Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.610
Filtrar
1.
Hu Li Za Zhi ; 67(1): 98-105, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-31960401

RESUMEN

Alzheimer's disease (AD) is one of the most common diseases in older populations. Its main clinical features include cognitive dysfunction, affective disorder, and abnormal mental behavior. Due to the lack of therapeutic drugs, professional care has become an important diagnostic and therapeutic strategy for Alzheimer's disease patients. At present, most Alzheimer's disease patients are cared for at home by relatives or caregivers, and less than l0% of city-based patients receive care in old-age institutions. Due to mixed treatment regimens in the hospital, care services do not necessarily match patient care needs and thus Alzheimer's disease patients do not receive adequate treatment. Developed countries have a mature care system for the elderly, but no graded care model for the elderly with Alzheimer's disease currently exists in China. In this paper, the author draws on the experience of developed countries to construct an index system for the graded care of Alzheimer's disease patients that is suited to conditions in China. This article addresses the burden faced by the elderly with Alzheimer's disease and the current standard of care for the elderly at home and abroad. After explaining the necessity of constructing a care model for the elderly with Alzheimer's disease, the author then explains the practicability of the care system proposed in this study in order to provide a whole-course care model for the mentally impaired elderly in China.


Asunto(s)
Enfermedad de Alzheimer/enfermería , Modelos de Enfermería , Garantía de la Calidad de Atención de Salud/métodos , Anciano , China , Humanos , Investigación en Evaluación de Enfermería
2.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1047996

RESUMEN

Objetivo: identificar as atividades de vida diárias com dependência de cuidados de enfermagem. Método: estudo exploratório com abordagem qualitativa realizado com 52 pessoas em situação de rua na cidade de Sobral, Ceará, Brasil. Utilizou-se o modelo de atividade de vida diária proposto por Roper, Logan e Tierney para nortear a coleta e análise de dados. Resultados: as atividades de vida com maior dependência de cuidados são: alimentação, devido consumo irregular de nutrientes básicos, que promove um estado de desnutrição permanente, outra atividade foi trabalho e distração, pois os mesmos não possuem remuneração fixa e vivem do que arrecadam ao realizar atividades que geram pequenas quantias monetárias, além das atividades, morte, sexualidade, sono, respiração e eliminação, as quais também se revelaram comprometidas. Conclusão: a utilização do modelo com pessoas em situação de rua proporcionou abordagem holística aos indivíduos, por favorecer a investigação dos fatores que interferem na manutenção da saúde


Objetivo: identificar las actividades de la vida cotidiana con dependencia del cuidado de enfermeira. Método: estudio exploratorio con un enfoque cualitativo realizado con 52 personas en situación de calle en Sobral, Ceará, Brasil. El modelo de actividad de la vida diaria propuesto por Ropen, Logan y Tierney se utilizó para guiar la recolección y el análisis de datos. Resultados: las actividades de vida con mayor dependencia de cuidados son: alimentación, debido consumo irregular de nutrientes básicos, que promueve un estado de desnutrición permanente, otra actividad fue trabajo y distracción, pues los mismos no poseen remuneración fija y viven de lo que recaudan al realizar actividades que generan pequeñas cantidades monetarias, además de las actividades, muerte, sexualidad, sueño, respiración y eliminación, las cuales también se revelaron comprometidas. Conclusión: la utilización del modelo con personas en situación de calle proporcionó un enfoque holístico a los individuos, por favorecer la investigación de los factores que interfieren en el mantenimiento de la salud


Objective: identify daily Activities of Daily Living with dependence on nursing care. Method: exploratory study with a qualitative approach performed with 52 people in a street situation in Sobral, Ceará, Brazil. The daily Daily Living Activity model proposed by Ropen, Logan and Tierney was used to guide the data collection and analysis. Results: the activities of life with greater dependence on care are: food, due to irregular consumption of basic nutrients, which promotes a state of permanent malnutrition; another activity was work and entertainment, because they do not have fixed remuneration and live on what they collect by performing activities that generate small amounts of Money, besides activities such as death, sex, sleep, breathing and elimination, which are also compromised. Conclusion: the use of the model with people living on the street provided a holistic view of individuals, favoring the investigation of the factors that interfere in the maintenance of health


