Evidence-Based Practice
PART 3
Disseminate best practices: The group presentation will cover the topic of interest chosen for the practice improvement paper. Each group will prepare and present a PowerPoint presentation.
Instructions:
A – Develop an abstract:
An abstract is an outline/brief summary of your paper and your whole project. Abstracts highlight major points of your research and explain why your work is important; what your purpose was, how you went about your project, what you learned, and what you concluded.
1. The body of the abstract may not exceed 350 words and should be single-spaced.
2. Short titles and standard abbreviations are recommended. The title should be specific in addressing the key concepts in the project.
3. Abstracts must include the following sections:
. Title conveys the project’s significance
. Background/Significance of the Problem Identification of the problem
. Clinical question PICOT question
. Purpose What you set up to do
. Methods How do you find the evidence (databases, keywords, inclusion and exclusion criteria)
. Synthesis of evidence Clinical appraisal of literature/best evidence guiding practice change
. Change Proposed change in practice discussed
. Implementation Strategies describe approach to the project and how the outcomes will be evaluated.
. Discussion/Conclusions/Implications: Integration into practice, lessons learned from this project and the implications in nursing practice
. References: Include at least 5 references that are no more than 10 years old.
· Use American Psychological Association (APA) 6th edition guidelines in the preparation of the proposal. Include at least five (5) references that are no more than 10 years old.
B – Develop a PowerPoint Poster presentation:
1. Create a PowerPoint Poster presentation using the abstract as a guide (like you will be presenting your findings in a conference).
2. Presentation must describe the process and outcomes resulting from the critical appraisal and use of the best and most relevant research evidence related to your clinical question.
3. See Calendar for due date.
4. View grading rubric grading rubric – Alternative Formats .
The issue of proper staffing has plagued the nursing profession since its start; it is a matter that affects everyone and is frequently addressed by politicians. Although healthcare institutions realize the necessity of proper staffing and its influence on quality of service and results, many are motivated only by financial considerations. In most jurisdictions, existing regulations need change to provide nurses a much-needed advantage when it comes to patient ratios. Nurse burnout and high turnover rates are a result of the demands put on today’s nurse-patient ratios, which leads to nurses seeking nonclinical professions and contributing to nursing shortages. Nurse understaffing and a high nurse-to-patient ratio are still major challenges that must be addressed to enhance nursing care quality. The purpose of this review is to find out how does a lack of nurse staffing affect nurse-to-patient ratios, patient safety, and care quality.
Inadequate staffing in health care facilities is when the number of patients in the health care facility is much higher than the number of nurses, this also affects the quality of services provided by the nurses. This situation has a negative effect not only to the nurses but also to the patients and their families, this will lead to higher mortality rates in acute health care facilities with inadequate staffing. This situation could be avoided by employing more nurses, but budgeting and other health facilities issues prevent this from happening, the safety of patients depends mostly on the nurse-to-patient ratio and the future of health care. This also leads the nurse to feel job dissatisfaction in the health care field.
When health care facilities have insufficient staff, the welfare of the patients and the health care facility at large is compromised. An overwhelmed nurse can overlook details of all patients or not engaging with the patients effectively. This can possibly leave patients feeling dissatisfied with the services provided by the nurses. Understaffing occurs when the government cut off budgets in the ministry affecting the employment and educating new healthcare staff, the high number of retiring nurses without a replacement and the shortage of nurse faculty to train new nurses. These are the reasons that may cause inadequate staffing in health care facilities.
To avoid dissatisfaction among nurses, the health care facility keeps a few nurses on duty to change shifts in time, this however can jeopardize the safety of patients due to the quality of services provided to them. In a situation where there are few nurses in the wards the patients tend to get less attention and any complain can be ignored, and patient safety is at risk. Overworked nurses may suffer from fatigue like any other human being, and this can lead to negligence at work, mainly due to lack of focus and this also jeopardizes patient safety.
Patients in understaffed facilities are faced by many risks concerning their health, they lack attention and support from the health care facility personnel, and this is the main cause of high mortality cases in hospitals. According to Blouin et all, (2019) patients are therefore worried with the situation where there are fewer nurses taking care of them, this also led to psychological problems, worrying about their well-being and if they will survive. Nurses on the other hand face difficult times and most of them suffer from emotional and physical health issues, this is due to the long shifts, lack of rest, overworked, not eating well, shorts periods of rest during shifts, among others. By doing so with little to no relief, where they can rest physically neither psychologically, this can eventually cause mental breakdown, leading the nurse to quit the job and many times quitting the profession all together.
According to Aiken et all, (2018), nurses who face constant stress can develop several health issues, including anxiety, exhaustion, depression, heart disease and hypertension. Nurses who have health issues may be absent from work, this adds more workload to the preset nurses whom at the end of the day are exhausted and increasing the chances of errors and negligence. Therefore, causing mistrust by the patients towards the health care facility. Negative patient perception is related to missed care, which can be a result of shortage in staffing in the health care facility.
