However, there are insufficient studies examining the relationship between unit-level staffing levels and patient outcomes. Numerous studies have examined cross-sectional data to determine the relationship between nurse staffing and patient outcomes (Seago, Williamson, & Atwood, 2006).
Setting
Data on the incidence of unwanted patients has traditionally been an important indicator of quality care in hospitals; few studies have examined the relationship between these indicators or the usefulness of the indicators to assess the quality of nursing care (Reed, Blegen & . Goode, 1998). In some parts of the world, greater investment in qualified nurses is part of a strategy to improve quality care (Lankshear, Sheldon & Maynard, 2005).
Problem statement
Studies suggest that changes in nurse staffing affect patient and organizational outcomes, but the impact of nurse staffing on patient outcomes has not been adequately documented (Sasichay-Akkadechanunt, Sacizi & Jawad, 2003). However, there are no published studies on the impact of nurse staffing on patient outcomes that have been examined in CHUK, where the proposed study was conducted.
Research Objective
Nursing staffing presents a cost accounting challenge that requires the application of management control systems by creative, energetic, and financially capable nursing system administrators. Future-oriented planning is critical if the consequences of a predictable progressive deterioration of this condition are to be avoided and control of future patient outcomes is to be achieved (Heinz, 2004).
Research question
Significance of the study
The following section describes each element of the framework and their relevance to this study, in which only the elements of staff expertise and workload will be investigated as they relate to adverse patient outcomes. It takes time to recruit and train replacements, and the remaining nurses become demotivated, resulting in adverse patient outcomes (Houser, 2003).
DEFINITION OF TERMS
- Pressure ulcers
- Nurse sensitive outcomes
- Wound infections
- Nurse workload
An infection in the urinary system that begins when microorganisms attach to the opening of the urethra (the duct from the bladder) and begin to multiply. The independent variables are workload (indicated by nurse:patient ratio) and expertise (indicated by the nurse's qualification level.
Introduction
Nurse staffing and adverse patient outcomes
A recent study (Brown, 2001) commissioned by the American Nurses Association (ANA) confirmed the association between low staffing and poor patient outcomes. A comprehensive review of nursing workforce studies (Buerhaus & Needleman, 2000) examined current efforts to investigate the relationship between hospital nurse staffing and nursing-sensitive patient outcomes.
Nursing expertise
Since its 1999 report, the IOM Committee on the Adequacy of Nursing Staffing in Hospitals and Nursing Homes has begun to illustrate the relationship between nursing staffing, patient outcomes, and healthcare costs. Until the science reaches a more mature stage, the most prudent policy is to monitor a variety of nurse staffing levels and nurse-sensitive patient outcome indicators to promote improvements in the quality of patient care. The science and art of deploying appropriate nursing staff to a department begins with an assessment of the patient's acuity.
Nurse staffing and medication errors
The impact of medication errors can be devastating to nurses' confidence and self-esteem. A study conducted by Reed et. 1998) found evidence that units with higher average patient acuity had lower rates of medication errors and patient falls, but higher rates of other adverse outcomes. Controlling for average unit patient acuity, the proportion of hours of care performed by RNs was inversely related to rates of medication errors, pressure ulcers, and patient complaints per unit.
Nurse staffing and infections
Pressure ulcers were defined as new incidences of skin breakdown secondary to pressure or exposure to urine or feces (Reed et. al., 1998). Reed et al. al., 1998) explores the possibility that patients with pressure ulcers may experience low tissue oxygenation and impaired hydration. Effective pressure ulcer prevention programs improve the quality of care by reducing the incidence of pressure ulcers and, therefore, the pain associated with pressure ulcers while controlling costs.
Sampling
The inclusion criteria
The exclusion criteria
The adverse condition usually associated with the primary diagnosis was limited, for example, the sample excluded patients in the main diagnostic category of 'kidney and urinary tract' diagnoses from the urinary tract infection rate, as these patients were considered to be at high risk for the development of the complication as a result of their functional health condition. The sample also excluded patients with diabetes and AIDS because they are at high risk of developing complications in the study.
Sample and sample size
Data collection instruments
The staffing instrument, which was developed by the researcher, was pilot tested along with the modified adverse event instrument to determine validity and reliability. Pilot testing was conducted on ten (10) patient records from one unit that was not selected for the study sample.
Data collection Process
Validity and reliability of instruments
Removing side effects that were not applicable to the instruments made it reliable and valid during the data collection process. It produced very similar results from the pilot study and the main study, although the main study involved a political survey conducted on different units.
Data analysis
Ethical consideration
Limitations of the study
Side effects studied included urinary tract infection, pressure ulcers and systemic sepsis, pneumonia, phlebitis and medication errors. The patient record in which one or more adverse events were found was recorded on the checklist. For each of the adverse events, the following indicators were used as evidence of an adverse event, unless the condition was present on admission, in which case the event was not recorded.