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Calidad de Vida , Personas sin Hogar , Modelos de Enfermería , Investigación Cualitativa , Pautas de la Práctica en Enfermería , Enfermería de Atención Primaria/métodos , Atención de Enfermería/métodos
3.
J Nurs Adm ; 50(1): 22-27, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31809453

RESUMEN

This article describes a practice improvement initiative (PII) demonstrating the impact of doctorate of nursing practice (DNP) skills beyond direct patient care. The Donna Wright Competency Assessment Model, AACN DNP Essentials, and National Organization of Nurse Practitioner Faculties nurse practitioner competencies framed the PII. The DNP graduates planned, implemented, and evaluated an assessment of 1,055 staff nurses on shift hand-off, physical assessment, and hand hygiene. Results indicated that 95% of the staff nurses scored 100% on competency assessment. The PII model was adopted for future competency evaluation.


Asunto(s)
Benchmarking , Modelos de Enfermería , Enfermeras Practicantes , Personal de Enfermería en Hospital/normas , Pautas de la Práctica en Enfermería/normas , Humanos , Estados Unidos
4.
J Nurs Adm ; 50(1): 28-33, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31809454

RESUMEN

Nursing leaders have embraced newly licensed registered nurse (NLRN) transition-to-practice programs, which contribute to nursing confidence, competence, work satisfaction, and retention in a complex healthcare environment. We report on the evolution of a Midwest urban pediatric medical center's transition-to-practice program, guided for 2 decades by foundational and emerging theory, research, and evidence that has supported accreditation with distinction as a Practice Transition Accreditation Program (PTAP) by the American Nurses Credentialing Center's Commission in Accreditation. Nursing leaders should use emerging evidence to inform curricular revisions that accelerate NLRN role transition and practice integration, increase organizational commitment, improve patient safety and satisfaction, and achieve PTAP accreditation.


Asunto(s)
Acreditación , Movilidad Laboral , Modelos de Enfermería , Personal de Enfermería en Hospital/normas , Humanos , Illinois , Evaluación de Programas y Proyectos de Salud
5.
Hu Li Za Zhi ; 66(6): 27-32, 2019 Dec.
Artículo en Chino | MEDLINE | ID: mdl-31802452

RESUMEN

This article reports on an effort to use the learning organization to change the existing mental model of a nursing team in order to transform from a nursing-oriented group to a patient-oriented group and to build shared vision, self-affirmation, and self-transcendence in order to change perspectives using team-learning spirit. The nursing group built partnerships with the patient group. The nursing group learning process fostered positive thinking logic and, under the inheritance of knowledge and technology, the patient-oriented group was successfully established. This model will be expanded to more patient-oriented groups. Through the experience sharing and joint supervision, this model may change lifestyles by implementing the concept of "My health, I care" and, ultimately, help patients achieve self-healthcare.


Asunto(s)
Aprendizaje , Grupo de Enfermería/organización & administración , Atención Dirigida al Paciente/organización & administración , Humanos , Modelos de Enfermería
6.
J Nurs Adm ; 49(12): 583-585, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31725517

RESUMEN

Developing a professional practice model (PPM) is essential for hospitals seeking Magnet designation. The article describes the development and implementation of a PPM in a tertiary hospital that was the 1st hospital in mainland China applying for Magnet recognition. This article provides a framework for hospital administrators who wish to reference a successful process when creating their own Magnet PPMs.


