Pat Rapley

Enough of the problem: A review of time for health care transition solutions for young adults with a chronic illness

AIMS AND OBJECTIVES In this article, we critically assess the state of the science of transition care in chronic conditions using diabetes care as an exemplar and provide a case for the adoption of the principles of the Chronic Care Model in driving health care reform. BACKGROUND Globally, there is an increasing burden of chronic conditions including among adolescents and young adults. As a consequence adolescents are transitioning, at an increasing rate, from paediatric services into mainstream adult services, which are often ill equipped to meet their needs. DESIGN Integrative literature review. METHODS An integrative literature review method was used to summarise key issues facing adolescents with chronic illness and generate strategies for improving health care services. CONCLUSION Strengthening the capacity for transitioning from a service that is family focused to one with an individual orientation requires a paradigmatic shift and clear identification of roles and responsibilities in the health care system. The absence of empirically developed models of care, in a context of growing need, signals the importance of ongoing discussion, debate and research. IMPLICATIONS FOR CLINICAL PRACTICE There is a need for a change in philosophical orientation to promote service provision on the basis of need, rather than a model based on diagnosis and chronology. Nurses and other health professionals need to increase their awareness of issues facing adolescents with chronic conditions making the transition to adult health services.

The Impact of Nurses on Patient Morbidity and Mortality - the Need for a Policy Change in Response to the Nursing Shortage

CONTEXT Workforce projections indicate that by 2012 there will be a shortfall of 61,000 registered nurses in Australia. There is a growing body of evidence that links registered nurse staffing to better patient outcomes. PURPOSE This article provides a comprehensive review of the research linking nurse staffing to patient outcomes at a time of growing shortages, highlighting that a policy response based on substituting registered nurses with lower skilled workers may have adverse effects on patient outcomes. METHOD An electronic search of articles published in English using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journals @ OVID and Medline was undertaken. FINDINGS Robust evidence exists nationally and internationally that links nurse staffing to patient outcomes. Recent meta-analyses have found that there was a 3-12% reduction in adverse outcomes and a 16% reduction in the risk of mortality in surgical patients with higher registered nurse staffing. Evidence confirms that improvements in nurse staffing is a cost-effective investment for the health system but this is not fully appreciated by health policy advisors. CONCLUSIONS An appropriate policy response demands that the evidence that patient safety is linked to nurse staffing be recognised. Policy makers must ensure there are sufficient registered nurses to guarantee patient safety.

Impact of skill mix variations on patient outcomes following implementation of nursing hours per patient day staffing: A retrospective study

AIMS This article is a report of a study of the association between skill mix and 14 nursing-sensitive outcomes following implementation of the nursing hours per patient day staffing method in Western Australian public hospitals in 2002, which determined nursing hours by ward category but not skill mix. BACKGROUND Findings from previous studies indicate that higher nurse staffing levels and a richer skill mix are associated with improved patient outcomes. Measuring skill mix at a hospital level for specific staffing methods and associated nursing-sensitive patient outcomes are important in providing staffing for optimal patient care. DESIGN The research design for the larger study was retrospectively analysing patient and staffing administrative data from three adult tertiary hospitals in metropolitan Perth over 4 years. METHODS A subset of data was used to determine the impact of skill mix on nursing-sensitive outcomes following implementation of the staffing method. All patient records (N=103,330) and nurse staffing records (N=73,770) from nursing hours per patient day wards from October 2002-June 2004 following implementation were included. RESULTS Increases in Registered Nurse hours were associated with important decreases in eight nursing-sensitive outcomes at hospital level and increases in three nursing-sensitive outcomes. The lowest skill mix saw the greatest reduction in nursing-sensitive outcome rates. CONCLUSIONS The skill mix of nurses providing care could impact patient outcomes and is an important consideration in strategies to improve nurse staffing. Levels of hospital nurse staffing and skill mix are important organizational characteristics when predicting patient outcomes.

Does the nursing diagnosis form the basis for patient care

There is a growing level of activity supporting the development of a taxonomy for nursing diagnoses, interventions, and outcomes. While this development is occurring at a theoretical level, more work is necessary at a clinical level in order to determine how these concepts are being operationalized; more specifically, to establish whether there is a link between assessment, diagnosis and interventions documented in the patients medical record. Using a retrospective audit this research reviewed 304 patient records. The study data revealed that the nursing diagnoses documented were not always supported by patient assessment information. It also illustrated inconsistent links between the documented nursing diagnosis and interventions. These findings challenge the a priori support for nursing diagnosis forming the basis for patient care, as it exposes clinical application weaknesses. Given the International Council of Nurses move to develop and evaluate an International Classification of Nursing Practice, these weaknesses need to be considered in any evaluation.