Effect of the hospital nursing environment on patient mortality: a systematic review

Kazanjian, Arminée; Green, Carolyn; Wong, Jennifer; Reid, Robert J.

doi:10.1258/1355819053559100

Cited by 81 publications

(66 citation statements)

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Section: Outcomes Of Variation In Hospital Nurse Staffing In English mentioning

confidence: 99%

“…A robust evidence base of studies demonstrating that better hospital nurse staffing is associated with more favourable patient outcomes has stimulated both legislative and voluntary actions by hospitals in the US to improve staffing levels (Aiken et al, 2002a, b;Estabrooks et al, 2005;Moses and Mosteller, 1968;Hartz et al, 1989;Needleman et al, 2002;Page, 2004;Lang et al, 2004;Kazanjian et al, 2005;Spetz, 2004). While many concerns about the quality of hospital care are shared internationally (McKee et al, 1997;McKee et al, 1998), decision-makers in other countries have not always considered these US findings to be applicable to their particular national contexts.…”

Section: Outcomes Of Variation In Hospital Nurse Staffing In English mentioning

confidence: 99%

“…In the US study, every one patient added to the average hospital-wide nurse workload increased the risk of death following common surgical procedures by 7% (Aiken et al, 2002a, b). There was a 31% difference in mortality between hospitals in which registered nurses cared for 8 patients each and those in which nurses cared for 4 patients each after taking into account patients' severity of illness and co-morbid conditions, and the size, technology level, and teaching status of the treating hospitals.Findings from the Canadian arm of the international study mirror those in the US, most notably, a staffing skill mix with a higher proportion of registered nurses was associated with significantly lower mortality (Estabrooks et al, 2005).A robust evidence base of studies demonstrating that better hospital nurse staffing is associated with more favourable patient outcomes has stimulated both legislative and voluntary actions by hospitals in the US to improve staffing levels (Aiken et al, 2002a, b;Estabrooks et al, 2005;Moses and Mosteller, 1968;Hartz et al, 1989;Needleman et al, 2002;Page, 2004;Lang et al, 2004;Kazanjian et al, 2005;Spetz, 2004 …”

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Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records

Rafferty

Clarke

Coles

et al. 2007

International Journal of Nursing Studies

440

330

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Context-Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention.Objectives-To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care.Design and setting-Cross-sectional analysis combining nurse survey data with discharge abstracts.Participants-Nurses (N = 3984) and general, orthopaedic, and vascular surgery patients (N = 118 752) in 30 English acute trusts.Results-Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12-49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals.Conclusions-Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA. Outcomes of variation in hospital nurse staffing in English hospitalsThe impact of nurse staffing on patient outcomes has been controversial in the US and as contentious in the UK. A 2001 Audit Commission report on ward staffing in National Health Service (NHS) hospitals noted considerable variation across trusts in expenditures on nurse staffing but was not able to determine whether those differences were associated with variation in patient outcomes (Audit Commission, 2001). The Commission concluded, "Unless and until trusts that spend more [on staffing] can demonstrate a clear link with the quality of care that is delivered, movement towards a more even allocation of resources seems reasonable both for patients and staff." (1, p. 15). The Healthcare Commission released a report in June 2005 suggesting that patients were more satisfied in hospitals with more qualified nurses but emphasized again the lack of evidence linking staffing to patient outcomes and the need for research to guide decision-making in this area (Healthcare Commission, 2005).The Audit Commission's report coincided with the publication of the first results from the five-country International Hospital Outcomes Study. The International Hospital Outcomes Study, involving seven interdisciplinary research teams in five countries (US, Canada, England, Scotland and Germany), examined the extent to which the relationships between nurse staffing, the quality of the nurse work environment, and patient and nurse outcomes are similar across countries with well-resourced health care systems (Aiken et al., 2002a, b). It was seen that...

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Section: Outcomes Of Variation In Hospital Nurse Staffing In English mentioning

confidence: 99%

Section: Outcomes Of Variation In Hospital Nurse Staffing In English mentioning

confidence: 99%

mentioning

confidence: 99%

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Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records

Rafferty

Clarke

Coles

et al. 2007

International Journal of Nursing Studies

440

330

View full text Add to dashboard Cite

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“…Thereby, it is an important factor in the theoretical team effectiveness models (input-processoutput models) that illustrate the relationship between input, process and output (Campion, Medsker, & Higgs, 1993;Campion, Papper, & Medsker, 1996;Gladstein, 1984;West, 2004;Xyrichis & Ream, 2008). Job satisfaction is often used to operationalize output (Campion et al, 1993;Campion et al, 1996;Körner, 2008) on the staff level because of its association with patient outcomes (Chang, Ma, Chiu, Lin, & Lee, 2009;Kazanjian, Green, Wong, & Reid, 2005;O'Leary, Sehgal, Terrell, & Williams, 2012). Job satisfaction is defined as "a pleasurable or positive emotional state resulting from the appraisal of one's job or job experiences" (Locke, 1976(Locke, , p. 1304.…”

