Nursing Workforce and quality of care

Theorizing a sociology of emotion that links micro-level resources to macro-level forces, this article extends previous work on emotional capital in relation to emotional experiences and management. Emerging from Bourdieu's theory of social practice, emotional capital is a form of cultural capital that includes the emotion-specific, trans-situational resources that individuals activate and embody in distinct fields. Contrary to prior conceptualizations, I argue that emotional capital is neither wholly gender-neutral nor exclusively feminine. Men may lay claim to emotional capital as a valued resource within particular fields. The concept of emotional capital should be seen as distinct from emotion management and felt emotional experience and distinctions between primary and secondary sources of capital clarify the simultaneously durable and evolving nature of capital and the habitus. To illustrate these conceptual refinements, I use interview and diary data from male nurses. Men bring primary emotional capital, developed during primary socialization, to the nursing profession while also developing secondary capital through occupational socialization centered on empathy and compassion. The construct of emotional capital is refined as a structured yet dynamic resource developed through primary and secondary socialization and activated and embodied in everyday emotion practice.

In 2012, the National Database of Nursing Quality Indicators launched a project to expand its falls indicator for use on pediatric, neonatal, and psychiatric units. We discuss challenges encountered, argue that schemes for categorizing falls by cause or supposed preventability are not suitable for large-scale efforts to track and prevent falls, express concern about the growing burden of collecting increasingly granular quality data, and discuss limitations of total and injurious fall rates as quality measures.

Background ‘Failure to rescue’ – death after a treatable complication – is used as a nursing sensitive quality indicator in the USA. It is associated with the size of the nursing workforce relative to patient load, for example patient to nurse ratio, although assessments of nurse sensitivity have not previously considered other staff groups. This study aims to assess the potential to derive failure to rescue and a proxy measure, based on long length of stay, from English hospital administrative data. By exploring change in coding practice over time and measuring associations between failure to rescue and factors including staffing, we assess whether two measures of failure to rescue are useful nurse sensitive indicators. Design Cross sectional observational study of routinely collected administrative data. Participants Discharge data from 66,100,672 surgical admissions to 146 general acute hospital trusts in England (1997–2009). Results Median percentage of surgical admissions with at least one secondary diagnosis recorded increased from 26% in 1997/1998 to 40% in 2008/2009. Regression analyses showed that mortality based failure to rescue rates were significantly associated (P < 0.05) with several hospital characteristics previously associated with quality, including staffing levels. Lower rates of failure to rescue were associated with a greater number of nurses per bed and doctors per bed in a bivariate analysis. Higher total clinically qualified staffing (doctors + nurses) per bed and a higher number of doctors relative to the number of nurses were both associated with lower mortality based failure to rescue in the fully adjusted analysis (P < 0.05); however, the extended stay based measure showed the opposite relationship. Conclusion Failure to rescue can be derived from English administrative data and may be a valid quality indicator. This is the first study to assess the association between failure to rescue and medical staffing. The suggestion that it is particularly sensitive to nursing is not clearly supported, nor is the suggestion that the number of patients with an extended hospital stay is a good proxy.

The ramifications of patient migration toward the foot of the bed in intensive care units are not well understood. Migration may cause shear and friction between the patient and the mattress, reduce elevation of the patient&#39;s torso, and require frequent repositioning of the patient. This study assesses how bed design impacts both the amount of migration that patients undergo during head section articulation to 30° and 45° and the extent of torso compression following the articulation.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

This paper based on my inaugural lecture discusses nursing workforce research, focusing on skill mix and
substitution, and considers how optimistic readings of research may ultimately be self-defeating for the professions, as well
as dangerous for patients. Two core examples are used to illustrate these ‘optimistic’ readings. Research on nursing-led inpatient
units – initially heralded as ‘proof’ of the independent therapeutic contribution of nursing – ultimately led to a less
optimistic conclusion for the profession when early results were not confirmed. Research exploring associations of the link
between nurse staffing and patient outcomes has been used to advance policies such as mandatory nurse to patient ratios
even though stronger associations are shown between patient outcomes and the working environment. The implications of
research showing associations between number of medical staff and patient outcomes have not been considered. Future
developments in the nursing workforce are underpinned by assumptions about the potential cost effectiveness of substituting
assistant practitioners with lower qualifications for registered nurses. Little evidence supports this and it is important that
changes are regarded as experiments in need of careful evaluation. The evidence on the impact of workforce characteristics
on outcomes presents a complex picture. The ‘easy’ answer is usually not the ‘right’ answer. While it may be that nurses are
more threatened as a professional group than doctors, both professions need to adapt to future demands. It is clear that
we simply don’t yet know what the best or right skill mix is. Nurses (and midwives) can substitute for doctors under some
circumstances but “cheaper” staff does not necessarily equal cheaper care. We don’t know if assistant practitioners can safely
substitute for nurses or whether such substitution is cost effective. The answer is likely to depend on exactly what substitution
occurs and where.

