Annual review of nursing research
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The most visible threats to patient safety associated with nursing care occur on hospital inpatient units. Patient safety research is a new phenomenon, but it builds on the knowledge provided by quality-of-care research done previously. The purpose of this chapter is to describe the current state of the science in the area of nurse staffing and patient safety. ⋯ Although research linking nurse staffing to the quality of patient care has increased markedly since 1996, the results of recent research projects do not yet provide a thorough and consistent foundation for producing solutions to the crisis in hospital nursing care. The inconsistencies are largely due to differing units of analysis (hospital, patient, care unit), variability in measures of nurse staffing, the variety of quality indicators chosen, the difficulty finding accurate measures of these indicators, and the difficulty creating risk-adjustment strategies for the indicators most sensitive to nursing care. Nursing administration and policy most urgently need research conducted with standardized data collected at the patient care unit level.
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The number of older persons in the United States is rapidly growing and, based on this growth projection, the number of consumers needing nursing home (NH) care will likely triple in the next 10 years. Although NHs have been bombarded and scrutinized about the care that they provide, the concept of safety (specifically, error prevention) remains at the margin of most quality improvement efforts. The purpose of this review is to explore what has recently been written (2000-2005) about the evolution of the NH as an organization focused on safety and the most critical clinical processes that must be closely monitored for a safe NH environment to occur. ⋯ This will help all members of the team to identify care improvement opportunities. Finally, a new frontier for the NH setting is the use of technology and the need to harness the information that has set in the NH system for years. Information mastery for staff and leadership is a necessary aspect of the organization that must be developed to provide sound information for strategic and focused change to occur.
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Falls and related injuries are increasingly being recognized as a nursing-sensitive quality indicator, and they continue to be an unsolved patient safety problem in inpatient and outpatient care areas as well as in the community at large. The purpose of this review is to summarize the current research related to fall and injury prevention. The chapter is organized presenting research in (1) the community and (2) acute and long-term care settings. ⋯ There is a large body of research that investigates fall and injury prevention across the care continuum. In the community setting, targeted risk evaluation in the emergency department and management of vitamin D deficiency appear to be promising preventive methods. However, further research needs to explore staffing ratios, automated methods of assessing and communicating fall risk, improved methods and timing of risk evaluation and methods by which existing and new evidence might be translated into practice.
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Limited access to health care and a system fraught with discriminatory practices inhibit some racial and ethnic minorities from gaining access to health care and assurance of equal treatment once they enter the health care system. The purpose of this chapter is to critically and systematically analyze the research literature to determine what impact individual and institutional racism has had on the prevailing health disparities across racial and ethnic minority groups. The chapter includes the following: (1) a review of the term racism and a brief overview of the history of racism in health care; (2) a review of the research literature analyzing the impact of racism on health disparities; and (3) recommendations to end the systematic institutional racism in scientific research, which is necessary to end health disparities.
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Discoveries, breakthroughs, and advances made in the area of cancer prevention and cancer control over the last 2 decades have led to declines in the rates of cancer incidence and mortality and increases in life expectancy and survival for many cancer patients. However, although the trends relative to cancer incidence, mortality, and 5-year survival for the nation as a whole have significantly improved, data reveal that there are significant disparities in the degree to which the burden of cancer that remains is borne by racial and ethnic minority population groups. As a practice-oriented discipline grounded in research, nursing could have a dominant role in efforts aimed toward eliminating the cancer disparities experienced by racial and ethnic population groups. ⋯ However, given that few efforts have been undertaken to comprehensively review and critique this body of research, little is known about the scope, quality, and potential impact of this body of nursing science. This report presents the results of one of the first comprehensive reviews of nursing research undertaken to explore and address factors associated with the evolution of the cancer-related health disparities in ethnic and racial minority population groups within the United States. The findings reveal that, while the body of nursing research has contributed much to the identification and understanding of factors associated with the excess cancer morbidity and mortality of minority populations, in order for the profession to more fully contribute to the elimination of cancer-related disparities, there is a need for nurses to further expand and strengthen this base of knowledge.