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Background Unrest in Chile over inequalities has underscored the need to improve public hospitals. Nursing has been overlooked as a solution to quality and access concerns, and nurse staffing is poor by international standards. Using Chile's new diagnosis-related groups system and surveys of nurses and patients, we provide information to policy makers on feasibility, net costs, and estimated improved outcomes associated with increasing nursing resources in public hospitals.Methods For this multilevel cross-sectional study, we used data from surveys of hospital nurses to measure staffing and work environments in public and private Chilean adult high-complexity hospitals, which were linked with patient satisfaction survey and discharge data from the national diagnosis-related groups database for inpatients. All adult patients on medical and surgical units whose conditions permitted and who had been hospitalised for more than 48 h were invited to participate in the patient experience survey until 50 responses were obtained in each hospital. We estimated associations between nurse staffing and work environment quality with inpatient 30-day mortality, 30-day readmission, length of stay (LOS), patient experience, and care quality using multilevel random-effects logistic regression models and zero-truncated negative binomial regression models, with clustering of patients within hospitals.Findings We collected and analysed surveys of 1652 hospital nurses from 40 hospitals (34 public and six private), satisfaction surveys of 2013 patients, and discharge data for 761 948 inpatients. Nurse staffing was significantly related to all outcomes, including mortality, after adjusting for patient characteristics, and the work environment was related to patient experience and nurses' quality assessments. Each patient added to nurses' workloads increased mortality (odds ratio 1•04, 95% CI 1•01-1•07, p<0•01), readmissions (1•02, 1•01-1•03, p<0•01), and LOS (incident rate ratio 1•04, 95% CI 1•01-1•06, p<0•05). Nurse workloads across hospitals varied from six to 24 patients per nurse. Patients in hospitals with 18 patients per nurse, compared with those in hospitals with eight patients per nurse, had 41% higher odds of dying, 20% higher odds of being readmitted, 41% higher odds of staying longer, and 68% lower odds of rating their hospital highly. We estimated that savings from reduced readmissions and shorter stays would exceed the costs of adding nurses by US$1•2 million and $5•4 million if the additional nurses resulted in average workloads of 12 or ten patients per nurse, respectively.Interpretation Improved hospital nurse staffing in Chile was associated with lower inpatient mortality, higher patient satisfaction, fewer readmissions, and shorter hospital stays, suggesting that greater investments in nurses could return higher quality of care and greater value.

Aims and Objectives:To characterise the problem of missed nursing care in Chilean hospitals and to test associations with hospital organisational variables.Background: Missed nursing care is a common problem in different countries, but it has not been studied in Chile. Design:Multihospital cross-sectional study (Supplementary file 1: STROBE guideline).Methods: Study population of 45 adult high-complexity hospitals and 1853 registered nurses (RN) working on medical-surgical units. Primary data were collected through a nurse survey. Nurses reported, out of a list of nursing care activities, the ones left undone during their last shift. The main independent variables were the work environment, measured through the Practice Environment Scale of the Nursing Work Index, patient-to-nurse ratios and RN skillmix. Adjusted logistic regression analyses were used to test associations, accounting for clustering of nurses working in the same hospital. Results:The hospital response rate was 88.9% and, for nurses, 88.1%. The mean patient-to-nurse ratio was 14.5 (range 6-23). The average skillmix was 31% RN.Eighty-six percent of nurses missed at least one activity. The activities most frequently missed included patient education, comforting patients and surveillance. The adjusted model showed a significant association between the work environment, staffing ratios and missed care. The RN skillmix was not associated.Conclusions: Missed care is highly prevalent problem in Chilean hospitals. Clinical activities were the least missed. It is necessary to improve work environments and reduce the number of patients per nurse to improve the safety and quality of care. Relevance for clinical practice:The study results are relevant since they provide new data to Chile. Better work environments and adequate human resources are modifiable factors that can be addressed from a managerial perspective, with low-cost strategies to effectively reduce missed care and improve safety and quality.