Indicators for documentation of an adverse event
For each of the selected units (one medical and one surgical), medical records were reviewed for each patient admitted to the medical and surgical units for the period February and March 2006. The checklist consisted of adverse events (sensitive nurses) that were interest to the researcher, the patient file was reviewed looking for any of the adverse events in the study. Missed Doses: When the medicine is given, it is signed or marked before the time of administration of the medicine.
Population and Sample description
In the files, where I did not find a signature or a tick on the treatment sheet, I recorded it as a missed dose.
Pilot Study
- Adverse event data
- Staffing data
- Analysis of adverse events in medical unit March 2006
- Analysis of adverse events in surgical unit February 2006
- Analysis of adverse event in surgical unit March 2006
- Instrument for staffing
- Analysis of staffing data and patient census
- Staffing data on medical unit February 2006
- Staffing data on medical unit March 2006
- Staffing data on surgical unit February 2006
- Staffing data on surgical unit March 2006
The researcher found that the adverse event instrument for the medical department included the adverse event of wound infection. This chapter presents data on adverse events in the Department of Medicine and Surgery for February and March 2006. In this section, percentages were calculated by dividing the number of adverse events by the total number of papers reviewed, multiplied by one hundred.
Poisson regression analysis
- Urinary tract infection
- Wound infection
- Pneumonia
- Phlebitis
- Missed doses
- Mean registered nurses
- Urinary tract infection
- Pressure ulcers
- Wound infection
- Pneumonia
- Phlebitis
- Missed doses
- Enrolled Nurse (EN) mean
- Urinary tract infection
- Pressure ulcers
- Wound infection
- Phlebitis
- Missed doses
The relationship between urinary tract infection and total average number of nurses of all qualifications (degree, registered and enrolled nurses) for the medical and surgical ward in February and March 2006. From the IRR (.91) There was a slightly protective, although not significant ( p =0.30) relationship between the average number of nurses and phlebitis. The following section describes the findings of the Poisson regressions that examined the relationship between the adverse events and average number of registered nurses on the medical and surgical wards for February and March 2006.
Mean Nurse Patient Ratio and Adverse Events
This showed that for every 1% increase in the ratio of nurses to patients (more nurses, fewer patients) there was a 25% increase in pressure ulcer protection. Poisson regression analysis for the mean percentage of patients with pneumonia yielded an IRR =.39, indicating a significant protective relationship ( p =0.04). This showed that for every 1% increase in the nurse-to-patient ratio (more nurses, fewer patients), there was a 61% increase in protection against pneumonia.
Mean number of nurses and adverse patient outcomes
A discussion of the study's findings, limitations, and recommendations will be presented in this chapter. Because there were no studies of the relationship between nurse staffing and patient outcomes in Rwanda, this discussion of each research question compares findings from the United States primarily. Staffing variables related to adverse events in the study were workload and staff expertise.
Staff qualifications and adverse patient outcomes
Incomplete risk assessment that will identify surgical patients at risk for wound infections (that is, immobility and malnutrition). These findings suggested that an increase in number of RNs has different effects on positive patient outcomes. 2002) found that there was also evidence of association between a higher registered nurse workforce and fewer infections. One can also conclude that there were insufficient RNs (Diploma or BN) in the wards where this study was conducted.
Nurse: patient ratios and adverse patient outcomes
This study found that the staffing variable significantly associated with in-hospital mortality was the ratio of total nursing staff to the number of patients. The findings in this study regarding infection are similar to a study conducted in the US by Nevada RN Formation (2003), which looked at hospital and Medicare data in nine states in five categories of adverse outcomes: length of hospital stay , hospitalization pneumonia, postoperative infection, pressure ulcers and hospitalization. This study was conducted in a low registered nurse to registered nurse setting. With one registered nurse for eighteen enrolled nurses on the medical unit and one registered nurse for twenty enrolled nurses on the surgical unit, it was surprising that the effect of RNs on patient outcomes was significant in this study.
Recommendations
A systematic review of the effects of nurse staffing on patients, nurse staffing, and hospital outcomes. Hospital staffing and patient mortality, nurse burnout and job dissatisfaction: ANA president urges hospitals to use nurse recruitment principles to solve problem. The findings of the study, whether or not patient outcomes are related to nursing staff, will be communicated to hospital authorities as appropriate.
UNIVERSITY OF
KWAZUlU-NATAl
If this application is accepted, I (we) declare that I (we) will be actively engaged and will be in the daily control of the project and give a copy of my work to CHUK after publication. of my research. We are pleased to inform you that the research unit and the Director of CHUK analyzed and considered your titled project relevant and authorize you to carry out your study at CHUK.
KVJAZULU-NATAL
EXPEDITED REVIEW
TO WHOM IT MAY CONCERN
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