Nursing-sensitive Outcomes Research Articles

Automatic Delirium Prediction System and Nursing-Sensitive Outcomes in the Medical Intensive Care Unit

In Korea, delirium risk screening has not been routinely implemented in intensive care units (ICUs). The purpose of this study was to implement an Automatic Prediction of Delirium in Intensive Care Units (APREDEL-ICU) system to investigate its impact on nursing-sensitive outcomes and to assess nurse satisfaction with the system. A pre-post research design was used. A total of 145 patients were involved prior to the system implementation and 172 were involved after implementation. Forty medical ICU nurses evaluated the system. The APREDEL-ICU system did not result in a reduction in the incidence of delirium. However, the nurses reported that their knowledge regarding delirium care increased after the system was introduced. The proposed system was successfully implemented without increasing the burden of nurses in their assessment of delirium risk. Long-term use of APREDEL-ICU could enhance preventive care and consequently result in positive patient outcomes.

Pediatric Skin Integrity Practice Guideline for Institutional Use: A Quality Improvement Project

Superior skin care is a nurse-sensitive outcome measure (Young, T., & Clark, M. (2009). Re-positioning for pressure ulcer prevention (protocol). The Cochrane Database of Systematic Review (2009) 3). This study sought to decrease incidence and risk of skin breakdown in the pediatric cardiac intensive care unit (PCICU). The study was conducted in a large hospital in upstate New York. A practice guideline was created and guided PCICU nurses on the interventions for potential skin-breakdown issues in their patients. The patients had a significant change in skin breakdown with a one-sided Fisher's Exact Test (p=.0422). A logistic regression model showed intervention as a significant factor in reducing incidence of pressure ulcers and length of stay (p=.0389).

Three structures for a healthy work environment.

Three structures for a healthy work environment.

Pflege, Patientensicherheit und die Erfassung pflegesensitiver Ergebnisse in deutschen Krankenhäusern

As the largest occupational group in healthcare, nurses continuously work in very close contact to patients and nursing home residents. No other professionals in the healthcare sector are involved in or responsible for so many different processes. They play a key role in, on the one hand, identifying and potentially avoiding errors and, on the other hand, in causing them. Traditionally, error handling in Germany is still strongly influenced by pointing a finger to and tabooing problematic behaviour. Structured systems for detecting errors and error reports can help to improve risk management in nursing. There is a need to develop fundamental structures like national indicators of nursing quality for systematic and valid error measurements and the structured collection of nursing-sensitive outcomes at a national level.

A Mentored Cooperative Group Pilot Study: Atrophic Vaginitis

To review nursing research initiatives from two cooperative groups and outline a pilot study performed by a junior nurse researcher mentored by cooperative group nurse researchers and institutional physicians. PubMed, Cochrane Library, Scopus, World Wide Web. Nursing research can be initiated and led by nurses in the cooperative group setting. The team approach model of research includes several disciplines to examine multiple facets of the same problem, or of multiple problems that a cancer patient may face. This new model will enable a greater number of nurse researchers to investigate symptom management, survivorship, and quality-of-life issues. Nurse researchers should be included in every cooperative group study to investigate nurse-sensitive outcomes and issues related to symptom management, survivorship, and quality of life.

Identification of Potential Barriers to Nurse-Sensitive Outcome Demonstration

The objective of this study was to determine differences in chief nursing officer, Magnet(®) program director, nurse leader, and direct care RN perspectives of potential barriers to demonstration of nurse-sensitive outcomes. The Magnet Recognition Program(®) and other designations are focusing on patient outcomes. No evidence is available addressing barriers to demonstration of nursing outcomes at multiple levels of practice. A Likert scale tool was developed and administered to 526 attendees at the 2012 national Magnet conference. Questions related to available resources, benchmarks, outcome demonstration process understanding, perception of value, and competing priorities. Significant perception differences by role were demonstrated related to available resources, competing priorities, and process understanding supporting demonstration of nurse-sensitive outcomes. No significant differences were identified related to benchmarks or perception of process value to the organization. This study provides new information demonstrating potential barriers to demonstration of nurse-sensitive outcomes differing by role. Opportunity exists to develop systems and processes to reduce perceived barriers among the nursing workforce.

The occurrence of adverse events potentially attributable to nursing care in medical units: Cross sectional record review

BackgroundEnsuring the safety of hospitalized patients remains a major challenge for healthcare systems, and nursing services are at the center of hospital care. Yet our knowledge about safety of nursing care is quite limited. In fact, most earlier studies examined one, or at most two, indicators, thus presenting an incomplete picture of safety at an institutional or broader level. Furthermore, methodologies have differed from one study to another, making benchmarking difficult. ObjectivesThe aim of this study was to describe the frequencies of six adverse events widely considered in the literature to be nursing-sensitive outcomes and to estimate the degree to which these events could be attributed to nursing care. MethodCross-sectional review of charts of 2699 patients hospitalized on 22 medical units in 11 hospitals in Quebec, Canada. The events included: pressure sores, falls, medication administration errors, pneumonias, urinary infections, and inappropriate use of restraints. Experienced nurse reviewers abstracted patients’ charts based on a grid developed for the study. ResultsPatient-level risk for at least one of these six adverse events was 15.3%, ranging from 9% to 28% across units. Of the 412 patients who experienced an event, 30% experienced two or more, for a total of 568 events. The risk of experiencing an adverse event with consequences was 6.2%, with a unit-level range from 3.2% to 13.5%. Abstractors concluded that 76.8% of the events were attributable to nursing care. ConclusionWhile the measurement approach adopted here has limitations stemming from reliance on review of documentation, it provided a practical means of assessing several nursing-sensitive adverse events simultaneously. Given that patient safety issues are so complex, tracking their prevalence and impact is important, as is finding means of evaluating progress in reducing them.

Nursing-Sensitive Outcome Change Scores for Hospitalized Older Adults with Heart Failure: A Preliminary Descriptive Study

Nursing has a social mandate to ensure effective practice within its domain and to be accountable for the outcomes of nursing care. Using standardized nursing terminologies makes it possible to measure aspects of nursing care. The purpose of this study was to determine whether a significant difference in outcome ratings exists from admission to discharge for hospitalized older adults with heart failure (HF) using Nursing Outcomes Classification (NOC). A retrospective descriptive research design was used. Data were obtained from 268 inpatient records of patients discharged with HF during a 1-year period. All top 10 NOC outcomes demonstrated statistically significant improvement in outcome ratings from admission to discharge. Findings from this study provide insight on the possible contribution of nursing to outcomes of hospitalized older adults with HF. Validating and incorporating nursing-sensitive outcome measures in future prospective experimental research can contribute to the advancement of science regarding effective treatment of older adults hospitalized with HF, while highlighting the contribution of nursing care to outcomes.

Evaluating Perioperative Nursing in Finland: An Initial Validation of Perioperative Nursing Data Set Outcomes

The current Finnish version of AORN's Perioperative Nursing Data Set consists of nursing diagnoses and interventions but not outcomes. During the early Finnish validation phase, researchers determined that almost half of the outcomes listed in the AORN version were impossible to measure in Finland. We conducted this study to determine the applicability of the nursing outcomes identified in the Perioperative Nursing Data Set, 2nd ed Rev, and to test the use of the outcomes by exploring the relevance of the outcome indicators for eight selected outcomes. We collected the data by using two surveys with structured questionnaires that were provided to an expert panel of nurses and physicians. Panel members found that most of the outcomes were acceptable for use in Finnish perioperative care; however, further validation of the outcome indicators is needed to develop tools to support nurses in their attempts to reach desirable nursing-sensitive outcomes for patients.

The Relationship Between Safety Culture and Patient Outcomes

Patient safety continues to be a serious health concern in acute-care hospitals. Safety culture has been a frequent target for patient safety improvement over the past decade, based on recommendations from the Institute of Medicine and its use in industry. However, the relationship between safety culture and patient safety in acute-care hospitals has yet to be systematically examined. Thus, a meta-analysis was devised to examine the relationship between patient safety outcomes and safety culture in that setting. Due to the limited empirical research reports available, five small pilot meta-analyses were conducted, examining the relationship between safety culture and each of the following: pressure ulcers, falls, medication errors, nurse-sensitive outcomes, and post-operative outcomes. No significant relationships of any size were identified. An assessment of the relevant literature is presented, offering potential explanations for this surprising finding and an agenda for future research.

The economic benefits of increased levels of nursing care in the hospital setting

To assess the economic impact of increased nursing hours of care on health outcomes in adult teaching hospitals in Perth, Western Australia. Advancing technology and increased availability of treatment interventions are increasing demand for health care while the downturn in world economies has increased demand for greater efficiency. Nurse managers must balance nurse staffing to optimize care and provide efficiencies. This longitudinal study involved the retrospective analysis of a cohort of multi-day stay patients admitted to adult teaching hospitals. Hospital morbidity and staffing data from September 2000 until June 2004, obtained in 2010 from a previous study, were used to analyse nursing-sensitive outcomes pre- and post-implementation of the Nurse Hours per Patient Day staffing method, which remains in place today. The cost of the intervention comprised increased nursing hours following implementation of the staffing method. The number of nursing-sensitive outcomes was 1357 less than expected post-implementation and included 155 fewer 'failure to rescue' events. The 1202 other nursing-sensitive outcomes prevented were 'surgical wound infection', 'pulmonary failure', 'ulcer, gastritis', 'upper gastrointestinal bleed', and 'cardiac arrest'. One outcome, pneumonia, showed an increase of 493. Analysis of life years gained was based on the failure to rescue events prevented and the total life years gained was 1088. The cost per life year gained was AUD$8907. The implementation of the Nurse Hours per Patient Day staffing method was cost-effective when compared with thresholds of interventions commonly accepted in Australia.

Care in local communities: a new vision for district nursing

British Journal of NursingVol. 22, No. 4 Healthcare PolicyCare in local communities: a new vision for district nursingAlan GlasperAlan GlasperSearch for more papers by this authorAlan GlasperPublished Online:16 Aug 2013https://doi.org/10.12968/bjon.2013.22.4.236AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health (2013) Care in Local Communities: A new vision and model for district nursing. Department of Health, NHS Commissioning Board Authority and The Queen's Nursing Institute http://tinyurl.com/bafe52q Google ScholarGlasper A (2012) A compassionate vision for nursing and midwifery. Br J Nurs 21(19): 1172–3 Link, Google ScholarGoodman C, Ross F, Mackenzie A, Vernon S (2003) A portrait of district nursing: its contribution to primary health care. J Interprof Care 17(1): 97–108 Crossref, Medline, Google ScholarNHS Commissioning Board (2012) Compassion in Practice: Nursing, midwifery and care staff. Our vision in practice http://tinyurl.com/conq7cl Google ScholarQueen's Nursing Institute (2011) Position Statement: Nursing people in their own homes—key issues for the future of care http://tinyurl.com/a3v74em Google ScholarRoss T (2012) Thousands of elderly needlessly in hospital. Telegraph http://tinyurl.com/bx355cn Google Scholar FiguresReferencesRelatedDetailsCited byThe Impact of COVID-19 from the Perspectives of Dutch District Nurses: A Mixed-Methods Study16 December 2021 | International Journal of Environmental Research and Public Health, Vol. 18, No. 24Evidence-based interventions and nurse-sensitive outcomes in district nursing care: A systematic reviewInternational Journal of Nursing Studies Advances, Vol. 3UK district nursing: the crisis continuesAlan Glasper28 September 2017 | British Journal of Nursing, Vol. 26, No. 17Reinstating district nursing: A UK perspectiveNurse Education in Practice, Vol. 26 28 February 2013Volume 22Issue 4ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 16 August 2013 Published in print 28 February 2013 Information© MA Healthcare LimitedPDF download

Effect of Magnet Hospital Recognition on 2 Patient Outcomes

The purpose of this study was to explore whether Magnet hospitals had better nursing-sensitive outcomes than non-Magnet hospitals. Eighty Magnet hospitals were identified in the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project databases and matched with 80 non-Magnet hospitals on 12 hospital characteristics. Comparative analysis demonstrated no significant differences for risk-adjusted rates for pressure ulcers and failure to rescue. Future investigation should examine what clinical benefits might exist that distinguish Magnet from non-Magnet hospitals.

The critical role of nurses to the successful implementation of the National Safety and Quality Health Service Standards

The National Safety and Quality Health Service Standards requires health service compliance by 2013 and covers several areas including governance arrangements, partnerships with consumers and eight key clinical processes. Nurses in Australia comprise 62% of the hospital workforce, are the largest component and hence play a critical role in meeting these standards and improving the quality of patient care. Several of the standards are influenced by nursing interventions, which incorporate any direct-care treatment that the nurse performs for a patient that may be nurse or physician initiated. The ability for nurses to undertake these interventions is influenced by the hours of care available, the skill mix of the nursing workforce and the environment in which they practice. Taking into consideration the predicted nursing shortages, the challenge to successfully implement the National Safety and Quality Health Service Standards will be great. This paper examines the role of nursing in the delivery of the National Standards, analyses the evidence with regard to nursing-sensitive outcomes and discusses the implications for health service decision makers and policy.

Linking HOBIC Measures with Length of Stay and Alternate Levels of Care: Implications for Nurse Leaders in Their Efforts to Improve Patient Flow and Quality of Care

Integral to understanding and leveraging performance data to monitor and drive quality improvement (QI) efforts to enhance patient care is a partnership between researchers (who generate data) and nurse executives (who lead QI efforts). In Canada, evidence-based, nursing-sensitive patient outcome data are included in the Health Outcomes for Better Information and Care (HOBIC) initiative. A descriptive study was undertaken to examine the relationships and predictive abilities of HOBIC measures with length of stay (LOS) and alternate levels of care (ALC) measures. Specifically, we were interested in determining (a) whether relationships among the HOBIC measures exist and (b) whether any of the HOBIC measures are associated with, and could subsequently be used to predict, the patient and the destination to which he or she is discharged (ALC). Our interest in understanding these relationships and predictive abilities was both research driven and practice driven, with the intent eventually to use study findings to target clinical practice and data feedback strategies. To address the two research aims, this study employed both descriptive and inferential statistical approaches with multiple analytic approaches. Study results suggest that many of the HOBIC measures are related, with a higher score in one measure corresponding to a higher score in another measure. The exception is the therapeutic self-care (TSC) measure, in which higher scores on other HOBIC measures were correlated with lower TSC scores. Associations were also found with the predictive ability of certain HOBIC measures on LOS and ALC. Our study findings call for nurse leaders to emphasize the importance to clinical nurses on hospital units of focusing their efforts on assisting patients in managing their fatigue and dyspnoea effectively; increasing their ability to engage in activities of daily living, functional status and therapeutic self-care; and preventing or minimizing pressure ulcers and falls in acute care patients. In turn, these efforts may decrease patients' LOS.

N023 Knowledge Is Power: Creating an Education Program to Support the Canadian Nurses Association Specialty Certification in the Cardiovascular Intensive Care Unit

The patient population in critical care is growing in complexity. This increased acuity results in patients with complex needs and requires increased vigilance and expanded knowledge when delivering safe and effective care. There is strong evidence that links nationally-recognized specialty certification with increases in patient satisfaction and improved nurse-sensitive outcomes, staff satisfaction, professional commitment, nursing retention, and decreased staffing turnover.

Identifying paediatric nursing-sensitive outcomes in linked administrative health data

BackgroundThere is increasing interest in the contribution of the quality of nursing care to patient outcomes. Due to different casemix and risk profiles, algorithms for administrative health data that identify nursing-sensitive outcomes in adult hospitalised patients may not be applicable to paediatric patients. The study purpose was to test adult algorithms in a paediatric hospital population and make amendments to increase the accuracy of identification of hospital acquired events. The study also aimed to determine whether the use of linked hospital records improved the likelihood of correctly identifying patient outcomes as nursing sensitive rather than being related to their pre-morbid conditions.MethodsUsing algorithms developed by Needleman et al. (2001), proportions and rates of records that identified nursing-sensitive outcomes for pressure ulcers, pneumonia and surgical wound infections were determined from administrative hospitalisation data for all paediatric patients discharged from a tertiary paediatric hospital in Western Australia between July 1999 and June 2009. The effects of changes to inclusion and exclusion criteria for each algorithm on the calculated proportion or rate in the paediatric population were explored. Linked records were used to identify comorbid conditions that increased nursing-sensitive outcome risk. Rates were calculated using algorithms revised for paediatric patients.ResultsLinked records of 129,719 hospital separations for 79,016 children were analysed. Identification of comorbid conditions was enhanced through access to prior and/or subsequent hospitalisation records (43% of children with pressure ulcers had a form of paralysis recorded only on a previous admission). Readmissions with a surgical wound infection were identified for 103 (4.8/1,000) surgical separations using linked data. After amendment of each algorithm for paediatric patients, rates of pressure ulcers and pneumonia reduced by 53% and 15% (from 1.3 to 0.6 and from 9.1 to 7.7 per 10,000 patient days) respectively, and an 84% increase in the proportion of surgical wound infection (from 5.7 to 10.4 per 1,000 separations).ConclusionsAlgorithms for nursing-sensitive outcomes used in adult populations have to be amended before application to paediatric populations. Using unlinked individual hospitalisation records to estimate rates of nursing-sensitive outcomes is likely to result in inaccurate rates.

Clinical Attributes of Non Ventilator-Associated Hospital-Acquired Pneumonia

Objectives: To describe the incidence and risk factors of patients with non ventilator-associated pneumonia (non-VAP HAP). Background: Numerous studies have reported the incidence and prevention of ventilator-associated pneumonia (VAP); conversely, non-VAP HAP is an underreported and unstudied area, with potential for measureable nurse-sensitive outcomes. With the National Healthcare Safety Network focus on VAP, hospitals are required to monitor VAP; however, there are currently no requirements to monitor non-VAP HAP. The limited studies available indicate that non-VAP HAP is an emerging factor in prolonged hospital stays, patient morbidity, and increased cost of $40,000 for each case. Understanding the incidence and determining patients most at risk of this hospital-acquired infection is essential to provide optimal patient care.

Nursing work directions in Australia: Does evidence drive the policy?

A significant body of research has shown a relationship between nurse staffing (in particular, skill-mix: the proportion of Registered Nurses [RNs]) and both morbidity and mortality. This relationship is typically investigated by measuring the incidence of Nursing Sensitive Outcomes (NSOs) under different skill-mix levels. Yet whilst the evidence suggests that richer skill-mix is associated with a lower incidence of NSOs, recent Australian policy reforms have proposed the replacement of Registered Nurses with less qualified staff. The present study sought to examine the relationship between staffing, skill-mix, and incidence of NSOs at two hospitals in one Australian state. The study sought to determine the rate of occurrence of several NSOs, the relationship of skill-mix to that rate, and the number of patients affected per annum. It was found that the current rate of NSOs across wards ranged from 0.17% to 1.05%, and that there was an inverse relationship between the proportion of hours worked by RNs and NSO rates: an increase of 10% in the proportion of hours worked by RNs was linked to a decrease in NSO rates by between 11% and 45%. It was estimated that increasing the RN staffing percentage by 10% would mean 160 fewer adverse outcomes for patients per year across these two hospitals. Importantly, increases in nursing hours overall (without increases in skill-mix) had no significant effect on patient outcomes. These findings challenge current policy recommendations, which propose increasing the number of unregistered staff without increasing skill-mix.

Nursing Care of Patients Undergoing Isolated Limb Procedures for Recurrent Melanoma of the Extremity

Isolated limb perfusion and isolated limb infusion are surgical interventions that provide high-dose regional chemotherapy to patients experiencing a recurrence of melanoma in an extremity. Nurses may be unfamiliar with these treatment options, as they are not available in all hospitals; however, the number of people diagnosed with melanoma is increasing. It is important for nurses to understand these surgical procedures to provide safe high-quality care before and after the surgery. Currently, there are several gaps in our knowledge about patients' experiences or nurse-sensitive outcomes. There are abundant opportunities for nurses to improve the care of patients who undergo surgical interventions to manage melanoma in the extremity.