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Chae, Song, Kang, and Lee: Impact of Nurse Staffing Level and Oral Care on Hospital Acquired Pneumonia in Long-term Care Hospitals
Original Article

Journal of Korean Academy of Nursing Administration 2015; 21(2): 174-183.

Published online: 31 March 2015

DOI: https://doi.org/10.11111/jkana.2015.21.2.174

Impact of Nurse Staffing Level and Oral Care on Hospital Acquired Pneumonia in Long-term Care Hospitals

Jung Mi Chae1, Hyunjong Song2, Gunseog Kang3, Ji Yun Lee4

1Health Insurance Review & Assessment Research Department, Korea.

2Department of Health Policy and Management, Sangji University, Korea.

3Department of Statistics and Actuarial Science, Soongsil University, Korea.

4Department of Nursing, Kangwon National University, Korea.

Corresponding author: Lee, Ji Yun. Department of Nursing, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon 200-701, Korea. Tel: +82-33-250-8885, Fax: +82-33-242-8840, leejiyun@kangwon.ac.kr

Received 20 October 2014       Revised 26 December 2014       Accepted 29 January 2015

Copyright © 2015 Korean Academy of Nursing Administration

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to explore the impact of nurse staffing level and oral care on pneumonia in elderly inpatients in long-term care hospitals (LTCHs).

Methods

Data were obtained from the Health Insurance Review and Assessment Services (HIRA) including the profiles of LTCHs, monthly patient assessment reports and medical report survey data of pneumonia patients by HIRA in the fourth quarter of 2010. The sample consisted of 37 LTCHs and 6,593 patients.

Results

Patient per nurse staff (OR=1.43, CI=1.22~1.68) and no oral care (OR=1.29, CI=1.01~1.64) were significantly related with hospital acquired pneumonia. The difference in percent of oral care by hospital was not significant between high and low group in nurse staffing level.

Conclusion

In order to reduce the occurrence of pneumonia in eldery patients, effective nursing interventions are not only required but also nurse staffing levels that enable nurses to provide the intervention.

Keywords: Nurse staffing, Oral care, Patient outcome, Pneumonia, Long term care

Figures and Tables

Table 1

Hospital and Patient Characteristics

jkana-21-174-i001

ADL=Activities of daily living.

Table 2

Staffing Level, Percent of Oral Care and Pneumonia Patients in the Hospitals (N=37)

jkana-21-174-i002

*Nursing staff include registered nurses and nursing assistants.

Table 3

Difference of Hospital Nurse Staffing Level by Provision of Oral Care (N=37)

jkana-21-174-i003

*Skill mix means percent of registered Nurses in nursing staff.

Table 4

Impact of Nurse Staffing Level on Provision of Oral Care in Long-term Care Hospitals (N=37)

jkana-21-174-i004

OR=Odds ratio; Ci=Confidence interval.

Table 5

Impact of Nurse Staffing Level and Oral Care on Hospital Acquired Pneumonia in Long-term Care Hospitals (N=6,593)

jkana-21-174-i005

OR=Odds ratio; Ci=Confidence interval.

