Academic literature on the topic 'Nurse-sensitive outcomes'

Healthcare contributes significant pollution to the natural environment. Nurses are obligated by professional commitment, to avoid causing harm in their care processes and decisions, including environmental harm. Nurse awareness of healthcare-generated pollution is growing but nurses may lack an understanding of how nursing contributes specifically to this pollution and what nurses can do within their scope and span to address it. This chapter introduces the concept “Nurse-Sensitive Environmental Indicators” as a proposal to identify, measure, and reduce the unintended harm of nursing practice that contributes to healthcare-generated pollution. It discusses the environmental problem, environmental health, and healthcare. The chapter explains what environmental stewardship has to do with nursing and describes nurse sensitive indicators. As has been the case with other quality outcomes measures, identifying agreed-upon environmental outcomes measures may give the nursing profession tools to measure and then address environmental impacts arising from nursing practice.

Background: Nurses are pivotal in the provision of high quality care in acute hospitals. However, the optimal dosing of the number of nurses caring for patients remains elusive. In light of this, an updated review of the evidence on the effect of nurse staffing levels on patient outcomes is required. Aim: To undertake a systematic review and meta-analysis examining the association between nurse staffing levels and nurse-sensitive patient outcomes in acute specialist units. Methods: Nine electronic databases were searched for English articles published between 2006 and 2017. The primary outcomes were nurse-sensitive patient outcomes. Results: Of 3429 unique articles identified, 35 met the inclusion criteria. All were cross-sectional and the majority utilised large administrative databases. Higher staffing levels were associated with reduced mortality, medication errors, ulcers, restraint use, infections, pneumonia, higher aspirin use and a greater number of patients receiving percutaneous coronary intervention within 90 minutes. A meta-analysis involving 175,755 patients, from six studies, admitted to the intensive care unit and/or cardiac/cardiothoracic units showed that a higher nurse staffing level decreased the risk of inhospital mortality by 14% (0.86, 95% confidence interval 0.79–0.94). However, the meta-analysis also showed high heterogeneity (I2=86%). Conclusion: Nurse-to-patient ratios influence many patient outcomes, most markedly inhospital mortality. More studies need to be conducted on the association of nurse-to-patient ratios with nurse-sensitive patient outcomes to offset the paucity and weaknesses of research in this area. This would provide further evidence for recommendations of optimal nurse-to-patient ratios in acute specialist units.

The impact health care delivery changes have on nursing and subsequently on the health of individuals, families, and the community are unknown to the nursing profession as well as the public. Delineation of patient outcomes sensitive to nursing care and their benchmarks would enable the nursing profession to evaluate system changes being implemented. Establishing targets for patient outcomes will provide facilities with benchmarks to measure themselves against. The purposes of this study were first, to identify if the nurse sensitive patient outcomes identified by the AAN expert panel are appropriate and second, to establish benchmarks for these outcomes that are applicable across the continuum of care. The appropriateness and benchmarks were determined through a Delphi study with nurse experts identified from the health care continuum of primary health care providers, hospitals, home care, hospice, and long term care. The five patient outcomes are Appropriate Self Care Behaviors, Symptom Management, Health Promoting Behaviors, Perceptions of Being Well Cared For, and Health Related Quality of Life (HRQOL). All patient outcomes were deemed appropriate for all healthcare settings. Two indicators of Health Related Quality of Life were excluded by the panel from Acute Care. Consensus was reached for the majority of patient outcomes. There were only seven benchmarks out of 18 for each continuum of care (a total of 90) that did not achieve consensus. The acute care participants did not reach consensus on one indicator within Health Promoting Behaviors. The remaining six were from Hospice participants: one indicator of Appropriate Self Care, all indicators of Health Promoting Behaviors and two within Health Related Quality of Life. The majority of benchmarks were in the mid to high range. Long Term Care tended to have lower scores than the other settings. Patient self care behaviors were very low for hospice patients. The indicators that did not meet consensus criteria were stable indicating that scores were not changing between rounds. Sample size of participants prevent citation of results for Home Care, Hospice and Long Term Care. Benchmarks can be set and used to evaluate the effectiveness of nursing care and the impact of system changes.

