Violet H. Barkauskas

The Effects of Nurse Staffing on Adverse Events, Morbidity, Mortality, and Medical Costs

BackgroundNurse staffing levels are an important working condition issue for nurses and believed to be a determinant of the quality of nursing care and patient outcomes. ObjectivesTo examine the effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. MethodsUsing two existing databases, the study sample included 232 acute care California hospitals and 124,204 patients in 20 surgical diagnosis-related groups. The adverse events included patient fall/injury, pressure ulcer, adverse drug event, pneumonia, urinary tract infection, wound infection, and sepsis. Multilevel analysis was employed to examine, simultaneously, the effects of nurse staffing and patient and hospital characteristics on patient outcomes. ResultsThree statistically significant relationships were found between nurse staffing and adverse events. An increase of 1 hour worked by registered nurses (RN) per patient day was associated with an 8.9% decrease in the odds of pneumonia. Similarly, a 10% increase in RN Proportion was associated with a 9.5% decrease in the odds of pneumonia. Providing a greater number of nursing hours per patient day was associated with a higher probability of pressure ulcers. The occurrence of each adverse event was associated with a significantly prolonged length of stay and increased medical costs. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization. ConclusionPatients are experiencing adverse events during hospitalization. Care systems to reduce adverse events and their consequences are needed. Having appropriate nurse staffing is a significant consideration in some cases.

The Safety Net: Academic Nurse-Managed Centers’ Role

This article reports on a study conducted in 2001 that examined the role of four schools of nursing (SONs) in Michigan and their challenges in serving the safety net population through primary care nurse-managed centers (NMCs). The NMCs are described and compared to community health centers (CHCs) in terms of patient mix, funding sources, and contributions SONs make as a substitute resource for federal funding to the NMCs. NMCs are frequently invisible providers in the health system, yet they serve high-need populations. Similarities and differences between NMCs and CHCs are discussed as well as the unique challenges faced by NMCs and their SONs as the result of policies that sometimes limit NMCs ability to serve safety net populations.

The HANDS project: Studying and refining the automated collection of a cross-setting clinical data set

The consistent availability of a core set of clinical nursing data is essential to promote quality patient care. Although important work to improve terminology and enhance comparability of data is underway, the efforts do not address the immediate need for useful nursing data sets and valid methods of collection at the point of data entry. The Hands-on Automated Nursing Data System (HANDS) project is dedicated to refining a feasible methodology for gathering, storing, and retrieving a standardized nursing data set. To date the project team has developed and tested a prototype research tool that is automated and contains the structured terminologies (North American Nursing Diagnosis Association, Nursing Outcomes Classification, and Nursing Interventions Classification) to represent nursing diagnoses, outcomes, and interventions, respectively. The Phase I project development activities are reported in this article, along with Phase II and III plans for testing and refining the methodology under actual clinical conditions. Results and lessons learned during Phase I are reported.

Evaluating Home Health Care Nursing Outcomes With OASIS and NOC

PURPOSE To determine the sensitivity and responsiveness of the Outcome and Assessment Information Set (OASIS) and the Nursing Outcomes Classification (NOC) to the effects of home healthcare nursing interventions. METHODS A quasi-experimental before-after study was conducted using a sample of 106 home healthcare participants referred to one of seven participating Midwest home healthcare agencies for treatment of a cardiac condition. Patient outcomes data were collected at home healthcare admission and discharge using OASIS and NOC. Nursing intervention data were collected at each visit using the Nursing Interventions Classification (NIC). Intervention intensity was calculated by totaling the number of NIC interventions provided over the episode of care. FINDINGS Neither OASIS nor NOC were sensitive to the effects of home healthcare nursing as measured by intervention intensity. The OASIS was not responsive to clinically discernable changes in patient outcomes; while the NOC was responsive to patient status change in the outcome categories including activities of daily living, cardiopulmonary status, coping, and illness management behavior. CONCLUSIONS Outcome measures that are more condition-specific and discipline-specific are more responsive to the effects of home healthcare nursing. Further research is needed to identify and refine outcome measures that are sensitive and responsive to the effects of nursing care in home health and other nursing settings. CLINICAL RELEVANCE The use of outcome measures that are more sensitive and responsive to nursing are more effective in guiding nursing practice.

