Nursing-sensitive Outcomes Research Articles

CN19 Comparison of Charlson and Elixhauser method for predicting nursing indicator in gastrectomy with gastric cancer patients

Both Charlson's comorbidity index (CCI) and Elixhauser's comorbidity index (ECI) have been used to adjust comorbidity in individual patients using administrative databases in health care quality. The Korean Health Insurance Review and Assessment Service (HIRA) database were used to compare the performance of CCI and ECI in predicting Nurse-Sensitive Outcomes (NSOs) with gastric resections for gastric cancer.

Nursing leadership in clinical practice, its efficacy and repercussion on nursing-sensitive outcomes: A cross-sectional multicentre protocol study.

The aim of this study to describe a research protocol for evaluating the relationship between nursing leadership, organisational well-being and nurse and patient outcomes. The head nurses' leadership style influences the organisational context. When an organisation promotes nurses' well-being, they perform better performances and are more satisfied and engaged with their job. This reduces stress levels, burnout and absenteeism and improves physical and psychological health. A multicentre study will be conducted. A self-report questionnaire will be administered to head nurses and nurses they coordinate. Study findings will include nurse-sensitive outcomes (e.g., pressure injuries, infections and mortality). Descriptive and correlational analyses will be conducted, and a structural equation model will be tested. Results might verify that a correctly judged leadership style of the head nurse will enhance the organisational context experienced by nurses and improve nursing sensitive outcomes. This study will demonstrate the organisational role of middle managers and the direct repercussions on their staff and patients, understanding the relationship between organisational, process and outcomes variables. If the results confirmed the hypothesis, health care managers would cultivate and stimulate the head nurses' leadership style, thus increasing nurses' organisational well-being and achieving better patient outcomes. No Patient or Public Contribution.

Exploring the Association Between Nurse Workload and Nurse-Sensitive Patient Safety Outcome Indicators: Retraction.

Exploring the Association Between Nurse Workload and Nurse-Sensitive Patient Safety Outcome Indicators: Retraction.

P347 NURSING SENSITIVE OUTCOME (NSO) IN CARDIOVASCULAR CARE: NEW PERSPECTIVES TO IMPROVE QUALITY OF CARE AND PERSONALIZED ASSISTANCE

Abstract Over the years, attention of literature on the relation between the caring process and the patient’s outcomes has increased. In healthcare Organization, collection and recording of data about Nursing Sensitive Outcomes (NSO) allow a reflection on the impact of some nursing interventions in the clinical practice. The goals is to improve the quality and safety of nursing care and of continuing nursing training too. The cardiac and / or cardiac surgery patient is complex. For this reason, Nurse has a central role in the Healthcare Team to ensure prevention, assessment and treatment along the clinical pathway. Objective Mapping a set of NSOs, through shared clinical indicators. These specific indicators refer to several macro–areas: multidimensional assessment, pain management, wound care, vascular access management and assessment, drug therapies management. The indicators are measured in all of setting involved in cardiac patient care. METHODS Monocentric, observational, retrospective study. The data are extracted from the Computerized Nursing Record on the total hospitalizations in the 2020 and 2021 and will be analyzed. RESULTS Some data about the total accesses to the ward, in 2020: Barthel scale evaluated within 6 hours of admission in 90% of cases, Braden in 91% and Retos in 92%. Specifically, in patients > = 65 years of age, Retos filled in 90% of cases. Mews score evaluated at least once in 24h in 95% of cases and if mews score > = 3 vital signs are revalued in 93% of patients. STU correctly completed by physicians in 95.2% of patients. Conclusions The preliminary results of this study are strategic in order to initiate a monitoring phase about the nursing process, organizational models and skills over time. It allows a reflection on the quality and safety of care and to enhance nursing skills. However, in the future, we will hope to carry out a survey aimed at nurses, to explore, with an intra–professional perspective, which outcomes are the most perceived as sensitive to nursing care in the cardiovascular field and to better describe the competences related to NSOs. The association between the results of the questionnaire and the indicators monitoring, will strategic in order to build future specific nursing training.

Validation of the Therapeutic Self-Care Scale-European Portuguese Version in Primary Care Type 2 Diabetes Adults.