Background Significant ongoing learning needs for nurses have occurred as a direct result of the continuous introduction of technological innovations and research developments in the healthcare environment. Despite an increased worldwide emphasis on the importance of continuing education, there continues to be an absence of empirical evidence of program and session effectiveness. Few studies determine whether continuing education enhances or develops practice and the relative cost benefits of health professionals’ participation in professional development. The implications for future clinical practice and associated educational approaches to meet the needs of an increasingly diverse multigenerational and multicultural workforce are also not well documented. There is minimal research confirming that continuing education programs contribute to improved patient outcomes, nurses’ earlier detection of patient deterioration or that standards of continuing competence are maintained. Crucially, evidence-based practice is demonstrated and international quality and safety benchmarks are adhered to. An integrated clinical learning model was developed to inform ongoing education for acute care nurses. Educational strategies included the use of integrated learning approaches, interactive teaching concepts and learner-centred pedagogies. A Respiratory Skills Update education (ReSKU) program was used as the content for the educational intervention to inform surgical nurses’ clinical practice in the area of respiratory assessment. The aim of the research was to evaluate the effectiveness of implementing the ReSKU program using teaching and learning strategies, in the context of organisational utility, on improving surgical nurses’ practice in the area of respiratory assessment. The education program aimed to facilitate better awareness, knowledge and understanding of respiratory dysfunction in the postoperative clinical environment. This research was guided by the work of Forneris (2004), who developed a theoretical framework to operationalise a critical thinking process incorporating the complexities of the clinical context. The framework used educational strategies that are learner-centred and participatory. These strategies aimed to engage the clinician in dynamic thinking processes in clinical practice situations guided by coaches and educators. Methods A quasi experimental pre test, post test non–equivalent control group design was used to evaluate the impact of the ReSKU program on the clinical practice of surgical nurses. The research tested the hypothesis that participation in the ReSKU program improves the reported beliefs and attitudes of surgical nurses, increases their knowledge and reported use of respiratory assessment skills. The study was conducted in a 400 bed regional referral public hospital, the central hub of three smaller hospitals, in a health district servicing the coastal and hinterland areas north of Brisbane. The sample included 90 nurses working in the three surgical wards eligible for inclusion in the study. The experimental group consisted of 36 surgical nurses who had chosen to attend the ReSKU program and consented to be part of the study intervention group. The comparison group included the 39 surgical nurses who elected not to attend the ReSKU program, but agreed to participate in the study. Findings One of the most notable findings was that nurses choosing not to participate were older, more experienced and less well educated. The data demonstrated that there was a barrier for training which impacted on educational strategies as this mature aged cohort was less likely to take up educational opportunities. The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group’s reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales following attendance at the ReSKU program. These subscales included influence on nursing care, educational preparation and clinical development. Findings suggest that the use of an integrated educational model underpinned by a robust theoretical framework is a strong factor in some perceptions of the ReSKU program relating to attitudes and behaviour. There were minimal differences in knowledge between groups across time. Conclusions This study was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies and a robust overarching theoretical framework to support study concepts. The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful and collective reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

Objective: This thesis aims to explore the concept of geriatric nursing-sensitive indicators (NSIs), which are used to measure care for the older population. Introduction: By the year 2050, the global number of older people is predicted to double, creating fiscal and practice challenges for nursing. Nursing is the largest workforce in the health sector and is best placed to influence the quality of care received by the older person as system demand increases. Geriatric NSIs provide the opportunity to describe this influence, as they reflect the quality and effectiveness of geriatric nurses when caring for the older person. Methods: Due to the broad nature of the research topic, a scoping review was considered appropriate. The methods were based on those of the Joanna Briggs Institute, which were in turn informed by Arksey and O’Malley. In addition, a group of context experts were utilised to ensure the conduct of the review was meaningful for clinical staff and policy makers. This thesis outlines the results of a scoping review prepared as a manuscript for publication. The manuscript presented for publication is positioned in chapter four as a continuation of the thesis that outlines the methods and results of the scoping review. Results: The scoping review was completed, and a manuscript was prepared and submitted for publication. Many indicators were identified that described the nursing care of the older person. In line with the methodology, these were mapped in a variety of ways including Donabedian’s Domains and Fundamentals of Care that are existing taxonomies and Specificity which was a novel approach. It was apparent that there was a great deal of inconsistency in the description of the indicators but grouping of indicators through commonality and classification simplified indicator descriptions. Conclusions: The scoping review identified that concepts associated with geriatric nursing sensitive indicators are complex, and that extracted indicators did not comprehensively reflect contemporary geriatric nursing care. The complexities identified in the scoping review included issues such as lack of indicator definition and consistency, relationships between indicators, methodology for risk adjustment of patient outcomes and performance measurement of indicators. Contemporary nursing issues were not comprehensively reflected in the extracted indicators. Additional indicators are required to address issues such as the consumer perspective of geriatric nursing care, nursing hospital avoidance strategies and case management of inpatients. The achievements of this project extended beyond the mere conduct of a review and subsequent reporting of results. The project provided an opportunity for the lead reviewer to immerse themselves and learn the methodology of a scoping review. In addition, the decision to present the thesis in this form also provided the experience of submitting a manuscript for publication.
Thesis (MClinSc) -- University of Adelaide, Adelaide Nursing School, 2020

