The impact of hospital nursing characteristics on 30-day mortality.

BACKGROUND: Evidence indicates that hospital nursing characteristics such as staffing contribute to patient outcomes. Less attention has been given to other hospital nursing characteristics central to optimal professional practice, namely nurse education and skill mix, continuity of care, and quality of the work environment. OBJECTIVE: To assess the relative effects and importance of nurse education and skill mix, continuity of care, and quality of work environment in predicting 30-day mortality after adjusting for institutional factors and individual patients characteristics. METHOD: A cross-sectional analysis of outcome data for 18,142 patients discharged from 49 acute care hospitals in Alberta, Canada, for diagnoses of acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or stroke between April 1, 1998, and March 31, 1999, was done. Mortality data were linked to patient demographic and comorbidity factors, institutional characteristics, and hospital nursing characteristics derived from a survey of all registered nurses working in acute care hospitals. RESULTS: Using multilevel analysis, it was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance .044, p < .001). Patient comorbidities and age explained 44.2% of the variance in 30-day mortality. After adjustment for patient comorbidities and demographic factors, and the size, teaching, and urban status of the study hospitals in a fixed-effects model, the odds ratios (95% confidence interval) of the significant hospital nursing characteristics that predict 30-day mortality were as follows: 0.81 (0.68-0.96) for higher nurse education level, 0.83 (0.73-0.96) for richer nurse skill mix, 1.26 (1.09-1.47) for higher proportion of casual or temporary positions, and 0.74 (0.6-00.91) for greater nurse-physician relationships. The institutional and hospital nursing characteristics explained an additional 36.9%. DISCUSSION: Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients.

The impact of hospital nursing characteristics on 30-day mortality.

BACKGROUND: Evidence indicates that hospital nursing characteristics such as staffing contribute to patient outcomes. Less attention has been given to other hospital nursing characteristics central to optimal professional practice, namely nurse education and skill mix, continuity of care, and quality of the work environment. OBJECTIVE: To assess the relative effects and importance of nurse education and skill mix, continuity of care, and quality of work environment in predicting 30-day mortality after adjusting for institutional factors and individual patients characteristics. METHOD: A cross-sectional analysis of outcome data for 18,142 patients discharged from 49 acute care hospitals in Alberta, Canada, for diagnoses of acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or stroke between April 1, 1998, and March 31, 1999, was done. Mortality data were linked to patient demographic and comorbidity factors, institutional characteristics, and hospital nursing characteristics derived from a survey of all registered nurses working in acute care hospitals. RESULTS: Using multilevel analysis, it was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance = .044, p < .001). Patient comorbidities and age explained 44.2% of the variance in 30-day mortality. After adjustment for patient comorbidities and demographic factors, and the size, teaching, and urban status of the study hospitals in a fixed-effects model, the odds ratios (95% confidence interval) of the significant hospital nursing characteristics that predict 30-day mortality were as follows: 0.81 (0.68-0.96) for higher nurse education level, 0.83 (0.73-0.96) for richer nurse skill mix, 1.26 (1.09-1.47) for higher proportion of casual or temporary positions, and 0.74 (0.60-0.91) for greater nurse-physician relationships. The institutional and hospital nursing characteristics explained an additional 36.9%. DISCUSSION: Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients.

The Internet and access to evidence: how are nurses positioned?

BACKGROUND: Published literature that describes the use of the Internet by nurses is scant, but it does reveal that there has been a delay in the acceptance of the Internet as a workplace tool by the medical community and, in particular by nurses. AIMS: The purpose of this article is to report on a study of how often and from what location nurses accessed the Internet, as well as the types of information they were seeking. In addition, our goal was to compare nurses' Internet use with that of physicians and the public at large, and to highlight structural and institutional challenges to nurses' use. METHODS: Surveys (1996 and 1998) of Alberta Registered Nurses were used to examine their use of technology at work and at home. Additional data sources were used to compare nurses to physicians and to the general public. RESULTS: While nurses' Internet and e-mail use at home increased over the 2-year period and was comparable with other groups, Internet use at work was low compared with other groups despite adequate workplace access. CONCLUSIONS: Nurses are more likely to value interpersonal contact, and prefer to use personal experience and communication with colleagues and patients rather than on-line and traditional sources of practice knowledge. In order for an information source to be seen as valuable in the clinical setting, contextually relevant information needs to be accessed quickly and efficiently. Energies should be focused on constructing information systems that address the particular needs of nurses.

Goal-Directed Aiming: Correcting a Force-Specification Error With the Right and Left Hands.

In 2 experiments, the authors examined manual aiming asymmetries as well as the ability of participants to adjust their aiming trajectories following an unexpected change to the inertial resistance to movement. In Experiment 1, participants (N = 11) were able to rapidly adjust their movement trajectories to conform to the new movement requirements. They were faster and more consistent when aiming with their right hand than with their left hand, regardless of whether or not the movement was perturbed. In Experiment 2, participants' (N = 11) vision of the hand was manipulated so that the role of visual feedback in the corrective process could be examined. Vision had an impact not only on performance but also on the characteristics of the movement trajectories. Manual asymmetries in aiming were associated with a right hand superiority during the final corrective stages of the movement.