Dataset Information

Staffing levels and nursing-sensitive patient outcomes: Umbrella review and qualitative study.

ABSTRACT:

Objective

To derive a comprehensive list of nursing-sensitive patient outcomes (NSPOs) from published research on nurse staffing levels and from expert opinion.

Data sources/study setting

Published literature reviews and their primary studies analyzing the link between nurse staffing levels and NSPOs and interviews with 16 experts on nursing care.

Study design

Umbrella review and expert interviews.

Data collection/extraction methods

We screened three electronic databases for literature reviews on the association between nurse staffing levels and NSPOs. After screening 430 potentially relevant records, we included 15 literature reviews, derived a list of 22 unique NSPOs from them, and ranked these in a systematic fashion according to the strength of evidence existing for their association with nurse staffing. We extended this list of NSPOs based on data from expert interviews.

Principal findings

Of the 22 NSPOs discussed in the 15 included literature reviews, we rated the strength of evidence for four as high, for five as moderate, and for 13 outcomes as low. Four additional NSPOs that have not been considered in literature were identified through expert interviews.

Conclusions

We identified strong evidence for a significant association between nurse staffing levels and NSPOs. Our results may guide researchers in selecting NSPOs they might wish to prioritize in future studies. In particular, rarely studied NSPOs as well as NSPOs that were only identified through expert interviews but have not been considered in literature so far should be subject to further research.

SUBMITTER: Blume KS

PROVIDER: S-EPMC8522577 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Publications

Staffing levels and nursing-sensitive patient outcomes: Umbrella review and qualitative study.

Blume Kai Svane KS Dietermann Karina K Kirchner-Heklau Uta U Winter Vera V Fleischer Steffen S Kreidl Lisa Maria LM Meyer Gabriele G Schreyögg Jonas J

Health services research 20210315 5

<h4>Objective</h4>To derive a comprehensive list of nursing-sensitive patient outcomes (NSPOs) from published research on nurse staffing levels and from expert opinion.<h4>Data sources/study setting</h4>Published literature reviews and their primary studies analyzing the link between nurse staffing levels and NSPOs and interviews with 16 experts on nursing care.<h4>Study design</h4>Umbrella review and expert interviews.<h4>Data collection/extraction methods</h4>We screened three electronic datab ...[more]

PMID: 33723857

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Project description:ObjectiveTo identify nurse staffing and patient care outcome literature in published systematic reviews and map out the evidence gaps for low/middle-income countries (LMICs).MethodsWe included quantitative systematic reviews on nurse staffing levels and patient care outcomes in regular ward settings published in English. We excluded qualitative reviews or reviews on nursing skill mix. We searched the Cochrane Register of Systematic Reviews, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Medline, Embase and Cumulative Index to Nursing and Allied Health Literature from inception until July 2021. We used the A Measurement Tool to Assess Systematic Reviews -2 (AMSTAR-2) criteria for risk of bias assessment and conducted a narrative synthesis.ResultsFrom 843 papers, we included 14 in our final synthesis. There were overlaps in primary studies summarised across reviews, but overall, the reviews summarised 136 unique primary articles. Only 4 out of 14 reviews had data on LMIC publications and only 9 (6.6%) of 136 unique primary articles were conducted in LMICs. Only 8 of 23 patient care outcomes were reported from LMICs. Less research was conducted in contexts with staffing levels that are typical of many LMIC contexts.DiscussionOur umbrella review identified very limited data for nurse staffing and patient care outcomes in LMICs. We also identified data from high-income countries might not be good proxies for LMICs as staffing levels where this research was conducted had comparatively better staffing levels than the few LMIC studies. This highlights a critical need for the conduct of nurse staffing research in LMIC contexts.LimitationsWe included data on systematic reviews that scored low on our risk of bias assessment because we sought to provide a broad description of the research area. We only considered systematic reviews published in English and did not include any qualitative reviews in our synthesis.Prospero registration numberCRD42021286908.

