A systematic review of the association between nursing staff and nursing-sensitive outcomes in long-term institutional care

Aims To examine the association between type of nursing staff and nursing-sensitive outcomes in long-term institutional care. Design This systematic review included studies published in English, German, and Dutch between January 1997 and January 2020. Data sources The databases Medline (PubMed), CINAHL, PsycINFO, Embase, and the Cochrane Library were searched. Original quantitative studies were included. Review methods The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to critically appraise the reporting of the studies. Results Fifteen articles were included. Of 33 quality of care outcomes, 21 were identified as nursing-sensitive outcomes of which 13 showed a significant association with nursing staff, specifically: Activities of daily living, aggressive behavior, bladder/bowel incontinence, contractures, expressive language skills, falls, infection (including vaccination), range of motion, pain, pressure ulcers, and weight loss. However, studies reported inconsistent results regarding the association among RNs, LPNs, CNAs, and HCAs and these nursing-sensitive outcomes, evidence shows that more RNs have a positive impact on nursing-sensitive outcomes. As to the evidence regarding the other type of nursing staff, especially HCA, findings regularly showed a negative association. Conclusion Future research should be expanded with structure and process variables of which the mediating and moderating effect on nursing-sensitive outcomes is known. These may explain variances in quality of care and guide quality improvement initiatives. Researchers should consider fully applying Donabedian's structure-process-outcomes framework as it is a coherent entirety for quality assessment. Impact This review provides an overview of quality of care outcomes that are responsive to nursing interventions in long-term institutional care. As the effects can be monitored and documented, quality assessment should focus on these nursing-sensitive outcomes. The inconclusive results make it difficult to provide recommendations on who should best perform which care

A systems-focused context for understanding the RN role and performance

Abstract from 64th Annual Scientific Meeting "Lifestyle>Lifespan"A myriad of sociocultural, political, organizational, and micro unit-level systems comprise contexts in which the registered nurse (RN) role is defined, operationalized, and evaluated. This paper offers several systems- focused perspectives for understanding the RN role and performance within and across systems of care. An organization-level systems approach highlights the interaction effect of the organizational design factors that link organizational structure to RN work. Another approach addresses one specific aspect of the RN role – delegation of nursing services – highlighting the regulatory and functional mechanisms that influence ways the RN role is operationalized. A micro-systems approach addresses specific RN practices associated with prevention of pressure ulcers, and the unit-level interactions that facilitate and/or limit RN knowledge, beliefs, and values associated with best practices. The knowledge gained from applying systems-focused perspectives to understanding the RN role provides critical insights and directions for interventions aimed to maximize RN role effectiveness in long term care.Peer reviewe

Pressure injury prevalence and predictors among older adults in the first 36-hours of hospitalisation

To describe the prevalence and predictors of pressure injuries among older adults with limited mobility, within the first 36-hours of their hospital admission in Australia. Pressure injuries are significant health, safety and quality of care issues for patients and healthcare organisations. The early implementation of the recommended pressure injury prevention international clinical practice guidelines is a way to reduce hospital-acquired pressure injuries. There is a paucity of evidence on the number of older persons who are admitted hospital with a pre-existing pressure injury. Prospective correlational study conducted in eight tertiary referral hospitals across Australia. Our sample comprised of 1047 participants aged ≥65 years with limited mobility, drawn from a larger Australian pragmatic cluster randomised trial. Using the STROBE statement, observational data were collected on participants' age, gender, presence of a pressure injury, Body Mass Index score, number of comorbidities and place of residence. These variables were analysed as potential predictors for pressure injuries within the first 36-hours of hospitalisation. From our sample, 113/1047 (10.8%) participants were observed to have a pressure injury within the first 36-hours of hospital admission. Age, multiple comorbidities, and living in an aged care facility predicted the prevalence of pressure injury among older people within the first 36-hours of hospitalisation. Our findings confirm that older adults, those with multiple comorbidities, and individuals living in aged care facilities are more likely to come to hospital with a pre-existing pressure injury or develop one soon after admission. This article is protected by copyright. All rights reserved