Section: Introductionmentioning

confidence: 99%

Healthcare professionals’ evaluation of interprofessional teamwork and job satisfaction / Evaluation der Teamarbeit und der Arbeitszufriedenheit von Gesundheitsfachberufen

Körner

Göritz

Bengel

2014

International Journal of Health Professions

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Interprofessional teamwork among healthcare professionals in healthcare organizations is a key factor for both their job satisfaction and patients' effective and efficient treatment. One precondition for successful interprofessional teamwork is a shared mental model (a common cognitive frame of reference and knowledge) of working together as a team. However, there often exist subcultures, and each of these has its own mental model of teamwork. Hence, it can be assumed that different healthcare professional groups do not share the evaluation of their interprofessional teamwork and job satisfaction (Hypothesis 1). Additionally, based on the input-process-output model of team effectiveness, it can be expected that interprofessional teamwork determines job satisfaction (Hypothesis 2). These hypotheses were tested in a survey of 272 employees in 15 rehabilitation clinics in Germany. Results showed that healthcare professionals' evaluation of their interprofessional teamwork (F(3, 203) = 9.118, p < 0.001, η 2 = 0.119) as well as their job satisfaction (F(3, 210) = 3.357, p = 0.02, η 2 = 0.046) differed significantly. Physicians reported the highest level of interprofessional teamwork and job satisfaction compared with other groups. Perceptions of interprofessional teamwork explain approximately 20% of the variance in job satisfaction. Thus, both hypotheses were confirmed. Interprofessional interventions in education and practice are recommended to establish a shared mental model, which could improve teamwork and subsequently job satisfaction.Interprofessional relations -questionnaire design -quantitative method -interdisciplinary -professional identity -teamwork -job satisfaction Keywords Abstract AbstractInterprofessionelle Beziehung -Fragebogen -quantitative Methode -Interdisziplinarität-professionelle Identität -Teamarbeit -Arbeitszufriedenheit

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“…Quanto ao índice de mortalidade, diversos estudos (69)(70)(71)(72)(73) demonstraram associação dessa variável com a elevada carga de trabalho de enfermagem. Aiken et al (74) também concluíram que o risco de morte aumenta em 7,0% para cada paciente adicional/enfermeiro.…”

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Segurança do paciente em Unidade de Terapia Intensiva: carga de trabalho de enfermagem e sua relação com a ocorrência de eventos adversos e incidentes

Gonçalves¹

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An observational prospective study of an quantitative approach, aimed at analyzing the workload of nurses, according to the hours of care required by patients, and the allocation of the nursing staff, per patient a day, and its relationship with the occurrence of adverse events and incidents, in four intensive care units (ICUs) belonging to a university hospital, of a tertiary level, in São Paulo, Brazil. This research was performed in the ICU on the 4th floor (Emergency Room and Hematology) and the 6th floor (Pulmonary and Clinics). The sample consisted of 86 patients. To measure the hours of care required by patients, it was applied in a 40-day study, Nursing Activities Score. The data from this study was obtained from the daily analysis of patient charts, the daily monitoring of physician visits and nursing change of shifts on two shifts (morning and night). Patients in the ICU on the 4th floor demanded greater nursing care (15.7 hours) than patients in the ICU on the 6th floor (14.7 hours), with a significant difference (p = 0.008). The available nursing time in the ICU on the 4th floor (16.9 hours) were inferior to the one on the 6th floor (24.4 hours), also with a statistically significant result (p = 0.000). The average difference between the available hours and required ones on nursing care for ICU patients was higher on the 6th floor, compared to the ICU on the 4th floor (p = 0.000). In both ICUs there were 1082 adverse events and incidents, of which 865 (79.9%) were incidents and 217 (20.1%) adverse events. The increase in the difference between the available hours and the required ones on nursing care to patients resulted in increased frequency of adverse events and incidents per patient a day, only in the combined analysis of both ICUs, with an equal correlation of 0.444 (p = 0.000). Out of 1165 allocations of the nursing staff in both ICUs, 893 (76.7%) were adequate and 272 (23.3%) inadequate. The average number of incidents and adverse events was higher in the inadequate allocation of the nursing staff, compared to adequate allocation in both the 4th floor ICU (p = 0.004) and 6th floor ICU (p = 0.000), and when analyzed together both ICUs (p = 0.000). It was also observed that in both ICUs, when analyzed separately and together, the higher the difference between the available hours of nursing care and the required ones by patients, in the allocation of the nursing staff, the lower the frequency of adverse events and incidents was, these significant correlations. In conclusion, the results showed the importance of a proper distribution of the daily nursing staff per patient to ensure patient safety.

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Effect of the hospital nursing environment on patient mortality: a systematic review

Cited by 81 publications

References 0 publications

Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records

Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records

Healthcare professionals’ evaluation of interprofessional teamwork and job satisfaction / Evaluation der Teamarbeit und der Arbeitszufriedenheit von Gesundheitsfachberufen

Segurança do paciente em Unidade de Terapia Intensiva: carga de trabalho de enfermagem e sua relação com a ocorrência de eventos adversos e incidentes

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