Background: An important goal of home health care is to assist
patients to remain in community living arrangements. Yet home
care often fails to prevent hospitalizations and to facilitate discharges
to community living, thus putting patients at risk of additional
health challenges and increasing care costs.
Objectives: To determine the relationship between home health
agency work environments and agency-level rates of acute hospitalization
and discharges to community living.
Methods and Design: Analysis of linked Center for Medicare and
Medicaid Services Home Health Compare data and nurse survey
data from 118 home health agencies. Robust regression models
were used to estimate the effect of work environment ratings on
between-agency variation in rates of acute hospitalization and
community discharge.
Results: Home health agencies with good work environments had
lower rates of acute hospitalizations and higher rates of patient

ABSTRACT
Theory on men and masculinities has emphasized practice—
situated action—as the key site to analyze masculinity. Individual
and organizational practices as well as cultural resources are sites
to investigate gender dominance. Similarly, though more recently,
theory on emotion has called for a shift toward an emotion-as-practice
approach in which emotion is seen as both an outcome
and resource situationally activated and embodied by constrained
actors. Using empirical work on men in nursing, this article
develops a synthesis of masculine and emotion practice.
Bourdieu’s [(1990). The logic of practice. (R. Nice, Trans.). Stanford,
CA: Stanford University Press] broader notion of social practice
provides a link between the two fields. Reflections from men in
nursing suggest a new masculine ideal centered on the
emotionally adept man. Rather than signal an alternative form of
masculinity that challenges gender dominance, these changes
might signal a new hegemony—a reconfiguration of practices
better suited to an era of post-industrialization. Economic shifts,
including an increase in both the number of middle-class women
in the labor force and the number of emotionally demanding,
service-based jobs, may be the catalyst for a new ideal,
particularly for white, middle-class men.

Heart failure has become the world's problem due high rate of morbidity, mortality, hospitalization, and disability. Nursing is a professional field which can become caring concepts development. The objective of the research was to examine caring model on quality of nursing care in heart failure patients. The research used quasi-experiment method. It was conducted at RSUP Haji Adam Malik, Medan. The sampels were 64 patients as respondent that consisted of 32 respondents in the intervention group and the other 32 respondents in the control group, taken by using purposive sampling technique. The subjects of the research were 16 nurses that consisted of 8 nurses in the intervention group and the other 8 nurses in the control group. The data were gathered by using questionnaires and analyzed by using independent t-test. The result of the mean quality of nursing care, measured by using GNCS, in the intervention group was 4.15 and in the control group was 4.10. The result of independent t-test showed that quality of nursing care between the intervention group and the control group was t=-2.26 and p=0.02 which indicated that there was the discrepancy in quality of nursing care between the intervention group and the control group. It is recommended that nurses increase quality of nursing care by applying caring model. Keyword: caring, heart failure, quality of nursing care ABSTRAK Gagal jantung masih menjadi permasalahan dunia karena tingginya angka morbiditas, mortalitas, hospitalisasi, dan disabilitas. Keperawatan adalah suatu bidang profesional yang dapat menjadi perkembangan konsep caring. Tujuan penelitian ini adalah menguji model caring terhadap kualitas asuhan keperawatan pada pasien gagal jantung. Desain penelitian ini adalah Quasi-eksperimen. Total sampel pasien dalam penelitian ini adalah 64 pasien gagal jantung, tiga puluh dua responden kelompok intervensi dan tiga puluh dua responden pada kelompok kontrol. Total subjek perawat dalam penelitian ini adalah 16 perawat, delapan responden kelompok intervensi dan delapan responden kelompok kontrol. Penelitian dilakukan di Rumah Sakit Umum Pusat H. Adam Malik, Medan. Pengambilan sampel dengan menggunakan teknik purposive sampling. Pengumpulan data dengan menggunakan kuesioner, analisa data dengan menggunakan Independent t-test. Hasil mean kualitas asuhan keperawatan yang diukur dengan GNCS pada kelompok intervensi sebesar 4.15 dan pada kelompok kontrol sebesar 4.10. Hasil Independent t-test pada kualitas asuhan keperawatan antara kelompok intervensi dan kontrol menunjukkan t=-2.26, dengan nilai p=0.02. Penelitian ini menunjukkan ada perbedaan kualitas asuhan keperawatan antara kelompok intervensi dan kontrol. Hasil penelitian ini merekomendasikan kepada perawat dapat meningkatkan kualitas asuhan keperawatan dengan menerapkan model caring tersebut.