Transcript Slide 1

NURS 350
EBNP Group Project
http://able2know.org/topic/99389-1
Presented by:
Christina Bookheimer
Michelle Rowe
Sandra Saylor
Meagan Smoyer
Jackie Tiefenthal
PICO
• Our purpose was to identify and determine patient satisfaction
levels related to staffing in a medical-surgical setting
• P - medical surgical patients I - low nurse to patient ratio C high nurse to patient ratio O - patient satisfaction
• In medical surgical patients, what is the effect of high nurseto-patient ratios on patient satisfaction compared with low
nurse-to-patient ratios?
http://www.citytowninfo.com/employment/registered-nurses
Why this matters to nursing
• Nurses are advocates for their patients and as
such need to listen and provide for them.
• High nurse-to-patient ratios can result in less
attention given to patients due to tasks that need
to be completed.
• Appropriate nurse-to-patient ratios result in
higher patient satisfaction and higher quality
patient care
http://www.monroetwp.k12.nj.us/Whitehall/NursesCorner/
article one
Patients' perception of hospital care in the United States
Highlights from Article
• A representation of patients’ experiences in U.S. hospitals can be seen
in the data from the Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) (Jha, Orav, Zheng & Epstein,
2008).
• Patients’ experiences were used to assess the performance of hospitals
and if key characteristics of the hospitals enhanced patient
experiences (Jha, Orav, Zheng & Epstein, 2008).
• This article examines whether key characteristics of hospitals
enhance patient experiences through HCAHPS data from July 2006
through June 2007 (Jha, Orav, Zheng & Epstein, 2008).
• “The ratio of nurses to patient-days was a predictor of performance
on the HCAHPS survey” (Jha, Orav, Zheng & Epstein, 2008).
article one
Patients' perception of hospital care in the United States
Recommendations & Findings
• The results “found a moderate relationship between the ratio of nurses to patient-days
and patients’ experiences in the hospital” (Jha, Orav, Zheng & Epstein, 2008).
• The authors felt that the need for reporting by hospitals on performance related to quality
indicators may improve the care given to patients (Jha, Orav, Zheng & Epstein, 2008).
• In respect to interpersonal aspects of care, the study reveals that higher ratio of nurses to
patient-days may be associated with better performance (Jha, Orav, Zheng & Epstein,
2008)
• “Hospitals with a high level of patient satisfaction provided clinical care that was
somewhat higher in quality for all conditions examined” (Jha, Orav, Zheng & Epstein,
2008).
EBNP Recommendations & Impact on Nursing Practice
• The authors do not directly relate findings to a specific intervention that could be
included but more to the level of staffing.
Article two
Nursing: a key to patient satisfaction
Highlights from Article
• 430 hospitals were examined to determine the relationship between nursing
and patient satisfaction across (Kutney-Lee, McHugh, Sloane, Cimiotti,
Flynn, Neff & Aiken, 2009).
• Cross-sectional data from the Hospital Consumer Assessment of
Healthcare Providers and Systems (HCAHPS) survey, a four-state nurse
survey of hospital quality, and the American Hospital Association (AHA)
Annual Survey were used to evaluate the relationship between the nurse
work environment and patient satisfaction (Kutney-Lee, McHugh, Sloane,
Cimiotti, Flynn, Neff & Aiken, 2009).
• To improve the patient experience and quality of care, work environments,
including staffing should be addressed.
• Higher job satisfaction is linked with better nurse work environment and
lower burnout rate. (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff &
Aiken, 2009)
Article two
Nursing: a key to patient satisfaction
Recommendations & Findings
•
This article states, “findings demonstrate that patients’ reports of satisfaction are higher in
hospitals where nurses practice in better work environments or with more favorable patientto-nurse ratios (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken, 2009).
•
A cross-sectional design was used which revealed study limitations because it “did not inform
causation” (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken, 2009).
•
“Patient-to-nurse workloads were significantly associated with patients’ ratings and
recommendation of the hospital to others, and with their satisfaction with the receipt of
discharge information” (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken,
2009).
