Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster-unit-level descriptive comparison.

AIM: To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters. BACKGROUND: Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood. METHOD: Descriptive design with data from four unit-clusters: medical, surgical, combined and step-down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse-sensitive outcomes. RESULTS: Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters. CONCLUSION: Patient acuity is similar among unit-clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit-clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.

[Corporal hygiene of the critical patient. Adverse effects]. / Higiene corporal del enfermo crítico. Efectos adversos.

Hygiene is a technique that has to do with strict monitoring and control based on knowledge and a good team for the critically ill patient does not suffer its consequences such as: hemodynamic instability mismatch breathing... Considering this and there is little literature on the subject, the objectives of the study are what the patient's hemodynamic changes are more common when conducting hygiene and in what time period are, find out what are the complications or accidental events that prevail during the procedure and consider whether the experience of the nurse in relation to these events, among others. This is a descriptive research design and intervention. The sample consists of patients admitted to the ICU Hospital Universitario de Girona Dr. Josep Trueta. To collect the data has been used a record that shows the patient's vital signs before, during and after the hygiene, and a number of additional data that refer to different situations and events are considered of interest. Taking into account the patient's baseline, data were analyzed considering changes or hemodynamic instability in any patient that varies by 10% in any of the following constants: blood pressure (B.P.), heart rate (H.R.), Saturation (Sat. O2) or intracranial pressure (I.C.P.). The most relevant results, calculated with the SPSS program, we show that the most common complication is the increase of the H.R. (58.3%) and I.C.P. (100%) and that years of nursing experience does not relate to a greater degree of instability. We conclude that sometimes, before a potentially unstable patient or very labile to tampering, it is not essential to health that is why it is vital to the assessment and decision of the nurse.

Higiene corporal del enfermo crítico. Efectos adversos / Corporal hygiene of the sick person critic. Adverse effects

La higiene corporal es una técnica que se debe realizar con estricta monitorización y control, en base a unos conocimientos y un buen trabajo en equipo, para que el paciente crítico no sufra sus consecuencias, tales como: inestabilidad hemodinámica, desadaptación al respirador... Planteando esto y existiendo poca bibliografía sobre el tema, los objetivos del estudio son saber qué cambios hemodinámicos del paciente resultan más frecuentes al realizar una higiene y en qué periodo de tiempo se dan, descubrir cuáles son las complicaciones o hechos accidentales que más prevalecen durante el procedimiento y estudiar si la experiencia del enfermero/a guarda relación en dichos sucesos, entre otros. Se trata de un diseño de investigación descriptiva y de intervención. La muestra la forman los pacientes ingresados en la U.C.I. del Hospital Universitario Dr. Josep Trueta de Girona. Para recoger los datos se ha utilizado un registro que muestra las constantes vitales del paciente, tanto antes como durante y después de la higiene, y una serie de datos adicionales que hacen referencia a diferentes situaciones y sucesos que se consideran de interés. Teniendo en cuenta la situación basal del enfermo, los datos se analizan considerando cambio o inestabilidad hemodinámica a todo paciente que varía un 10% en cualquiera de las constantes siguientes: tensión arterial (TA), frecuencia cardiaca (FC), saturación (Sat.O2) o presión intracraneal (PIC.). Los resultados más relevantes, calculados con el programa SPSS, nos muestran que la complicación más frecuente es la elevación de la TA (58,3%) y la PIC (100%) y que los años de experiencia del enfermero/a no guardan relación con un mayor grado de inestabilidad. Se concluye que, algunas veces, ante un enfermo potencialmente inestable o con mucha labilidad a las manipulaciones, no es imprescindible realizar la higiene. Por esa razón es vital la valoración y decisión correcta de la enfermera(AU)

Hygiene is a technique that has to do with strict monitoring and control based on knowledge and a good team for the critically ill patient does not suffer its consequences such as: hemodynamic instability, mismatch breathing... Considering this and there is little literature on the subject, the objectives of the study are what the patient's hemodynamic changes are more common when conducting hygiene and in what time period are, find out what are the complications or accidental events that prevail during the procedure and consider whether the experience of the nurse in relation to these events, among others. This is a descriptive research design and intervention. The sample consists of patients admitted to the ICU Hospital Universitario de Girona Dr. Josep Trueta. To collect the data has been used a record that shows the patient's vital signs before, during and after the hygiene, and a number of additional data that refer to different situations and events are considered of interest. Taking into account the patient's baseline, data were analyzed considering changes or hemodynamic instability in any patient that varies by 10% in any of the following constants: blood pressure (B.P.), heart rate (H.R.), Saturation (Sat. O2) or intracranial pressure (I.C.P.). The most relevant results, calculated with the SPSS program, we show that the most common complication is the increase of the H.R. (58.3%) and I.C.P. (100%) and that years of nursing experience does not relate to a greater degree of instability. We conclude that sometimes, before a potentially unstable patient or very labile to tampering, it is not essential to health that is why it is vital to the assessment and decision of the nurse(AU)