Problématique : Les organisations de santé font face à des pressions diverses pour offrir des soins et des services qui répondent aux plus hauts critères de performance et rendre compte de cette performance. Ces pressions proviennent de différents acteurs tels que les usagers du système de santé et les décideurs politiques. En raison de la place importante que prennent les infirmières dans l’offre de services de santé, il existe un intérêt croissant pour la mise en place d’interventions visant à mesurer et à améliorer la performance des services infirmiers. Cependant, dans le cadre de ces processus, les organisations sont souvent confrontées à des visions différentes et conflictuelles de la performance et à diverses approches pour la mesurer. Objectifs : Cette étude qualitative exploratoire a pour but d’explorer les conceptions de la performance des membres de l’équipe d’encadrement impliqués dans la prestation des services infirmiers et des infirmières soignantes et d’examiner dans quelle mesure les conceptions de la performance des deux groupes d’acteurs correspondent ou entrent en conflit. Méthodologie : Des entrevues semi-dirigées ont été conduites auprès de cinq membres de l’équipe d’encadrement et de trois infirmières. Une analyse de contenu a été effectuée à la fois pour faire ressortir l’éventail des conceptions et celles qui sont les plus prépondérantes dans les discours. Le cadre de référence ayant guidé cette analyse est une adaptation du modèle conceptuel de Donabedian comprenant trois dimensions soit la structure, le processus et les résultats (Unruh & Wan, 2004). Résultats : L’analyse des données recueillies auprès des membres de l’équipe d’encadrement fait ressortir dix conceptions distinctes, mais interreliées de la performance qui mettent l’accent sur les éléments de processus de soins infirmiers et de résultats chez la clientèle. Concernant les infirmières, neuf conceptions ont été répertoriées et l’accent a été porté surtout sur les éléments concernant l’adéquation des ressources humaines infirmières et de processus de soins infirmiers. Certaines similitudes et différences ont été repérées entre les conceptions de ces deux groupes d’acteurs. Conclusion : Cette étude permet de mieux comprendre les conceptions de la performance des acteurs impliqués dans l’offre de services infirmiers. Le modèle intégrateur qui résulte de la combinaison de ces différentes conceptions offre un cadre utile pour guider la construction d’outils de mesure de performance directement en lien avec les soins infirmiers et répondre à la demande d’imputabilité par rapport à ces services.
Background : Healthcare organizations face pressure to supply care and services that meet the highest level of performance and to show accountability in regards to this performance. These pressures come from different individuals ranging from the users of the healthcare system to political leaders. Since the nursing staffs occupy an important part in the supply of the healthcare services, there is a growing interest to put in place actions that would increase the performance of the nursing services as well as measure it. However, as part of this process, healthcare organizations often face conflictual notions of what performance is and how to properly measure it. Objectives : This qualitative exploratory study aims to explore the different notions of what performance is as seen by management teams involved in the nursing services delivery and by the field nurses to determine how much these notions are similar to each other or rather in opposition. Methodology: Semi-directed interviews have been held with five management teams’ members and also with three nurses. A content analysis has been made to illustrate the various notions of what performance is and those that show up the most. The framework used in this study is an adaptation of Donabedian’s model which includes three components: structure, process and results (Unruh & Wan, 2004). Findings: Ten distinct but related performance notions that focus on nursing’s process and impact on the users have been identified from data collected from management team members. On the nurses’ side, nine notions have been identified and put the focus mainly on the adequacy of nursing human resources with the nursing process. Some differences and similarities have also been identified between the performance notions of the two groups. Conclusion : This study gives a better understanding of the different performance notions that come from the various individuals involved in the nursing supply. The integrator model that result from the mix of these different notions will be useful in the creation of performance measurement tools directly linked with the nursing services, which will help respond to the accountability demand towards these services.