EBNP Recommendations & Impact on Nursing Practice
•
This article concludes that it is necessary to “reform nurse work environments, and offer a
promising strategy for improving hospital performance” (Kutney-Lee, McHugh, Sloane,
Cimiotti, Flynn, Neff & Aiken, 2009).
•
“The effect of nurse staffing could be stronger when all hospitals report HCAHPS results.
Thus, additional research on the impact of nursing on patient satisfaction is warranted when
more hospitals are reporting HCAHPS results” (Kutney-Lee, McHugh, Sloane, Cimiotti,
Flynn, Neff & Aiken, 2009).
Article three
Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue
Highlights
• There are many cross-sectional studies that support the relationship
between staffing and patient outcomes, however this study uses a
longitudinal design (Seago, Williamson & Atwood, 2006).
• This longitudinal design “examines the variation in the relationship
between the staffing and the outcomes of interest over time within a
given unit, and to compare that variance across units” (Seago,
Williamson & Atwood, 2006).
• There were two main objectives in this study
• #1 “Compare the relationships between nurse staffing and positive
patient outcomes for 3 medical-surgical nursing units in one university
teaching hospital across 4 years” (Seago, Williamson & Atwood, 2006).
• #2 “Explore the use of 2 new failure-to-rescue (FTR) rates as outcomes,
specifically from medication errors and FTR from decubitus ulcers”
(Seago, Williamson & Atwood, 2006).
Article three
Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue
Recommendations & Findings
• This study concludes that, “all patient satisfaction measures increased as
total hours of care per patient day increased” (Seago, Williamson &
Atwood, 2006).
• The study also concluded that it is necessary to have a “rich RN skill mix
and also a need for higher total hours of care, if patient satisfaction is a
priority” (Seago, Williamson & Atwood, 2006).
• The findings of this longitudinal analysis support the cross-sectional studies
in that higher patient satisfaction comes as total hours of care per patient
day increase (Seago, Williamson & Atwood, 2006).
EBNP Recommendations & Impact on Nursing Practice
• The authors recommend to “vary staffing hours and staff mix” as a direct
nursing intervention depending on which patient outcome one wishes to
achieve (Seago, Williamson & Atwood, 2006).
Article four
Nurse burnout and patient satisfaction
Highlights from Article
• Objective of this study was to examine “the effect of the nurse work environment on
nurse burnout, and the effects of the nurse work environment and nurse burnout on
patients’ satisfaction with their nursing care” (Vahey, Aiken, Sloane, Clarke & Vargas,
2004).
• Cross-sectional surveys of nurses were conducted from 40 units in 20 urban hospitals in
the United States (Vahey, Aiken, Sloane, Clarke & Vargas, 2004).
• The authors wanted to begin the exploration of the link between patient dissatisfaction
in care and nurse burnout while studying nurse burnout and patient satisfaction (Vahey,
Aiken, Sloane, Clarke & Vargas, 2004).
• RN work environment was measured using a revised Nursing Work Index (NWI-R)
subscales (Vahey, Aiken, Sloane, Clarke & Vargas, 2004).
• RN outcomes were “measured by the Maslach Burnout Inventory (MBI) and intentions
to leave” (Vahey, Aiken, Sloane, Clarke & Vargas, 2004).
• The La Monica-Oberst Patient Satisfaction Scale (LOPSS) was used to interview
patients about satisfaction (Vahey, Aiken, Sloane, Clarke & Vargas, 2004).
Article four
Nurse burnout and patient satisfaction
Recommendations & Findings
• This study proved that, “patients cared for on units that nurses
characterized as having adequate staff…were more than twice likely as
other patients to report high satisfaction with their care” (Vahey, Aiken,
Sloane, Clarke & Vargas, 2004).
• “Nurse burnout…is a significant factor influencing how satisfied patients
are with their care” (Vahey, Aiken, Sloane, Clarke & Vargas, 2004).