References

1. Statistics Korea. Annual report on the causes of death statistics 2012. Daejeon: Statistics Korea;2013.
2. Attridge RT. Healthcare-associated pneumonia: Refining the HCAP criteria [Internet]. Texas: The University of Texas at Austin College of Pharmacy;2009. cited 2014. May 21. Available from: http://www.utexas.edu/pharmacy/divisions/pharmaco/rounds/11-20-09.pdf.
3. Chae JM, Song HJ, Park CM, Kim YJ. Management of pneumonia and sepsis development of inpatients in long term care hospital. Health Insurance Review & Assessment Service. 2012. 02. Report No:F8E-2012-19.
5. Fry AM, Shay DK, Holman RC, Cums AT, Anderson LJ. Trends in hospitalizations for pneumonia among persons aged 65 years or older in the United States, 1988-2002. JAMA. 2005; 294(21):2712–2719. DOI: 10.1001/jama.294.21.2712.
6. Shanley C, O'Loughlin G. Dysphagia among nursing home residents: An assessment and management protocol. J Gerontol Nurs. 2000; 26(8):35–48.
7. El-Solh AA. Nursing home acquired pneumonia: Approach to management. Curr Opin Infect Dis. 2011; 24(2):148–151. DOI: 10.1097/QCO.0b013e328343b6cc.
8. Abe S, Ishihara K, Adachib M, Okudaa K. Oral hygiene evaluation for effective oral care in preventing pneumonia in dentate elderly. Arch Gerontol Geriatr. 2006; 43(1):53–64. DOI: 10.1016/j.archger.2005.09.002.
9. Yoneyama T, Yoshida M, Matsui T, Sasaki H. Oral care and pneumonia. Lancet. 1999; 354(9177):515. DOI: 10.1016/S0140-6736(05)75550-1.
10. Sjögren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: Effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 2008; 56:2124–2130. DOI: 10.1111/j.1532-5415.2008.01926.x.
11. Unruh L. Licensed nurse staffing and adverse events in hospitals. Med Care. 2003; 41(1):142–152. DOI: 10.1097/01.mlr.0000039835.19305.1d.
12. Needleman J, Buerhaus S, Mattke M, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care of hospitals. N Engl J Med. 2002; 346(22):1715–1722. DOI: 10.1056/NEJMsa012247.
13. Kovner C, Jones C, Zhan C, Gergen PJ, Basu J. Nurse staffing and postsurgical adverse events: An analysis of administrative data from a sample of U.S. hospitals, 1990-1996. Health Serv Res. 2002; 37(3):611–629. DOI: 10.1111/1475-6773.00040.
14. Zimmerman S, Gruber-Baldini AL, Hebel JR, Sloane PD, Magaziner J. Nursing home facility risk factors for infection and hospitalization: Importance of registered nurse turnover, administration and social factors. J Am Geriatr Soc. 2002; 50:1987–1995. DOI: 10.1046/j.1532-5415.2002.50610.x.
15. Kim Y, Cho SH, June KJ, Shin SA, Kim J. Effect of hospital nurse staffing on in-hospital mortality, pneumonia, sepsis, and urinary tract infection in surgical patients. J Korean Acad Nurs. 2012; 42(5):719–729. DOI: 10.4040/jkan.2012.42.5.719.
16. Donabedian A. The quality of care: How can it be assessed? JAMA. 1988; 260(12):1743–1748. DOI: 10.1001/jama.1988.03410120089033.
17. Spilsbury K, Hewitt C, Stirk L, Bowman C. The relationship between nurse staffing and quality of care in nursing homes: A systematic review. Int J Nurs Stud. 2011; 48:732–750. DOI: 10.1016/j.ijnurstu.2011.02.014.
18. Bostick JE, Rantz MJ, Flesner MK, Riggs CJ. Systematic review of studies of staffing and quality in nursing homes. J Am Med Dir Assoc. 2006; 7:366–376. DOI: 10.1016/j-jamda.2006.01.024.
19. Castle NG, Anderson RA. Caregiver staffing in nursing homes and their influence on quality of care using dynamic panel estimation methods. Med Care. 2011; 49(6):545–552. DOI: 10.1097/MLR.0b013e31820fbca9.
20. Arling G, Kane RL, Mueller C, Bershadsky J, Degenholtz HB. Nursing effort and quality of care for nursing home residents. Gerontologist. 2007; 47(5):672–682. DOI: 10.1093/geront/47.5.672.
21. Zhang X, Grabowski DC. Nursing home staffing and quality under the nursing home reform act. Gerontologist. 2004; 44(1):13–23. DOI: 10.1093/geront/44.1.13.
22. Lee JY, Kim EY, Cho E. Factors impacting the physical function of older adults in Korean long-tern care hospitals. J Korean Acad Nurs. 2011; 41(6):780–787. DOI: 10.4040/jkan.2011.41.6.780.
23. Yoon JY, Lee JY, Bowers BJ, Zimmerman DR. The impact of organizational factors on the urinary incontinence care quality in long-term care hospitals: A longitudinal correlational study. Int J Nurs Stud. 2012; 49:1544–1551. DOI: 10.1016/j.ijnurstu.2012.07.011.
24. Kim YA, Lee JY, Kim HS, Hwang JH. A comparison of nursing problems identified through RAI-FC and by nurses caring for nursing home residents. J Korean Gerontol Nurs. 2011; 13(1):58–68.
25. Bates-Jensen BM, Schnelle JF, Alessi CA, Al-Samarrai NR, Levy-Storms L. The effect of staffing on in-bed times and nursing home residents. J Am Geriatr Soc. 2004; 52:931–938. DOI: 10.1111/j.1532-5415.2004.52260.x.
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