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The use of predesigned labeling in invasive lines reduces errors in medication in the last two phases: preparation and administration.

a,b , alejandra galiano 3,a , María conSuelo cerón 1,a , eileen T. laKe 4,a,c , linda h. aiKen 4,a,c Nurse staffing, skill mix and job outcomes in Chilean public hospitals Background: International evidence shows that there are organizational factors and nurse job outcomes that may negatively affect healthcare quality. Aim: To measure and analyze associations between nurse organizational factors, such as staffing ratios and skill mix, and job outcomes in public hospitals in Chile. Material and Methods: An observational, cross-sectional study of 1,855 registered nurses working in medical-surgical units in 37 public hospitals was conducted. Data collection followed the RN4CAST research protocol. Inferential analyses used logistic regression models. Results: The survey was answered by 1,395 registered nurses in 34 hospitals. The average staffing ratio was 14 patients-per-nurse, and the average skill mix was 31% registered nurses. Of all nurses, 35% reported burnout, 22% were dissatisfied, and 33% intended to leave. Being burned out increased by 9 and 6% the odds of being dissatisfied and the intent to leave, respectively (Odds ratio (OR) 1.09, p < 0.01 and 1.06, p < 0.01). Being dissatisfied increased by five times the odds of intent to leave (OR 5.19, p < 0.01). Conclusions: Staffing levels, burnout, and intent to leave warrant healthcare and governmental authorities' attention. All these factors may be threatening healthcare quality and safety.

Objetivo: buscar evidencia que responda a la pregunta ¿cuál es el impacto en el paciente, familia y personal de salud de visitas no restrictivas versus restrictivas? Método: revisión sistemática. Estrategia de búsqueda: 1993-2016 en Cochrane Library, Joanna Briggs, EBSCO,PubMed, CINHAL, Trip DataBase, con términos Mesh y palabras claves. Criterios de selección de artículos: revisiones sistemáticas,ensayos clínicos randomizados, no randomizados, cohortes, casos controles, estudios descriptivos correlacionales, UCI adultos, español e inglés. Recolección y análisis: selección inicial de 293 artículos, aplicando criterios de selección quedaron 13 artículos para análisis crítico.Calidad metodológica analizada con guías CASPe. Resultados: la visita no restrictiva no incrementa riesgo de infección, la ansiedad delpaciente es menor, la satisfacción de enfermeras es mayor, la presencia familiar ayuda a recuperación del paciente, la familia está más informada, satisfecha y con mejor conocimiento de situación. La frecuencia de complicaciones cardiovasculares es mayor en pacientes con visitas restrictivas. Conclusiones: las visitas no restrictivas en UCI no generan daño al paciente, por el contrario contribuyen a la recuperación de su salud física y emocional.

RESUMENObjetivo: Determinar si existen diferencias entre las enfermeras de pacientes hospitalizados y sus familiares, respecto de la percepción de cuáles conductas de cuidado son importantes. Material y método: Estudio descriptivo, transversal, cuya muestra, estratificada por servicio, estuvo constituida por 54 enfermeras y 96 familiares de un hospital general. Para medir la variable respuesta se empleó el Caring Assessment Instrument (Care-Q) de Patricia Larson, que consta de 50 preguntas dividas en 6 subescalas que miden el comportamiento del profesional de enfermería en la entrega de cuidado: a) es accesible, b) explica y facilita, c) conforta, d) se anticipa, e) mantiene relación de confianza y f) monitorea y hace seguimiento. Resultados: La priorización de la primera conducta, representada por la subescala "monitorea y hace seguimiento", coincide en ambos grupos. En relación a la importancia asignada al resto de las conductas de cuidado y sus subescalas, se observan diferencias en ambos grupos. Conclusión: La priorización de las categorías y conductas de cuidado entre las enfermeras y los familiares de los pacientes son diferentes y como primera selección se enfocan hacia conductas del tipo técnicas, más que al desarrollo de habilidades sociales.Palabras clave: Conductas del cuidado, percepción, enfermeras, pacientes, familia. ABSTRACTObjective: To determine whether there are differences between nurses of hospitalized patients and their relatives, regarding the perception they have of what care behaviors are important. Material and method: A cross-sectional descriptive study whose sample, stratified by service, consisted of 54 nurses and 96 relatives of a general hospital. To measure the response variable, the Caring Assessment Instrument (Care-Q) by Patricia Larson was used, which consists of 50 questions divided into 6 sub-scales that measure the behavior of the nursing professional in the delivery of care: a) it is accessible, b) explains and facilitates, c) comforts, d) anticipates, e) maintains a relationship of trust and f) monitors and follows up. Results: The prioritization of the first behavior, represented by the subscale "monitors and follows-up", coincides in both groups. Regarding the importance assigned to the rest of the care behaviors and their subscales, differences are observed in both groups. Conclusion: The prioritization of care categories and behaviors between nurses and patients' relatives are different and, as a first choice, it focuses on technical type behavior rather than the development of social skills.