Impact of having a certified nurse specialist in critical care nursing as head nurse on ICU patient outcomes.
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SUBMITTER: Fukuda T
PROVIDER: S-EPMC7001939 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background/objectivesCertified nursing assistants (CNAs) who work in nursing homes (NHs) face significant work and personal stress. Self-compassion training has been shown to decrease stress postintervention in previous studies among healthcare providers and those in helping professions. This study examines the feasibility, acceptability, and preliminary outcomes of self-compassion training to address CNA stress and well-being.DesignPre-post intervention.SettingThree mid-size, nonprofit NHs in North Carolina.ParticipantsThirty CNAs, with a mean age of 49, 96% of whom were female, and 83% black/African American.InterventionIn one NH, participants received an 8-week, 2.5-h/session (20 h total) group intervention. At the time of recruitment for NHs 2 and 3, a briefer format (6-week, 1-h/session; 6 h total) became available and was preferred by CNAs, thus both NHs 2 and 3 participants received a 6-h group intervention. All interventions occurred in meeting rooms within participating NHs during shift changes.MeasurementsIntervention attendance, retention, and acceptability; self-compassion, stress, burnout, depression, and attitudes toward residents with dementia, and job satisfaction pre-, post-, 3-month post-, and 6-month postintervention were assessed.ResultsAttendance and program satisfaction were high, and attrition was low for both training formats. Self-compassion was significantly improved at all time periods (p < 0.001), and stress and depression improved significantly through 3 months (p < 0.05), but not 6 months. No statistically significant change in job satisfaction was noted.ConclusionSelf-compassion interventions are feasible and acceptable for CNAs working in NHs and show promise for managing stress and improving well-being and compassion toward residents. The briefer 6-h format may maximize participation, while still providing benefits.
| S-EPMC8273132 | biostudies-literature
Project description:OBJECTIVES:To assess whether Massachusetts legislation directed at ICU nurse staffing was associated with improvements in patient outcomes. DESIGN:Retrospective cohort study; difference-in-difference design to compare outcomes in Massachusetts with outcomes of other states (before and after the March 31, 2016, compliance deadline). SETTING:Administrative claims data collected from medical centers across the United States (Vizient). PATIENTS:Adults between 18 and 99 years old who were admitted to ICUs for greater than or equal to 1 day. INTERVENTIONS:Massachusetts General Law c. 111, § 231, which established 1) maximum patient-to-nurse assignments of 2:1 in the ICU and 2) that this determination should be based on a patient acuity tool and by the staff nurses in the unit. MEASUREMENTS AND MAIN RESULTS:Nurse staffing increased similarly in Massachusetts (n = 11 ICUs, Baseline patient-to-nurse ratio 1.38?±?0.16 to Post-mandate 1.28?±?0.15; p = 0.006) and other states (n = 88 ICUs, Baseline 1.35?±?0.19 to Post-mandate 1.31?±?0.17; p = 0.002; difference-in-difference p = 0.20). Massachusetts ICU nurse staffing regulations were not associated with changes in hospital mortality within Massachusetts (Baseline n = 29,754, standardized mortality ratio 1.20?±?0.04 to Post-mandate n = 30,058, 1.15?±?0.04; p = 0.11) or when compared with changes in hospital mortality in other states (Baseline n = 572,952, 1.15?±?0.01 to Post-mandate n = 567,608, 1.09?±?0.01; difference-in-difference p = 0.69). Complications (Massachusetts: Baseline 0.68% to Post-mandate 0.67%; other states: Baseline 0.72% to Post-mandate 0.72%; difference-in-difference p = 0.92) and do-not-resuscitate orders (Massachusetts: Baseline 13.5% to Post-mandate 15.4%; other states: Baseline 12.3% to Post-mandate 14.5%; difference-in-difference p = 0.07) also remained unchanged relative to secular trends. Results were similar in interrupted time series analysis, as well as in subgroups of community hospitals and workload intensive patients receiving mechanical ventilation. CONCLUSIONS:State regulation of patient-to-nurse staffing with the aid of patient complexity scores in intensive care was not associated with either increased nurse staffing or changes in patient outcomes.