Asunto(s)
Competencia Clínica/normas , Guías como Asunto , Personal de Enfermería en Hospital/normas , Rol Profesional , Calidad de la Atención de Salud/normas , Centros de Atención Terciaria/normas , Adulto , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Enfermería
8.
J. coloproctol. (Rio J., Impr.) ; 39(3): 265-273, June-Sept. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1040317

RESUMEN

ABSTRACT Objective: To identify in literature the scientific production about self-care in elderly people with ostomies by colorectal cancer. Method: Integrative review, performed with the descriptors "self-care", "ostomy" and "elderly/aged" with the Boolean operator AND in the following databases: SCOPUS, CINAHL, MEDLINE, LILACS and COCHRANE. For the theoretical basis, Orem's Self-Care Deficit Theory was used. Results: A total of 533 papers were found, however, after applying the eligibility criteria, 16 studies composed the final sample of the review. Conclusion: The nurse is one of the professionals closest to the person with the stoma and his family, and should act as a link between the elderly person, the family and the multi-professional health team. In this sense, health professionals, especially nurses, should be trained and competent in assisting the diverse demands of care of this specific population, so that it is effective, resolutive, integral and, above all, humanized, aiming at the improvement of quality of life.


RESUMO Objetivo: Identificar na literatura a produção científica sobre o autocuidado em pessoas idosas com estomia por câncer colorretal. Método: Revisão integrativa de literatura, realizada com os descritores "autocuidado/self-care", "estomia/ostomy" e "pessoa idosa/idoso/aged" com o operador Booleano and nas Bases de Dados SCOPUS, CINAHL, MEDLINE, LILACS e COCHRANE. Para o embasamento teórico empregou-se a Teoria do Déficit de Autocuidado de Orem. Resultados: Encontrou-se um total de 533 artigos, no entanto, após a aplicação dos critérios de elegibilidade 16 estudos compuseram a amostra final da revisão. Conclusão: O enfermeiro é um dos profissionais mais próximos da pessoa com estomia e de sua família, devendo atuar como um elo entre a pessoa idosa, a família e a equipe multiprofissional de saúde. Nesse sentido, profissionais da área da saúde, especialmente o enfermeiro, devem estar capacitados e ser competentes na assistência às diversas demandas de cuidado dessa população específica, para que ela seja efetiva, resolutiva, integral e, sobretudo, humanizada, visando à melhora da qualidade de vida.


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Autocuidado , Estomía , Neoplasias Colorrectales , Modelos de Enfermería , Calidad de Vida , Servicios de Salud para Ancianos
9.
J Forensic Nurs ; 15(3): 143-151, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31436682

RESUMEN

In 2012, the Massachusetts Department of Public Health Sexual Assault Nurse Examiner (SANE) Program was awarded a grant from the Department of Justice, Office for Victims of Crime, to pilot the use of telemedicine technology to extend the reach of SANE expertise to six diverse communities across the United States. To meet the goals of this project, the National TeleNursing Center (NTC) developed a three-phase professional practice model integrating the Quality-Caring Model (QCM) to support the delivery of NTC teleSANE services. Using the QCM as a foundation for teleSANE practice ensures that patients experiencing a recent sexual assault who participate in teleSANE encounters receive quality forensic nursing care. In this article, we briefly review elements of the QCM, describe the application of the model to the NTC Professional Practice Model, and detail how teleSANEs integrate the QCM Caring Behaviors into all three phases of its model. The NTC Professional Practice Model provides a quality-based teleSANE model that may be translatable to other areas of telenursing practice.


Asunto(s)
Víctimas de Crimen , Enfermería Forense/organización & administración , Delitos Sexuales , Teleenfermería/organización & administración , Humanos , Modelos de Enfermería , Rol de la Enfermera , Garantía de la Calidad de Atención de Salud , Estados Unidos
10.
J Nurs Adm ; 49(9): 423-429, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31436740

RESUMEN

The development of a program to integrate an organization's values and culture, Watson's Caring Theory, and personal motivators resulted in transforming nursing theory into practice and a noted improvement in the patient experience. This article will teach the reader how this was accomplished.


Asunto(s)
Emociones , Relaciones Enfermero-Paciente , Atención de Enfermería/organización & administración , Atención de Enfermería/psicología , Personal de Enfermería en Hospital/psicología , Cultura Organizacional , Relaciones Profesional-Familia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Enfermería
11.
Holist Nurs Pract ; 33(4): 237-253, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31192836

RESUMEN

To promote excellence in care, person centered care based on humanistic values are essential. This integrative literature review summarizes the current research on the use of a caring model or approach in rehabilitation wards for elderly and explores the issues or benefits on patient's care or on patient-nurse interactions.


