Feedback of Group Projects to Peers
Ellen2020
MyGroupNursinghome.patientsafetyEBPRUA.pptxEvidence-Based Practice
By: Kylee Bell, Elizabeth Bognuda, Lidiya Eshetu, Kelemua Munyie, Roseline Teye
Identification of Problem
The topic assigned to our group is “Nursing Home Survey on Patient Safety Culture”. The Agency for Healthcare Research and Quality (AHRQ) focuses on 12 dimensions of patient safety culture. As a group, we decided to focus on the importance of adequate nursing staffing in nursing homes.
Why the need for adequate nursing staffing?
More than ½ of U.S. nursing homes have lower than the minimum recommended staffing levels (Harrington, 2020).
Improvements in patient outcomes→ Fewer pressure ulcers, lower restraint use, decreased infections, lower pain, improvements in ADL independence, less weight loss/dehydration, less use of antipsychotics and lower mortality rates (Harrington, 2020).
Kylee Bell
In the past, nursing homes were subject to reports of neglect and abuse throughout the United States. Congress passed the Nursing Home Reform Act in 1987, which required Medicare and Medicaid facilities to comply with quality of care rules. Since the passing of the act, care in nursing homes has improved but there is still room for improvement. Our group decided to focus on adequate nurse staffing in nursing homes to provide quality care. “Why the need for adequate nursing staffing?”
Klauber, M. (2001, February 01). The 1987 Nursing Home Reform Act. Retrieved August 18, 2020, from https://www.aarp.org/home-garden/livable-communities/info-2001/the_1987_nursing_home_reform_act.html
Harrington, C., Dellefield, M. E., Halifax, E., Fleming, M. L., & Bakerjian, D. (2020). Appropriate Nurse Staffing Levels for U.S. Nursing Homes. Health Services Insights, 1–14. https://doi.org/10.1177/1178632920934785
Clinical Question
“Does an increase in staffing level in nursing homes improve the overall safety of residents by preventing the occurrence of adverse events and improving patient outcomes?”
Breakdown of PICOT question
Population of Interest→ Nursing home residents, adults aged 65+
Intervention→ Increase in nurse staffing level
Comparison→ Lower nurse staffing level
Outcome→ Improvements in resident safety and outcomes
Time→ No time element
Kylee Bell
The PICOT question is used to guide our research throughout our presentation.
Search Strategy & Results
Database Used: Chamberlain Library EBSCO : CINAHL, MEDLINE, Nursing Reference Center Plus, & Journals@OVID
Search Terms Used: “ nursing home, nurse staffing, resident safety”
Search Narrowing Criteria : peer-review, full text, academic journals, year of publication, and subject
Results: Four relevant articles were selected from 115 refined search results
Kelemua
Database used: As Houser (2018) states information literacy include the competency of “using the appropriate Internet database, websites of professional organizations, and other reliable resources” (p. 111) in searching of credible evidence, the group used Chamberlain Library to access the electronic database for the sake of credibility, reliability, and availability. Cumulative Index for Nursing and Allied Health (CINAHL), MEDLINE, Nursing Reference Center Plus, and Journals@OVID were the databases utilized for searching for the evidence.
Search terms used: Searching for evidence to answer a clinical question should focus on the question (Houser, 2018). The PICO(T) format helps to identify appropriate search terms in the process of searching for evidence to answer the research problem (Chamberlain University, 2020). Therefore, the group applied the PICO(T) elements of the clinical question to identify key terms for the search. The search terms identified from each PICO(T) elements were ‘nursing home’ (P), ‘nurse staffing’ (I), ‘resident safety’ (O). No key term was selected from (C) because it is referred in (I).
Search narrowing criteria: When the search terms plugged in the database, a total of 5,814 search results were found. However, the search result could be narrowed down into 1,160 when the search was specified by the criteria that could assure the quality, currency, reliability and accessibility of the evidences, namely peer-review, year of publication, academic journals, and full text respectively (Houser, 2018). In an attempt of narrowing further to get reasonable number of search result, the subject area was specified into only ‘nursing homes’. Therefore, the search result could be reduced into 115.
Results: Among the 115 refined search result, the group selected four articles based on relevancy,currency, and credibility to answer the PICO(T) clinical question. The four selected articles are:
“Daily Nursing Home Staffing Levels Highly Variable, Often Below CMS Expectations” by Geng et al. published in Health Affairs (Project Hope) in 2019;
“Appropriate Nurse Staffing Levels for U.S. Nursing Homes” by Harrington et al. published in Health Services Insights in 2020;
“Failure to Meet Nurse Staffing Standards: A Litigation Case Study of a Large US Nursing Home Chain. Inquiry” by Harrington et al. published in a Journal of Medical Care Organization, Provision and Financing in 2018;
“The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes” by Harrington et al. published in Health Services Insights in 2016.
