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

Abstract

Aims To examine the association between type of nursing staff and nursing‐sensitive outcomes in long‐term institutional care. Design This systematic review included studies published in English, German, and Dutch between January 1997 and January 2020. Data sources The databases Medline (PubMed), CINAHL, PsycINFO, Embase, and the Cochrane Library were searched. Original quantitative studies were included. Review methods 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. Results 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. Conclusion 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. Impact 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.

Factors associated with retention intention of Registered Nurses in Korean nursing homes

“…RNs working in nursing homes are important because they are responsible for older adults’ health, safety, and quality of life. Higher RN hours have a positive effect on reducing pressure ulcers, preventing falls, reducing tube feeding, and improving residents’ activities of daily living (Courvoisier et al., 2018 ; Shin & Hyun, 2015 ; Tuinman et al., 2021 ). Moreover, RNs play an important role in communicating with families and other staff, and engaging in indirect treatment activities such as equipment and drug management (McCloskey et al., 2015 ).…”

Comment on Peters, M.D.J., Marnie, C., Butler, A., 2021. Delivering, funding, and rating safe staffing levels and skills mix in aged care

“…Most prior studies examining the educational background of nursing home staff focus on the total amount of care provided by one type of staff, for example, registered nurses or certified nurse assistants, and do not consider the skills mix (e.g., the percentage of the total number of hours of care provided by registered nurses). The inconclusive findings of a recent systematic review ( Tuinman et al, 2021 ) on the association between type of nursing staff and nursing-sensitive outcomes in institutional long-term care do not allow one to make recommendations on "who should best perform which care." In most of these studies, no distinction is made between vocationally trained or baccalaureate-educated registered nurses, while their educational backgrounds differ substantially ( Tuinman et al, 2021 ).…”

“…The inconclusive findings of a recent systematic review ( Tuinman et al, 2021 ) on the association between type of nursing staff and nursing-sensitive outcomes in institutional long-term care do not allow one to make recommendations on "who should best perform which care." In most of these studies, no distinction is made between vocationally trained or baccalaureate-educated registered nurses, while their educational backgrounds differ substantially ( Tuinman et al, 2021 ).…”

The impact of safety culture, quality of care, missed care and nurse staffing on patient falls: A multisource association study

“…A systematic review by Recio‐Saucedo et al (2018) reported that only two out of four studies found significant associations between missed care and patient falls. Tuinman et al (2021) reported mixed results on the relationship between staffing levels and patient falls. A more recent study by Nantsupawat et al (2022) reported higher numbers of patients per nurse were associated with higher missed care and increased adverse events; however, there was no significant association between missed care and patient falls.…”