Predictors of pressure ulcer and physical restraint prevalence in Japanese acute care units

Abstract

Aim: To investigate the predictors of pressure ulcer and physical restraint prevalence in Japanese acute care units and their relationship to the nursing hours, skill mix, and Nursing Need Scores (NNS). Methods: In this descriptive study, quantitative methods were employed to determine if pressure ulcers and physical restraint prevalence, as outcomes of nursing care, were related to the nursing hours, skill mix, and intensity of nursing-care needs. The sample included 87 acute care units in 42 hospitals in Tokyo and its surrounding prefectures in Japan. The NNS was used as the instrument to measure the intensity of nursing-care needs. The data were analyzed with descriptive statistics, correlations, and multiple regression analyses. Results: Pressure ulcer prevalence was positively correlated with the NNS-A and NNS-B. Physical restraint use was positively correlated with the NNS-B and negatively correlated with the NNS-A. However, the total nursing hours per patient day was positively related with both pressure ulcer and physical restraint prevalence. Conclusions:The nursing hours and NNS are predictors of pressure ulcer development and physical restraint use. The results also suggest that we should revise our process of nursing care. Many functions that might be shared with other personnel are performed by nurses, which results in longer total nursing hours but shorter direct nursing hours, used in order to observe and care for patients. Japan's aging population will result in higher NNS, requiring more direct nursing hours and other personnel to participate in our process of nursing care.

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

“…Eight mostly weak studies gave no strong evidence of beneficial associations between nursing support worker staffing and patient safety. Studies found no association with mortality (Unruh et al, 2007), failure to rescue (Park et al, 2012), length of stay (Unruh et al, 2007), venous thromboembolism (Ibe et al, 2008), or missed care . However, higher assistant staffing was associated with higher rates of falls (Hart andDavis, 2011, Lake et al, 2010), pressure ulcers (Seago et al, 2006), readmission rates (Weiss et al, 2011), medication errors (Seago et al, 2006), use of physical restraints M a n u s c r i p t…”

“…Page 11 (Hart and Davis, 2011) and lower levels of patient satisfaction (Seago et al, 2006), although one weak study found that higher HCA staffing levels were associated with lower rates of pressure ulcers (Ibe et al, 2008). …”

“…A number of these studies found an association between a nursing skill mix that has a higher proportion of RNs and better outcomes including lower mortality / failure to rescue (Blegen et al, 2011, Estabrooks et al, 2005, lower rates of infections (Blegen et al, 2011, Cho et al, 2003, McGillis Hall et al, 2004, falls (Blegen and Vaughn, 1998, Donaldson et al, 2005, Patrician et al, 2011, pressure ulcers (Blegen et al, 2011, Ibe et al, 2008, and higher patient satisfaction (Potter et al, 2003). The overall pattern of results is largely consistent, with the only significant contradictory evidence coming from one of the weaker studies which showed that a higher proportion of registered nurses was associated with a higher nurse reported incidence of pneumonia (Ausserhofer et al, 2013).…”

Nurse staffing levels, missed vital signs and mortality in hospitals: retrospective longitudinal observational study

“…Eight, mostly weak, studies gave no strong evidence of beneficial associations between nursing assistant staffing levels and patient safety. Studies found no association between assistant staffing level and mortality, 46 failure to rescue, 47 length of stay, 46 venous thromboembolism 48 or missed care. 19 However, higher assistant staffing was associated with higher rates of falls, 43,49 pressure ulcers, 50 readmission rates, 51 medication errors 50 and use of physical restraints 43 and lower levels of patient satisfaction.…”

The incidence of pressure ulcer in patients on mechanical ventilation andeffects of selected risk factors on pressure ulcer development*

“…Although prevention of PUs is a multidisciplinary responsibility, nurses play a major role. In a study on Japanese nurses, long work hours were found to increase the prevalence of physical restraint and PUs (20).…”