Nursing care received by older patients in Italian medical units: findings from an explorative study
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Nursing care received by older patients in Italian medical units: findings from an explorative study Alvisa Palese • Marina Cuel • Paolo Zanella Paola Zambiasi • Annamaria Guarnier • Elisabetta Allegrini • Luisa Saiani
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Received: 18 October 2012 / Accepted: 7 June 2013 / Published online: 19 October 2013 Ó Springer International Publishing Switzerland 2013
Abstract Background According to available evidence, when the nurse-to-patient ratio is insufficient the occurrence of accidental falls, pressure sores, malnutrition, hospitalacquired dependency in activities of daily living, infections associated with nursing practice and errors in administration of medication as well as mortality all increase. However, while several countries have established a body of evidence and policies concerning the minimum nurse-topatient ratio, the amount of nursing care offered in Italian medical units remains under-studied. Methods Evaluating variability in the nurse-to-patient ratio and in the skill-mix offered, 12 medical units willing to participate were evaluated with a face-to-face interview performed by a researcher to the nurse manager of the unit. The role of the unit at the hospital level, the nurse-topatient ratio available on a daily basis, the skill-mix and the
A. Palese (&) School of Nursing, Udine University, Viale Ungheria 20, 33100 Udine, Italy e-mail: [email protected] M. Cuel P. Zanella School of Nursing, Polo Universitario di Trento, Verona University, Verona, Italy P. Zambiasi A. Guarnier Azienda per i Servizi Sanitari Provinciali di Trento, Trento, Italy E. Allegrini Azienda Ospedaliero-Universitaria Verona, Verona, Italy L. Saiani School of Nursing, Verona University, Verona, Italy
strategies enacted in the case of patient overcrowding or understaffing were collected. Results The mission of the medical units is devoted mainly towards elderly people. The bed occupancy is high and the strategies adopted in case of patient overcrowding determine unstable environments both for medical units (extra beds) and other units (patients temporarily hosted). In the medical units, nurses attend to 5–13 patients in the morning, 7.6–14.6 in the afternoon, and 12.3–30.5 during the night. The skill-mix ranges from 43.5 % (more nursing aides than nurses are available on the ward) to 81.2 % (more nurses than nursing aides are available). Conclusions This assessment exercise indicates that nursing care in medical units faces high workloads. Establishing national minimum standards of nursing care to be delivered towards older people admitted in Italian medical units is recommended. Keywords Nurse-to-patient ratio Skill-mix Medical units Aged Italy
Introduction With the worldwide growing elderly population, their level of vulnerability, as well as their risk to being admitted in the hospital for acute or decompensate chronic conditions the scientific and professional debate regarding the number of nurses needed at the bedside has recently increased with controversial results [1, 2]. From the e
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