Summary Background Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making ...about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. Methods For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. Findings An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Interpretation Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. Funding European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.
Die Beiträge in diesem Open-Access-Sammelband beschreiben und analysieren aus multidisziplinärer Sicht die Herausforderungen und Bewältigungsstrategien von Alterung und Pflege in japanischen und ...deutschen Gemeinden. Thematisiert werden rechtliche Rahmenbedingungen, zivilgesellschaftliches Engagement, Pflegekräftemangel, Technologiekonzepte für die Pflege und schließlich auch der Einfluss der Covid-19 Pandemie auf die Situation älterer und pflegebedürftiger Bürgerinnen und Bürger. Die Gegenüberstellung der Ansätze und Erfahrungen beider Länder erweitert das Spektrum an Gestaltungsmöglichkeiten und kann Impulse für eine Neuausrichtung bestehender Lösungsstrategien geben.
The flipped classroom (FC) andragogy purports an improvement of critical thinking and problem-solving skills in students. This literature review explores fourteen research studies and discusses ...outcome measures reported on the effectiveness of using this teaching modality. Students described the learning activities during the classroom meeting times as valuable and indicated the interaction and engagement were beneficial to their learning. Many students opined an increased comprehension of the subject matter. Overall, the FC required more work on the part of the students and the faculty, and the majority of students preferred the traditional classroom (TC) passive method of learning over the FC active learning andragogy as a result of the substantial time commitment required for preparation necessitated by the FC. Five of the fourteen studies evaluated student learning outcome measures; four studies showed an improvement in the FC environment compared to the TC and one reported the FC was at least as effective as the TC. Further studies with quantifiable outcome measures are required to determine the effectiveness of a FC on critical thinking and problem-solving skills of nursing students.
•Flipped classroom demonstrated increased knowledge for some students.•Faculty observed enhanced learning and critical thinking in some students.•Further studies with quantifiable outcome measures are recommended.
Globally nurses and midwives are working hard to detect cases of COVID‐19, to save lives or give comfort in the face of death, to educate themselves and the public about protective measures to stop ...the viral spread, while still caring for those not infected with the virus. In many countries nurses are working under virtual siege from this pandemic, with not enough resources or personal protective equipment, overwhelming numbers of patients, staff shortages, underprepared health systems and supply chain failures. Nurses and other health and emergency workers are suffering physical and emotional stress, and moral distress from conflicting professional values. They are faced with unpalatable and complex ethical issues in practice, with moral conflicts, high levels of acuity and patient deaths, and long working hours. A rising number of nurses are infected with SARS‐CoV‐2 or dying in the line of duty. Nurses need strong moral courage, stamina and resilience to work on the front lines of the pandemic, often while separated from their loved ones.
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