Systematic review of studies of staffing and quality in nursing homes.

PURPOSE: To evaluate a range of staffing measures and data sources for long-term use in public reporting of staffing as a quality measure in nursing homes. METHOD: Eighty-seven research articles and government documents published from 1975 to 2003 were reviewed and summarized. Relevant content was extracted and organized around 3 themes: staffing measures, quality measures, and risk adjustment variables. Data sources for staffing information were also identified. RESULTS: There is a proven association between higher total staffing levels (especially licensed staff) and improved quality of care. Studies also indicate a significant relationship between high turnover and poor resident outcomes. Functional ability, pressure ulcers, and weight loss are the most sensitive quality indicators linked to staffing. The best national data sources for staffing and quality include the Minimum Data Set (MDS) and On-line Survey and Certification Automated Records (OSCAR). However, the accuracy of this self-reported information requires further reliability and validity testing. CONCLUSIONS: A nationwide instrument needs to be developed to accurately measure staff turnover. Large-scale studies using payroll data to measure staff retention and its impact on resident outcomes are recommended. Future research should use the most nurse-sensitive quality indicators such as pressure ulcers, functional status, and weight loss.

Use of videotaping to assess competencies and course outcomes.

A constant challenge in nursing education is effectively teaching competencies and allowing students to safely practice essential nursing skills. Faculty members must develop sound methods of instruction to achieve program outcomes, which determine program effectiveness, assure professional readiness, and meet accreditation standards. To this end, the use of videotaping is suggested. Videotaping offers a safe way for students to practice skills and develop confidence prior to actual performance. This article reviews the literature on videotaping and discusses videotaping as used at Central Missouri State University baccalaureate school of nursing. Videotaping is a teaching-learning strategy used to help students develop effective communication, physical assessment, and selected psychomotor skills. Videotaping also provides students with a mechanism for detailed instructor feedback to improve performance.

Quality measurement in nursing: an update of where we are now.

This article summarizes the findings of the third review of nursing quality measurement literature commissioned by the American Nurses' Association, discusses implications of the current state of the art of nursing measurement, and suggests directions based upon lessons learned from all 3 reviews. Using both computer and hand searching methods, 326 articles describing measurement of nursing care quality were abstracted. Recommendations based on the analysis of Literature include incorporating the Nursing Minimum Data Set into databases; documenting nursing hours and nursing educational preparation; determining appropriate patient outcomes within different settings; continued research identifying nurse-sensitive outcomes; and continued nursing leadership in quality improvement efforts for health care.