Asunto(s)
Empatía , Servicios de Salud para Ancianos/tendencias , Rehabilitación/métodos , Humanos , Modelos de Enfermería , Rehabilitación/psicología , Rehabilitación/tendencias
12.
Cien Saude Colet ; 24(5): 1609-1616, 2019 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-31166496

RESUMEN

This study targets the development of a nursing clinical data model for neuromuscular processes. To achieve this purpose, content analysis based on Bardin's perspective was performed on the Portuguese nursing local customizations regarding neuromuscular processes, with the International Classification for Nursing Practice concepts and the ISO 18104:2014 used as encoding rules. From analysis of the data, a total of 1766 diagnoses were related to neuromuscular processes. After application of exclusion criteria, a corpus with a total of 900 diagnoses was subjected to content analysis. After application of the encoding rules, a total of 81 context units were obtained, and through an inductive approach, were defined into three categories: clinical findings (e.g. aphasia); negative judgment diagnoses (e.g. impaired communication); transition properties (e.g. preparation and knowledge). These interpretations were validated by experts in the field. This study not only demonstrates the need to standardize data, but also the importance of neuromuscular processes in nursing practice. We hope this study will guide the definition of a nursing clinical data model that will help in increasing complexity in the level of care provided with high impact in the patient's quality of life.


Asunto(s)
Modelos de Enfermería , Enfermedades Neuromusculares/diagnóstico , Diagnóstico de Enfermería , Calidad de Vida , Humanos , Portugal , Terminología Normalizada de Enfermería
13.
J Christ Nurs ; 36(3): 158-165, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31180960

RESUMEN

Transition of Care Models can reduce the 30-day hospital readmission rate up to 67% by offering coordination and continuity of care. The purpose of this project was to evaluate a Congregation Transition of Care (CTOC) program in faith-based communities with the use of a faith community nurse and volunteer faith-based registered nurses. Descriptive statistics were used to describe findings, revealing a CTOC program can be effective in reducing 30-day readmissions in the faith community.


Asunto(s)
Cristianismo , Modelos de Enfermería , Readmisión del Paciente/estadística & datos numéricos , Cuidado de Transición , Voluntarios , Anciano , Servicios de Salud para Ancianos , Humanos , Ohio , Enfermeras Parroquiales
14.
Eur J Oncol Nurs ; 40: 53-62, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31229207

RESUMEN

PURPOSE: Post-treatment follow-up for lymphoma potentially fails to address the supportive care needs of survivors. A nurse-led lymphoma survivorship model of care was developed and tested in a phase II pilot pragmatic randomised controlled trial (RCT). The intervention comprised three face-to-face appointments, delivery of tailored resources and an individualised survivorship care plan and treatment summary (SCPTS), shared with the general practitioner (GP). METHOD: Three months' post-treatment completion, eligible lymphoma patients were randomised 1:1 to usual care (control) or usual care plus intervention. Survivorship unmet needs (Short-Form Survivor Unmet Needs Survey), distress (Depression Anxiety Stress Scale 21), adjustment to cancer (Mini-Mental Adjustment to Cancer scale) and self-empowerment (Patient Empowerment Scale) were assessed at baseline, three and six months. Univariate and multivariate analyses examined changes within and between groups at the three time points. A GP evaluation survey sought information on the perceived utility of the SCPTS. RESULTS: Statistical significance was set at 0.05 (2-tailed). Although not statistically significant, by study completion, intervention participants (n = 30), reported less unmet needs (M = 21.41 vs M = 25.72, p = .506), less distress ((M = 13.03 vs M = 15.14, p = .558) and an increase in empowerment (M = 50.21 vs M = 47.21, p = .056) compared with control participants (n = 30). The SCPTS was rated good to very good by a majority of GPs (n = 13, 81%). CONCLUSIONS: The nurse-led lymphoma survivorship model of care may be a helpful intervention for lymphoma patients who had completed treatment. Survivors require individualised and tailored support and resources. A tailored SCPTS may promote survivor self-management and increase GP engagement.


