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Purpose: To examine which characteristics of the practice environment were associated with missed nursing care in U.S. acute care hospital units. Design: A descriptive, correlational study used secondary analysis of the 2015 National Database of Nursing Quality Indicators® Registered Nurse (RN) Survey data. Subscales of the Practice Environment Scale of the Nursing Work Index were used to measure practice environment characteristics. The sample included 1,583 units in 371 hospitals, containing survey responses from 31,650 RNs. Methods: Multilevel logistic regression was performed to estimate the effects of the practice environment characteristics on missed care, controlling for hospital and unit characteristics. Results: About 84.1% of unit RNs reported missing at least one of the 15 necessary care activities. Good environment units had 63.3% significantly lower odds of having RNs miss care activities than poor environment units. Units had 81.5% lower odds of having RNs miss any necessary activities with 1 point increase of the staffing and resource adequacy score; 21.9% lower odds for 1 point increase in the nurse–physician relations score; and approximately 2.1 times higher odds with 1 point increase in the nurse participation in hospital affairs score. Conclusions: Good environments were significantly associated with lower levels of missed care. The impact on missed care differed by the characteristics of the practice environment. Clinical Relevance: Hospital and nursing administrators should maintain good practice environments for nurses to reduce missed care activities and thus potentially improve patient outcomes. Specifically, their efforts should be targeted on improving staffing and resource adequacy and nurse–physician relations and on reducing workloads on hospital affairs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study is to examine characteristics of the nursing practice environment associated with lower RN turnover. BACKGROUND: Identifying characteristics of the practice environment that contribute to lower RN turnover is important for meeting the national quality strategy priority of reducing healthcare costs. METHODS: Data from 1002 adult care units in 162 National Database of Nursing Quality Indicators participating hospitals were analyzed using multivariate linear regression. The Practice Environment Scale of the Nursing Work Index was used to measure practice environment characteristics. RN turnover was measured at the unit level. RESULTS: Nursing units with higher overall ratings of the nursing practice environment had lower rates of RN turnover. Units with higher RN perceived staffing and resource adequacy experienced significantly lower RN turnover. CONCLUSIONS: Unit managers and hospital administrators should consider RN perception of staffing and resource adequacy and the overall practice environment when developing targeted strategies for decreasing RN turnover. [ABSTRACT FROM AUTHOR]

The article presents a study on trends in nursing care efficiency in acute care nursing units in the U.S. Topics discussed include adaptation of the Donabedian quality improvement model, definition of efficiency in the health care system and use of the data envelopment analysis to estimate efficiency. It discusses findings on changes in efficiency between Magnet and non-Magnet hospital units, teaching status and nurse staffing skills.

This descriptive study used mock codes and a written education intervention to address RN under-performance during patient emergencies. Units with shorter lengths of stay, more experienced RNs, and a greater percentage of RNs had higher mock code scores. [ABSTRACT FROM AUTHOR]

Background: The hospital nursing practice environment has been found to be crucial for better nurse and patient outcomes. Yet little is known about the professional nursing practice environment at the unit level where nurses provide 24-hour bedside care to patients. Objectives: To examine differences in nursing practice environments among 11 unit types (critical care, step-down, medical, surgical, combined medical--surgical, obstetric, neonatal, pediatric, psychiatric, perioperative, and emergency) and by Magnet status overall, as well as four specific aspects of the practice environment. Design: Cross-sectional study. Settings: 5322 nursing units in 519 US acute care hospitals. Methods: The nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index. The Practice Environment Scale of the Nursing Work Index mean composite and four subscale scores were computed at the unit level. Two statistical approaches (one-way analysis of covariance and multivariate analysis of covariance analysis) were employed with a Tukey-Kramer post hoc test. Results: In general, the nursing practice environment was favorable in all unit types. There were significant differences in the nursing practice environment among the 11 unit types and by Magnet status. Pediatric units had the most favorable practice environment and medical--surgical units had the least favorable. A consistent finding across all unit types except neonatal units was that the staffing and resource adequacy subscale scored the lowest compared with all other Practice Environment Scale of the Nursing Work Index subscales (nursing foundations for quality of care, nurse manager ability, leadership, and support, and nurse--physician relations). Unit nursing practice environments were more favorable in Magnet than non-Magnet hospitals. Conclusions: Findings indicate that there are significant variations in unit nursing practice environments among 11 unit types and by hospital Magnet status. Both hospital-level and unit-specific strategies should be considered to achieve an excellent nursing practice environment in all hospital units. [ABSTRACT FROM AUTHOR]