Self-care is an important nursing-sensitive outcome. Reliable and valid measures are needed for therapeutic self-care assessment that may inform the development and evaluation of individualized nursing interventions co-created with type 2 diabetes mellitus (T2DM) adults. The therapeutic self-care scale European Portuguese version (TSCS-EPV) is a validated generic measure that may be used to assess self-care in T2DM adults. Aim: To examine the psychometric properties of the TSCS-EP version in T2DM adults, in primary health care. Methods: A cross-sectional pilot study in a convenience sample of 80 adults with T2DM from two primary health care centers in Portugal was conducted. Individuals completed the Portuguese version of the TSC scale. Results: A three-factor solution emerged from the principal component analysis: “Recognizing and managing signs and symptoms”; “Managing changes in health condition” and “Managing medication”, explaining 75% of the total variance. Total scale Cronbach’s alpha was 0.884 and for the three factors ranged from 0.808 to 0.954. Conclusion: the therapeutic self-care scale European Portuguese version is a promising scale for assessing therapeutic self-care abilities in adults with T2DM in primary care settings. More consistent results on its validity and reliability are needed for it to be used in the country.

Derivation and validation of a prediction model to establish nursing-sensitive quality benchmarks in medical inpatients: a secondary data analysis of a prospective cohort study.

Hospitals are using nursing-sensitive outcomes (NSOs) based on administrative data to measure and benchmark quality of nursing care in acute care wards. In order to facilitate comparisons between different hospitals and wards with heterogeneous patient populations, proper adjustment procedures are required. In this article, we first identify predictors for common NSOs in acute medical care of adult patients based on administrative data. We then develop and cross-validate an NSO-oriented prediction model. We used administrative data from seven hospitals in Switzerland to derive prediction models for each of the following NSO: hospital-acquired pressure ulcer (≥ stage II), hospital-acquired urinary tract infection, non-ventilator hospital-acquired pneumonia and in-hospital mortality. We used a split dataset approach by performing a random 80:20 split of the data into a training set and a test set. We assessed discrimination of the models by area under the receiver operating characteristic curves. Finally, we used the validated models to establish a benchmark between the participating hospitals. We considered 36,149 hospitalisations, of which 51.9% were male patients with a median age of 73 years (with an interquartile range of 59-82). Age and length of hospital stay were independently associated with all four NSOs. The derivation and validation models showed a good discrimination in the training (AUC range: 0.75-0.84) and in the test dataset (AUC range: 0.77-0.81), respectively. Variation among different hospitals was relevant considering the risk for hospital-acquired pressure ulcer (≥ stage II) (adjusted Odds ratio [aOR] range: 0.51 [95% CI: 0.38-0.69] - 1.65 [95% CI: 1.33-2.04]), the risk for hospital-acquired urinary tract infection (aOR range: 0.46 [95% CI: 0.36-0.58] - 1.45 [95% CI: 1.31-1.62]), the risk for non-ventilator hospital-acquired pneumonia (aOR range: 0.28 [95% CI: 0.09-0.89] - 2.87 [95% CI: 2.27-3.64]), and the risk for in-hospital mortality (aOR range: 0.45 [95% CI: 0.36-0.56] - 1.39 [95% CI: 1.23-1.60]). The application of risk adjustment when comparing nursing care quality is crucial and enables a more objective assessment across hospitals or wards with heterogeneous patient populations. This approach has potential to establish a set of benchmarks that could allow comparison of outcomes and quality of nursing care between different hospitals and wards.

Comprehensive mapping of NICU developmental care nursing interventions and related sensitive outcome indicators: a scoping review protocol

IntroductionNeurodevelopmental outcomes of preterm infant are still a contemporary concern. To counter the detrimental effects resulting from the hospitalisation in the neonatal intensive care unit (NICU), developmental care (DC) interventions...

Challenges using electronic nursing routine data for outcome analyses: A mixed methods study

ObjectivesTo explore the challenges of secondary use of routinely collected data for analyzing nursing-sensitive outcomes in Austrian acute care hospitals. MethodA convergent parallel mixed methods design was performed. We conducted a quantitative representative survey with nursing managers from 32 Austrian general acute care hospitals and 11 qualitative semi-structured interviews with nursing quality management experts. Both results were first analyzed independently and afterward merged in the discussion. ResultsOn average, 76% of nursing documentation is already electronically supported in the surveyed Austrian hospitals. However, existing nursing data is seldom used for secondary purposes such as nursing-sensitive outcome analyses. This is due to four major reasons: First, hospitals often do not have a data strategy for the secondary use of routine data. Second, hospitals partly lack the use of standardized and uniform nursing terminologies, especially for nursing evaluation. Third, routine nursing data is often not documented correctly and completely. Fourth, data on nursing-sensitive outcomes is usually collected in specific documentation forms not integrated into routine documentation. ConclusionThe awareness of the possibilities for secondary use of nursing data for nursing-sensitive outcome analyses in Austrian hospitals is still in its infancy. Therefore, nursing staff and nursing management must be trained to understand how to collect and process nursing data for nursing-sensitive outcome analyses. Further studies would be interesting in order to determine the factors that influence the decision-making processes for the secondary use of nursing data for outcome analyses.