| S-EPMC6138549 | biostudies-literature
Project description:AimsTo identify and describe profiles of nursing resources and compare nurse and patient outcomes among the identified nursing resource profiles.BackgroundResearch linking nurse education, staffing, and the work environment treats these nursing resources as separate variables. Individual hospitals exhibit distinct profiles of these resources.MethodsThis cross-sectional secondary analysis used 2006 data from 692 hospitals in four states. Latent class mixture modelling was used to identify resource profiles. Regression models estimated the associations among the profiles and outcomes.ResultsThree profiles were identified (better, mixed and poor) according to their nursing resource levels. Hospitals with poor profiles were disproportionately mid-sized, for-profit, and had lower technology capability. Nurse job outcomes, patient mortality and care experiences were significantly improved in hospitals with better resource profiles.ConclusionsHospitals exhibit distinct profiles of nursing resources that reflect investments into nursing. Nurse and patient outcomes and patients' experiences are improved in hospitals with better nursing resource profiles. This finding is consistent with the literature that has examined these resources independently.Implications for nursing managementNurse managers can identify their nursing resource profile and the associated outcomes. Our results show the advantages of improving one's hospital nursing resource profile, motivating managers to make an informed decision regarding investments in nursing resources.
| S-EPMC8989670 | biostudies-literature
Project description:Certified Nurse Specialists (CNS) are advanced practice nurses that often play a role in management. This study aims to investigate whether cooperation between CNSs in the position of Intensive Care Unit (ICU) head nurse and intensivists change the length of stay for ICU patients. A single centered retrospective cohort study design was followed. A multivariable regression analysis was performed to determine whether there is a difference in patients' length of ICU stay for two years before and after CNS as ICU head nurse and an intensivist started collaborating. The patients' diagnosis, age, gender, scheduled/emergency admission, surgical history, length of ICU stay, usage of ventilator, and details of ICU treatment were collected from the institution's electronic medical records. During the study period (April 2015 to March 2019), 3,135 patients were admitted to ICU, with 1,471 in the before collaboration group and 1,664 in the after-collaboration group. Collaboration between the CNS as head nurse and intensivists was significantly associated with shorter length of ICU stay (coefficient -0.03 [95% CI, -0.05-0.01], p < 0.001, t-statistic -3.29). Our main finding illustrates that in low-intensity ICUs, collaboration between CNSs as head nurses and intensivists may reduce patients' length of ICU stay.
| S-EPMC7295221 | biostudies-literature
Project description: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.
| S-EPMC8214586 | biostudies-literature
Project description:AimProfessional communication between nurse and patient has a significant role in patient satisfaction with nursing care. The aim of this study was to assess nurse-patient communication and patient's satisfaction from nursing services in the burn wards of women and men.DesignParticipants were all patients admitted to the Burn wards at the Sina Hospital of Tabriz between September-December 2018. Nurse-patient communication and patient's satisfaction were assessed using at the time of discharge. Data were analysed by SPSS applying descriptive and inferential statistics.ResultsThe results show that most patients were dissatisfied with nursing care. More than 80% did not know their nurse. There was a correlation between nurse-patient communication and patient satisfaction with nursing care and the sex variable was found to be significantly correlated with patients' satisfaction level. The weakness of nurses 'communication with patients was evident in our study and patients were dissatisfied from this kind of communication, and consequently, patients' satisfaction was reported very low. Improving the satisfaction of patients in the hospital should be the priorities of the hospital managers. Therefore, by educating staff, especially nurses, identifying motivating factors as well as identifying dissatisfaction factors, improved patient satisfaction.