Asunto(s)
Cuidados Posteriores/organización & administración , Supervivientes de Cáncer/psicología , Linfoma/enfermería , Modelos de Enfermería , Pautas de la Práctica en Enfermería , Adulto , Anciano , Anciano de 80 o más Años , Supervivientes de Cáncer/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Linfoma/psicología , Masculino , Persona de Mediana Edad , Investigación en Evaluación de Enfermería , Proyectos Piloto , Automanejo/psicología , Adulto Joven
15.
Am J Nurs ; 119(7): 46-52, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31232775

RESUMEN

: By the 1920s, Lillian Wald's model of care, with nurses working side by side with social workers at the intersection of medicine and society, had become an important component of the U.S. health care system. Over subsequent decades, however, a confluence of historic forces resulted in its marginalization. Today, people are recognizing that medical cures alone, although important, will not reduce the epidemic of diseases of despair or the growing challenges involved in achieving health equity. Wald's approach, extended to a broader range of settings in which nurses work today, could be the missing ingredient.To provide background for the National Academy of Medicine Committee on the Future of Nursing 2020-2030, as it develops its follow-up to the Institute of Medicine's 2010 Future of Nursing: Leading Change, Advancing Health, the Robert Wood Johnson Foundation commissioned a report on nursing's historic role in advancing health. This article summarizes that report, which can be found in its entirety at www.rwjf.org/content/dam/farm/reports/reports/2019/rwjf452706.


Asunto(s)
Prestación de Atención de Salud/historia , Prestación de Atención de Salud/legislación & jurisprudencia , Historia de la Enfermería , Modelos de Enfermería , Historia del Siglo XX , Hospitales , Humanos , Estados Unidos
16.
Dimens Crit Care Nurs ; 38(4): 221-227, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31145169

RESUMEN

BACKGROUND: Self-extubation is an adverse patient event that can lead to severe complications. Gaps in clinical practice from the lack of nursing awareness and decision making capacity have often resulted in cases of preventable self-extubation. Review of current evidence suggests that initiatives to support nursing clinical decision making can help prevent adverse patient events such as self-extubation. AIMS: The aim of this study was to reduce the incidence of self-extubation by 50% in a cardiology intensive care unit over 1 year. METHODS: A quality improvement project was undertaken with a PEST model of nursing care introduced from January 2017 to December 2017 in the cardiology intensive care unit to guide nursing staff to assess and render appropriate interventions along patient domains such as pain, endotracheal tube securement, sedation, and tie to prevent incidences of self-extubation. RESULTS: Incidences of self-extubation have reduced to 5 cases in 2017, reflecting a 50% improvement from 10 cases in 2016. CONCLUSIONS: Formalizing practice standards into an easy-to-remember mnemonics or framework can improve patient outcomes. Policy makers must be aware that initiatives to facilitate decision making can improve patient safety.


Asunto(s)
Extubación Traqueal/efectos adversos , Extubación Traqueal/enfermería , Enfermería de Cuidados Críticos , Unidades de Cuidados Intensivos , Modelos de Enfermería , Mejoramiento de la Calidad , Autocuidado/efectos adversos , Humanos , Singapur
17.
BMC Med Educ ; 19(1): 135, 2019 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-31068167

RESUMEN

BACKGROUND: Preparing a 21st century nursing workforce demands future-oriented curricula that address the population's evolving health care needs. With their advanced clinical skill sets and broad scope of practice, Advanced Practice Nurses strengthen healthcare systems by providing expert care, especially to people who are older and/or have chronic diseases. Bearing this in mind, we revised our established Master of Nursing Science curriculum at the University of Basel, Switzerland. METHODS: Guided by the Advanced Nursing Practice framework, interprofessional guidelines, fundamental reports on the future of health care and the Bologna declaration, the reform process included three interrelated phases: preparation (work packages (WPs): curriculum analysis, alumni survey), revision (WPs: program accreditation, learning outcomes), and regulations (WPs: legal requirements, program launch). RESULTS: The redesigned MScN curriculum offers two specializations: ANP and research. It was implemented in the 2014 fall semester. CONCLUSIONS: This curriculum reform's strategic approach and step-by-step processes demonstrate how, beginning with a solid conceptual basis, congruent logical steps allowed development of a program that prepares nurses for new professional roles within innovative models of care.


