Nurse staffing, direct nursing care hours and patient mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study

Abstract

BackgroundStudies over the past decades have shown an association between nurse staffing and patient outcomes, however, most of these studies were conducted in the West. Accordingly, the purpose of this study aimed to provide an overview of the research/evidence base which has clarified the relationship between nurse staffing and patient mortality of acute care hospital wards under a universal health insurance system and attempted to provide explanations for some of the phenomena that are unique in Taiwan.MethodsThrough stratified random sampling, a total of 108 wards selected from 32 hospitals in Taiwan were collected over a consecutive seven month period. The mixed effect logit model was used to explore the relationship between nurse staffing and patient mortality.ResultsThe medians of direct-nursing-care-hour, and nurse manpower were 2.52 h, and 378 persons, respectively. The OR for death between the long direct-nursing-care-hour (> median) group and the short direct-nursing-care-hour (≦median) group was 0.393 (95% CI = [0.245, 0.617]). The OR for death between the high (> median) and the low (≦median) nurse manpower groups was 0.589 (95% CI = [0.381, 0.911]).ConclusionsFindings from this study demonstrate an association of nurse staffing and patient mortality and are consistent with findings from similar studies. These findings have policy implications for strengthening the nursing profession, nurse staffing, and the hospital quality associated with nursing. Additional research is necessary to demonstrate adequate nurse staffing ratios of different wards in Taiwan.

Predictors of quality of care provided for older adults

“…Similarly, it has been found previously that balancing nursing work assignments significantly affects nurses' and patients' satisfaction (Acar & Butt, ; Liang, Chen, Lee, & Huang, ). Previous research indicated that insufficient nurse staffing was associated with increased medical errors, adverse medical outcomes and increased mortality (Liang et al, ). Previously Khademi, Mohammadi, and Vanaki (), in a qualitative study in Tehran similarly found that nurses mainly experience excessive workload by the high proportion of patients to nurses, shortage of necessary equipment, assigning tasks for nurses without previous preparation and assigning nurses to perform irrelevant non‐medical tasks.…”

“…Similarly, it has been found previously that balancing nursing work assignments significantly affects nurses' and patients' satisfaction (Acar & Butt, 2016;Liang, Chen, Lee, & Huang, 2012). Previous research indicated that insufficient nurse staffing was associated with increased medical errors, adverse medical outcomes and increased mortality (Liang et al, 2012).…”

“…This is one of the biggest challenges nurses usually report (West, Barron, & Reeves, 2005). A study that was conducted in 108 wards selected from 32 hospitals in Taiwan, indicated that direct nursing care hours have a significant negative relationship with the patient's death (Liang et al, 2012), which means that more direct nursing care protects against patient's mortality. Similarly, it has been found previously that the time that nurses spend in direct patient care was a significant predictor of better patient outcomes (Duffield, Diers, et al, 2011).…”

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

“…This is likely in part because more than a third of all cases of non-adherence can be attributed to forgetfulness [21]. Since forgetting to take one’s medicines, sometimes referred to as “unintentional non-adherence,” seems to be reinforced by social and economic factors; the next two sections will examine how alignment of social and health system forces could help to overcome these lapses in memory [22]. …”

Inactive nurses in Taiwan: human capital, intention to return to hospital nursing, and incentives for returning

“…The adequacy of nurse staffing is closely related to patient safety and care quality (Liang et al . ); nurses are an essential component of the health‐care delivery system and play an important role in patient‐centred care. Thus, hospitals should hire sufficient numbers of nursing staff to reduce the workload.…”