Evidence-based interventions and nurse-sensitive outcomes in district nursing care: A systematic review.

Measuring nursing interventions and nurse-sensitive outcomes in a standardized manner is essential because it provides insight into the quality of delivered care. However, there is currently no systematic overview of the interventions conducted by district nurses, the evidence for the effects of these interventions, or what nurse-sensitive outcomes should be measured. 1) To provide an overview of interventions for community-living older people evaluated in district nursing care and evidence for the effects of these interventions and 2) to identify the nurse-sensitive outcomes that are used to evaluate these district nursing care interventions, how these outcomes are measured, and in which patient groups they are applied. A systematic review of the literature. District nursing care. MEDLINE, CINAHL, PsycInfo, and EMBASE. Only experimental studies evaluating district nursing care interventions for communkity-living older people were included. A data extraction form was developed to extract the study characteristics and evaluate interventions and nurse-sensitive outcomes. The methodological quality of the included studies was reviewed using the 13-item critical appraisal tool for randomized controlled trials by the Joanna Briggs Institute. A total of 22 studies were included. The methodological quality of the studies varied, with scores ranging from 6 to 11 on a scale of 0-13. The 22 interventions identified were heterogeneous with respect to intervention components, intervention delivery, and target population. The 44 outcomes identified were grouped into categories following the Nursing Outcome Classification and were measured in various ways and at various times. This is the first systematic review summarizing the evidence for the effectiveness of nurse-led interventions conducted by district nurses on community-living older people. It is unclear what interventions are effective and what outcomes should be used to substantiate district nursing care effectiveness. Because only studies with experimental designs were included, this analysis may provide an incomplete assessment of the effectiveness of interventions in district nursing care. Therefore, it is highly necessary to produce methodologically strong evidence through research programs focusing on district nursing care.

Nursing-Sensitive Outcomes among Patients Cared for in Paediatric Intensive Care Units: A Scoping Review.

Measuring the effectiveness of nursing interventions in intensive care units has been established as a priority. However, little is reported about the paediatric population. The aims of this study were (a) to map the state of the art of the science in the field of nursing-sensitive outcomes (NSOs) in paediatric intensive care units (PICUs) and (b) to identify all reported NSOs documented to date in PICUs by also describing their metrics. A scoping review was conducted by following the framework proposed by Arksey and O’Malley. Fifty-eight articles were included. Publications were mainly authored in the United States and Canada (n = 28, 48.3%), and the majority (n = 30, 51.7%) had an observational design. A total of 46 NSOs were documented. The most reported were related to the clinical (n = 83), followed by safety (n = 41) and functional (n = 18) domains. Regarding their metrics, the majority of NSOs were measured in their occurrence using quantitative single measures, and a few validated tools were used to a lesser extent. No NSOs were reported in the perceptual domain. Nursing care of critically ill children encompasses three levels: improvement in clinical performance, as measured by clinical outcomes; assurance of patient care safety, as measured by safety outcomes; and promotion of fundamental care needs, as measured by functional outcomes. Perceptual outcomes deserve to be explored.

Implementation and Evaluation of an Acute Care Multicomponent Intervention for Dementia-Related Behavioral Expressions.

Despite the high prevalence and negative outcomes associated with poorly managed dementia-related behavioral expressions (BE) during hospitalization, evidence-based interventions for BE management in acute care environments are lacking. To address this gap, we designed, implemented, and evaluated feasibility, utility, and exploratory nurse and patient outcomes associated with a low-cost, nurse-led multicomponent decision support intervention-the Personalized Approach and Targeted Interventions (PROACTIVE) Treatment Approach-which was implemented as a quality improvement program and evaluated with a historical matched comparison group. The intervention was feasibly implemented and improved nurse-sensitive outcomes (stress, confidence), practices (use of nonpharmacological approaches) for BE management, and perceived utility of intervention resources. Patients receiving the PROACTIVE Treatment Approach (N = 40) had higher rates of acetaminophen use, and shorter lengths of stay (N = 40). More rigorous evaluation is needed to better determine optimal implementation strategies and intervention impact. [Journal of Gerontological Nursing, 47(9), 21-30.].