EBNP Recommendations & Impact on Nursing Practice
• The authors state the “need for change in the workplace that would both
reduce nurses’ high level of job burnout and risk of turnover while
maintaining patients’ satisfaction with their care” (Vahey, Aiken, Sloane,
Clarke & Vargas, 2004).
• Nurses would be able to provide quality care and meet the satisfaction of
their patients.
Article five
Nurse staffing and patient perceptions of nursing care
Highlights from Article
• Objective of this study was to reveal the relationship between nurse staffing
and patient perceptions of nursing care from a sample of 40 California
hospitals (Bolton, Aydin, Donaldson, Brown, Nelson & Harms, 2003).
• Descriptive and inferential statistics were the analytic methods used (Bolton,
Aydin, Donaldson, Brown, Nelson & Harms, 2003).
• Hospitals with Patients’ Evaluation of Performance in California (PEP-C)
and California Nursing Outcomes Coalition (CalNOC) data available for
the same time period were used to “explore the relationship among nurse
staffing structural variables and patient perceptions of nursing care”
(Bolton, Aydin, Donaldson, Brown, Nelson & Harms, 2003).
• “The 40-hospital analyses presented in this report summarize survey data
from 6,200 medical/surgical patients” (Bolton, Aydin, Donaldson, Brown,
Nelson & Harms, 2003).
Article five
Nurse staffing and patient perceptions of nursing care
Recommendations & Findings
• The results in patient perceptions of nursing care were similar in hospitals
with wide ranges of staffing levels (Bolton, Aydin, Donaldson, Brown, Nelson
& Harms, 2003).
• This study found that “nurse staffing alone showed a significant but weak
relationship to patients perceptions of their care” (Bolton, Aydin, Donaldson,
Brown, Nelson & Harms, 2003).
• The authors felt that nurse staffing is not the only variable in relationship to
how patients perceive their care (Bolton, Aydin, Donaldson, Brown, Nelson &
Harms, 2003).
EBNP Recommendations & Impact on Nursing Practice
• In terms of management level, the article states, "it is essential that nurse
executives integrate results from this and other studies in developing strategic
and tactical staffing plans” (Bolton, Aydin, Donaldson, Brown, Nelson &
Harris, 2003).
summary
• Review of the literature did not support any specific changes in
nursing practice.
• Literature did support nursing practice to advocate for improved
nurse-to-patient staffing ratios.
• No true suggestions were made as to how nurses can effectively
increase a patients’ satisfaction with overall care.
• Studies reviewed were qualitative verses quantitative and results
were self-reported experiences of patients.
• Clinical trials that use specific variables and interventions would
help to identify changes in nursing practice.
• Literature did support the intervention of nursing management and
the ability to create staffing changes.
References
• Jha, A., Orav, E., Zheng, J., & Epstein, A. (2008). Patients' perception of
hospital care in the United States. New England Journal Of Medicine,
359(18), 1921-1931.
• Kutney-Lee, A., McHugh, M., Sloane, D., Cimiotti, J., Flynn, L., Neff, D.,
& Aiken, L. (2009). Nursing: a key to patient satisfaction. Health Affairs,
28(4), w669-77. doi:10.1377/hlthaff.28.4.w669
• Seago, J., Williamson, A., & Atwood, C. (2006). Longitudinal analyses of
nurse staffing and patient outcomes: more about failure to rescue. Journal
Of Nursing Administration, 36(1), 13-21.Nurse Staffing and Patient
Perceptions of Nursing Care, Journal of Nursing Administration 2003 Nov;
33(11): 607-14
• Vahey, D., Aiken, L., Sloane, D., Clarke, S., & Vargas, D. (2004). Nurse
burnout and patient satisfaction. Medical Care, 42(2), II-57-66. doi:
10.1097/01.mir.0000109126.50398.5a
• Bolton, L., Aydin, C., Donaldson, N., Brown, D., Nelson, M., & Harms, D.
(2003). Nurse staffing and patient perceptions of nursing care. Journal Of
Nursing Administration, 33(11), 607-614.