Project description:There is a lack of evidence to guide district nurses in using nurse-sensitive patient outcomes as it is unclear how these outcomes are currently used in daily district nursing practice. Therefore, we aimed to explore (1) which nurse-sensitive patient outcomes are measured and how these outcomes are measured, (2) how district nurses use the outcomes to learn from and improve current practice and (3) the barriers and facilitators to using outcomes in current district nursing practice. An exploratory cross-sectional survey study was conducted. The survey was distributed online among nurses working for various district nursing care organisations across the Netherlands. The responses from 132 nurses were analysed, demonstrating that different instruments or questionnaires are available and used in district nursing care as outcome measures. The nurse-sensitive patient outcomes most often measured with validated instruments are pain using the Numeric Rating Scale or Visual Analogue Scale, delirium using the Delirium Observation Scale, weight loss using the Short Nutritional Assessment Questionnaire and caregiver burden using the Caregiver Strain Index or a Dutch equivalent. Falls and client satisfaction with delivered care are most often measured using unvalidated outcome measures. The other nurse-sensitive outcomes are measured in different ways. Outcomes are measured, reported and fed back to the nursing team multiple times and in various ways to learn from and improve current practice. In general, nurses have a positive attitude towards using nurse-sensitive outcomes in practice, but there is a lack of facilitation to support them. Because insight into how nurses can and should be supported is still lacking, exploring their needs in further research is desirable. Additionally, due to the high variation in the utilisation of outcomes in current practice, it is recommended to create more uniformity by developing (inter)national guidelines on using nurse-sensitive patient outcomes in district nursing care.

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.

Project description:Background/objectivesNursing homes have experienced a disproportionate share of COVID-19 cases and deaths. Early analyses indicated that baseline quality was not predictive of nursing home cases, but a more nuanced study of the role of nurse staffing is needed to target resources and better respond to future outbreaks. We sought to understand whether baseline nurse staffing is associated with the presence of COVID-19 in nursing homes and whether staffing impacts outbreak severity.DesignWe analyzed Centers for Medicare & Medicaid Services (CMS) facility-level data on COVID-19 cases and deaths merged with nursing home and county characteristics. We used logistic regressions to examine the associations of staffing levels from Nursing Home Compare with the outcomes of any COVID-19 cases and, conditional on at least one case, an outbreak. Among facilities with at least one case, we modeled count of deaths using hurdle negative binomial-2 regressions.SettingAll nursing homes in the CMS COVID-19 Nursing Home Dataset with reports that passed the CMS Quality Assurance Check as of June 25, 2020.ParticipantsResidents of nursing homes that met COVID-19 reporting requirements.MeasurementsA nursing home is defined as having at least one case is if one or more confirmed or suspected COVID-19 case among residents or staff is reported. Conditional on at least one case, we examine two outcomes: an outbreak, defined as confirmed cases/certified beds >10% or total confirmed and suspected cases/beds >20% or >10 deaths, and the total number of deaths attributed to COVID-19 among residents and staff.ResultsA total of 71% of the 13,167 nursing homes that reported COVID-19 data as of June 14 had at least one case among residents and/or staff. Of those, 27% experienced an outbreak. Higher registered nurse-hours are associated with a higher probability of experiencing any cases. However, among facilities with at least one case, higher nurse aide (NA) hours and total nursing hours are associated with a lower probability of experiencing an outbreak and with fewer deaths. The strongest predictor of cases and outbreaks in nursing homes is per capita cases in the county.ConclusionThe prevalence of COVID-19 in the community remains the strongest predictor of COVID-19 cases and deaths in nursing homes, but higher NA hours and total nursing hours may help contain the number of cases and deaths.

Dataset Information

Staffing levels and nursing-sensitive patient outcomes: Umbrella review and qualitative study.

Objective

Data sources/study setting

Study design

Data collection/extraction methods

Principal findings

Conclusions

Publications

Staffing levels and nursing-sensitive patient outcomes: Umbrella review and qualitative study.

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