Nurses represent the largest group of health care workers, (Aiken 2018) their main responsibility is taking care of patients. Their working environment and staffing impacts the quality of healthcare and patient’s safety. Inadequate staffing in acute hospitals is associated with adverse events such as patient falls and health care related infections. Improved nurse staffing and higher proportion of nurses who are well educated and holds a bachelor’s degree reduces the rate of mortality in health care facilities within 30 days of admission. (Aiken 2003) Adequate nurse staffing influences the surveillance because it allows nurses to spend more time with the patients.
According to Haegdorens et all, (2019) insufficient staffing leads to rationing the time to care for the patients who are in intensive care units and the ones who need more care. This is a clear explanatory factor linking nurses and patients’ outcomes such as hospital deaths. There are no clear ways to measure nurse’s workload and how many nurses should be present in the wards to provide better services. However, the management should be able to balance the nurse’s workload and the number of nurses in each ward, this is aimed at providing better services and reducing health care related infections and eliminating deaths caused by errors and negligence.
Nurses play an integral role in the health care system. They provide acute care to patients in intensive care units and emergency rooms. Further Haegdorens et all, (2019) observed that, however nurses are overworked and under-supported as hospital administrators seeks to lower cost and maximize the profits. Minimum staffing levels are necessary to ensure better quality patients care, safety of nurses and patients will also be ensured. Better nurse staffing will help improve patients care and nurse retention, while poor staffing endangers patients and drives nurses away from the profession, the demand of health care staff grows, making the health care administrators worried and making staffing a growing a concern for nurses and patients.
The demand of nursing professionals in different types of health care settings are making many qualified nurses to prefer part-time nursing, or sometimes look for alternative careers. Many nurses have had a career change or planning to have a career change due to the pressure involved in the health care sector. While increasing the number of nurses in the health care facilities improves the quality of services provided by the nurses, however much improvement will be seen in hospitals with poor working conditions, therefore increasing the number of nurses while the working conditions remains poor does not improve the quality of services provided by the nurses.
According to Olley et all, (2019), each additional patients over four per nurse carries a 23 percent risk of burnout and a 15 percent decrease in job satisfaction in the nurse. The same study found that each addition patient per nurse was associated with seven percent increase in the likelihood of dying within 30 days of admission.
Registering nurses and other health care professionals, through their unions and professional associations, have been advocating for better staffing standards in various means for more than two decades. Nurses in the unions are using this power to bargain the push for improving staffing standards. In the face of aggressive cost-cutting, minimum staffing levels are important to ensure the safety of patients and nurses. These unions have seen an improvement in better working conditions and the number of newly employed staff. Additional pay for overtime will ensure nurses and health care professionals get motivation.
Health care staffing problem can be solved when all the health care sectors come together and work together to improve the quality of services provided. Further, Aiken et al., (2018) state that by increasing the number of staff and avoid overworking, the nurses will encourage more students to join the profession. This will also aid in job satisfaction among the nurses and other health care professionals. Staffing of health care professionals is crucial to the health care system and proper allocation of funds in the sector should be reviewed. Construction and development of many faculties to aid in training more nurses and health professionals will help reduce the staffing problem.
Background Information
Inadequate staffing is an issue that continues to plague healthcare facilities around the
country. Understaffing has far-reaching implications that can include medical mistakes, patient falls, prescription mistakes, infections, and death. Longer periods of stay, patient discontent, and
increased readmission rates can all be consequences of insufficient nurse staffing (Lee, Cheung,
Leo, Leung, & Hung, 2017). Safe staffing has a significant impact on the safety and quality of
patient treatment, as most healthcare practitioners are aware. There is a lot of research that identifies the consequences and results of dangerous staffing methods, but there is not much research that explains why it is tolerated. Lack of efficient staffing lowers the quality of services provided, which has a direct or indirect impact on the patient’s result. According to studies, a lack of proper personnel can have a significant impact on the quality of patient care, putting patients’ safety at risk.
Methodology
Using CINAHL database, ProQuest and Google Scholar, the study located an overall of
100 scholarly articles. However, the selection criteria for the most appropriate articles relied on
date of publication and relevance to the topic in terms of addressing the how lack of nurse staffing affect nurse-to-patient rations, patient safety and care quality. 10 scholarly articles were chosen for this review. The keywords used are nurse-to-patient ratio, nurse staffing, impact of nurse staffing to patient safety, and care quality.
Results
The findings of the ten-research analyzed revealed that insufficient staffing is linked to poor patient management and a higher death rate. The proportion of satisfaction and quality care was high in situations when appropriate nurse staffing was provided. However, hospitals with a staffing shortfall had a higher mortality rate, as well as a greater risk of patient safety and care.
