Health problems and violence experiences of nurses working in acute care hospitals, long-term care facilities, and home-based long-term care in Germany: A systematic review.

BACKGROUND: Working in the nursing sector is accompanied by great physical and mental health burdens. Consequently, it is necessary to develop target-oriented, sustainable profession-specific support and health promotion measures for nurses. OBJECTIVES: The present review aims to give an overview of existing major health problems and violence experiences of nurses in different settings (acute care hospitals, long-term care facilities, and home-based long-term care) in Germany. METHODS: A systematic literature search was conducted in PubMed and PubPsych and completed by a manual search upon included studies' references and health insurance reports. Articles were included if they had been published after 2010 and provided data on health problems or violence experiences of nurses in at least one care setting. RESULTS: A total of 29 studies providing data on nurses health problems and/or violence experience were included. Of these, five studies allowed for direct comparison of nurses in the settings. In addition, 14 studies provided data on nursing working in acute care hospitals, ten on nurses working in long-term care facilities, and four studies on home-based long-term care. The studies either conducted a setting-specific approach or provided subgroup data from setting-unspecific studies. The remaining studies did not allow setting-related differentiation of the results. The available results indicate that mental health problems are the highest for nurses in acute care hospitals. Regarding violence experience, nurses working in long-term care facilities appear to be most frequently affected. CONCLUSION: The state of research on setting-specific differences of nurses' health problems and violence experiences is insufficient. Setting-specific data are necessesary to develop target-group specific and feasible interventions to support the nurses' health and prevention of violence, as well as dealing with violence experiences of nurses.

Hospital costs of acute pulmonary embolism.

OBJECTIVE: Pulmonary embolism places a heavy economic burden on health care systems, but the components of hospital cost have not been elucidated. We evaluated hospitalized patients with the primary diagnosis of pulmonary embolism. Our goal was to determine the total and component costs associated with their hospital care. METHODS: We included patients hospitalized at Brigham and Women's Hospital from September 2003 to May 2010. Patient demographics, characteristics, comorbidities, interventions, and treatments were obtained from the electronic medical record. Costs were obtained using the hospital's accounting software and categorized into the areas providing direct patient supplies or care. RESULTS: We identified 991 hospitalized patients with acute pulmonary embolism. In-hospital mortality was 4.2%, and 90-day mortality after hospital discharge was 13.8%. The median length of hospital stay was 3 days, and the mean length of hospital stay was 4 days. The mean total hospitalization cost per patient was $8764. Nursing costs, which included room and board, were $5102. Pharmacy ($966) and radiology ($963) costs were similar. Pharmacy costs ($966) were dominated by the use of low-molecular-weight heparin ($232). Radiology costs ($963) were dominated by the use of diagnostic imaging examinations ($672). During the observation period, an average of 160 patients with pulmonary embolism were admitted each year, requiring an annual hospital expense ranging from $884,814 to $1,866,489. CONCLUSIONS: Pulmonary embolism has a high case fatality rate and remains an expensive illness to diagnose and treat. Nursing costs comprise the largest component of costs.

Dificultades y oportunidades para la enfermería: una revisión narrativa sobre evaluación económica en salud / Difficulties and chances for nursing: a narrative review about the economic evaluation in health

Revisión narrativa sobre evaluación económica en salud que tuvo como objetivo identificar los estudios desarrollados sobre el tema en los últimos diez años. Fue utilizado el descriptor costo y análisis de costos en las bases de datos: LILACS, MEDLINE, IBECS y CAPES. Fueron encontradas 88 publicaciones y seleccionadas 65, de las cuales 44,62% pertenecían a la base LILACS, 44,62% a MEDLINE, 4,60% a IBECS y 6,16% a CAPES. 75,38% eran sobre evaluación parcial de costos y 24,62% sobre evaluación económica. La medicina fue la sub-área que más publicó (41,54%), considerando los dos tipos de metodologías; seguida por la enfermería, que solo publicó sobre evaluación parcial de costos (15,38%). El enfermero como herramienta administrativa dentro de la Institución de Salud, necesita buscar conocimientos sobre este segmento de la economía, reconociendo su papel como agente transformador y buscar el equilibrio entre calidad, cantidad y costos en el momento de decidir cómo distribuir los recursos financieros disponibles (AU)

It is a narrativre review about the economic evaluation in health which had as an objective to identify the developed studies about the topic in the last ten years. The expenses and cost analysis descriptors were used at the data bases: LILACS, MEDLINE, IBECS AND CAPES. 88 publications were found and 65 were selected, from which the 44’62% belonged to the database LILACS, the 44’62% to MEDLINE, 4’6% to IBECS and to CAPES. The 75’38% were about the partial assessment of expenses and the 24’62% about the economic assessment. The medicine was the sub-area that published (41’54%), considering the two types of methodologies; followed by the nursing, which only published about partial evaluation of expenses (15’38%). The nurse as an administrative tool in the Health Institution, needs to look for the knowledge about this segment of the economy, recognizying his role as a transformator agent and looking for the balance betewwen quality, quantity and expenses when deciding how to distribute the available financial resources (AU)

The Italian economic crisis and its impact on nursing services and education: hard and challenging times.

