AimsTo examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals.DesignA quantitative systematic review included studies published in English between January 2000 – September 2018.Data sourcesCochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix‐methods designs were included if the quantitative component met the criteria.Review methodsThe Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument were used. An inverse association was determined when seventy‐five percent or more of studies with significant results found this association.ResultsSixty‐three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e., higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure‐to‐rescue; pneumonia; sepsis; urinary tract infection; mortality/30‐day mortality; pressure injury; infections and shock/cardiac arrest/heart failure.ConclusionNursing skill mix affected 12 patient outcomes. However, further investigation using experimental or longitudinal study designs are required to establish causal relationships. Consensus on the definition of skill mix is required to enable more robust evaluation of the impact of changes in skill mix on patient outcomes.ImpactSkill mix is perhaps more important than the number of nurses in reducing adverse patient outcomes such as mortality and failure to rescue, albeit the optimal staffing profile remains elusive in workforce planning.
These findings suggest that the CHEST Australia intervention is achieving the desired objectives at the qualitative level through the proposed theoretical mechanisms.
To examine risk assessment tools to predict patient violence in acute care settings. An integrative review of the literature. Five electronic databases – CINAHL Plus, MEDLINE, OVID, PsycINFO, and Web of Science were searched between 2000 and 2018. The reference list of articles was also inspected manually. The PICOS framework was used to refine the inclusion and exclusion of the literature, and the PRISMA statement guided the search strategy to systematically present findings. Forty‐one studies were retained for review. Three studies developed or tested tools to measure patient violence in general acute care settings, and two described the primary and secondary development of tools in emergency departments. The remaining studies reported on risk assessment tools that were developed or tested in psychiatric inpatient settings. In total, 16 violence risk assessment tools were identified. Thirteen of them were developed to assess the risk of violence in psychiatric patients. Two of them were found to be accurate and reliable to predict violence in acute psychiatric facilities and have practical utility for general acute care settings. Two assessment tools were developed and administered in general acute care, and one was developed to predict patient violence in emergency departments. There is no single, user‐friendly, standardized evidence‐based tool available for predicting violence in general acute care hospitals. Some were found to be accurate in assessing violence in psychiatric inpatients and have potential for use in general acute care, require further testing to assess their validity and reliability.
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