Measuring Quality in Nurse‐Managed Centers Using HEDIS Measures

&NA; Nurse‐managed centers (NMCs) provide viable options for primary healthcare and contribute substantially to filling access gaps for vulnerable populations. The purposes of this paper are to (a) describe a pilot application and adaptation of eight Health Plan Employer Data and Information Set (HEDIS) measures to six NMCs, (b) report the findings from the quality assessments, and (c) compare findings to national HEDIS data. The eight quality assessment areas are asthma, cervical cancer screening, childhood immunizations, depression, diabetes, hypertension, mammography screening, and smoking cessation. The NMCs achieved or exceeded HEDIS 50th percentile levels in a number of important clinical areas, but did not attain the 50th percentile level in others. Thus, HEDIS measures are relevant for the assessment of care quality and provide useful data for quality improvement in NMCs.

Impact of academic nurse-managed centers on communities served

Purpose: This paper presents findings from six community focus groups that addressed the impact of academic nurse‐managed centers (ANMCs) on the overall community being served as well as the quality of care provided in the centers. Data sources: Experts in focus group methodology from a public health institute conducted the six focus groups at ANMCs from four universities in the Midwest. Discussions were guided by nine questions presented to each group. All groups were tape‐recorded and transcribed. A total of 37 participants were recruited from the ANMCs and included patients and families, advisory board members, and local community organizations. Conclusions: Four themes were identified across the six focus groups: valuing patient‐centered care, which included two subthemes—continuous specific provider and specific aspects of care; quality of care; increasing access to care/addressing the safety net; and evidence of outreach. Implications for practice: Findings from these focus groups verify that community members do “get it” in terms of the unique aspects of ANMCs. Participants were able to articulate the differences between nurse‐managed care and other types of ambulatory primary care. The unique strengths of nurse practitioners were repeatedly articulated as well as the centers’ outreach into the community.

Selecting Control Interventions for Clinical Outcome Studies

In the current research environment the design and management of control groups is becoming more complex. The selection of a control group design is dependent on study goals, presence and quality of existing interventions, urgency of the problem or issue being addressed by the intervention, and factors related to the study site. The purpose of the presentation is to identify various approaches to the design of control groups in experimental studies and to identify their strengths, limitations, and applications. A case study exemplifies the issues associated with control group selection and design.

Toward a national nurse-managed health center data set: Findings and lessons learned over 3 years

Although primary care nurse-managed health centers (NMHCs) have gained increasing recognition, there are limited standardized clinical and financial data on these centers. The purpose of this paper is to present the process, benefits, and challenges in collecting standardized national data based on a consensus process from NMHCs over 3 consecutive years. The Institute for Nursing Centers (INC) NMHC Survey focuses on demographic, clinical, and financial data. A detailed codebook accompanied the INC NMHC Survey. A total of 42 NMHCs responded in at least 1 of the 3 years. Despite the challenges in collecting some of the data, especially for the first survey year, data quality improved remarkably when the INC NMHC Survey was repeated. Financial data seemed to be more easily reported than demographic or clinical data. NMHCs increase access to care, often for vulnerable populations, yet to date there are limited standardized clinical and financial data on these centers. The INC NHMC Survey and data described in this paper begins to address that gap.

Home Health Care

Home care has been an organized system of health care in the United States for over 100 years. Home health care was initiated in response to the needs of the poor sick, who had limited choices among options for health care and has endured as an integral component of the American health care system since that time. Professional nurses provided leadership in the initiation and development of home care and continue to be the largest group of professional providers within

Health Problems Encountered by Nurse Practitioners and Physicians

The effects of specialty, setting, and provider group on the distributions of health problems managed by nurse practitioners and physicians in obstetric-gynecology, adult medicine, pediatrics, and family practice specialties are studied. Proportional samples by clinic were drawn from a total of 39,243 patient visits made to 16 ambulatory care clinics during an 18-week period. A Patient Encounter Form was used as the instrument and the ICD-9-CM was used as the coding system. Distributions of health problems differed between nurse practitioners and physicians in each clinic. Specialty affected the distributions of health problems managed by both provider groups. Setting affected the distributions of health problems for all specialties except the distributions of health problems not related to diseases or injuries (V codes) in family practice. Provider group effects were inconclusive. Community-based settings seem especially appropriate for nurse practitioner practice.