Identifying nurse-sensitive indicators for stand-alone high acuity areas: A systematic review

Myers, Helen; Pugh, Judith Dianne; Twigg, Di

doi:10.1016/j.colegn.2017.10.004

Cited by 17 publications

(36 citation statements)

References 55 publications

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“…Our review findings are in harmony with the findings of Myers et al. (2018) and Audet et al. (2018) since both reviews also found the mortality as the most frequently explored patient‐focused indicators.…”

Section: Discussionsupporting

confidence: 91%

“…In their review, Myers et al. (2018) identified the most important indicators for quality of nursing care as mortality, length of stay, central‐line‐associated bloodstream infection, ventilator‐associated pneumonia, sepsis, falls with injury, re‐intubation and medication errors. Similarly, Audet et al.…”

Section: Discussionmentioning

confidence: 99%

“…(2018), Driscoll et al. (2018), and Myers et al., (2018). We concluded that the list of keywords was comprehensive to identify the literature on nursing‐sensitive indicators.…”

Section: The Reviewmentioning

confidence: 97%

“…In this context, one of the most comprehensive two reviews that aimed to generate a pool of nursing‐sensitive indicators included studies through 2008 (Dubois et al., 2013). The other comprehensive review, however, focused on nursing‐sensitive indicators only in stand‐alone high acuity areas (Myers et al., 2018). All of the other systematic reviews had a specific focus, such as nurse staffing (Kane et al., 2007; Lang et al., 2004; Lankshear et al., 2005), nurse education (Liao et al., 2016) or nurse‐to‐patient ratios (Driscoll et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

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Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017)

et al. 2020

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Aim To provide a systematic review of the literature from 1997 to 2017 on nursing‐sensitive indicators. Design A qualitative design with a deductive approach was used. Data sources Original and Grey Literature references from Cochrane Library, Medline/PubMed, Embase, and CINAHL, Google Scholar Original and Grey Literature. Review methods Quality assessment was performed using the NIH Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. Results A total of 3,633 articles were identified, and thirty‐nine studies met the inclusion criteria. The quantitative assessment of investigated relationships in these studies suggests that nursing staffing, mortality, and nosocomial infections were the most frequently reported nursing‐sensitive indicators. Conclusion This review provides a comprehensive list of nursing‐sensitive indicators, their frequency of use, and the associations between these indicators and various outcome variables. Stakeholders of nursing research may use the findings to streamline the indicator development efforts and standardization of nursing‐sensitive indicators. Impact This review provides evidence‐based results that health organizations can benefit from nursing care quality.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

“…(2018), Driscoll et al. (2018), and Myers et al., (2018). We concluded that the list of keywords was comprehensive to identify the literature on nursing‐sensitive indicators.…”

Section: The Reviewmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017)

et al. 2020

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“…Despite these efforts, clear evidence-based guidelines on staffing levels are lacking, particularly in regard to skill mix (Brennan, Daly, & Jones, 2013;Sharma, Hastings, Suter, & Bloom, 2016). A recent systematic review (Myers, Pugh, & Twigg, 2018) that examined the importance of nurse skill mix on patient outcomes focussed specifically on stand-alone high acuity areas, meaning that findings from this review may not be easily transferrable to other care settings. The only other systematic review on skill mix and patient outcomes (Lankshear, Sheldon, & Maynard, 2005) examined articles published up to 2004 and highlighted the relationship between nurse staffing factors (Registered Nurse staffing levels and proportion of RNs in the skill mix) and patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

A quantitative systematic review of the association between nurse skill mix and nursing‐sensitive patient outcomes in the acute care setting

Twigg

Kutzer

Jacob

et al. 2019

Journal of Advanced Nursing

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AimsTo examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals.DesignA quantitative systematic review included studies published in English between January 2000 – September 2018.Data sourcesCochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix‐methods designs were included if the quantitative component met the criteria.Review methodsThe Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument were used. An inverse association was determined when seventy‐five percent or more of studies with significant results found this association.ResultsSixty‐three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e., higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure‐to‐rescue; pneumonia; sepsis; urinary tract infection; mortality/30‐day mortality; pressure injury; infections and shock/cardiac arrest/heart failure.ConclusionNursing skill mix affected 12 patient outcomes. However, further investigation using experimental or longitudinal study designs are required to establish causal relationships. Consensus on the definition of skill mix is required to enable more robust evaluation of the impact of changes in skill mix on patient outcomes.ImpactSkill mix is perhaps more important than the number of nurses in reducing adverse patient outcomes such as mortality and failure to rescue, albeit the optimal staffing profile remains elusive in workforce planning.

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