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Using Multivariate Statistics

https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

ContextThe worsening hospital nurse shortage and recent California legislation
mandating minimum hospital patient-to-nurse ratios demand an understanding
of how nurse staffing levels affect patient outcomes and nurse retention in
hospital practice.ObjectiveTo determine the association between the patient-to-nurse ratio and
patient mortality, failure-to-rescue (deaths following complications) among
surgical patients, and factors related to nurse retention.Design, Setting, and ParticipantsCross-sectional analyses of linked data from 10 184 staff nurses
surveyed, 232 342 general, orthopedic, and vascular surgery patients
discharged from the hospital between April 1, 1998, and November 30, 1999,
and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.Main Outcome MeasuresRisk-adjusted patient mortality and failure-to-rescue within 30 days
of admission, and nurse-reported job dissatisfaction and job-related burnout.ResultsAfter adjusting for patient and hospital characteristics (size, teaching
status, and technology), each additional patient per nurse was associated
with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12)
increase in the likelihood of dying within 30 days of admission and a 7% (OR,
1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After
adjusting for nurse and hospital characteristics, each additional patient
per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase
in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in
the odds of job dissatisfaction.ConclusionsIn hospitals with high patient-to-nurse ratios, surgical patients experience
higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses
are more likely to experience burnout and job dissatisfaction.

https://jamanetwork.com/journals/jama/articlepdf/195438/JOC20547.pdf

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

The Social Psychology of Organizations.

ContextGrowing evidence suggests that nurse staffing affects the quality of
care in hospitals, but little is known about whether the educational composition
of registered nurses (RNs) in hospitals is related to patient outcomes.ObjectiveTo examine whether the proportion of hospital RNs educated at the baccalaureate
level or higher is associated with risk-adjusted mortality and failure to
rescue (deaths in surgical patients with serious complications).Design, Setting, and PopulationCross-sectional analyses of outcomes data for 232 342 general,
orthopedic, and vascular surgery patients discharged from 168 nonfederal adult
general Pennsylvania hospitals between April 1, 1998, and November 30, 1999,
linked to administrative and survey data providing information on educational
composition, staffing, and other characteristics.Main Outcome MeasuresRisk-adjusted patient mortality and failure to rescue within 30 days
of admission associated with nurse educational level.ResultsThe proportion of hospital RNs holding a bachelor's degree or higher
ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics
and hospital structural characteristics (size, teaching status, level of technology),
as well as for nurse staffing, nurse experience, and whether the patient's
surgeon was board certified, a 10% increase in the proportion of nurses holding
a bachelor's degree was associated with a 5% decrease in both the likelihood
of patients dying within 30 days of admission and the odds of failure to rescue
(odds ratio, 0.95; 95% confidence interval, 0.91-0.99 in both cases).ConclusionIn hospitals with higher proportions of nurses educated at the baccalaureate
level or higher, surgical patients experienced lower mortality and failure-to-rescue
rates.

/pdf/educational-levels-of-hospital-nurses-and-surgical-patient-3nt1t78029.pdf

Educational levels of hospital nurses and surgical patient mortality.

The current nursing shortage, high hospital nurse job dissatisfac- tion, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physi- cians appear satisfactory, core problems in work design and workforce manage- ment threaten the provision of care. Resolving these issues, which are amena- ble to managerial intervention, is essential to preserving patient safety and care of consistently high quality.

Nurses' Reports On Hospital Care In Five Countriese ways in which nurses' work is structured have left nurses

The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.

Nurses’ Reports On Hospital Care In Five Countries

The hospital nurse workforce is experiencing greater workloads resulting from shorter hospital stays, rising average patient acuity, fewer support resources, and a national nurse shortage. Higher nurse workloads are associated with burnout and job dissatisfaction, precursors to voluntary turnover that contribute to the understaffing of nurses in hospitals and poorer patient outcomes.1 Indeed, more than 40% of hospital staff nurses score in the high range for job-related burnout, and more than 1 in 5 hospital staff nurses say they intend to leave their hospital jobs within 1 year.2 The understaffing of nurses and the overwork of health professionals in hospitals are ranked by consumers as major threats to patient safety,3 and more patients are bringing their own caregivers to the hospital with them.4

Research on job-related burnout among human service workers, nurses in particular, suggests that organizational stressors in the work environment are important determinants of burnout and subsequent voluntary turnover.5-9 A largely separate research literature on patient satisfaction documents the importance of patients' satisfaction with nursing care in their overall ratings of satisfaction with their hospital care.10-13 This article examines the association between nurse burnout and patient satisfaction, and explores whether the factors that account for nurse burnout also account for patient dissatisfaction. The findings are important to understanding how to simultaneously stem the flight of nurses from hospital bedside care and improve patient satisfaction with care.

/pdf/nurse-burnout-and-patient-satisfaction-1qtkuz9afa.pdf

Sean P. Clarke

Papers

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

Educational levels of hospital nurses and surgical patient mortality.

Nurses' Reports On Hospital Care In Five Countriese ways in which nurses' work is structured have left nurses

Nurses’ Reports On Hospital Care In Five Countries

Nurse Burnout and Patient Satisfaction