Nurse-sensitive outcomes in district nursing care: A Delphi study.

To determine nurse-sensitive outcomes in district nursing care for community-living older people. Nurse-sensitive outcomes are defined as patient outcomes that are relevant based on nurses' scope and domain of practice and that are influenced by nursing inputs and interventions. A Delphi study following the RAND/UCLA Appropriateness Method with two rounds of data collection. District nursing care in the community care setting in the Netherlands. Experts with current or recent clinical experience as district nurses as well as expertise in research, teaching, practice, or policy in the area of district nursing. Experts assessed potential nurse-sensitive outcomes for their sensitivity to nursing care by scoring the relevance of each outcome and the ability of the outcome to be influenced by nursing care (influenceability). The relevance and influenceability of each outcome were scored on a nine-point Likert scale. A group median of 7 to 9 indicated that the outcome was assessed as relevant and/or influenceable. To measure agreement among experts, the disagreement index was used, with a score of <1 indicating agreement. In Delphi round two, 11 experts assessed 46 outcomes. In total, 26 outcomes (56.5%) were assessed as nurse-sensitive. The nurse-sensitive outcomes with the highest median scores for both relevance and influenceability were the patient's autonomy, the patient's ability to make decisions regarding the provision of care, the patient's satisfaction with delivered district nursing care, the quality of dying and death, and the compliance of the patient with needed care. This study determined 26 nurse-sensitive outcomes for district nursing care for community-living older people based on the collective opinion of experts in district nursing care. This insight could guide the development of quality indicators for district nursing care. Further research is needed to operationalise the outcomes and to determine which outcomes are relevant for specific subgroups.

The impact of nurse staffing levels on nursing-sensitive patient outcomes: a multilevel regression approach

The goal of this study is to provide empirical evidence of the impact of nurse staffing levels on seven nursing-sensitive patient outcomes (NSPOs) at the hospital unit level. Combining a very large set of claims data from a German health insurer with mandatory quality reports published by every hospital in Germany, our data set comprises approximately 3.2 million hospital stays in more than 900 hospitals over a period of 5 years. Accounting for the grouping structure of our data (i.e., patients grouped in unit types), we estimate cross-sectional, two-level generalized linear mixed models (GLMMs) with inpatient cases at level 1 and units types (e.g., internal medicine, geriatrics) at level 2. Our regressions yield 32 significant results in the expected direction. We find that differentiating between unit types using a multilevel regression approach and including postdischarge NSPOs adds important insights to our understanding of the relationship between nurse staffing levels and NSPOs. Extending our main model by categorizing inpatient cases according to their clinical complexity, we are able to rule out hidden effects beyond the level of unit types.

A systematic review of the association between nursing staff and nursing-sensitive outcomes in long-term institutional care.

To examine the association between type of nursing staff and nursing-sensitive outcomes in long-term institutional care. This systematic review included studies published in English, German, and Dutch between January 1997 and January 2020. The databases Medline (PubMed), CINAHL, PsycINFO, Embase, and the Cochrane Library were searched. Original quantitative studies were included. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to critically appraise the reporting of the studies. Fifteen articles were included. Of 33 quality of care outcomes, 21 were identified as nursing-sensitive outcomes of which 13 showed a significant association with nursing staff, specifically: Activities of daily living, aggressive behavior, bladder/bowel incontinence, contractures, expressive language skills, falls, infection (including vaccination), range of motion, pain, pressure ulcers, and weight loss. However, studies reported inconsistent results regarding the association among RNs, LPNs, CNAs, and HCAs and these nursing-sensitive outcomes, evidence shows that more RNs have a positive impact on nursing-sensitive outcomes. As to the evidence regarding the other type of nursing staff, especially HCA, findings regularly showed a negative association. Future research should be expanded with structure and process variables of which the mediating and moderating effect on nursing-sensitive outcomes is known. These may explain variances in quality of care and guide quality improvement initiatives. Researchers should consider fully applying Donabedian's structure-process-outcomes framework as it is a coherent entirety for quality assessment. This review provides an overview of quality of care outcomes that are responsive to nursing interventions in long-term institutional care. As the effects can be monitored and documented, quality assessment should focus on these nursing-sensitive outcomes. The inconclusive results make it difficult to provide recommendations on who should best perform which care.

