Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care

Objectives To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Design Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Setting Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Participants Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Main outcome measures Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Results Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80<OR<0.93), after adjusting for patient and hospital factors. Each 10 percentage point reduction in the proportion of professional nurses is associated with an 11% increase in the odds of death. In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying. Conclusions A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, Erode quality and safety of hospital care and contribute to hospital nurse shortages. © 2017 BMJ Publishing Group. All Rights Reserved

Métodos de adaptação transcultural de instrumentos na área da enfermagem

Resumo OBJETIVO Identificar os métodos de adaptação transcultural de instrumentos mais utilizados na área da enfermagem. MÉTODOS Revisão integrativa, em fontes eletrônicas Medline via Pubmed, Cinahl, Lilacs, Scopus e Web of Science. Foram selecionados 96 artigos revisados por pares e publicados entre 2010 e 2015. RESULTADOS Os artigos que compuseram a amostra foram publicados em 59 periódicos diferentes, sendo 15,2% destes brasileiros. O maior número de publicações concentrou-se em 2015 (31,2%). Além disso, 28 países apareceram na lista liderada pelo Brasil (33,3%), seguido de China (10,4%). Utilizaram-se 27 modelos de adaptação transcultural diferentes. Entretanto, o proposto por Beaton e colaboradores foi citado em 47(49,0%) artigos, e o de Brislin em 12 (12,5%). CONCLUSÕES Não há consenso sobre adaptação transcultural, entretanto todos os métodos coincidiram na utilização da etapa de retrotradução. Além disso, diversos estudos em diferentes idiomas e países apontaram a aceitabilidade internacional do método desenvolvido por Beaton e colaboradores