Nurse staffing and patient care outcomes: protocol for an umbrella review to identify evidence gaps for low and middle-income countries

Abstract

Background: Adequate staffing is key to the delivery of nursing care and thus to improved inpatient and health service outcomes. Several systematic reviews have addressed the relationship between nurse staffing and these outcomes. Most primary studies within each systematic review are likely to be from high-income countries which have different practice contexts to low and middle-income countries (LMICs), although this has not been formally examined. We propose conducting an umbrella review to characterise the existing evidence linking nurse staffing to key outcomes and explicitly aim to identify evidence gaps in nurse staffing research in LMICs. Methods and analysis: This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). Literature searching will be conducted across Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Two independent reviewers will conduct searching and data abstraction and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be performed using the AMSTAR-2. Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals. PROSPERO registration number: CRD42021286908

Identifying gaps in global evidence for nurse staffing and patient care outcomes research in low/middle-income countries: an umbrella review

“…30 Our review protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42021286908) and has been published. 31…”

“…We conducted an umbrella review using guidance from the Joanna Briggs Institute (JBI) for the preparation and conduct of the review 30. Our review protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42021286908) and has been published 31…”

“…These were the Cochrane Register of Systematic Reviews, the JBI Database of Systematic Reviews and Implementation Reports, Medline, Embase and Cumulative Index to Nursing and Allied Health Literature. Our search strategy for this is detailed in online supplemental file 1 and has previously been published 31…”

“…Our search strategy for this is detailed in online supplemental file 1 and has previously been published. 31 We included some of the following keywords and their synonyms: nurse, nursing, outcome, quality, missed nursing, mortality and identified some key Medical Subject Headings (MESH) terms (online supplemental file 1). We combined these using Boolean operators 'AND' and 'OR' where appropriate.…”

“…Our exposure for this review is the level of nurse staffing and thus reflects nursing metrics that focus on nursing numbers or nursing time available to patients, for example, nurse-to-patient ratios or NHPPD and not on how the nursing workforce is organised. 31 Outcome Our outcome of interest was patient care outcomes, for example, mortality and healthcare-associated infection. For reviews that reported mixed outcomes, for example, reviews summarising literature on both nurse and patient outcomes, we reported only on patient care outcomes.…”