Improving nurse staffing measures: Discharge day measurement in adjusted patient days of care

Previous research cannot account for the discrepancy between registered nurse (RN) reports of understaffing and studies showing slight improvement. One reason may be that adjusted patient days of care (APDC) underestimates patient load. Using data from all Pennsylvania acute care general hospitals for the years 1994 through 1997, we found that APDC is underestimated by two hours. After adjusting APDC, we examined the difference in nurse staffing over the period 1991-2000 before and after the adjustment. We found a significant difference between unadjusted and adjusted measures. However, when applied to the changes in nurse staffing between 1991 and 2000, the difference was not enough to account for the discrepancy between reports and data. Other measurement and conceptual problems may exist in terms of patients\u27 increasing acuity levels, patients\u27 declining lengths of stay and the associated greater proportion of nurse time devoted to admission and discharge, and lack of recent data in some empirical studies

The 2013 cholesterol guideline controversy: Would better evidence prevent pharmaceuticalization?

AbstractCardiovascular disease (CVD) remains the leading cause of death globally. A class of medications, known as statins, lowers low-density lipoprotein cholesterol levels, which are associated with CVD. The newest 2013 U.S. cholesterol guideline contains an assessment of risk that greatly expands the number of individuals without CVD for whom statins are recommended. Other countries are also moving in this direction. This article examines the controversy surrounding these guidelines using the 2013 cholesterol guidelines as a case study of broader trends in clinical guidelines to use a narrow evidence base, expand the boundaries of disease and overemphasize pharmaceutical treatment.We find that the recommendation in the 2013 cholesterol guidelines to initiate statins in individuals with a lower risk of CVD is controversial and there is much disagreement on whether there is evidence for the guideline change. We note that, in general, clinical guidelines may use evidence that has a number of biases, are subject to conflicts of interest at multiple levels, and often do not include unpublished research. Further, guidelines may contribute to the “medicalization” or “pharmaceuticalization” of healthcare.Specific policy recommendations to improve clinical guidelines are indicated: these include improving the evidence base, establishing a public registry of all results, including unpublished ones, and freeing the research process from pharmaceutical sector control

Challenges facing the United States of America in implementing universal coverage

In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features - health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies - remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes - for the assessment of the cost-effectiveness of pharmaceuticals, health services and technologies - comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorite de Sante in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was - and remains - weakened by a lack of cross-party political consensus. The ACA\u27s performance and its resulting acceptability to the general public will be critical to the Act\u27s future

Occupational Therapy Intervention with Children Survivors of War

A preventive occupational therapy program with children surviving the Kosovo conflict is examined. The objective of the program was to facilitate the emotional expression of traumatic experiences in order to prevent the development of future psychological problems. The intervention was based on a community-centred approach with spirituality as a central focus of the intervention.The Model of Human Occupation and the Occupational Performance Process Model were utilized to guide the identification and intervention of occupational performance issues.The children’s return from a land of war to a land of children demonstrates the potential of occupational therapy intervention in this field. With increasing awareness of populations facing social and political challenges, there is a growing importance of the concept of occupational justice and the need to work against occupational apartheid.Cet article décrit un programme de prévention en ergothérapie qui était destiné aux enfants ayant survécu au conflit du Kosovo. L’objectif du programme était d’aider les enfants à exprimer les émotions qu’ils avaient ressenties lors d’expériences traumatiques afin de prévenir l’apparition de problèmes psychologiques. L’intervention était basée sur une approche communautaire s’articulant autour de la spiritualité. Le Modèle de l’occupation humaine et le Modèle du processus d’intervention dans le rendement occupationnel ont été utilisés pour cibler les difficultés en matière de rendement occupationnel et pour déterminer les interventions requises. Le retour des enfants d’un monde de guerre vers le monde de l’enfance démontre la possibilité de proposer une intervention ergothérapique dans ce domaine. La conscientisation de plus en plus grand face à la détresse des populations confrontées à des problèmes politiques et sociaux entraîne une augmentation de l’importance du concept de la justice occupationnelle et du besoin de lutter contre l’apartheid occupationnel

Nursing Staff Reductions In Pennsylvania Hospitals: Exploring The Discrepancy Between Perceptions And Data

Previous research has not confirmed public and practitioner perceptions of a decline in hospital nurse staffing. One reason for this discrepancy is that aggregate or mean values may not be an accurate description of the situation in a sizable percentage of hospitals. This article calculates the mean percentage change in various measures of nursing staff in Pennsylvania hospitals, 1991-1997, and the percentage of hospitals that experienced various degrees of this change. Major findings are that the means of changes in nursing staff understate the declines. When adjusted for patient severity and outpatient care, 50 percent of the hospitals experienced large decreases in RNs per patient days of care, 70 percent had large decreases in LPNs per patient days of care, and 56 percent had large declines in licensed nurses per patient days of care. Overall, the findings support perceptions of a decline in licensed nurse staffing. Policy implications are discussed

The Effect Of Lpn Reductions On Rn Patient Load

Objective: This study explores the effect of licensed practical nurse (LPN) reductions on registered nurse (RN) staffing. Background: RN staffing is usually evaluated by assessing RN/patient and RN/nursing staff ratios. Using these measures, researchers generally have not found deteriomtion in RN staffing. Despite differences in roles, RNs and LPNs frequently share a substantial amount of patient load. Given reductions in LPNs, adequate RN staffing can be assessed more completely by looking at the changes in the staffing of licensed nurses (RNs and LPNs combined). Methods: This study measures the percent change in RN, LPN, and licensed nurse staffing from 1991 to 2000 in 185 to 215 Pennsylvania hospitals. Paired sample t tests measure the significance of change from year to year and for the period overall. Results: A 29% reduction in LPNs during the years 1991 to 2000 affected RN staffing through an increase in licensed nurses\u27 patient load and a slight decrease in skill mix. When adjusted for acuity, both RN and licensed nurse patient load increased significantly. Conclusions/Implications: These results help explain the perception that hospitals are understaffed. Future research and managerial decision-making should consider the adequacy of licensed nurse staffing, and its impact on cost, performance, and quality

Nurse Staffing And Patient, Nurse, And Financial Outcomes

Because there\u27s no scientific evidence to support specific nurseĝ€ patient ratios, and in order to assess the impact of hospital nurse staffing levels on given patient, nurse, and financial outcomes, the author conducted a literature review. The evidence shows that adequate staffing and balanced workloads are central to achieving good outcomes, and the author offers recommendations for ensuring appropriate nurse staffing and for further research

Trends In Adverse Events In Hospitalized Patients.

The Institute of Medicine reported unacceptably high rates of medical error but did not identify whether this is a growing or a stabilized problem. This study used longitudinal data from all acute care hospitals in Pennsylvania to track rates of acuity-adjusted iatrogenic atelectasis, cardiac complications, complications in general, decubitus ulcers, gangrenous ulcers, falls, hemorrhage, mortality, penumonia, post-procedural infections, treatment complications, and urinary tract infections, from 1994 to 1997. More than one-half of these adverse events increased during this time. It is important to identify the causes and correct trends in hospital systems that may produce an increase in preventable adverse events