AIMS: Three levels of impact are reported and discussed in this commentary: the 'macro' level, which corresponds to policy(ies); the 'meso' level, which corresponds to nursing services and nursing education; and the 'micro' level, which deals with clinical practice and education, where interactions between patients and nurses and/or students take place. BACKGROUND: The Italian economy is showing some signs of recovery after the worst economic crisis of past decades. However, these signs are still quite weak and insufficient to declare that the country is finally coming out of it. KEY ISSUES: Several negative impacts of the economic crisis on nursing services and nursing education are documented. Reports have started to document initial signs of the economical crisis impact on patients too. Present and future issues related to nursing services, education and clinical practice are commented both from national data and from nurses' daily perceptions. IMPLICATIONS FOR NURSING MANAGEMENT: The Italian economic crisis will leave a heavy burden on the shoulders of future generations. Nurses' leaders are coping with these challenges, innovating the nursing system and preparing a sustainable future for generations of patients and nurses.

Feeling the cold: implications for nurse managers arising from the financial pressures in health care in England.

AIM: The purpose of this short paper is to identify some of the implications and opportunities nurse managers in England face as a result of the current global economic recession. BACKGROUND: Government borrowing and poor global economic conditions have combined to create a pound175 billion budget deficit in the UK. The National Health Service in England will be required to make substantial savings in order to help offset this shortfall. KEY ISSUES: This is a brief critical commentary which examines some of the challenges and opportunities for nurse managers in England. It draws on a number of sources to identify key issues concerning nursing management arising from the financial pressures facing health care. CONCLUSION: The next few years are going to be very difficult for nurses and their managers, however, the current situation also presents opportunities to advance the contribution and influence of nursing and nursing management. IMPLICATIONS FOR NURSING MANAGEMENT: What nurse managers do next will be crucial in shaping the NHS response to the financial storm and the future nature of health care in England.

Cuidados de salud basados en la eficiencia. Conceptos generales en evaluación económica de intervenciones sanitarias / Efficiency-based healthcare. General concepts on economic evaluation of healthcare interventions

En el presente artículo se presentan algunos de los conceptos básicos de la economía de la salud y la evaluación económica, de modo que pueda facilitarse la comprensión de algunas de las técnicas empleadas y el lector, decisor y profesional, principalmente del ámbito de los cuidados de salud (p. ej., clínico, profesional de enfermería, gestor, etc.) pueda incorporar la cultura evaluadora a su práctica habitual. La evaluación económica implica el análisis comparativo de acciones alternativas en términos de costes y resultados en salud. Los principales tipos de estudios son: el análisis de minimización de costes, el análisis coste-efectividad, el análisis coste-utilidad y el análisis coste-beneficio. Este tipo de análisis son una parte fundamental de todo proceso de toma de decisiones sanitarias en contextos actuales con escasez de recursos. Una mayor aplicación de la evaluación económica a la hora de orientar futuras actuaciones sanitarias permitiría reducir la arbitrariedad en la priorización, posibilitando la provisión de unos cuidados de calidad basados en la mejor evidencia científica(AU)

This article aims to introduce some of the key concepts in health economics and economic evaluation, with a view to facilitating proper understanding of certain frequently used economic techniques so that readers, decision makers and professionals, mainly from the healthcare context (e.g. clinicians, nurses, managers), can adopt an evaluation culture to support their routine practice. Economic evaluation compares alternative courses of action in terms of costs and health outcomes.The main methods are cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. In the current context of scarce resources, economic evaluation is a fundamental component of healthcare decision-making processes. Increasing the use of economic evaluation in the context of future healthcare strategies could minimize arbitrary decision-making, providing guidance in addressing and assuring quality and evidence-based healthcare(AU)

Migration of nurses: is there any other option?

BACKGROUND: Migration of nurses has taken center stage as a human resource issue in global discussion. Migration of nurses is associated with shortage of manpower, HIV/AIDS and the expanded roles of nurses. PURPOSE: To examine reasons behind migration and to argue that there are greater incentives for migrating than staying. RESULTS: There are greater incentives for migrating than staying. CONCLUSION: Migration will remain an option until governments put in place professional mechanisms and incentives that will counteract various push factors.