Discussion
The association between patient expectations of care and RN staffing was investigated in a qualitative study conducted by Nelson, Hearld, and Wein (2018). According to the study, having more RNs on staff may assist in meeting the expectations of patients. Oostveen, Mathijssen, and Vermeulen (2015) investigated patients’ quality care with enough nursing staffing. The study discovered that appropriate personnel are required to deliver quality treatment. The Affordable Health Care Act (AHCA) presented in 2012, for instance included a component targeted at lowering readmission rates by punishing hospitals with high readmission rates among Medicare beneficiaries (Metcalf, Wang &, Habermann, 2018). The Act’s purpose was to lower readmission rates by awarding hospitals that provided high-quality care and had low readmission rates. According to Metcalf, Wang, and Habermann (2018), lowering readmission rates requires appropriate nurse staffing to provide appropriate discharge planning, coordinated care, and patient education. As a result, hospitals with higher nurse staffing have a lower chance of being penalized than identical healthcare institutions with lower staffing.
Registered nurses face a variety of stresses, including a lack of staff and resources, seeing patient deaths, dissatisfaction with the work environment, job overload, and time spent on administrative activities (Marie, 2017). Stress resulted in poor patient care, work dissatisfaction,
and burnout syndrome. To establish a working atmosphere conducive to high-quality patient care, RN stresses must be addressed. The first study by Aiken in 2002 indicated that patients are at a 7% higher risk of dying within 30 days of admission for every additional patient a nurse cared for (Aiken, 2002). According to the study, every extra patient a nurse cared for increased the probability of failing to rescue in an emergency circumstance. Individuals suffering from heart failure or other life-threatening diseases were more likely to survive in hospitals and other medical institutions with acceptable nurse staffing ratios, according to supplementary studies. Furthermore, research show that hospitals with proper staffing ratios typically score higher on patient satisfaction surveys (Kiekkas et al, 2019).
Setting required nurse-to-patient ratios might be one answer to insufficient nurse staffing.
This is, however, a profoundly divisive approach. For years, there has been a discussion about
whether obligatory staffing restrictions assist or harm inadequate staffing. Mandatory staffing ratios, according to proponents, reduce nurse stress, staff turnover, patient mortality, and avoidable blunders, to mention a few. Opponents of mandated nurse-to-patient ratio legislation contend that they impose significant financial expenses on hospitals and give them little control over staffing decisions (Jenkins, 2018,). They also express concerns that, if mandated ratios are implemented, beds may be inaccessible to patients seeking medical care due to a lack of nurses available to staff beds in accordance with the required ratios. Even though both sides make strong arguments, the focus must always be on the patient’s best interests. California was the first state to pass legislation imposing strict nurse-to-patient ratios in hospitals. The legislation aims to improve patient-centered care, and though a consensus has yet to be established, evidence from multiple studies show that the law has accomplished its goals in several areas. Many additional states have voiced a desire for mandated minimum ratios since then, but just a handful have enacted legislation. Inadequate staffing, according to research, can result in increased expenses and lower quality of treatment (Kiekkas et.al, 2019). As a result, legislation should be passed in every state to safeguard not only patients but also nursing personnel. In current times of qualified nursing shortages, there are solutions to nurse staffing issues. They include making the most of current personnel, balancing permanent and contingent personnel, and better projecting future employment needs (Wolf, Perhats, Delao, Clark, & Moon, 2017).
Inadequate nurse staffing may lead to longer lengths of stay, patient discontent, increased readmissions, and more adverse events, all of which can lower quality and hurt the bottom line. As stated by Lee et.al (2017), the success of evaluations and activities aimed at optimizing patient outcomes and decreasing adverse occurrences determine the quality of nursing care. The extent to which nurses estimate the risk of falls in hospital patients upon admission, adopt evidence-based fall-prevention protocols, and manage such prevention measures, for example, has an impact on nursing care quality. According to Wendsche, Hacker, and Wegge (2017) low nurse-to-patient ratio means that safety issues such as drug administration accuracy receive less attention. With a low nurse-to-patient ratio, safe treatment and monitoring tailored to the patient’s needs to guarantee early detection of patient deterioration is impeded. When healthcare facilities have insufficient nurses on staff, patients’ health may be threatened (Rochefort et.al, 2020).
Furthermore, overworked nurses are more likely to overlook key facts or fail to interact with patients effectively. Patients may be unsatisfied with nursing treatment because of understaffing.
Conclusion
The findings imply that providing enough nurse staffing and working hours will help improve care quality and safety while also reducing the amount of care that is left undone in
hospitals. According to the findings, insufficient staffing is linked to an increased occurrence of
back pain and other work-related issues that contribute to patient problems. Whether one supports or opposes obligatory nurse-to-patient ratios, everyone concerned recognizes the need for reform. Finding strategies to protect patients and employees as healthcare changes and adapts should be a key priority. Patient outcomes will improve as nurse staffing improves. As the focus moves to value-based care, nurse staffing will be important in delivering high-quality, cost-effective care. As a result, the number of persons employed in health-care facilities has a significant impact on patient safety. Nurse staffing, therefore, should not be cut or lowered for financial reasons, as this might jeopardize patient safety.
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Haegdorens, F., Van Bogaert, P., De Meester, K., & Monsieurs, K. G. (2019). The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study. BMC health services research, 19(1), 1-9.
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