Health workforce planning : which countries include Nurse Practitioners and Physician Assistants and to what effect?

This paper emanated from two studies, the MUNROS project and the TaskShift2Nurses study. The MUNROS project ‘Health Care Reform: The iMpacton practice, oUtcomes and cost of New Roles for health profeSsionals (MUNROS), received funding from the European Union under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1), grant agreement number HEALTH-F3-2012-305467EC. Funding for the TaskShift2Nurses study was obtained through the Harkness Fellowship in Healthcare Policies and Practice (to CB Maier) by the Commonwealth Fund and the B. Braun Foundation. The funders had no role in the design of the study, data collection, analysis or interpretation of the data and material, nor in the write up phase of the manuscript. Acknowledgements We thank all those who supported and guided this work both as part of the TaskShift2Nurses study and the MUNROS research. In particular, the support by Christine Bond (MUNROS research Co-PI, University of Aberdeen) is acknowledged.Peer reviewedPostprin

Focus on nursing: towards high patient safety and satisfied staff

Hintergrund: Die Zahl der internationalen Studien, die einen Zusammenhang zwischen dem organisatorischen Kontext, in dem Krankenpflegekräfte arbeiten und der Versorgungsqualität herstellen, ist in den letzten Jahren enorm angewachsen. Gleichzeitig rücken steigende Fluktuationsraten und die erhöhte Bereitschaft des Pflegepersonals zu einem Arbeitsplatzwechsel in den Fokus des Interesses vieler Forschungsvorhaben. Trotz Limitationen suggerieren diese Studien, dass eine höhere pflegerische Personalbesetzung sowie eine als gut und produktiv empfundene Arbeitsumgebung verbesserten Nutzen für die Versorgungsqualität und Patientensicherheit versprechen. Gleichzeitig wird die Zufriedenheit der Pflegekräfte erhöht, emotionale Erschöpfung gesenkt und die Mitarbeiterbindung gestärkt. In Deutschland konnten die Effekte bisher noch nicht ausreichend erfasst werden. Zielstellung: Ziel dieser Arbeit ist es zu überprüfen, ob sich die internationalen Ergebnisse auf den deutschen Versorgungskontext übertragen lassen und sich ein Zusammenhang zwischen der pflegerischen Arbeitsumgebung und der Personalbesetzung mit (a) einer verbesserten Versorgungsqualität und (b) relevanten Pflegeergebnissen bestätigen lässt. Ferner sollen Handlungsempfehlungen für ein verbessertes Arbeitsumfeld, eine größtmögliche Versorgungsqualität und erfolgreiche Mitarbeiterbindung abgeleitet werden. Methodik: Die der Dissertation zugrundeliegenden wissenschaftlichen Beiträge basieren auf unterschiedlichen methodischen Ansätzen: Kapitel 3, 4 und 6 basieren auf multivariaten Analysemethoden, wobei Kapitel 6 quantitative und qualitative Analysemethoden kombiniert. Kapitel 7 legt ebenfalls den Schwerpunkt auf ein qualitatives Studiendesign anhand von Experteninterviews, während Kapitel 5 auf einer systematischen Übersichtsarbeit basiert. Mit Ausnahme des Kapitels 6 basieren alle Beiträge auf Befragungen von examinierten Pflegefachkräften im Rahmen der internationalen RN4Cast-Studie (Nurse Forecasting: Human Resources Planning in Nursing). Ergebnisse: Zusammengefasst kann die vorliegende Dissertation die internationale Evidenz bestätigen, dass es unabdinglich für eine hohe Versorgungsqualität ist, Personalressourcen auf Patientenbedürfnisse abzustimmen und dabei die Bedürfnisse der Pflegekräfte nach einer adäquaten Arbeitsumgebung nicht zu vernachlässigen. Im Detail zeigt Kapitel 3, dass sich die pflegerische Arbeitsumgebung in Deutschland seit 1999 signifikant verschlechtert hat, was sich negativ auf die wahrgenommene Versorgungsqualität auswirkte. Als Konsequenz stieg die Unzufriedenheit unter den Pflegekräften und deren emotionale Erschöpfung stark an. Kapitel 4 bestätigt den Negativtrend in der berichteten Versorgungsqualität: notwendige Pflegetätigkeiten mussten aus Zeit- bzw. Personalmangel vernachlässigt werden: 93% der Befragten (n=1399) mussten mindestens eine notwendige Pflegetätigkeit in der letzten Schicht rationieren, im Durchschnitt wurden 4,7 Pflegetätigkeiten rationiert. Die Spannbreite reicht dabei von 15% bei therapeutischen Tätigkeiten (z. B. Behandlungen) bis 82% bei psychosozialen Tätigkeiten und der Kommunikation (z. B. Zeit und Zuwendung für Patientengespräche). Dies deutet darauf hin, dass Pflegekräfte bei ihren Rationierungsentscheidungen priorisieren. Ferner wurden Zusammenhänge mit der Arbeitsumgebung hergestellt: ausreichende Zeit- und Personalressourcen, ein unterstützendes Pflegemanagement und eine adäquate Dokumentation wurden als protektive Faktoren identifiziert. Kapitel 5 untersucht den Einfluss der pflegerischen Personalbesetzung auf ausgewählte Patientenereignissen (u.a. Mortalität und Failure-to-rescue (FTR)). Die Analyse ergab, dass vor allem die Ergebnisse zur Mortalität – mehr als 75% der eingeschlossenen Studien zeigten einen statistisch signifikanten Effekt des Pflegepersonals auf die Mortalität – die wichtige Rolle der Pflegekräfte in der Gewährleistung einer sicheren Patientenumgebung sowie einer hohen Versorgungsqualität unterstützen. Weitere Patientenereignisse (z. B. Patientenstürze, Harnwegsinfekte und Dekubitus) zeigten gemischte Ergebnisse. Kapitel 6 untersucht die erhöhte Wechselabsicht bei Pflegekräften und identifiziert folgende signifikante Einflussfaktoren (sog. Push-Faktoren): eine schlechte Arbeitsumgebung, hohe emotionale Erschöpfung, fehlendes Lob und Anerkennung, schlechte Fort- und Weiterbildungsangebote, mangelnde Zusammenarbeit zwischen Ärzten und Pflegekräften, fehlende personelle Ressourcen und begrenzte Entscheidungsbefugnisse. Daneben zeigt Kapitel 6, dass in einigen europäischen Ländern, die als interessante Zielländer für deutsche Pflegekräfte gelten um im Ausland zu arbeiten, das