes (n = 5), schools (n = 3), child abuse clinics (n = 1), via communication technologies (n = 6), and through combined face-to-face and communication technologies (n = 5). The scope of nurse practitioner work varied on a continuum from being targeted towards a specific disease process or managing individual health and wellbeing needs in a holistic manner. Enhanced skills included co-ordination, collaboration, education, counselling, connecting clients with services and advocacy. Measures used to evaluate outcomes varied widely from physiological data (n = 25), hospital admissions (n = 10), use of health services (n = 15), self-reported health (n = 13), behavioural change (n = 14), patient satisfaction (n = 17), cost savings (n = 3) and mortality/morbidity (n = 5).ConclusionsThe majority of nurse practitioners working in community settings did so within a selective model of primary health care with some examples of nurse practitioners contributing to comprehensive models of primary health care. Nurse practitioners predominantly worked with populations defined by an illness with structured protocols for curative and rehabilitative care. Nurse practitioner work that also incorporated promotive activities targeted improving social determinants of health for people rendered vulnerable due to ethnicity, Aboriginal identity, socioeconomic disadvantage, remote location, gender and aging. Interventions were at individual and community levels with outcomes including increased access to care, cost savings and salutogenic characteristics of empowerment for social change.     

Safe patient handling behaviors and lift use among hospital nurses: A cross-sectional study

PurposePatient handling is well known for the risk of musculoskeletal injury. Safe work practices are important to reduce risk of injury while performing patient handling tasks. This study investigated factors associated with safe patient handling behaviors and lift use among hospital nurses in the United States.MethodsThis study analyzed cross-sectional survey data from a statewide random sample of 221 hospital nurses in California who had patient handling duties. Safe patient handling behaviors and lift use were examined for the relationships with demographic characteristics, organizational safety practices, physical and psychosocial job factors, musculoskeletal symptoms, and perceptions about lift use and risk of injury.ResultsIn multivariable logistic regression, high safe patient handling behaviors were significantly associated with a positive organizational safety climate (Odds Ratio [OR] = 2.76, 95% Confidence Interval [CI] 1.51–5.03), people-oriented culture (OR = 2.59, 95% CI 1.45–4.62), and ergonomic practices (OR = 1.67, 95% CI 1.04–2.67). High lift use (>50% of the time when needed) were significantly associated with high lift availability (OR = 3.1, 95% CI 1.06–9.01) and positive perceptions about lift use (OR = 3.48, 95% CI 1.63–7.44). In bivariate analysis, high safe patient handling behaviors were associated with shorter height, non-White race, lower physical workload, lower job strain, higher job satisfaction, and less musculoskeletal symptoms.ConclusionsThe study findings underscore the importance of organizational safety practices and culture to promote safe work practices for patient handling injury prevention. Also, making lift equipment readily available and improving positive perceptions and experiences about lifts can be crucial to ensure the use of lift equipment.     

Hospital mortality and optimality of nursing workload: A study on the predictive validity of the RAFAELA Nursing Intensity and Staffing system

BackgroundPatient classification systems have been developed to manage workloads by estimating the need for nursing resources through the identification and quantification of individual patients’ care needs. There is in use a diverse variety of patient classification systems. Most of them lack validity and reliability testing and evidence of the relationship to nursing outcomes.ObjectivePredictive validity of the RAFAELA system was tested by examining whether hospital mortality can be predicted by the optimality of nursing workload.MethodsIn this cross-sectional retrospective observational study, monthly mortality statistics and reports of daily registrations from the RAFAELA system were gathered from 34 inpatient units of two acute care hospitals in 2012 and 2013 (n = 732). The association of hospital mortality with the chosen predictors (hospital, average daily patient to nurse ratio, average daily nursing workload and average daily workload optimality) was examined by negative binomial regression analyses.ResultsCompared to the incidence rate of death in the months of overstaffing when average daily nursing workload was below the optimal level, the incidence rate was nearly fivefold when average daily nursing workload was at the optimal level (IRR 4.79, 95% CI 1.57–14.67, p = 0.006) and 13-fold in the months of understaffing when average daily nursing workload was above the optimal level (IRR 12.97, 95% CI 2.86–58.88, p = 0.001).ConclusionsHospital mortality can be predicted by the RAFAELA system. This study rendered additional confirmation for the predictive validity of this patient classification system. In future, larger studies with a wider variety of nurse sensitive outcomes and multiple risk adjustments are needed. Future research should also focus on other important criteria for an adequate nursing workforce management tool such as simplicity, efficiency and acceptability.     