Picture by: https://paperpile.com/g/find-credible-sources/
Summary of Evidence: Quantitative & Qualitative
Quantitative:
In 2014, the U.S. Medicare reported 33% of its members in nursing homes faced harmful incidence (Harrington et al., 2016).
CMS expected staffing levels of nursing homes based on residents’ acuity should be a total of 4.17 nursing hprd, out of which is 1.08 RN hprd (Harrington et al., 2016).
Based on Payroll-Based Journal (PBJ) data, 75% of nursing homes were not compliant with the requirement of “RN staffing level based on resident acuity in 2017-2018” (Geng et al., 2019, p. 1099).
More than 28,000 nursing home residents and workers died by 2020 due to COVID-19 (Harrington et al., 2020).
Kelemua
As stated in Harrington et al. (2016) according to the 2014 report of the U.S. Office of the Inspector General on the national incidence among medicare beneficiaries in nursing homes, 33% of nursing home residents who were beneficiaries of medicare experienced adverse events between the years 2008-2012; and more than 59 % of these adverse events were preventable.
Although Nursing Home Reform Act of 1987 that was passed by the U.S. Congress set minimum staffing requirement, the 2017-2018 Payroll-Based Journal Staffing data of Centers for Medicare and Medicaid Services (CMS) shows that more than 75% of nursing homes were non-compliant (Geng et al., 2019).
According to Harrington et al. (2020) “lower staffing levels in facilities before the pandemic made these facilities more vulnerable to the coronavirus, resulting in more than 28,000 U.S. nursing home resident and worker deaths by May 11, 2020” (p. 12).
Picture by: https://omniupdate.com/blog/posts/2018/understanding-quantitative-data-from-content-audit.html
Summary of Evidence Continued
Qualitative:
Lack of sufficient nurse staffing level to provide safe and appropriate care put the safety of residents in jeopardy (Harrington et al., 2018).
Research shows a positive connection between better staffing levels in nursing homes and quality of care (Harrington et al., 2020).
Nursing homes can establish the sufficiency and appropriateness of their nurse staffing levels taking the resident acuity into consideration (Harrington et al., 2020).
Kelemua/Roseline
Based on a historical case study that examined the impact of staffing levels on the quality outcomes of resident care, it was indicated that inadequate staffing levels in the nursing homes resulted in residents’ “injury, and deaths, as well as violations of their rights to human dignity” (Harrington et al., 2018, p. 9).
Harrington et al. (2020) state that number of researches indicate that “higher nurse staffing improves both the process and outcome measures of nursing home quality” (p. 1). Fewer adverse events such as pressure ulcers and decreased incidence of infections are associated with higher RN staffing levels (Harrington et al., 2020).
Harrington et al. (2020) recommended a five step guideline that can be used by nursing homes to determine their staffing levels. The five steps include determining appropriate nurse staffing levels by assessing and identifying residents acuity and care needs, and the nursing home’s actual staffing per resident per day (Harrington et al., 2020).
Recommended Practice Change
Recommended state minimum staffing levels in each facility is essential to providing professional nursing value (Harrington et al, 2016).
Staffing increases would lead to improved quality of care.
Additional alternative method would be to transform excessive facility profits and overhead to overall staffing and patient care.
Lidiya Eshetu
Strategies for Implementation of Measurable Outcomes
Don't overwork staff
Collaborate with staff to set measurable goals
In person communication and collaborations with staff
Increase staff numbers - Lowering staff labor costs may be viewed as a cost efficient solution but this can have a negative impact on the quality of care being delivered and patient outcomes.
Set incentives - Not only will this keep the staff’s morale high but it will also increase job satisfaction and productivity.
Lidiya Eshetu
Nursing home staffing is considered safe when the availability of appropriate nursing care on a shift-to-shift basis results in patient care needs being met in a hazard-free work environment (Harrington et al, 2016).
Collaborate with staff
By focusing more on thier individual performance
Develop EBP and budget friendly approaches to optimizing labor costs
Provide adequate training
Hold regular staff meetings and ask for staff feedbacks on issues that can be improved.
Barriers
Shortage of nurses in nursing home is number one barrier to staffing problems across the United States.
Lack of competitive pay for nurses leads to inadequate staffing. Low pay rate does not encourage nurses to stay long in home. They leave whenever they get attractive pay rate.
Heavy workload on nurses is a problem. Nurses are burnout, when one nurse is to care for 40 patients on his or he shift.
The cost involved in hiring and training nurses is very expensive.
Leadership and staff culture that is not supportive of staff can contribute to staff turnover.