Asunto(s)
Curriculum , Bachillerato en Enfermería , Reforma de la Atención de Salud/organización & administración , Enfermeras y Enfermeros/provisión & distribución , Educación Continua en Enfermería , Práctica Clínica Basada en la Evidencia , Humanos , Modelos Educacionales , Modelos de Enfermería , Enfermeras y Enfermeros/normas , Evaluación de Programas y Proyectos de Salud , Informe de Investigación , Suiza
18.
Nurs Womens Health ; 23(3): 234-244, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31075219

RESUMEN

OBJECTIVE: To compare perceived quality of prenatal care and pregnancy-related self-reported empowerment between women participating in CenteringPregnancy versus those receiving individual prenatal care provided by certified nurse-midwives in the same clinic. DESIGN: Nonexperimental, longitudinal, descriptive feasibility study of two independent groups. SETTING/LOCAL PROBLEM: A prenatal clinic in northern Texas where all care is provided by certified nurse-midwives. PARTICIPANTS: The study assessed 51 women receiving self-selected prenatal care in the form of individual prenatal care (n = 37) or CenteringPregnancy (n = 14). INTERVENTION/MEASUREMENTS: Outcomes analyzed included perceived quality of prenatal care and pregnancy-related self-reported empowerment. RESULTS: The results showed no statistical significance between the individual prenatal care and CenteringPregnancy groups with regard to perceived quality of prenatal care or pregnancy-related self-reported empowerment. CONCLUSION: CenteringPregnancy has the capability to provide women with quality of care equal to that achieved through traditional prenatal care. Despite the lack of statistically significant findings, this study exposes several areas of interest and provides guidance for future studies evaluating prenatal care.


Asunto(s)
Satisfacción del Paciente , Pacientes/psicología , Percepción , Atención Prenatal/normas , Adulto , Femenino , Humanos , Estudios Longitudinales , Modelos de Enfermería , Participación del Paciente/métodos , Participación del Paciente/psicología , Embarazo , Psicometría/instrumentación , Psicometría/métodos , Calidad de la Atención de Salud/normas , Encuestas y Cuestionarios , Texas
19.
J Nurs Adm ; 49(6): 315-322, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31135639

RESUMEN

OBJECTIVE: This study determined whether 1 health system's frontline nursing model redesign to integrate clinical nurse leaders (CNLs) improved care quality and outcome score consistency. METHODS: Interrupted time-series design was used to measure patient satisfaction with 7 metrics before and after formally integrating CNLs into a Michigan healthcare system. Analysis generated estimates of quality outcome: a) change point; b) level change; and c) variance, pre-post implementation. RESULTS: The lowest-performing unit showed significant increases in quality scores, but there were no significant increases at the hospital level. Quality metric consistency increased significantly for every indicator at the hospital and unit level. CONCLUSIONS: To our knowledge, this is the 1st study quantifying quality outcome consistency before and after nursing care delivery redesign with CNLs. The significant improvement suggests the CNL care model is associated with production of stable clinical microsystem practices that help to reduce clinical variability, thus improving care quality.