Job satisfaction as a mediator between structural empowerment and intent-to-leave: A study of critical care nurses

BackgroundNurse turnover is an issue that impacts a hospital’s financial resources and the quality of patient care. There is a need to discover what actions can be taken to improve nurse retention.ObjectiveNurses’ job satisfaction has been shown to improve organizational outcomes, such as nurses’ retention. The objective of this study is to examines the relationship between intent to leave, job satisfaction and structural empowerment (SE), providing a theoretical basis for further research.MethodsA convenience sample of 83 critical care nurses, recruited from two Facebook groups and the AACN website. The nurses completed a survey that used three tools; Conditions of Work Effectiveness II (CWEQ II), Job Satisfaction Survey (JSS), and Turnover Intention (TIS-6) to address 4 hypotheses to determine the relationship of the three constructs.ResultsFindings indicated that SE was not significantly related to intent-to-leave; SE was positively related to job satisfaction (β = 0.760, p < 0.01) , and job satisfaction was negatively related to Intent-to-leave (β = −0.610, p < 0.01).ConclusionThe research provided a theoretical framework for further research on SE and its importance in improving job satisfaction and reducing turnover in critical nurse.     

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.     

A clinical prediction tool for hospital mortality in critically ill elderly patients

BackgroundVery elderly (80 years of age and above) critically ill patients admitted to medical intensive care units (ICUs) have a high incidence of mortality, prolonged hospital length of stay, and living in a dependent state should they survive.ObjectiveThe objective was to develop a clinical prediction tool for hospital mortality to improve future end-of-life decision making for very elderly patients who are admitted to Canadian ICUs.DesignThis was a prospective, multicenter cohort study.SettingData from 1033 very elderly medical patients admitted to 22 Canadian academic and nonacademic ICUs were analyzed.InterventionsA univariate analysis of selected predictors to ascertain prognostic power was performed, followed by multivariable logistic regression to derive the final prediction tool.Main resultsWe included 1033 elderly patients in the analyses. Mean age was 84.6 ± 3.5 years, 55% were male, mean Acute Physiology and Chronic Health Evaluation II score was 23.1 ± 7.9, Sequential Organ Failure Assessment score was 5.3 ± 3.4, median ICU length of stay was 4.1 (interquartile range, 6.2) days, median hospital length of stay was 16.2 (interquartile range, 25.0) days, and ICU mortality and all-cause hospital mortality were 27% and 41%, respectively. Important predictors of hospital mortality at the time of ICU admission include age (85-90 years of age had an odds ratio of hospital mortality of 1.63 [1.04-2.56]; > 90 years of age had an odds ratio of hospital mortality of 2.64 [1.27-5.48]), serum creatinine (120-300 had an odds ratio of hospital mortality of 1.57 [1.01-2.44]; > 300 had an odds ratio of hospital mortality of 5.29 [2.43-11.51]), Glasgow Coma Scale (13-14 had an odds ratio of hospital mortality of 2.09 [1.09-3.98]; 8-12 had an odds ratio of hospital mortality of 2.31 [1.34-3.97]; 4-7 had an odds ratio of hospital mortality of 5.75 [3.02-10.95]; 3 had an odds ratio of hospital mortality of 8.97 [3.70-21.74]), and serum pH (< 7.15 had an odds ratio of hospital mortality of 2.44 [1.07-5.60]).ConclusionWe identified high-risk characteristics for hospital mortality in the elderly population and developed a Risk Scale that may be used to inform discussions regarding goals of care in the future. Further study is warranted to validate the Risk Scale in other settings and evaluate its impact on clinical decision making.     

