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1.
J Clin Nurs ; 31(17-18): 2518-2529, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34723415

RESUMO

AIMS AND OBJECTIVES: To characterise the problem of missed nursing care in Chilean hospitals and to test associations with hospital organisational variables. BACKGROUND: Missed nursing care is a common problem in different countries, but it has not been studied in Chile. DESIGN: Multihospital cross-sectional study (Supplementary file 1: STROBE guideline). METHODS: Study population of 45 adult high-complexity hospitals and 1853 registered nurses (RN) working on medical-surgical units. Primary data were collected through a nurse survey. Nurses reported, out of a list of nursing care activities, the ones left undone during their last shift. The main independent variables were the work environment, measured through the Practice Environment Scale of the Nursing Work Index, patient-to-nurse ratios and RN skillmix. Adjusted logistic regression analyses were used to test associations, accounting for clustering of nurses working in the same hospital. RESULTS: The hospital response rate was 88.9% and, for nurses, 88.1%. The mean patient-to-nurse ratio was 14.5 (range 6-23). The average skillmix was 31% RN. Eighty-six percent of nurses missed at least one activity. The activities most frequently missed included patient education, comforting patients and surveillance. The adjusted model showed a significant association between the work environment, staffing ratios and missed care. The RN skillmix was not associated. CONCLUSIONS: Missed care is highly prevalent problem in Chilean hospitals. Clinical activities were the least missed. It is necessary to improve work environments and reduce the number of patients per nurse to improve the safety and quality of care. RELEVANCE FOR CLINICAL PRACTICE: The study results are relevant since they provide new data to Chile. Better work environments and adequate human resources are modifiable factors that can be addressed from a managerial perspective, with low-cost strategies to effectively reduce missed care and improve safety and quality.


Assuntos
Recursos Humanos de Enfermagem Hospitalar , Qualidade da Assistência à Saúde , Adulto , Chile , Estudos Transversais , Pesquisa sobre Serviços de Saúde , Hospitais , Humanos , Admissão e Escalonamento de Pessoal , Recursos Humanos
2.
Lancet Glob Health ; 9(8): e1145-e1153, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34224669

RESUMO

BACKGROUND: Unrest in Chile over inequalities has underscored the need to improve public hospitals. Nursing has been overlooked as a solution to quality and access concerns, and nurse staffing is poor by international standards. Using Chile's new diagnosis-related groups system and surveys of nurses and patients, we provide information to policy makers on feasibility, net costs, and estimated improved outcomes associated with increasing nursing resources in public hospitals. METHODS: For this multilevel cross-sectional study, we used data from surveys of hospital nurses to measure staffing and work environments in public and private Chilean adult high-complexity hospitals, which were linked with patient satisfaction survey and discharge data from the national diagnosis-related groups database for inpatients. All adult patients on medical and surgical units whose conditions permitted and who had been hospitalised for more than 48 h were invited to participate in the patient experience survey until 50 responses were obtained in each hospital. We estimated associations between nurse staffing and work environment quality with inpatient 30-day mortality, 30-day readmission, length of stay (LOS), patient experience, and care quality using multilevel random-effects logistic regression models and zero-truncated negative binomial regression models, with clustering of patients within hospitals. FINDINGS: We collected and analysed surveys of 1652 hospital nurses from 40 hospitals (34 public and six private), satisfaction surveys of 2013 patients, and discharge data for 761 948 inpatients. Nurse staffing was significantly related to all outcomes, including mortality, after adjusting for patient characteristics, and the work environment was related to patient experience and nurses' quality assessments. Each patient added to nurses' workloads increased mortality (odds ratio 1·04, 95% CI 1·01-1·07, p<0·01), readmissions (1·02, 1·01-1·03, p<0·01), and LOS (incident rate ratio 1·04, 95% CI 1·01-1·06, p<0·05). Nurse workloads across hospitals varied from six to 24 patients per nurse. Patients in hospitals with 18 patients per nurse, compared with those in hospitals with eight patients per nurse, had 41% higher odds of dying, 20% higher odds of being readmitted, 41% higher odds of staying longer, and 68% lower odds of rating their hospital highly. We estimated that savings from reduced readmissions and shorter stays would exceed the costs of adding nurses by US$1·2 million and $5·4 million if the additional nurses resulted in average workloads of 12 or ten patients per nurse, respectively. INTERPRETATION: Improved hospital nurse staffing in Chile was associated with lower inpatient mortality, higher patient satisfaction, fewer readmissions, and shorter hospital stays, suggesting that greater investments in nurses could return higher quality of care and greater value. FUNDING: Sigma Theta Tau International, University of Pennsylvania Global Engagement Fund, University of Pennsylvania School of Nursing's Center for Health Outcomes, and Policy Research and Population Research Center. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.


Assuntos
Recursos Humanos de Enfermagem Hospitalar/organização & administração , Avaliação de Resultados da Assistência ao Paciente , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Adulto , Chile , Estudos Transversais , Feminino , Hospitais Privados , Hospitais Públicos , Humanos , Masculino , Análise Multinível , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Inquéritos e Questionários
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