Institute of Nursing Science, University of Basel, Switzerland. Electronic address: https://twitter.com/cathblatter.
Institute of Nursing Science, University of Basel, Switzerland.
Int J Nurs Stud. 2024 Feb;150:104641. doi: 10.1016/j.ijnurstu.2023.104641. Epub 2023 Nov 10.
Resident safety is an important topic for nursing home practice with up to 33 % of residents subjected to an adverse event. In spite of a large evidence base examining the relationship between nursing home staffing and resident outcomes, the findings of several systematic reviews remain inconclusive and contradicting, possibly due to methodological shortcomings.
The main aim of this review was to provide a comprehensive overview of the literature on nursing home staffing and its relationship with resident safety outcomes.
We undertook a systematic review of reviews. We searched Medline, CINAHL and Embase by the end of November 2022. Reviews were included if they assessed the relationship between nursing home staffing and resident safety outcomes using objective measures and data at resident level. Quality appraisal was conducted using the SIGN-checklist, but we did not exclude any reviews based on quality assessment. We used a narrative approach, tables and figures to summarize the findings.
We included 13 systematic reviews published between 2006 and 2022 building on primary evidence from 1977 to 2022. Twelve reviews investigated the relationship between nurse staffing and resident safety outcomes (187 unique primary studies), and one review focused on allied health professionals (28 primary studies). Five reviews originated as work to inform governmental recommendations on staffing. We found diverse approaches used to investigate the staffing-outcome relationship with regard to design, timeframe, operationalization, data-source and theoretical rationales guiding the studies. The most prominently reported resident safety outcomes were pressure ulcers and urinary tract infections. Commonly reported staffing measures included number and level of education of nursing home staff. Based on narrative summaries, staffing seems to have a favorable relationship with resident safety outcomes, but logic models explaining the mechanisms of this relationship were sparsely reported.
The existing literature shows methodological limitations that demand a change in research on the staffing-outcome relationship in the nursing home setting. Our work highlights the need for carefully designed primary studies that address the pertinent shortcomings by design, timeframe, operationalization, data-source and theoretical rationales. These future studies will allow to carefully examine the causal relationship between selected staffing measures and resident safety outcomes in further detail and serve as legitimate evidence bases to inform action plans for clinical practice and to evaluate staffing policies.
居民安全是养老院实践中的一个重要课题，多达 33%的居民遭受不良事件的影响。尽管有大量证据研究了养老院人员配备与居民结果之间的关系，但几项系统评价的结果仍不确定且相互矛盾，这可能是由于方法学上的缺陷。
本综述的主要目的是提供养老院人员配备及其与居民安全结果关系的文献综述。
我们对综述进行了系统评价。我们在 2022 年 11 月底之前检索了 Medline、CINAHL 和 Embase。如果综述使用客观测量和居民层面的数据评估了养老院人员配备与居民安全结果之间的关系，则将其纳入。使用 SIGN 清单进行质量评估，但我们没有根据质量评估排除任何综述。我们使用叙述方法、表格和图形来总结研究结果。
我们纳入了 2006 年至 2022 年期间发表的 13 项系统评价，这些评价基于 1977 年至 2022 年的原始证据。12 项综述调查了护士配备与居民安全结果之间的关系（187 项独特的原始研究），一项综述关注的是联合健康专业人员（28 项原始研究）。有 5 项综述最初是为了为人员配备的政府建议提供信息。我们发现，研究人员在设计、时间框架、操作化、数据源和指导研究的理论基础方面，使用了不同的方法来调查人员配备与结果的关系。最常报告的居民安全结果是压疮和尿路感染。常见的人员配备措施包括养老院工作人员的数量和教育水平。基于叙述性总结，人员配备似乎与居民安全结果呈正相关，但解释这种关系机制的逻辑模型报告很少。
现有文献表明，该领域的研究存在方法学上的局限性，需要改变养老院人员配备与结果关系的研究。我们的工作强调需要精心设计的原始研究，通过设计、时间框架、操作化、数据源和理论基础来解决相关的缺陷。这些未来的研究将能够更仔细地检查选定的人员配备措施与居民安全结果之间的因果关系，并作为为临床实践提供行动计划和评估人员配备政策的合法证据基础。