Describing clinical faculty experiences with patient safety and quality care in acute care settings: A mixed methods study

BackgroundA major safety initiative in acute care settings across the United States has been to transform hospitals into High Reliability Organizations. The initiative requires developing cognitive awareness, best practices, and infrastructure so that all healthcare providers including clinical faculty are accountable to deliver quality and safe care.ObjectiveTo describe the experience of baccalaureate clinical nursing faculty concerning safety and near miss events, in acute care hospital settings.MethodsA mixed method approach was used to conduct the pilot study. Nurse faculty (n = 18) completed study surveys from the Agency for Healthcare Research and Quality (AHRQ) to track patient safety concerns: Incidents; Near misses; or Unsafe conditions, during one academic semester, within 9 different acute care hospitals. Additionally, seven nurse faculty participated in end of the semester focus groups to discuss the semester long experience.ResultsClinical faculty identified a total of 24 patient occurrences: 15 Incidents, 1 Near miss event, and 8 Unsafe conditions. Focus group participants (n = 7) described benefits and challenges experienced by nursing clinical faculty and students in relation to the culture of safety in acute care hospital settings. Six themes resulted from the content analysis.ConclusionsUtilizing nursing clinical faculty and students may add significant value to promoting patient safety and the delivery of quality care, within acute care hospital settings.     

Association of presence and timing of invasive airway placement with outcomes after pediatric in-hospital cardiac arrest

BackgroundLittle data exist regarding the association of presence of an invasive airway before cardiac arrest or early placement of an invasive airway after cardiac arrest with outcomes in children who experience in-hospital cardiac arrest.MethodsWe conducted a retrospective review of patients aged 1 day to 18 years who received cardiopulmonary resuscitation (CPR) for ≥1 min in any of the three intensive care units (ICUs) at a tertiary care, academic children's hospital between 2002 and 2010. Specific outcomes evaluated included survival to hospital discharge, return of spontaneous circulation (ROSC), 24-h survival, and good neurological status at hospital discharge. We fitted multivariable logistic regression models to evaluate the association between the presence of an invasive airway prior to cardiac arrest and timing of placement of an invasive airway with these outcomes.ResultsThree hundred and ninety-one patients were included. Of these, 197 (51%) patients were already tracheally intubated before the occurrence of cardiac arrest. Median time to intubation was 6 min [interquartile range (IQR): 2, 12] among the 194 patients tracheally intubated following cardiac arrest. We found lower survival to hospital discharge among patients intubated prior to cardiac arrest (intubated vs. non-intubated group, 43% vs. 61%, p < 0.001). After adjusting for patient and event characteristics, presence of an invasive airway prior to cardiac arrest was not associated with a significant improvement in survival to hospital discharge [odds ratio (OR): 0.70, 95% confidence interval (CI): 0.42–1.16, p = 0.17], or good neurological outcomes (OR: 0.60, 95% CI: 0.34–1.05, p = 0.07). Similarly, early placement of an invasive airway after cardiac arrest was also not associated with an improvement in survival to hospital discharge (OR: 1.05, 95% CI: 0.78–1.42, p = 0.73), or good neurological outcomes (OR: 1.08, 95% CI: 0.77–1.53, p = 0.65).ConclusionsOur study demonstrates that presence of an invasive airway prior to cardiac arrest or early placement of an invasive airway after cardiac arrest is not associated with an improvement in survival to hospital discharge or good neurological outcomes. Further study of the relationship between invasive airway management and survival following cardiac arrest is warranted.     