Asunto(s)
Liderazgo , Enfermeras Clínicas/organización & administración , Atención de Enfermería/organización & administración , Atención de Enfermería/normas , Mejoramiento de la Calidad/estadística & datos numéricos , Prestación de Atención de Salud/organización & administración , Unidades Hospitalarias/organización & administración , Humanos , Análisis de Series de Tiempo Interrumpido , Michigan , Modelos de Enfermería , Investigación en Evaluación de Enfermería , Satisfacción del Paciente/estadística & datos numéricos
20.
Cochrane Database Syst Rev ; 4: CD007019, 2019 04 23.
Artículo en Inglés | MEDLINE | ID: mdl-31012954

RESUMEN

BACKGROUND: Nurses comprise the largest component of the health workforce worldwide and numerous models of workforce allocation and profile have been implemented. These include changes in skill mix, grade mix or qualification mix, staff-allocation models, staffing levels, nursing shifts, or nurses' work patterns. This is the first update of our review published in 2011. OBJECTIVES: The purpose of this review was to explore the effect of hospital nurse-staffing models on patient and staff-related outcomes in the hospital setting, specifically to identify which staffing model(s) are associated with: 1) better outcomes for patients, 2) better staff-related outcomes, and, 3) the impact of staffing model(s) on cost outcomes. SEARCH METHODS: CENTRAL, MEDLINE, Embase, two other databases and two trials registers were searched on 22 March 2018 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: We included randomised trials, non-randomised trials, controlled before-after studies and interrupted-time-series or repeated-measures studies of interventions relating to hospital nurse-staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective reported measure of patient-, staff-related, or economic outcome. The most important outcomes included in this review were: nursing-staff turnover, patient mortality, patient readmissions, patient attendances at the emergency department (ED), length of stay, patients with pressure ulcers, and costs. DATA COLLECTION AND ANALYSIS: We worked independently in pairs to extract data from each potentially relevant study and to assess risk of bias and the certainty of the evidence. MAIN RESULTS: We included 19 studies, 17 of which were included in the analysis and eight of which we identified for this update. We identified four types of interventions relating to hospital nurse-staffing models:- introduction of advanced or specialist nurses to the nursing workforce;- introduction of nursing assistive personnel to the hospital workforce;- primary nursing; and- staffing models.The studies were conducted in the USA, the Netherlands, UK, Australia, and Canada and included patients with cancer, asthma, diabetes and chronic illness, on medical, acute care, intensive care and long-stay psychiatric units. The risk of bias across studies was high, with limitations mainly related to blinding of patients and personnel, allocation concealment, sequence generation, and blinding of outcome assessment.The addition of advanced or specialist nurses to hospital nurse staffing may lead to little or no difference in patient mortality (3 studies, 1358 participants). It is uncertain whether this intervention reduces patient readmissions (7 studies, 2995 participants), patient attendances at the ED (6 studies, 2274 participants), length of stay (3 studies, 907 participants), number of patients with pressure ulcers (1 study, 753 participants), or costs (3 studies, 617 participants), as we assessed the evidence for these outcomes as being of very low certainty. It is uncertain whether adding nursing assistive personnel to the hospital workforce reduces costs (1 study, 6769 participants), as we assessed the evidence for this outcome to be of very low certainty. It is uncertain whether primary nursing (3 studies, > 464 participants) or staffing models (1 study, 647 participants) reduces nursing-staff turnover, or if primary nursing (2 studies, > 138 participants) reduces costs, as we assessed the evidence for these outcomes to be of very low certainty. AUTHORS' CONCLUSIONS: The findings of this review should be treated with caution due to the limited amount and quality of the published research that was included. We have most confidence in our finding that the introduction of advanced or specialist nurses may lead to little or no difference in one patient outcome (i.e. mortality) with greater uncertainty about other patient outcomes (i.e. readmissions, ED attendance, length of stay and pressure ulcer rates). The evidence is of insufficient certainty to draw conclusions about the effectiveness of other types of interventions, including new nurse-staffing models and introduction of nursing assistive personnel, on patient, staff and cost outcomes. Although it has been seven years since the original review was published, the certainty of the evidence about hospital nurse staffing still remains very low.


Asunto(s)
Modelos de Enfermería , Personal de Enfermería en Hospital , Calidad de la Atención de Salud , Mortalidad Hospitalaria , Humanos , Readmisión del Paciente , Admisión y Programación de Personal , Especialidades de Enfermería , Recursos Humanos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA