The Case for Baccalaureate-Prepared Nurses

The nursing workforce plays a central role in our present health care system, and will likely have an even greater role in the future. Nurses already provide the vast majority of care to patients in hospitals, and so it should come as no surprise that the quality of nursing care affects patient outcomes. Over the past decade, studies have linked certain nursing characteristics—such as staffing levels, education, job satisfaction, and work environment—with better outcomes in hospitals. This Issue Brief adds to that evidence with a longitudinal study that links changes in nurse education with improvements in surgical patients’ survival. It also discusses how a more educated nurse workforce could fill a range of new roles in primary care, prevention, and care coordination as health reform is implemented

Psychiatric Comorbidity and Greater Hospitalization Risk, Longer Length of Stay, and Higher Hospitalization Costs in Older Adults with Heart Failure

OBJECTIVES: To explore associations between psychiatric comorbidity and rehospitalization risk, length of hospitalization, and costs. DESIGN: Cross‐sectional study of 1‐year hospital administrative data. SETTING: Claims‐based study of older adults hospitalized in the United States. PARTICIPANTS: Twenty‐one thousand four hundred twenty‐nine patients from a 5% national random sample of U.S. Medicare beneficiaries aged 65 and older, with at least one acute care hospitalization in 1999 with a Diagnostic‐Related Group of congestive heart failure. MEASUREMENTS: The number of hospitalizations, mean length of hospital stay, and total hospitalization costs in calendar year 1999. RESULTS: Overall, 15.8% of patients hospitalized for heart failure (HF) had a coded psychiatric comorbidity; the most commonly coded comorbid psychiatric disorder was depression (8.5% of the sample). Most forms of psychiatric comorbidity were associated with greater inpatient utilization, including risk of additional hospitalizations, days of stay, and hospitalization charges. Additional hospitalization costs associated with psychiatric comorbidity ranged up to $7,763, and additional days length of stay ranged up to 1.4 days. CONCLUSION: Psychiatric comorbidity appears in a significant minority of patients hospitalized for HF and may affect their clinical and economic outcomes. The associations between psychiatric comorbidity and use of inpatient care are likely to be an underestimate, because psychiatric illness is known to be underdetected in older adults and in hospitalized medical patients

The effect of the patient care environment on the outcomes of surgical patients with comorbid serious mental illness

Surgical patients with comorbid serious mental illness (SMI) are a vulnerable patient population susceptible to poor care outcomes. A study of the patient care environment surrounding patients with SMI is of primary interest to highlight differences in outcomes and clinical areas where nursing care matters most. The purpose of this study is to identify hospitalized surgical patients with comorbid SMI, compare their outcomes to patients without SMI, and determine the effects of the patient care environment on outcomes. This study built upon a current program of research on the impact of nurse staffing and nurse practice environments on patient outcomes and advanced nursing science by applying these concepts to a new population: surgical patients with comorbid SMI. The Quality Health Outcomes Model was used to guide the study. The patient care environment, including nurse staffing, nurse education and nurse practice environment, was examined for its effect on the outcomes of surgical patients with and without comorbid SMI, and included 30-day mortality, failure to rescue (FTR), complications, and length of stay (LOS). This was a cross-sectional study of linked nurse survey, patient and administrative data including 9,989 nurses, 228,433 surgical patients discharged from Pennsylvania hospitals between April 1, 1998, and November 30, 1999, and administrative data from 157 hospitals. Generalized estimating equations were used for predictive modeling with detailed risk adjustment. Approximately 5% of surgical patients had a diagnosis of SMI. The odds of mortality for patients with SMI were significantly lower than patients without SMI, but nurse staffing had a stronger effect on the prevention of death in patients with SMI. In hospitals where nurses cared for 5 as compared to 4 patients each, the odds of dying for patients with SMI were 30% higher than patients without SMI and the odds of FTR for patients with SMI were 35% higher than patients without SMI. Surgical patients with SMI in hospitals with poor care environments had a LOS almost 4% longer than patients in better environments. Improved nurse staffing and patient care environments mitigate poor patient outcomes, particularly among highly vulnerable patients such as those with SMI

