Nursing intensity and nurse staffing in perioperative settings

The goal of this study was to design and test a nursing intensity (NI) instrument in perioperative settings to produce information concerning patients’ care needs. This information is intended to be used for knowledge-based management purposes when applying optimal nurse staffing. In Phase I, a Delphi method with two rounds (n=55) was used to define the core elements of perioperative nursing. Then those core elements were tested to evaluate NI during the pre-, intra-, and postoperative phases of the surgical patient’s care process (n=308 patients). In Phase II, the core elements were implemented in an instrument, and further testing was carried out in different perioperative settings (n=876 patients). In Phase III, an integrative review was con-ducted to find out how nurse staffing had been executed in perioperative settings. According to the results, the core elements of perioperative nursing describing patient’s safety or patient’s physiological needs were seen as the most crucial. A principal component analysis revealed that a patient’s care needs vary from the intraoperative to postoperative phases of perioperative nursing. Patients in a high ASA class more frequently had high intraoperative NI points, but patients in a low ASA class did not automatically have fewer intraoperative care needs. The length of stay in the post-anesthesia care unit (PACU) and the type of follow-up unit could be predicted with intraoperative NI. Scant evidence was found concerning nurse staffing in perioperative settings. The need to take into account patients’ care needs showed up in some papers, but these were not expressed in an assessable form. Staffing models in relation to perioperative nursing-sensitive outcomes were not found. This study offers an instrument for evaluating NI in perioperative settings. This information produced can be utilized for nurse staffing and nurse staff allocation purposes. More research is needed that focuses more on the detailed use of information based on NI. Its potential to serve as a knowledge-based management tool also needs clarifying in future studies

The Criterion Validity, Reliability, and Feasibility of an Instrument for Assessing the Nursing Intensity in Perioperative Settings

Peer reviewe

Õdede töökoormuse mõõtmise meetodid täiskasvanute kirurgia ja sisehaiguste osakondades - kirjanduse süstemaatiline ülevaade

Autorite kirjalikud load asuvad õendusteaduse osakonnas õppekorralduse spetsialisti käes

The Criterion Validity, Reliability, and Feasibility of an Instrument for Assessing the Nursing Intensity in Perioperative Settings

Patient classification systems generate information for staff allocation based on a patient's care needs. This study aims to test further the instrument for assessing nursing intensity (NI) in perioperative settings. Nine operating departments from five university hospitals were involved. The perioperative nurses gathered data from patients (N = 876) representing different fields of surgery. Reliability was tested by parallel classifications (N = 144). Also, the users' (N = 40) opinions were surveyed. The results support the predictive validity and interrater reliability of the instrument. Thenurses considered the instrument feasible to use. Thepatients' low ASA class did not automatically signify low NI; however, high ASA class was more frequently associated with high intraoperative NI. Intraoperative NI indicated the length of the postanaesthesia care and the type of the follow-up unit. Parallel classifications ensured the homogenous use of the instrument. The use of the instrument is recommended

Potilaiden hoitoisuuteen perustuvan henkilöstöresursoinnin ja potilasturvallisuuden välinen yhteys erikoissairaanhoidon kirurgisilla vuodeosastoilla

English abstractTutkimuksen tarkoitus: Tutkimuksen tarkoituksena oli tutkia potilaiden hoitoisuuteen perustuvan henkilöstöresursoinnin ja potilasturvallisuuden valista yhteyttä erikoissairaanhoidon kirurgisilla vuodeosastoilla. Aineisto ja menetelmät: Aineistona käytettiin yhden yliopistollisen sairaanhoitopiirin 13 kirurgisen vuodeosaston tietoja HaiPro-vaaratapahtumien raportointijärjestelmästä ja RAFAELA-hoitoisuusluokitusjärjestelmästä vuosilta 2011–2014. Henkilöstöresursointia tutkittiin tarkastelemalla yksikön toteutunutta hoitoisuutta ja potilasturvallisuutta tarkastelemalla tehtyjen HaiPro-ilmoitusten lukumäärää. Aineisto analysoitiin kuvailevalla ja korrelaatioanalyysilla. Tulokset: Aineiston 1861 HaiPro-ilmoituksesta puolet liittyi lääkehoitoon. Yksiköiden keskimääräinen toteutunut hoitoisuus vaihteli 80:n ja 107 prosentin välillä. Yhteyttä toteutuneen hoitoisuuden ja HaiPro-ilmoitusten lukumäärän välillä ei löydetty tarkasteltaessa koko aineistoa. Yksikkökohtaisissa analyyseissa löytyi tilastollisesti merkitsevä korrelaatio kolmen yksikön kohdalla. Päätelmät: Tutkimus ei täysin vahvista aikaisempien tutkimusten tuloksia henkilöstöresurssien ja potilasturvallisuuden välisestä yhteydestä. Tulokset kuitenkin tukevat kirjallisuudessa esitettyä kritiikkiä, jonka mukaan vapaaehtoisuuteen perustuvia vaaratapahtumailmoituksia ei välttämättä voida käyttää potilasturvallisuuden mittarina.Peer reviewe

Information Management for Tactical Decision-making in the Cardiac Care Process

Siirretty Doriast

An exploratory analysis of the nurse dependency of patients with burn injuries using data collected in a national burn injury database

It has long been recognized that poor nurse staffing levels can have a detrimental effect on patient care and outcomes. Yet there is a lack of validated UK nurse dependency tools available to predict or support staffing levels and none specifically related to burn care. The international Burn Injury Database (iBID) has been collecting data on the nurse dependency of patients with a burn injury alongside information on their burn injury from specialised burn services in England and Wales. The aim of this research was to “explore the nurse dependency data contained within iBID; to gain an increased understanding of nurse dependency in relation to burn injuries and to assess if iBID contained information that could be used to predict nurse dependency of acute burn inpatients and help with nursing staff planning”. An observational exploratory study approach was undertaken. First, to ascertain whether the iBID nurse dependency tool measured nurse dependency it was compared to the Safer Nursing Care Tool (SNCT) tool, the most commonly used nurse dependency tool in the UK. Nurses in three burn services scored the nurse dependency of their burn-injured patients daily using both nurse dependency tools as well as fictional case studies to assess inter-rater reliability. The results were analysed using Spearman correlation and Krippendorff alpha. Secondly, the nurse dependency data from iBID was analysed. Multiple regression was used to build a predictive nurse dependency model and the nurse dependency trajectories were plotted to understand how staffing levels are influenced by the recovery pathway a patient may be on. This research has shown a correlation between the iBID nurse dependency tool and the SNCT scores suggesting that the iBID nurse dependency tool does indeed measure aspects of nurse dependency. There is a positive relationship between nursing dependency and burn severity. In particular, the size of the burn has been shown to have an influence on the nursing dependency trajectory over a patients’ stay. Moving forward this may be used to help predict nursing workload for a group of patients in advance and whether the individual patient’s stay is likely to be longer than 1 day/percentage burn. The regression modelling has highlighted several variables that have predictive properties. The variables that had some clinical judgement associated with them appear to be better predictors than pure objective variables, thus giving weight to the argument that ND tools should be used alongside professional judgement