Background: Various staffing measures have been used in examining the relationship between nurse staffing and patient outcomes. Little research has been conducted to compare these measures based on their explanatory power as predictors of nursing- sensitive outcomes. In this study, both administrative and nurse-reported measures were examined. Administrative measures included registered nurse (RN) skill mix and three versions of nursing hours per patient day (HPPD); nurse-reported measures included RN-reported number of assigned patients and RN-perceived staffing adequacy. Objectives: To examine correlations among six nurse staffing measures and to compare their explanatory power in relation to unit-acquired pressure ulcers (UAPUs). Design: Descriptive, correlational study. Settings: 2397 nursing units in 409 U.S. acute care hospitals. Methods: Random-intercept logistic regression analyses were performed using 2011 data from a national database. Relationships between nurse staffing measures and UAPU occurrences were examined in eight models, each with one or more staffing measures as predictors. Characteristics of nursing units (RN workgroup education level and RN workgroup unit tenure) and hospitals (size, teaching status, and Magnet status) were included as control variables. Results: Two versions of HPPD (total nursing HPPD and RN HPPD) and RN skill mix were significantly correlated with RN-reported number of assigned patients (r range = -0.87 to -0.75). These staffing measures had weaker correlations with RN-perceived staffing adequacy (r range = 0.16 to 0.23). Of the six staffing variables, only RN-perceived staffing adequacy and RN skill mix were significantly associated with UAPU odds, the former being the better predictor. Conclusions: Although RN-perceived staffing adequacy was not highly correlated with administrative measures of HPPD and RN skill mix, it was the strongest predictor of UAPU occurrences. RN-perceived staffing adequacy can serve as a more appropriate measure of staffing for nursing-sensitive outcomes research than administrative measures, as it reflects relevant aspects of staffing and involves an implicit adjustment for patient acuity. [ABSTRACT FROM AUTHOR]

AIM The study compared students' perceptions of their clinical learning experiences in a dedicated education unit (DEU) with their experiences in traditional clinical education. BACKGROUND Unlike traditional academic-instructor models, expert nurses in the DEU provide clinical education to students with faculty support. METHOD This repeated measures design used student surveys, supplemented by focus group data. RESULTS Students were more likely to agree that their clinical learning experience was high quality and they had a consistent mentoring relationship during DEU rotations. Students also reported the quality of the unit's learning environment, the leadership style of the nurse manager, and the nursing care on the unit was more favorable in DEUs than traditional units. Consistent with their changed role in DEUs, faculty members were less active in helping students integrate theory and practice. CONCLUSION These findings provide additional evidence of the value that the DEU model contributes to high-quality clinical education. [ABSTRACT FROM AUTHOR]

Researchers evaluated the agreement of temperatures measured with a temporal artery thermometer when sequentially used by the same person and a second user in 34 postoperative patients. The differences in two temperatures measured by a single user and between two persons were small and within the range of acceptable values set by experts when evaluating temperature devices for hospital use. [ABSTRACT FROM AUTHOR]

Aim To report the development and psychometric testing of the Supportive Needs of Adolescents Breastfeeding Scale. Background Nurses worldwide can influence adolescent mothers' decisions to initiate and continue breastfeeding through understanding their social support needs in the early postpartum. Review of the literature reveals a lack of instruments that measure adolescents' perceptions of supportive nursing behaviours when initiating breastfeeding. Method An instrument development and psychometric evaluation study was conducted. In phase 1, scale items were developed from the literature using social support theory. Eight lactation consultants evaluated the scale's content validity in phase 2. During phase 3, the psychometric properties of the scale were tested using item analysis, scale reliability, and exploratory factor analysis. A convenience sample of 101 adolescents, aged 15-20 years old, was recruited during their postpartum stay at three hospitals in the USA between July 2009-July 2010. Results Content validity index was 0·82. Alpha estimate of internal consistency was 0·83. Principal components analysis resulted in a 3 factor scale that explained 48% of the total variance: Practical support, Informational support and Miscellaneous. Conclusion The findings suggest evidence of the scale's adequate internal consistency. The factor analysis suggests two clear underlying dimensions of support: instrumental/emotional/appraisal and informational/emotional/appraisal, and a third miscellaneous dimension related to immediate skin-to-skin care and mothers' support persons. Further exploration of the possible global implications of the scale's dimensions is needed. [ABSTRACT FROM AUTHOR]