The relationship between work engagement and psychological distress of hospital nurses and the perceived communication behaviors of their nurse managers: A cross-sectional survey

BackgroundCommunication between nurse managers and nurses is important for mental health of hospital nurses.ObjectiveThe aim of the present study was to investigate the relationship between managers’ communication behaviors toward nurses, and work engagement and psychological distress among hospital nurses using a multilevel model.DesignThe present study was a cross-sectional questionnaire survey.SettingsThe participants were nurses working at three hospitals in Japan.ParticipantsA total of 906 nurses from 38 units participated in the present study. The units with small staff sizes and participants with missing entries in the questionnaire were excluded. The data for 789 nurses from 36 questionnaire survey units were analyzed.MethodA survey using a self-administered questionnaire was conducted. The questionnaire asked staff nurses about communication behaviors of their immediate manager and their own levels of work engagement, psychological distress, and other covariates. Three types of manager communication behaviors (i.e., direction-giving, empathetic, and meaning-making language) were assessed using the Motivating Language scale; and the scores of the respondents were averaged for each unit to calculate unit-level scores. Work engagement and psychological distress were measured using the Utrecht Work Engagement Scale and the K6 scale, respectively. The association of communication behaviors by unit-level managers with work engagement and psychological distress among nurses was analyzed using two-level hierarchical linear modeling.ResultsThe unit-level scores for all three of the manager communication behaviors were significantly and positively associated with work engagement among nurses (p < 0.05). This association was smaller and non-significant after adjusting for the psychosocial work environment. The individual levels of all three of the manager communication behaviors were also significantly and positively associated with work engagement (p < 0.05). None of the three manager communication behaviors was significantly associated with psychological distress (p > 0.05).ConclusionMotivating language by unit-level managers might be positively associated with work engagement among hospital nurses, which is mediated through the better psychosocial work environment of the unit.     

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data

ContextNurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting.ObjectivesTo examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge.Design and settingCross sectional analysis combining nurse survey data with infant discharge data.ParticipantsA national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997).MethodsSequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on “any human milk”) and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support).ResultsThe majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p < 0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p < 0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p = .056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p < 0.001).ConclusionsNeonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge.     

Comparison of out-of-hospital cardiac arrest occurring before and after paramedic arrival: Epidemiology,survival to hospital discharge and 12-month functional recovery

BackgroundDespite immediate resuscitation, survival rates following out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical service (EMS) are reportedly low. We sought to compare survival and 12-month functional recovery outcomes for OHCA occurring before and after EMS arrival.MethodsBetween 1st July 2008 and 30th June 2013, we included 8648 adult OHCA cases receiving an EMS attempted resuscitation from the Victorian Ambulance Cardiac Arrest Registry, and categorised them into five groups: bystander witnessed cases ± bystander CPR, unwitnessed cases ± bystander CPR, and EMS witnessed cases. The main outcomes were survival to hospital and survival to hospital discharge. Twelve-month survival with good functional recovery was measured in a sub-group of patients using the Extended Glasgow Outcome Scale (GOSE).ResultsBaseline and arrest characteristics differed significantly across groups. Unadjusted survival outcomes were highest among bystander witnessed cases receiving bystander CPR and EMS witnessed cases, however outcomes differed significantly between these groups: survival to hospital (46.0% vs. 53.4% respectively, p < 0.001); survival to hospital discharge (21.1% vs. 34.9% respectively, p < 0.001). When compared to bystander witnessed cases receiving bystander CPR, EMS witnessed cases were associated with a significant improvement in the risk adjusted odds of survival to hospital (OR 2.02, 95% CI: 1.75–2.35), survival to hospital discharge (OR 6.16, 95% CI: 5.04–7.52) and survival to 12 months with good functional recovery (OR 5.56, 95% CI: 4.18–7.40).ConclusionWhen compared to OHCA occurring prior to EMS arrival, EMS witnessed arrests were associated with significantly higher survival to hospital discharge rates and favourable neurological recovery at 12-month post-arrest.     

Impacto de la ratio paciente-enfermera en los resultados de salud en los hospitales públicos del Servicio Andaluz de Salud. Estudio ecológico

AimTo analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS).MethodCross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis.ResultsA response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio- county (13.5). By type of unit, the medical units were 11.8 (SD = 1.8) lower than the surgical ones 13.5 (SD = 2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD = 1.4) and district hospitals 13.03 (SD = 1.46) (p = .001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p = .005), prevalence of nosocomial infections (p = .036), postoperative sepsis (p = .022), zero bacteraemia verification (p = .045) and mortality from heart failure (p = .004).ConclusionsThe results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.