Eunhee Cho

Importance of work environments on hospital outcomes in nine countries

PURPOSE To determine the effect of hospital work environments on hospital outcomes across multiple countries. DESIGN Primary survey data using a common instrument were collected from separate cross sections of 98 116 bedside care nurses practising in 1406 hospitals in 9 countries between 1999 and 2009. MAIN OUTCOME MEASURES Nurse burnout and job dissatisfaction, patient readiness for hospital discharge and quality of patient care. RESULTS High nurse burnout was found in hospitals in all countries except Germany, and ranged from roughly a third of nurses to about 60% of nurses in South Korea and Japan. Job dissatisfaction among nurses was close to 20% in most countries and as high as 60% in Japan. Close to half or more of nurses in every country lacked confidence that patients could care for themselves following discharge. Quality-of-care rated as fair or poor varied from 11% in Canada to 68% in South Korea. Between one-quarter and one-third of hospitals in each country were judged to have poor work environments. Working in a hospital with a better work environment was associated with significantly lower odds of nurse burnout and job dissatisfaction and with better quality-of-care outcomes. CONCLUSIONS Poor hospital work environments are common and are associated with negative outcomes for nurses and quality of care. Improving work environments holds promise for nurse retention and better quality of patient care.

Effects of nurse staffing, work environments, and education on patient mortality: an observational study.

BACKGROUND While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. OBJECTIVE To examine the effects of nurse staffing, work environment, and education on patient mortality. METHODS This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. RESULTS Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. CONCLUSIONS Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths.

Construct validity and reliability of the Korean version of the practice environment scale of nursing work index for Korean nurses

PURPOSE To develop and test the validity and reliability of the Korean version of PES-NWI measuring nursing work environments in hospitals. METHODS The Korean version of the PES-NWI was developed through forward-backward translation techniques, and revision based on feedback from focus groups. An internal consistency reliability and construct validity using confirmatory factor analysis were conducted using SPSS WIN (16.0) and AMOS (18.0). Survey data were collected from 733 nurses who worked in three acute care hospitals in Seoul, South Korea. RESULTS The Korean version of PES-NWI showed reliable internal consistency with a Cronbachs alpha for the total scale of .93. Factor loadings of the 29 items on the five subscales ranged from .28 to .85. The five subscales model was validated by confirmatory factor analysis (RMR<.05, CFI>.9). CONCLUSION The findings of this study demonstrate that the Korean version of PES-NWI has satisfactory construct validity and reliability to measure nursing work environments of hospitals in Korea.

Factors associated with needlestick and sharp injuries among hospital nurses: A cross-sectional questionnaire survey

BACKGROUND The current status of needlestick or sharp injuries of hospital nurses and factors associated with the injuries have not been systematically examined with representative registered nurse samples in South Korea. OBJECTIVE To examine the incidence to needlestick or sharp injuries and identify the factors associated with such injuries among hospital nurses in South Korea. DESIGN, SETTINGS AND PARTICIPANTS A cross-sectional survey of hospital nurses in South Korea. Data were collected from 3079 registered nurses in 60 acute hospitals in South Korea by a stratified random sampling method based on the region and number of beds. METHODS The dependent variable was the occurrence of needlestick or sharp injuries in the last year, and the independent variables were protective equipment, nurse characteristics, and hospital characteristics. This study employed logistic regression analysis with generalized estimating equation clustering by hospital to identify the factors associated with needlestick or sharp injuries. RESULTS The majority (70.4%) of the hospital nurses had experienced needlestick or sharp injuries in the previous year. The non-use of safety containers for disposal of sharps and needles, less working experience as a registered nurse, poor work environments in regards to staffing and resource adequacy, and high emotional exhaustion significantly increased risk for needlestick or sharp injuries. Working in perioperative units also significantly increased the risk for such injuries but working in intensive care units, psychiatry, and obstetrics wards showed a significantly lower risk than medical-surgical wards. CONCLUSIONS The occurrence of needlestick or sharp injuries of registered nurses was associated with organizational characteristics as well as protective equipment and nurse characteristics. Hospitals can prevent or reduce such injuries by establishing better work environments in terms of staffing and resource adequacy, minimizing emotional exhaustion, and retaining more experienced nurses. All hospitals should make safety-engineered equipment available to registered nurses. Hospitals as well as specific units showing higher risk for needlestick and sharp injuries should implement organizational strategies to prevent such injuries. It is also necessary to establish a monitoring system of needlestick and sharp injuries at a hospital level and a reporting system at the national level in South Korea.

