Health Care System Needs Improvement for Patient Safety - Essay Sample

Introduction

There is a need to improve the health care system and the quality of care to patients. Some injuries are caused by a weak health care system. The health care workforce plays a vital role in ensuring patient safety and quality of work. There is a great association between nurse staffing and the safety of the patients. The work environment in Korea is a threat to safe nursing practices that are supposed to be conducted in hospitals. There is the restructuring of the health care system, but enough is yet to be done. The patient turnover is increasing, and the nurses' number is not keeping up to pace. This is putting a lot of burden and overwork on the existing nurses. The increased workload is an obstacle to providing quality care. There is a high tendency to slow response to emergencies, especially craniotomy patients who need special attention. Patient outcomes are affected by the registered nurse ratio as they are complications with the postoperative patients. The nurses work 24 hours a day to be able to detect changes in the condition regarding the patient. They are also able to respond promptly to the interventions needed. There has been a high rate of mortality due to inadequate nurse, and this has caused concern. This paper reviews how this has affected the health care system. The purpose of this study is to examine the correlation between nurses' staffing levels and the mortality rate among the craniotomy patients in Korea.

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Literature Review

The article in its review states that when there is a lack of the staffing at the required level, patient safety is compromised, and there is likely to be an increase in adverse effects such as increased mortality rate. The staffing needs to be adequate to effectively provide the surveillance since close monitoring is required by these patients (Clarke S, 2008). In Korea, it's a requirement that the registered nurses' ratio is one registered nurse per 2.5 inpatients in a single day through the year. Despite this requirement, more than fifty percent of hospitals have failed to meet this requirement (Aiken LH, 2014). It has been impossible to regulate hospitals that do not meet these requirements since the punishment is not strong enough. It is to this fact that this implementation is considered to be recommended rather than a must thing.

There has been a provision of incentives by the government to improve the nursing levels in hospitals. The government pays high admission fees to hospitals with a high number of registered nurses. The staffing levels in every hospital are publicized so that patients have a good choice in selecting the care unit to take. According to the article, the hospitals which had a low number of registered nurses had a high number of patient’s death rates (Aiken LH, 2011). The improvement in the registered nursing staffing registered a reduced mortality rate among cardiac patients. Hospitals with high registered staffing levels registered low mortality, while those with low registered staffing levels had high mortality rates (Kim Y, 2012). In the article, a systematic review was conducted, and the conclusion based on the analysis was that the registered nurse's staffing level had a close association with failure to rescue rate, length of hospital stay, hospital outcomes, and the inpatient mortality rate.

In a study within the article, there was an investigation between nurses' staffing levels and the care given. The study indicated a strong association between the registered nurses staffing level and better care for patients hospitalized. In this study, there was a lower level of adverse outcomes associated with a high level of staffing and not the high levels of licensed practical nurses (Brooks C, 2015). In the same article, another study indicated that the secondary hospital ICUs was related to the registered nurse's staffing and mortality rate, not tertiary hospital ICUs (Cho E 2015). Neurosurgical patients require a high number of registered nurses for vigilance, and postoperative monitoring while in the ICU. Craniotomy patients have severe diseases and require frequent nursing care and thorough observations (Kim YM, 2016). These patients are at a high risk of infection from the invasive instruments used, and a high number of registered nurses are required to prevent these infections. Postoperative monitoring is an essential routine in many hospitals in which these nurses play a vital responsibility. They need to stabilize the parameters and neurological state, and for the successful conduct of these activities, the mortality rate is affected.

Theoretical Framework

The research was mainly focused on the care for patients and the quality of health care. It focuses more on how these patients are affected by the registered nurses' ration. The research also is focused on the contributions on how to improve the patient ratio, which will lead to an improved healthcare system. The research also explained how the craniotomy patients require high care and attention and how they are susceptible to danger. The concept here was a high number of registered nurses is needed in these patients. However, there was a focus on hospitals and their need to improve the quality of service among patients and relieve nurses' unnecessary burdens.

Variables/Hypotheses/Questions/Assumptions

There was one dependent variable and to independents variable. The two independent variables were related to hospitals and patients. The dependent variable was the topic under discussion. The operational definitions were given, and there was a clear guideline on conducting the research to avoid confounding variables. The research questions were not stated, and the study focused on giving data concerning the topic.

Methodology

The design used in this study was quantitative. This is because the study drew its data from the Korean national health insurance service. Again it was a cross-section study. The data was collected from a single point, and that is the Korean national health insurance. However, they used data from 46,779 subjects and 203 hospitals. The sample included 43 tertiary hospitals,153 general hospitals, and seven other smaller hospitals. The sampling was probability as the data was gathered from several hospitals form a larger group of hospitals. The reliability and validity of data were high since it came from the Korean national health insurance service, and they have these data from first hand. There was ethical consideration where patients who were below 19 years of age and those above 89 years of age were excluded from the study.

Data Analysis

Data analysis in this research was conducted using the chi-square (χ2) test. The general estimating equations were used to characterize the relationship between a registered nurse and the mortality rate after craniotomy—clustered data was used from the hospitals. The data was presented using a table throughout the paper. One of the findings of the article indicated that among the 46779 patients who received craniotomy, 3315 of them died. This was a 7.1 % rate of mortality. The mortality rate increased with a high bed to registered nurses ratio. The mortality rate of 4.0%, which was the lowest, was found in hospitals with a bed to designated nurses ratio less than 2:5: 1 in general wards. The mortality rate of hospitals with higher beds per RN, such as 19.5%, was 4.9 times higher.

Summary/Conclusions, Implications, and Recommendations

The study involved several limitations. One study used bed to RN ratio per quarter, and this does not reflect the actual nursing workload and mortality per shift daily. Secondly, the bed number is not equal to patients; hence the results are not the exact figures. Thirdly, the data analyzed was limited to the number of registered nurses and physicians. The data on medical staff was not available. Lastly, it is a cross-sectional study, and therefore, it is impossible to infer causal relationships between registered nurses and hospital mortality. The results provided that higher staffing level was associated with a lower risk of in-hospital mortality for craniotomy patients. In conclusion, it was found out that in nursing, sufficient staffing levels should be ensured to reduce in-hospital mortality.

References

Cho, S.-H., Hwang, J. H., & Kim, J. (2008). Nurse Staffing and Patient Mortality in Intensive Care Units. Nursing Research, 57(5), 322–330. https://doi.org/10.1097/01.nnr.0000313498.17777.71

Livesay, S., & Moser, H. (2014). Evidence-Based Nursing Review of Craniectomy Care. Stroke, 45(11). https://doi.org/10.1161/strokeaha.114.006355

Van den Heede, K., Lesaffre, E., Diya, L., Vleugels, A., Clarke, S. P., Aiken, L. H., & Sermeus, W. (2009). The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: Analysis of administrative data. International Journal of Nursing Studies, 46(6), 796–803. https://doi.org/10.1016/j.ijnurstu.2008.12.018