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Influence of Workload on Primary Care Nurses' Health and Burnout, Patients' Safety, and Quality of Care: Integrative Review.

ABSTRACT: The increase in the demand for care has not led to a proportional growth in the number of primary care nurses. This imbalance is related to the decrease in the quality of care and patient safety, and also to the impact on the health of the professional group. The objective of this study is to identify relationships between overload, illness of the nurse, professional exhaustion, quality and safety in the services; and differentiate study methods and instruments for measuring the phenomena. For this, a comprehensive and structured review of the literature following the scoping review model is performed. The studies on which this review is based allow us to recognize that the scope of this phenomenon is global. The review includes 45 studies that show that there is a high pressure of care for Primary Care nursing, who suffer many alterations of their health due to burnout syndrome and that this situation contributes to the impairment of the quality of care and patient safety. However, for future lines, new evidence is needed to determine the degree of relationship between the high pressure suffered by Primary Care nursing and the attainment of health goals for professionals and patients.

SUBMITTER: Perez-Francisco DH

PROVIDER: S-EPMC7151231 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Influence of Workload on Primary Care Nurses' Health and Burnout, Patients' Safety, and Quality of Care: Integrative Review.

Pérez-Francisco Darío Hilario DH Duarte-Clíments Gonzalo G Del Rosario-Melián José María JM Gómez-Salgado Juan J Romero-Martín Macarena M Sánchez-Gómez María Begoña MB

Healthcare (Basel, Switzerland) 20200103 1

The increase in the demand for care has not led to a proportional growth in the number of primary care nurses. This imbalance is related to the decrease in the quality of care and patient safety, and also to the impact on the health of the professional group. The objective of this study is to identify relationships between overload, illness of the nurse, professional exhaustion, quality and safety in the services; and differentiate study methods and instruments for measuring the phenomena. For t ...[more]

PMID: 31947761

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Project description:BackgroundWork-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians.ObjectiveTo study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams.DesignWe conducted an individual-level cross-sectional analysis of survey and administrative data in 2014.ParticipantsPrimary care personnel at VA clinics responding to a national survey.Main measuresBurnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity).Key resultsThere were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition.ConclusionsComplete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.

Project description:PURPOSE: Preparing residents for future practice, knowledge, and skills in quality improvement and safety (QI/S) is a requisite element of graduate medical education. Despite many challenges, residency programs must consider new curricular innovations to meet the requirements. We report the effectiveness of a primary care QI/S curriculum and the role of the chief resident in quality and patient safety in facilitating it. METHOD: Through the Veterans Administration Graduate Medical Education Enhancement Program, we added a position for a chief resident in quality and patient safety, and 4 full-time equivalent internal medicine residents, to develop the Primary Care Interprofessional Patient-Centered Quality Care Training Curriculum. The curriculum includes a first-or second-year, 1-month block rotation that serves as a foundational experience in QI/S and interprofessional care. The responsibilities of the chief resident in quality and patient safety included organizing and teaching the QI/S curriculum and mentoring resident projects. Evaluation included prerotation and postrotation surveys of self-assessed QI/S knowledge, abilities, skills, beliefs, and commitment (KASBC); an end-of-the-year KASBC; prerotation and postrotation knowledge test; and postrotation and faculty surveys. RESULTS: Comparisons of prerotation and postrotation KASBC indicated significant self-assessed improvements in 4 of 5 KASBC domains: knowledge (P < .001), ability (P < .001), skills (P < .001), and belief (P < .03), which were sustained on the end-of-the-year survey. The knowledge test demonstrated increased QI/S knowledge (P = .002). Results of the postrotation survey indicate strong satisfaction with the curriculum, with 76% (25 of 33) and 70% (23 of 33) of the residents rating the quality and safety curricula as always or usually educational. Most faculty members acknowledged that the chief resident in quality and patient safety enhanced both faculty and resident QI/S interest and participation in projects. CONCLUSIONS: Our primary care QI/S curriculum was associated with improved and persistent resident self-perceived knowledge, abilities, and skills and increased knowledge-based scores of QI/S. The chief resident in quality and patient safety played an important role in overseeing the curriculum, teaching, and providing leadership.

Project description:BackgroundThe acceptance of digital health technologies to support patient care for various clinical conditions among primary care providers and staff has not been explored.ObjectiveThe purpose of this study was to explore the extent of potential differences between major groups of providers and staff in primary care, including behavioral health consultants (BHCs; eg, psychologists, social workers, and counselors), primary care providers (PCPs; eg, physicians and nurse practitioners), and nurses (registered nurses and licensed practical nurses) in the acceptance of various health technologies (ie, mobile apps, wearables, live video, phone, email, instant chats, text messages, social media, and patient portals) to support patient care across a variety of clinical situations.MethodsWe surveyed 151 providers (51 BHCs, 52 PCPs, and 48 nurses) embedded in primary care clinics across the United States who volunteered to respond to a web-based survey distributed in December 2020 by a large health care market research company. Respondents indicated the technologies they consider appropriate to support patients' health care needs across the following clinical contexts: acute and chronic disease, medication management, health-promoting behaviors, sleep, substance use, and common and serious mental health conditions. We used descriptive statistics to summarize the distribution of demographic characteristics by provider type. We used contingency tables to compile summaries of the proportion of provider types endorsing each technology within and across clinical contexts. This study was exploratory in nature, with the intent to inform future research.ResultsMost of the respondents were from urban and suburban settings (125/151, 82.8%), with 12.6% (n=19) practicing in rural or frontier settings and 4.6% (n=7) practicing in rural-serving clinics. Respondents were dispersed across the United States, including the Northeast (31/151, 20.5%), Midwest (n=32, 21.2%), South (n=49, 32.5%), and West (n=39, 25.8%). The highest acceptance for technologies across clinical contexts was among BHCs (32/51, 63%) and PCPs (30/52, 58%) for live video and among nurses for mobile apps (30/48, 63%). A higher percentage of nurses accepted all other technologies relative to BHCs and PCPs. Similarly, relative to other groups, PCPs indicated lower levels of acceptance. Within clinical contexts, the highest acceptance rates were reported among 80% (41/51) of BHCs and 69% (36/52) of PCPs endorsing live video for common mental health conditions and 75% (36/48) of nurses endorsing mobile apps for health-promoting behaviors. The lowest acceptance across providers was for social media in the context of medication management (9.3% [14/151] endorsement across provider type).ConclusionsThe survey suggests potential differences in the way primary care clinicians and staff envision using technologies to support patient care. Future work must attend to reasons for differences in the acceptance of various technologies across providers and clinical contexts. Such an understanding will help inform appropriate implementation strategies to increase acceptability and gain greater adoption of appropriate technologies across conditions and patient populations.

Dataset Information

Influence of Workload on Primary Care Nurses' Health and Burnout, Patients' Safety, and Quality of Care: Integrative Review.

Publications

Influence of Workload on Primary Care Nurses' Health and Burnout, Patients' Safety, and Quality of Care: Integrative Review.

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