The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events

PURPOSE The purpose of this study was to examine the relationships of nurse staffing level and work environment with patient adverse events. DESIGN This cross-sectional study used a combination of nurse survey data (N = 4,864 nurses), facility data (N = 58 hospitals), and patient hospital discharge data (N = 113,426 patients) in South Korea. METHODS The three most commonly nurse-reported adverse events included administration of the wrong medication or dose to a patient, pressure ulcers, and injury from a fall after admission. Multilevel ordinal logistic regression was employed to explore the relationships of nurse staffing level (number of patients assigned to a nurse) and work environment (Practice Environment Scale of the Nursing Work Index) with patient adverse events after controlling for nurse, hospital, and patient characteristics. FINDINGS A larger number of patients per nurse was significantly associated with a greater incidence of administration of the wrong medication or dose (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 1.007-1.016), pressure ulcer (OR = 1.01, 95% CI = 1.007-1.016), and patient falls with injury (OR = 1.02, 95% CI = 1.013-1.022). A better work environment had a significant inverse relationship with adverse events; the odds of reporting a higher incidence of adverse events were 45% lower for administration of the wrong medication or dose (OR = 0.55, 95% CI = 0.400-0.758), followed by 39% lower for pressure ulcer (OR = 0.61, 95% CI = 0.449-0.834) and 32% lower for falls with injury after admission (OR = 0.68, 95% CI = 0.490-0.939). CONCLUSIONS This study found that a larger number of patients per nurse and poor work environment increase the incidence of patient adverse events, such as administration of the wrong medication or dose to a patient, pressure ulcers, and injury from falling after admission. The findings suggest that South Korean hospitals could prevent patient adverse events by improving nurse staffing and work environment. CLINICAL RELEVANCE Healthcare strategies and efforts to modify adequate nurse staffing levels and better work environments for nurses are needed to improve patient outcomes.

Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study

OBJECTIVE The purpose of this study was to explore the association of nurse staffing and overtime with nurse-perceived patient safety, nurse-perceived quality of care, and care left undone. DESIGN A cross-sectional survey. SETTING AND PARTICIPANTS A total of 65 hospitals were selected from all of the acute hospitals (n=295) with 100 or more beds in South Korea by using a stratified random sampling method based on region and number of beds, and 60 hospitals participated in the study. All RNs working on the date of data collection in units randomly selected from the list of units in each hospital were invited to participate. The analyses in this study included only bedside RNs (n=3037) and hospitals (n=51) with responses from at least 10 bedside RNs. METHODS We collected data on nurse staffing level, overtime, nurse-perceived patient safety, nurse-perceived quality of care, nurse-reported care left undone, and nurse characteristics through a nurse survey. Facility data from the Health Insurance Review Agency (HIRA) were used to collect hospital characteristics. Multilevel logistic regression models considering that nurses are clustered in hospitals were used to analyze the effects of hospital nurse staffing and overtime on patient safety, quality of care, and care left undone. RESULTS A higher number of patients per RN was significantly associated with higher odds of reporting poor/failing patient safety (OR=1.02, 95% CI=1.004-1.03) and poor/fair quality of care (OR=1.02, 95% CI=1.01-1.04), and of having care left undone due to lack of time (OR=1.03, 95% CI=1.01-1.05). Compared with RNs who did not work overtime, RNs working overtime reported an 88% increase in failing or poor patient safety (OR=1.88, 95% CI=1.40-2.52), a 45% increase in fair or poor quality of nursing care (OR=1.45, 95% CI=1.17-1.80), and an 86% increase in care left undone (OR=1.86, 95% CI=1.48-2.35). CONCLUSIONS Our findings suggest that ensuring appropriate nurse staffing and working hours is important to improve the quality and safety of care and to reduce care left undone in hospitals.