| S-EPMC6650658 | biostudies-literature
Project description:ObjectiveTo estimate and contrast the relationships between nurse staffing and health outcomes in nursing homes with low and high dementia census, to understand the association of staffing hours with dementia care quality.Data sources and study settingA national sample of nursing homes during 2017-2019 (pre-COVID). Data included the Payroll-Based Journal, Medicare Claims, Nursing Home Care Compare, and Long-Term Care Focus.Study designRetrospective, regression analyses. We estimated separate linear models predicting six long-term facility-level outcomes. Independent variables included staffing hours per resident-day (HPRD) interacted with the facility percentage of dementia residents, controlling for other resident and facility characteristics.Data collection/extraction methodsHospital-based nursing homes, those with fewer than 30% dementia residents, and missing data were excluded.Principal findingsWe found that registered nurses and certified nurse assistants HPRDs were likely to exhibit positive returns in terms of outcomes throughout most of the range of HPRD for both high and low-census dementia facilities, although, high- and low-dementia facilities differed in most outcome rates at all staffing levels. Average predicted antipsychotics and activities of daily living as functions of HPRD were worse in higher dementia facilities, independent movement, and hospitalizations did not differ significantly, and Emergency Rooms and pressure sores were worse in lower dementia facilities. Average marginal effects were not statistically different [CI included zero] between the high and low dementia facilities for any outcome.ConclusionsThese findings suggest that increasing staffing will improve outcomes by similar increments in both low- and high-dementia facilities for all outcomes. However, at any given level of staffing, absolute differences in outcomes between low- and high-dementia facilities remain, suggesting that additional staffing alone will not suffice to close these gaps. Further studies are required to identify opportunities for improvement in performance for both low- and high-dementia census facilities.
| S-EPMC11250382 | biostudies-literature
Project description: Not available
| S-EPMC7049918 | biostudies-literature
Project description:RationaleCaring for patients at the end of life is emotionally taxing and may contribute to burnout. Nevertheless, little is known about the factors associated with emotional distress in intensive care unit (ICU) nurses.ObjectivesTo identify patient and family factors associated with nurses' emotional distress in caring for dying patients in the ICU.MethodsOne hundred nurses who cared for 200 deceased ICU patients at two large academic medical centers in the Northeast United States were interviewed about patients' psychological and physical symptoms, their reactions to those patient experiences (e.g., emotional distress), and perceived factors contributing to their emotional distress. Logistic regression analyses modeled nurses' emotional distress as a function of patient symptoms and care.ResultsPatients' overall quality of death (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.31-7.25), suffering (OR, 2.34; CI, 1.03-5.29), and loss of dignity (OR, 2.95; CI, 1.19-7.29) were significantly associated with nurse emotional distress. Some 40.5% (79 of 195) of nurses identified families' fears of patient death, and 34.4% (67 of 195) identified families' unrealistic expectations as contributing to their own emotional distress.ConclusionsPatients' emotional distress, physical distress, and perceived quality of death are associated with nurse emotional distress. Unrealistic family expectations for the patient may be a source of nurse emotional distress. Improving patients' quality of death, including enhancing their dignity, reducing their suffering, and promoting acceptance of an impending death among family members may improve the emotional health of nurses.
| S-EPMC6322021 | biostudies-literature
Project description:The objectives of this study were to examine differences in nurse engagement in shared governance across hospitals and to determine the relationship between nurse engagement and patient and nurse outcomes.There is little empirical evidence examining the relationship between shared governance and patient outcomes.A secondary analysis of linked cross-sectional data was conducted using nurse, hospital, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data.Engagement varied widely across hospitals. In hospitals with greater levels of engagement, nurses were significantly less likely to report unfavorable job outcomes and poor ratings of quality and safety. Higher levels of nurse engagement were associated with higher HCAHPS scores.A professional practice environment that incorporates shared governance may serve as a valuable intervention for organizations to promote optimal patient and nurse outcomes.
| S-EPMC5117656 | biostudies-literature