The effect of the patient care environment on the outcomes of surgical patients with comorbid serious mental illness

Surgical patients with comorbid serious mental illness (SMI) are a vulnerable patient population susceptible to poor care outcomes. A study of the patient care environment surrounding patients with SMI is of primary interest to highlight differences in outcomes and clinical areas where nursing care matters most. The purpose of this study is to identify hospitalized surgical patients with comorbid SMI, compare their outcomes to patients without SMI, and determine the effects of the patient care environment on outcomes. This study built upon a current program of research on the impact of nurse staffing and nurse practice environments on patient outcomes and advanced nursing science by applying these concepts to a new population: surgical patients with comorbid SMI. The Quality Health Outcomes Model was used to guide the study. The patient care environment, including nurse staffing, nurse education and nurse practice environment, was examined for its effect on the outcomes of surgical patients with and without comorbid SMI, and included 30-day mortality, failure to rescue (FTR), complications, and length of stay (LOS). This was a cross-sectional study of linked nurse survey, patient and administrative data including 9,989 nurses, 228,433 surgical patients discharged from Pennsylvania hospitals between April 1, 1998, and November 30, 1999, and administrative data from 157 hospitals. Generalized estimating equations were used for predictive modeling with detailed risk adjustment. Approximately 5% of surgical patients had a diagnosis of SMI. The odds of mortality for patients with SMI were significantly lower than patients without SMI, but nurse staffing had a stronger effect on the prevention of death in patients with SMI. In hospitals where nurses cared for 5 as compared to 4 patients each, the odds of dying for patients with SMI were 30% higher than patients without SMI and the odds of FTR for patients with SMI were 35% higher than patients without SMI. Surgical patients with SMI in hospitals with poor care environments had a LOS almost 4% longer than patients in better environments. Improved nurse staffing and patient care environments mitigate poor patient outcomes, particularly among highly vulnerable patients such as those with SMI

Additional file 1 of Exploring the relationships between resilience, burnout, work engagement, and intention to leave among nurses in the context of the COVID-19 pandemic: a cross-sectional study

Supplementary Material

Early post-intensive care syndrome among older adult sepsis survivors receiving home care

Background/Objectives: New or worsened disabilities in functional, cognitive, or mental health following an intensive care unit (ICU) stay are referred to as post‐intensive care syndrome (PICS). PICS has not been described in older adults receiving home care. Our aim was to examine the relationship between length of ICU stay and PICS among older adults receiving home care. We expected that patients in the ICU for 3 days or longer would demonstrate significantly more disability in all three domains on follow‐up than those not in the ICU. A secondary aim was to identify patient characteristics increasing the odds of disability. Design: Retrospective cohort study. Setting: Hospitalization for sepsis in the United States. Participants: A total of 21 520 Medicare patients receiving home care and reassessed a median of 1 day (interquartile range 1‐2 d) after hospital discharge. Measurements: PICS was defined as a decline or worsening in one or more of 16 indicators tested before and after hospitalization using OASIS (Home Health Outcome and Assessment Information Set) and Medicare claims data. Results: The sample was predominantly female and white. All had sepsis, and most (81.8%) had severe sepsis. In adjusted models, an ICU stay of 3 days or longer, compared with no ICU stay, increased the odds of physical disability. Overall, the declines were modest and found in specific activities of daily living (16% for feeding and lower body dressing to 26% for oral medicine management). No changes were identified in cognition or mental health. Significant determinants of new or worsened physical disabilities were sepsis severity, older age, depression, frailty, and dementia. Conclusion: Older adults receiving home care who develop sepsis and are in an ICU for 3 days or longer are likely to develop new or worsened physical disabilities. Whether these disabilities remain after the early postdischarge phase requires further study. J Am Geriatr Soc 67:520–526, 2019