dortige Personal die Push-Faktoren als überwiegend besser einschätzt. Kapitel 7 legt schlussendlich dar, dass sich durch die Verbesserung der pflegerischen Arbeitsumgebung gleichzeitig an der Stellschraube Personal drehen lässt, ohne unbedingt Personal aufzustocken. Besonderer Bedeutung kommt dabei dem Einfluss eines zentral gesteuerten, verantwortungsbewussten Führungsmanagements zu. Schlussfolgerung: Die Arbeit zeigt, dass die Lösung nicht in einem einzelnen Konzept liegt, z.B. der pflegerischen Personalausstattung, sondern in einem Bündel an Maßnahmen, abgestimmt auf die jeweiligen Bedürfnisse der einzelnen Krankenhäuser. Aus den Ergebnissen dieser Arbeit lassen sich 2 Handlungsstrategien für den deutschen Versorgungskontext ableiten: (1) in eine adäquate, auf den individuellen Stationsbedarf abgestimmte, Personalbesetzung in Akutkrankenhäusern investieren, sowie (2) auf nachhaltige und effektive Ansätze zur Personalgewinnung und -bindung setzen, die die Personalaufstockung gezielt begleiten. Verbesserungen in der pflegerischen Arbeitsumgebung versprechen hierbei einen größtmöglichen Nutzen.Background: The number of international studies showing an association between nurses’ organizational context in hospitals and the quality of care, turnover rates and intents to leave among nurses has grown substantially over the last years. Despite limitations, those studies revealed associations between higher nurse staffing and good and productive nurse work environments with improved quality of care and patient safety as well as increased nurse satisfaction, less emotional exhaustion and successful retention of staff. Objective: Aim of this study is to analyze whether international findings can be applied to the German health care context and associations between the nurse work environment and nurse staffing with (a) the quality of care and (b) relevant nurse outcomes. Further, this study aims to identify success factors for an improved nurse work environment, high-quality care and successful staff retention. Methods: The scientific contributions of this work are based on different methodological approaches: Chapter 3, 4 and 6 use multivariate analyses, chapter 6 additionally adopts a qualitative design (focus groups). Chapter 7 also bases on a qualitative design (expert interviews), whereas for chapter 5 a systematic review was conducted. Excluding chapter 6, all contributions are based from the registered nurse surveys as part of the RN4Cast study. Results: In summary, this work confirms international research results that matching staffing resources and patient needs is necessary to provide high quality care and that simultaneously nurses’ needs in terms of adequate nurse work environment should be considered. In detail, chapter 3 shows that the nurse work environment has worsened significantly in Germany since 1999 which as a consequence had significant negative impact on the nurse-perceived quality of care. Both the aspects of the practice environment and the quality aspects impacted substantially on satisfaction and emotional exhaustion among nurses. Chapter 4 confirms this downward trend in the reported quality of care: necessary nursing tasks were rationed due to lack of time and personnel: a total of 93% of all surveyed nurses (n=1399) omitted at least one of the tasks in the latest shift, on average 4.7 nursing tasks. The range was between 82% for “comfort/talks with patients” and 15% for “treatment and procedures”, which suggests that nurses prioritize tasks which are likely to have negative consequences for patients. The analysis furthermore reveals that the work environment was significantly associated with the level of tasks undone: e.g. sufficient time and personnel resources, a supportive nurse management and adequate documentation are protective factors. Chapter 5 analyzes the impact of nurse staffing on selected patient outcomes (e.g. mortality and failure-to-rescue (FTR)). Especially for mortality, the results support the important role of nurses in providing safe environments for patients as well as improving their outcomes. More than 75% of the results indicate significant positive associations between nurse staffing levels and patient mortality. Other outcome measures (e.g. patient falls, urinary tract infections and pressure ulcers) showed mixed results. Chapter 6 focuses the increased intents to leave among nurses and identified following significant impact factors (so- called push factors): a poor nurse work environment, high emotional exhaustion, low recognition, poor advanced training prospects, lack of collaboration between nurses and physicians, perceived staff shorage and restricted decision-making power. Chapter 6 furthermore shows that in some European countries which are popular among migrating German nurses, local professionals assess their situtaion considerably better than their German collegues. Chapter 7 eventually demonstrates that by improving the nurse work environment concurrently the setcrew staffing would be improved without essentially increasing nurse staffing. The results clearly indicate the extensive impact of a centrally steered and responsive leadership. Conclusions: Findings of this work underline the importance of adopting a bundle of measures that are adapted for the specific needs of each particular hospital, rather than relying on one concept only, e.g. nurse staffing. Furthermore, this work recommends two actionable strategies for the German health care context: (1) to invest in an adequate ward-specific nurse staffing in hospitals, and (2) to simultaneously build on sustainable and effective strategies for successful staff attraction and retention. Improvements in the nurse work environment are thereby associated with maximal benefits.EC/FP7/223468/EU/Nurse Forecasting: Human Resources Planning in Nursing/RN4Cas

