ABSTRACT
PURPOSE: The aim of this study is to systematically review evidence with regard to answering the following questions: (1) What are the unmet care needs of older persons diagnosed with cancer who are undergoing active cancer treatment? (2) What are the predictors of unmet needs of older persons while undergoing active cancer treatment? METHODS: A systematic review of the literature published between January 1996 and December 2010 was completed. Manuscripts could be published in English, French, Dutch, or German searching the Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library databases. The literature search was performed by two researchers with the assistance of a university librarian. Abstracts were reviewed by two reviewers for inclusion. RESULTS: Thirty studies were included. A significant proportion of newly-diagnosed patients undergoing cancer treatment had unmet needs, ranging from 15 to 93%. The most common needs varied by study but included psychological needs, information needs, and needs in the physical domain. Most studies showed that the level of unmet needs was highest after diagnosis and start of treatment and decreased over time. Predictors of unmet needs included: younger age, female gender, depression, physical symptoms, marital status, treatment type, income, and education. CONCLUSIONS: The level of unmet needs in newly diagnosed older cancer patients after the start of treatment is high, and the most common needs are psychological and information needs. More research is needed which would focus on the needs of older adults with comorbid conditions, and how these comorbid conditions influence the level of unmet needs.
Subject(s)
Health Services Needs and Demand , Neoplasms/therapy , Patient Education as Topic/methods , Age Factors , Aged , Female , Humans , Male , Needs Assessment , Neoplasms/psychology , Sex Factors , Time FactorsABSTRACT
Understanding the determinants of patient mortality can lead to the development of strategies that reduce mortality and prevent unnecessary death. This paper synthesizes the body of published research that explores determinants of mortality for patients who have experienced acute care hospitalization. Fifteen research manuscripts were found to meet the selection criteria through an electronic search in MEDLINE and CINAHL (1986-2004). Seven categories of determinants of mortality were found: nurse-physician relationships, nurse staffing characteristics, physician characteristics, professional practice environment, nurse experience, registered nurse educational preparation, and clinical nursing support. Implications and recommendations for improving quality and safety in hospital care are discussed.
Subject(s)
Hospital Mortality/trends , Nurses/standards , Nursing Care , Quality Assurance, Health Care , Safety Management , Cross-Over Studies , Health Policy , Humans , Intensive Care Units , Physician-Nurse Relations , Physicians/standards , Retrospective Studies , Time FactorsABSTRACT
The purpose of this study was to further our understanding of the effects of nursing-related hospital variables on 30-day mortality rates for hospitalized patients. A retrospective design was used to test the proposed 30-Day Mortality Model. The sample consisted of 75 acute-care hospitals in the province of Ontario, Canada. To develop hospital mortality rates, 46,941 patients discharged from these hospitals who had a most responsible diagnosis of acute myocardial infarction, stroke, pneumonia, or septicemia were included. To develop hospital-level nursing predictor variables, 3,998 responses to the Ontario Registered Nurse Survey of Hospital Characteristics were also included. The findings support a relationship between lower 30-day mortality and 3 predictors: a richer registered nurse skill mix, more years of experience on the clinical unit, and reported larger number of shifts missed. These findings can be used to predict the effects of hospital changes in nursing skill mix and years of RN experience on patient mortality.
Subject(s)
Hospital Mortality , Nursing Staff, Hospital/organization & administration , Personnel Staffing and Scheduling , Diagnosis-Related Groups , Humans , Models, Theoretical , Multivariate Analysis , Nursing Staff, Hospital/standards , Ontario , Regression Analysis , Retrospective StudiesABSTRACT
The employment of unlicensed personnel in Canadian acute care hospitals has been undertaken without clear evidence of outcomes for patients, caregivers, and hospital organizations. This quasi-experimental evaluation study was completed in a metropolitan Toronto acute care hospital to examine the effects of a new nursing care delivery system which included unlicensed assistive personnel. Most of the expected benefits of the newly implemented nursing care delivery system did not materialize leading to the conclusion that the employment of unlicensed assistive personnel in acute care hospital systems may not offer additional benefits for patients, caregivers, or hospital organizations. The processes and results of this study provide useful information for nurse administrators who are seeking effective and innovative care delivery systems that are designed to optimize patient, caregiver, and hospital outcomes.