Activities of daily living in nursing home and home care settings: a retrospective 1-year cohort study.

OBJECTIVE Korea introduced universal long-term care insurance (LTCI) for physically dependent older adults in 2008. Older adults, their family members, and policy makers in Korea want to know patient outcomes in different care modalities because older adults who have a similar functional status and LTC needs can choose either nursing home care or home care. The aim of this study was to compare activities of daily living (ADLs) in nursing home care and home care settings for physically dependent older adults in Korea. DESIGN A retrospective 1-year cohort study using national LTCI data. SETTINGS This study used the LTCI dataset from the National Health Insurance Service in Korea. PARTICIPANTS Participants were identified from among those in the LTCI dataset who enrolled from July 2008 to June 2010. We extracted a sample consisting of 22,557 older adults who consistently received either nursing home care (n = 11,678) or home care (n = 10,879) for 1 year. MEASUREMENTS The outcome variable was change in ADLs after 1 year. Covariates were an older adults home geographical region, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis, baseline ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs. Multiple regression analysis of all participants unmatched and a paired t-test with a propensity-score-matched cohort were performed to explain the association of changes in ADLs with the types of LTC. RESULTS Multiple regression analysis with all participants (n = 22,557) unmatched showed that compared with older adults who received home care, those who received nursing home care had deteriorated further in terms of ADLs after 1 year (β = 0.44108, P < .0001). After propensity-score matching, paired t-test analysis also found that the ADLs of older adults had deteriorated less in the home care group compared with the nursing home group after 1 year (P < .0001). CONCLUSIONS The ADLs of older adults who received home care showed significantly less deterioration than those of the older adults in nursing home care after 1 year. The ADLs of older adults could differ according to the type of LTC they receive, and home care could result in better maintenance of ADLs than nursing home care.

Cognitive function, behavioral problems, and physical function in long-term care insurance beneficiaries with dementia in South Korea: comparison of home care and institutional care services.

To examine, in beneficiaries with long‐term care (LTC) insurance (LTCI) with dementia in Korea, changes in cognitive function, behavioral symptoms, and physical function over time in relation to LTCI service type and to determine the 2‐year effects of service type on those health outcomes.

A proposed theoretical framework addressing the effects of informal caregivers on health-related outcomes of elderly recipients in home health care.

PURPOSE The purpose of this review is to develop a theoretical framework addressing the effects of informal caregivers on health-related outcomes of elderly recipients in home health care. METHODS The investigator a) reviewed theories and literature related to informal caregiving and health-related outcomes of elderly recipients, b) critiqued the strengths and limitations of these theories and literature for research in this area, and c) developed a new conceptual framework by deductively applying these theories and literature to the effects of informal caregivers on health-related outcomes of elderly recipients in home health care. RESULTS Social network theories, social support theories, and the literature on informal caregiving are useful in understanding how informal caregivers affect the outcomes of elderly recipients in home health care. This review synthesizes these theories and literature into a new theoretical framework in order to fully address the effects of informal caregivers on health-related outcomes of elderly recipients in home health care. CONCLUSION The proposed theoretical framework suggests that health-related outcomes of elderly recipients are the result of interactions among types of informal caregivers, the nature of the caregiving relationship, caregiving as a function of such relationships, and the internal processes of the care recipient.

Effects of Informal Caregivers on Function of Older Adults in Home Health Care

This study aimed to examine the effects of informal caregivers on the functioning of older adults in home health care (HHC). The authors performed a secondary data analysis using the Outcome and Assessment Information Set of older adults (N = 8,750) who were admitted to a HHC agency from acute care hospitals. We conducted hierarchical multiple linear regression with functional dependence after a 60-day episode of formal HHC as an outcome variable. The older adults with informal caregivers showed less functional dependence at discharge (β = −0.821, p = .027) than those without informal caregivers. Older adults who have a spouse (β = −3.886, p < .001), offspring (β = −3.614, p < .001), relative (β = −4.360, p < .001), or nonrelative (β = −4.977, p < .001) caregiver showed less functional dependence at discharge compared with those who had a paid caregiver when controlling for risk factors.