EFFECTIVENESS OF COMPUTER-BASED NURSING DOCUMENTATION IN NURSING CARE IN HOSPITAL – A LITERATURE REVIEW

Background: Nurse population in hospitals has a greater proportion than other health workers. Nearly 60-70% of the total human resources available, occupied by nurses. In fact, 90% of the health services provided are a form of nursing service. Therefore, nursing service is a form of professional service that is the biggest indicator in realizing the quality of hospital services. One of the duties of nurses in providing nursing services in accordance with standards is to document all nursing care provided. Objective: To review journals about documenting computer-based nursing care in hospitals for the effectiveness of the preparation of nursing care. Methods: Quantitative, mixed-methods, and qualitative reviews that aim to evaluate the influence of computerized nursing documentation (eg, management, computerized decision support systems and information systems) on nursing care were included. We used the nursing care performance framework as an extraction grid and analytical tool. This model illustrates how the interplay between nursing resources and nursing services can produce changes in patient conditions. The primary outcomes included nurses' practice environment, nursing processes, professional satisfaction, and nursing-sensitive outcomes. The secondary outcomes included satisfaction or dissatisfaction with computerized nursing documentation according to nurses 'and patients' perspectives. Reviews published in English, French, or Spanish from January 1, 2000 to December 15, 2019, were considered.&#x0D; Results: A total of 5515 titles or abstracts were assessed for eligibility and full-text papers of 72 articles were retrieved for detailed evaluation. It was found that 22 reviews published between 2002 and 2015 met the eligibility criteria. Many nursing care themes (ie, indicators) were influenced by the use of computerized nursing documentation, including time management; time spent on patient care; documentation time; information quality and access; quality of documentation; knowledge updating and utilization; nurse autonomy; intra and interprofessional collaboration; nurses' competencies and skills; nurse-patient relationship; assessment, care planning, and evaluation; teaching of patients and families; communication and care coordination; perspectives of the quality of care provided; nurses and patients satisfaction or dissatisfaction with computerized nursing documentation; patient comfort and quality of life related to care; empowerment; and functional status.

Validation and psychometric evaluation of the Dutch person-centred care of older people with cognitive impairment in acute care (POPAC)\xa0scale

BackgroundPerson-centred care is the preferred model for caring for people with dementia. Knowledge of the level of person-centred care is essential for improving the quality of care for patients with dementia. The person-centred care of older people with cognitive impairment in acute care (POPAC) scale is a tool to determine the level of person-centred care. This study aimed to translate and validate the Dutch POPAC scale and evaluate its psychometric properties to enable international comparison of data and outcomes.MethodsAfter double-blinded forward and backward translations, a total of 159 nurses recruited from six hospitals (n=114) and via social media (n=45) completed the POPAC scale. By performing confirmatory factor analysis, construct validity was tested. Cronbach’s alpha scale was utilized to establish internal consistency.ResultsThe confirmatory factor analysis showed that the comparative fit index (0.89) was slightly lower than 0.9. The root mean square error of approximation (0.075, p=0.012, CI 0.057–0.092) and the standardized root mean square residual (0.063) were acceptable, with values less than 0.08. The findings revealed a three-dimensional structure. The factor loadings (0.69–0.77) indicated the items to be strongly associated with their respective factors. The results also indicated that deleting Item 5 improved the Cronbach’s alpha of the instrument as well as of the subscale ‘using cognitive assessments and care interventions’. Instead of deleting this item, we suggest rephrasing it into a positively worded item.ConclusionsOur findings suggest that the Dutch POPAC scale is sufficiently valid and reliable and can be utilized for assessing person-centred care in acute care hospitals. The study enables nurses to interpret and compare person-centred care levels in wards and hospital levels nationally and internationally. The results form an important basis for improving the quality of care and nurse-sensitive outcomes, such as preventing complications and hospital stay length.

Nursing-sensitive outcomes in adult inflammatory bowel disease: A systematic review.

To evaluate nursing activity through outcomes that are affected, provided, and/or influenced by nurses and defined as nursing-sensitive outcomes in adult IBD patients. Systematic review without meta-analysis. PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library databases on August 2019. Peer-reviewed articles published between 2000-2020 were reviewed. The outcome measures were contextualized and presented by OMERACT Filter 2.0. Twenty-four studies were included. Eighteen nursing-sensitive outcomes were identified. These outcomes defined eight domains for health intervention, fitting into three core areas (resource use/economic impact, life impact, pathophysiological manifestations). Fifty-three measurement instruments were identified. Through 53 measurement tools, with use of OMERACT framework, 18 nursing-sensitive outcomes in the main 3 core areas were identified, highlighting the multidimensional role of nursing. Further insights are to be carried out to define nursing outcomes included in IBD nursing intervention studies. These results could serve as a cornerstone for further investigations and validation by a panel of experts to standardizing nursing activity in a multidisciplinary context.

