scholarly journals Association between the nurse work environment and severe maternal morbidity in high-income countries: A systematic review protocol

2020 ◽  
Author(s):  
Kyrah K Brown ◽  
Jessica G. Smith ◽  
RaeAnna L Jeffers ◽  
Claudy Jean Pierre
Keyword(s):  
Systematic Review ◽  
Work Environment ◽  
Patient Outcomes ◽  
Maternal Morbidity ◽  
The United States ◽  
High Income ◽  
Future Research ◽  
Cochrane Central Register ◽  
Related Factors ◽  
Nurse Work Environment

Abstract Background The United States has the highest maternal mortality and morbidity rates compared to its high-income peer nations. In high-income nations, a considerable amount of maternal morbidity cases are preventable and linked to provider-related factors. Better nurse work environments are associated with positive patient outcomes, but little is known about its impact on maternal morbidity. In this systematic review, we aim to identify the association between nurse work environment and maternal morbidity, specifically in high-income countries. Methods This systematic review will include original articles on the association between nurse work environment and maternal morbidity. CINAHL, PubMed/Medline and the Cochrane Central Register of Controlled Trials will be searched to retrieve potential original articles that are published between 1990 and 2019 in English language. Citations will be screened by two reviewers, in two rounds, for inclusion based on a priori inclusion and exclusion criteria. Data extraction templates will be populated with data to evaluate the methodological and reporting quality of each study. A combination of structured narrative synthesis and quantitative summaries in tabular format will allow for discussion and recommendations for future research. Discussion Results from this systematic review will provide evidence to elucidate the association between nurse work environment and maternal morbidity. While there is strong evidence demonstration the relation between nurse work environment and general patient outcomes, less is known about its influence on maternal morbidity. Findings from this review will help to guide research in the field and nursing professional in the development of targeted practices and policies aimed at reducing the rates of maternal morbidity.

Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

2021 ◽  
Author(s):  
Rachel A Prusynski ◽  
Allison M Gustavson ◽  
Siddhi R Shrivastav ◽  
Tracy M Mroz
Keyword(s):  
United States ◽  
Systematic Review ◽  
Patient Outcomes ◽  
Hospital Readmissions ◽  
The United States ◽  
Skilled Nursing Facilities ◽  
Functional Improvement ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

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