Roseline Teye
Lack of of adequate staffing in the nursing homes play a very important role when it come to care. A care home with enough nurses provide patients with good quality of care. If nurses are been pay well, they would not leave for attractive pay rate, and there would be more nurses on every shift at any point in time. Leadership and staff culture is big issue when it come to care. In any work environment leadership and staff culture support play a big role. Leaders serve as skills personals in healthcare. Staff with culture competent background understand patient points of view during treatment. There is a relationship between heavy workload on nurses and patients care with staffing issues (Buljac-Samardžić M al et). There is a prove that when the workload is decrease on nurses, the care was improved in all the home where the survey is carry. The cost of training is very newly hiring nurses is expensive and for nurses to stay at post, all the barrier must be resolved with adequate staffing with competitive pay. (Houser J., 2018). Lastly, leadership and staff culture that is not supportive of staff can contribute to staff turnover.
References
Buljac-Samardžić M, van Woerkom M (2018) Improving quality and safety of care in nursing homes by team support for strengths use: A survey study. PLoS ONE 13(7): e0200065. https://doi.org/10.1371/journal.pone.0200065
Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones & Bartlett
.
Description of Group Process
Description of research process:
Identified the problem
Formulated a clinical question
Used a database search to find evidence to support the clinical question
Recommend changes to clinical practice to improve on the problem
Identified barriers to implementation
What went well: communication via group text, sharing of workload and ideas, time management
What is still needed: real world application to determine the validity of our recommended changes
Liz
During our research process, we identified the problem, formulated a clinical question, used database searches to find evidence to support the clinical question, recommended changes to clinical practice to improve on the problem, and identified barriers to implementation.
What went well: Our group maintained good communication via group text. We shared the workload and equally contributed ideas. We also had good time management.
What is still needed: One thing we would add is real world application of our proposed strategies to determine the validity of our recommended changes.
Conclusion
Picot Question: Does an increase in staffing level in nursing homes improve the overall safety of residents by preventing the occurrence of adverse events and improving patient outcomes?”
Conclusion: Appropriate staffing numbers are essential for patient, culture, and satisfaction
Recommendations: increase staffing numbers, higher state mandated staffing levels and the conversion of excess profits to increase staffing and improve patient care
Barriers: Lack of competitive pay, heavy workload, cost of hiring and training nurses, leadership and staff culture
Liz
As a group, we successfully created the PICOT question “Does an increase in staffing level in nursing homes improve the overall safety of residents by preventing the occurrence of adverse events and improving patient outcomes?” Our conclusion is that staffing is one of the major contributing factors for patient safety culture in nursing homes. Appropriate staffing numbers are essential for patient, culture, and satisfaction. In addition to increase staffing numbers, we recommend higher state mandated staffing levels and the conversion of excess profits to increase staffing and improve patient care. Potential barriers to adequate staffing include Lack of competitive pay, heavy workload, cost of hiring and training nurses, leadership and staff culture.
References
Buljac-Samardžić M, van Woerkom M (2018) Improving quality and safety of care in nursing homes by team support for strengths use: A survey study. PLoS ONE 13(7): e0200065. https://doi.org/10.1371/journal.pone.0200065
Chamberlain College of Nursing. (2020). NR449 Unit 1 Lesson: Introduction to Evidence-Based Practice: Basic Concepts. [Online lesson]. Downers
Grove, IL: DeVry Education Group
Geng, F., Stevenson, D. G., & Grabowski, D. C. (2019). Daily Nursing Home Staffing Levels Highly Variable, Often Below CMS Expectations. Health Affairs (Project Hope), 38(7), 1095–1100. https://doi.org/10.1377/hlthaff.2018.05322
Harrington, C., Dellefield, M. E., Halifax, E., Fleming, M. L., & Bakerjian, D. (2020). Appropriate Nurse Staffing Levels for U.S. Nursing Homes. Health Services Insights, 1–14. https://doi.org/10.1177/1178632920934785
Harrington, C., & amp; Edelman, T. S. (2018). Failure to Meet Nurse Staffing Standards: A Litigation Case Study of a Large US Nursing Home Chain. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 55,46958018788686. https://doi.org/10.1177/0046958018788686
Harrington, C., Schnelle, J. F., McGregor, M., & Simmons, S. F. (2016). The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes. Health Services Insights, 9, 13–19. https://doi.org/10.4137/HSI.S38994
Houser, J. (2018). Nursing Research: Reading, Using, and Creating Evidence (4th ed.). Jones & Bartlett.
Klauber, M. (2001, February 01). The 1987 Nursing Home Reform Act. Retrieved August 18, 2020, from https://www.aarp.org/home-garden/livable-communities/info-2001 /the_1987_nursing_home_reform_act