A Pilot One Group Feasibility, Acceptability, and Initial Efficacy Trial of LISTEN for Loneliness in Lonely Stroke Survivors.

IntroductionLoneliness is a prevalent problem for adult stroke survivors, and a known contributor to hypertension, secondary stroke, functional decline, poorer quality of life, and mortality in older adults. LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a theoretically based behavioral health intervention designed to target loneliness, in a sample of lonely survivors of ischemic stroke. Objectives: To assess the feasibility and acceptability of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes) in lonely stroke survivors and to evaluate the initial efficacy of LISTEN for loneliness, depressive symptoms, neurological quality of life, and blood pressure in a sample of lonely survivors of ischemic stroke. Methods: The study design was framed using the psychoneuroimmunology paradigm and employed a prospective non-randomized one group design. Six adult stroke survivors were recruited from a Neurology outpatient clinic. Once consented and enrolled, participants attended 5 sequential weekly group sessions of LISTEN. Evaluations, field notes, and video recordings of each session were used to assess feasibility and acceptability of LISTEN. Quantitative data was collected at enrollment and at 1, 6, and 12 weeks post last LISTEN session to assess initial efficacy on loneliness (revised UCLA loneliness scale), depressive symptoms (PHQ-9), neurological quality of life (NeuroQoL), and blood pressure. SPSS was used for descriptive and comparative data analysis to examine within subject changes. Results: LISTEN was feasible to deliver in the selected clinical setting and participants rated LISTEN as highly useful, organized, and clear with an overall rating as excellent for loneliness. Participants reported significant decline in loneliness and improved scores on three subscales of the NeuroQoL; executive function, positive affect and well-being, and satisfaction with social roles. Recruiting stroke survivors for the trial was time intensive for the study team. Conclusions: Larger randomized trials of LISTEN in stroke survivors are needed to build evidence for the longer term effectiveness of LISTEN on loneliness, depressive symptoms, and quality of life. Future study designs will include planning to diminish barriers to recruitment.

A Newly Developed Egyptian Tool for Evaluating Rationing of Nursing Care: Relation to Organization Attributes and Patient Outcomes.

This work developed an Egyptian tool for evaluating rationing of nursing care in critical units and investigated its association with nursing organization attributes and six nurse-sensitive patient outcomes. Rationing of the nursing care questionnaire and concurrent record review were conducted to collect data. Developed Egyptian tool of rationing of nursing care contained 36 items in six components. Adverse patient outcomes were detected as medication administration errors (27.9%), pulmonary infection (24.5%), pressure ulcer (20.3%), bloodstream infections (12.6%), urinary tract infections (10.3%), and patient falls (4.7%). The mild level of rationing of nursing care was positively associated with negative patient outcomes and negatively correlated with fair nursing organization attributes. The valid and reliable Egyptian tool for evaluating the rationing of nursing care was developed.

The relationship between nurse staffing levels and nursing-sensitive outcomes in hospitals: Assessing heterogeneity among unit and outcome types

ObjectiveTo identify which unit types are most sensitive to nurse staffing levels. Data sources/study settingCollection of secondary data took place from March to July 2016. For our study, we analyzed administrative hospital claims data and self-reported structural data from hospitals in Germany. We used 26,502,579 admissions nested in 13,089 units in 3,680 hospitals from 2012 to 2014. Study designWe used regression analysis to examine the relationship between 11 established nursing-sensitive outcomes (NSOs) and nurse-to-patient ratios on a unit level. Nurse-to-patient ratios were our key explanatory variable. We conducted separate OLS regressions for each NSO in each unit type using linear and non-linear terms. Data collection/extraction methodsWe linked hospital claims data with self-reported structural data from hospitals from 2012 to 2014. Principal findingsWe identified 15 unit types with at least one significant NSO. The effect of potential understaffing on NSOs depends on the unit type. ConclusionsOur study indicates that the relationship between nurse staffing levels and NSOs varies greatly depending on the unit type concerning both significance and magnitude. Future research might consider performing analyses on unit level instead of hospital level.