The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey

Ausserhofer, Dietmar; Schubert, Maria; Desmedt, Mario; Blegen, Mary A.; Geest, Sabina De; Schwendimann, René

doi:10.1016/j.ijnurstu.2012.04.007

Cited by 184 publications

(205 citation statements)

References 62 publications

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“…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).…”

Section: March 2016mentioning

confidence: 52%

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

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

205

214

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What is already known? A number of high quality reviews establish an association between lower registered nurse staffing levels, increased mortality rates and other adverse outcomes  Careful analysis of this evidence suggests that it is consistent with a causal relationship  Translation of this evidence into practice is disputedWhat this paper adds  This paper summarises and extends a recent systematic review on nurse staffing and outcomes undertaken for England's National Institute for Health and Care Excellence  Methodological limitations mean that existing studies may not give unbiased estimates of the benefits from increased nurse staffing, with over and underestimation of benefit both possible, which makes it difficult to directly translate evidence into guidance for practice. We identify avenues for progressing this important research so that future studies might be better able to provide the evidence needed to inform policy and practice, and provide a checklist to aid future study development AbstractA large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence (NICE), which concluded there is insufficient good quality evidence available to fully inform practice.In this paper we explore this apparent contradiction. After summarising the evidence review that informed the NICE guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey.Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a ser...

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Section: March 2016mentioning

confidence: 52%

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

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

205

214

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“…applied the same BERNCA survey within 118 acute hospital units in Switzerland and demonstrated a 37% reduction in the odds of patients reporting satisfaction with the care they received ( p = .08) with each 0.5 increase in the rationing score (Schubert et al., 2008). A smaller study (Ausserhofer et al., 2013) of 35 Swiss hospitals used the BERNCA‐R survey (which extends the original BERNCA instrument from 20–32 items and adds the statement Not required to the responses options) to capture rationing of care. Nurses reported how frequently they were unable to perform 32 basic nursing activities in the past seven working days due to inadequate time, nurse staffing and/or skill mix.…”

Section: Resultsmentioning

confidence: 99%

“…Five of the studies found that missed care was associated with adverse outcomes, but in regard to pressure ulcers, two studies (Ausserhofer et al., 2013; Thompson, 2014) found no significant associations between missed care and the incidence or prevalence of hospital‐acquired pressure ulcers. Results are summarised in Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…reported an association between rationing of nursing care and higher nurse‐reported levels of bloodstream infections (OR = 3.01; 95% CI = 1.42–6.34), pneumonia (OR = 2.67; 95% CI = 1.11–6.39) and medication administration errors (OR = 2.51; 95% CI = 1.18–5.65). However, there were no significant effects of rationing care on the incidence of pressure ulcers and urinary tract infections (Ausserhofer et al., 2013). Similarly, a study across 1,291 hospitals in the USA conducted by Thompson found no significant associations of missed care with the prevalence rates of hospital‐acquired pressure ulcers.…”

Section: Resultsmentioning

confidence: 99%

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What impact does nursing care left undone have on patient outcomes? Review of the literature

Recio‐Saucedo

Dall’Ora

Maruotti

et al. 2017

Journal of Clinical Nursing

292

291

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Aims and objectivesSystematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes.BackgroundA considerable body of evidence supports the hypothesis that lower levels of registered nurses on duty increase the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear.DesignSystematic review.MethodsWe searched Medline (via Ovid), CINAHL (EBSCOhost) and Scopus for studies examining the association of missed nursing care and at least one patient outcome. Studies regarding registered nurses, healthcare assistants/support workers/nurses’ aides were retained. Only adult settings were included. Because of the nature of the review, qualitative studies, editorials, letters and commentaries were excluded. PRISMA guidelines were followed in reporting the review.ResultsFourteen studies reported associations between missed care and patient outcomes. Some studies were secondary analyses of a large parent study. Most of the studies used nurse or patient reports to capture outcomes, with some using administrative data. Four studies found significantly decreased patient satisfaction associated with missed care. Seven studies reported associations with one or more patient outcomes including medication errors, urinary tract infections, patient falls, pressure ulcers, critical incidents, quality of care and patient readmissions. Three studies investigated whether there was a link between missed care and mortality and from these results no clear associations emerged.ConclusionsThe review shows the modest evidence base of studies exploring missed care and patient outcomes generated mostly from nurse and patient self‐reported data. To support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes as a result of missed care, more research that uses objective staffing and outcome measures is required.Relevance to clinical practiceAlthough nurses may exercise judgements in rationing care in the face of pressure, there are nonetheless adverse consequences for patients (ranging from poor experience of care to increased risk of infection, readmissions and complications due to critical incidents from undetected physiological deterioration). Hospitals should pay attention to nurses’ reports of missed care and consider routine monitoring as a quality and safety indicator.

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“…The national and international literature has made consistent recommendations, especially to hospital institutions, regarding the work environment, and emphasize that nurses and effective care contribute to the process of patient recovery (2)(3) . Other studies stress that in environments favorable to the professional practice, patient safety and quality of care are improveds (4)(5) , which contributes to promote an safety climate (6) , reducing the occurrence of adverse events (7) . In this context, the environment of health organizations is a determining factor in the quality and safety of health care, and the nursing team provides a significant contribution to the creation of a safety environment for health.…”

Section: Introductionmentioning

confidence: 99%

Ambiente de trabalho da enfermagem, segurança do paciente e qualidade do cuidado em hospital pediátrico

Alves

Guirardello

2016

Rev. Gaúcha Enferm.

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How to cite this article:Alves DFS, Guirardello EB. Nursing work environment, patient safety and quality of care in pediatric hospital. Rev Gaúcha Enferm. 2016 jun;37 (2) RESUMEN Objetivos:Describir las características del ambiente de trabajo, las actitudes hacia la seguridad, el cuidado de la calidad medida por el personal de enfermería de las unidades de pediatría, así como analizar la evolución de los indicadores de bienestar y desempeño de los hospitales. Métodos: Estudio descriptivo con 136 profesionales en un asilo de ancianos hospital pediátrico, realizado a través de la forma de caracterización personal y profesional, Enfermería Índice de Trabajo -Revisado, Actitudes Seguridad Cuestionario -Short Form 2006 y los indicadores de calidad. Resultados: Los profesionales perciben el ambiente tan favorable a la práctica profesional y de la buena calidad de la atención, una reducción de los eventos adversos y la estancia hospitalaria. Satisfacción en el trabajo se consideró favorable para la seguridad del paciente. Conclusiones: El ambiente de trabajo es propicio para la práctica de los profesionales de enfermería que aprueban la calidad de la atención y la reducción de puntos de indicadores de los eventos adversos y la estancia hospitalaria Palabras clave: Ambiente de instituciones de salud. Seguridad del paciente. Calidad de la atención de salud. Satisfacción en el trabajo. Evaluación del resultado de la atención al paciente.

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The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey

Cited by 184 publications

References 62 publications

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

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

What impact does nursing care left undone have on patient outcomes? Review of the literature

Ambiente de trabalho da enfermagem, segurança do paciente e qualidade do cuidado em hospital pediátrico

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