Is there enough research output of EU projects available to assess and improve health system performance? An attempt to understand and categorise the output of EU projects conducted between 2002 and 2012

Background: Adequate performance assessment benefits from the use of disaggregated data to allow a proper evaluation of health systems. Since routinely collected data are usually not disaggregated enough to allow stratified analyses of healthcare needs, utilisation, cost and quality across different sectors, international research projects could fill this gap by exploring means to data collection or even providing individual-level data. The aim of this paper is therefore to (1) study the availability and accessibility of relevant European-funded health projects, and (2) to analyse their contents and methodologies.Methods: The European Commission Public Health Projects Database and CORDIS were searched for eligible projects, which were then analysed by information openly available online.Results: Overall, only a few of the 39 identified projects produced data useful for proper performance assessment, due to, for example, lacking available or accessible data, or poor linkage of health status to costs and patient experiences. Other problems were insufficient databases to identify projects and poor communication of project contents and results.Conclusions: A new approach is necessary to improve accessibility to and coverage of data on outcomes, quality and costs of health systems enabling decision-makers and health professionals to properly assess performance

Additional file 1: of Is there enough research output of EU projects available to assess and improve health system performance? An attempt to understand and categorise the output of EU projects conducted between 2002 and 2012

List of projects and associated partner countries. (DOCX 55 kb

Molecular characterisation of a rabbit Hepatitis E Virus strain detected in a chronically HEV-infected individual from Germany

In immunocompromised individuals persisting viremia frequently leads to a chronic hepatitis E virus (HEV) infection. Zoonotic transmission of HEV from pigs and wild boar to humans is proven and sporadic infections with rabbit HEV (raHEV) have recently been reported. Here, the molecular characterisation of a raHEV strain isolated from an immunocompromised, chronically HEV-infected, heart-transplanted patient is described. After successful ribavirin (RBV) treatment of a HEV infection in 2019, the patient was again tested HEV positive in 2021 and received a second RBV therapy cycle. Full-length HEV genome amplification and next generation sequencing was performed on a plasma sample taken between first and second cycle of RBV therapy and a stool sample taken two months after starting the second cycle. The sequence of plasma (raHEV-83) and stool (raHEV-99) derived virus showed the highest nucleotide sequence identity to a Chinese raHEV and a phylogenetic relationship to a raHEV strain isolated from a French patient. Furthermore, sequence analysis revealed the presence of RBV-associated substitutions V1479I and G1634K in the HEV sequences from plasma and additionally K1398R from stool. The results underline the role of rabbits as putative sources of HEV infection and emphasize the need of a one health concept for a better understanding of HEV epidemiology and to develop tools for prevention and control of HEV infection

Rituele repertoires: volkscultuur in oostelijk Noord-Brabant, 1559-1853

Contains fulltext : mmubn000001_187378991.pdf (publisher's version ) (Open Access)Promotor : M. Spiertz cum laude702 p

Prevalence, patterns and predictors of nursing care left undone in European hospitals:results from the multicountry cross-sectional RN4CAST study

Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon.; The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors.; Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study.; Across European hospitals, the most frequent nursing care activities left undone included 'Comfort/talk with patients' (53%), 'Developing or updating nursing care plans/care pathways' (42%) and 'Educating patients and families' (41%). In hospitals with more favourable work environments (B=-2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone.; Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required