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Poor Nurse to Patient Ratios in the Philippines (Term Paper Sample)

Chapter 2 Review of Related Literature This chapter presents reviewed literature on the concept of nursing missed care and the reasons behind it, specifically poor nurse-patient ratios. This chapter focuses on the main drivers of the study which contribute to nurse performance and the prevalence of care omissions or missed care. This chapter also includes related literature published locally and internationally which helped in the conceptualization of the study. In addition, this chapter contains the theoretical framework, research framework, and research paradigm supporting the current research. Providing quality healthcare is one of the main objectives of nursing. Quality care is provided when the nurse has done all duties needed to be carried out to help or care for the patient they are in charge of. A nurse’s performance greatly affects the quality of care they provide. Worldwide, there has been evidence of nurse staffing problems (American Nurses Association, n.d). This provides a precursor for poor nurse performance due to large workloads assigned to every nurse per shift which exceeds their normal supposed workload which was aimed to help nurses perform optimally. Much research has delved into the impacts of missed care and many researchers in the USA have connected nurse staffing levels to care left undone, referred to as missed care in this study. Kalisch and her colleagues (2011) conducted a study that evaluated the effect of poor staffing practices contributing to poor staffing levels which predicts the possible occurrences of missed care in nurses in the USA. This suggests that missed care is a possible mediating factor between registered nurse staffing and their performance outcomes (Ball et al., 2016). NURSE-PATIENT RATIO The nurse-patient ratio or patient-nurse ratio are empirical measurement of nurse staffing. These ratios provide objective values measuring the number of patients or nurses who correspond to each other per shift in a hospital. These measurements are necessary for evaluating the workload of the nurses with respect to the acuity of the patients in their care. Much research has used this factor in determining the extent of the effects of many events that occur in nursing, especially those in need of attention because they have negative impacts on the patients. The prevalence of low nurse-patient ratios is being observed worldwide due to cases of nurse shortages brought about by various factors. The growing need to employ more registered nurses for hospital work has brought various concerns in terms of nurse staffing practices. The American Association of Colleges of Nursing (2019) identified the long-term causes of nurse shortages from information from significant demographic and societal trends. They stated that according to the Bureau of Labor Statistics’ Employment Projections 2016-2026, there is a need for 203,700 new registered nurses each year to fill nursing positions and replace retiring nurses in order to avoid bigger shortage impacts. However, the AACN also reported that many nursing candidates are being turned away yearly due to restrictions in learning resources such as teachers, classrooms, and clinical sites. This poses a problem for the healthcare industry because the number of nurses that can fill positions and potentially increase nurse-patient ratios cannot meet the demand for new registered nurses. In addition, financial constraints are some of the leading reasons behind nurse understaffing and shortages. The constant interaction of the need for allocating adequate ratios of nurses in hospitals and the financial implication of this relationship causes issues that attracted the interest of many researchers and motivated them to conduct studies regarding this phenomenon. Hospital administrators are tasked to maintain an efficiently functioning facility where healthcare can be provided in the best possible manner and with the best quality its staff can provide within the limits of the budget set to them by higher authorities of the institution they serve or as governed by the law (Clarke, Lerner, and Marella, 2007). Despite this, budgetary concerns still plague healthcare institutions which prevent them from solving understaffing problems. According to the Philippines’ Department of Labor and Employment, a nurse makes an average of P9,757 per month (n.d.). However, due to the approval of the General Appropriations Act of 2020, the government has approved the increase of salary of government nurses from salary grades 10-11 to a minimum of salary grade 15 where a nurse can earn as much as P33,279 per month (Buan, 2019). However, compared internationally, this is still low since in Canada, entry-level nurses can earn as much as $4,097 while the US offers an average of $3,800 monthly (DOLE, n.d.). This is a cause for concern because low income is one of the main drivers of poor nursing retention rates in the country. Philippine-trained nurses seek employment abroad due to the better opportunities in other countries such as competitive salaries, better benefits, better work environments, and fairer workloads per shift. The growing number of overseas Filipino nurses has an inverse effect on the number of nurses staying to work here in the Philippines which contributes greatly to nursing shortages. Because there are budgetary concerns involved in nurse staffing and compensation, the increased workload brought about by insufficient staffing causes poor nurse performance due to overworking. Poor nursing staffing causes low nurse-patient ratios in hospitals. Because there are many patients assigned to one nurse per shift in hospitals, the nurses become spread too thin, affecting their duties. Large workloads cause the inability of nurses to provide sufficient care in such a way that due to time constraints, they are only able to provide the bare minimum care needed by the patient to survive daily and not necessarily get better. A study by Rothberg and colleagues in 2005 described the relationship between the cost of staffing and patient mortality. The researcher determined that while a nurse-patient ratio of 1:8 is the least expensive, it is also linked to higher patient mortality rates compared to the more expensive 1:4 ratio. These findings support the notion that fewer patients handled by nurses contribute to less workload and better performance. This is in line with the cost-effectiveness of shortened lengths of stays of patients which can be attributed to better care received. Jones, Hamilton, and Murry (2015) reported in their study that patient satisfaction with the quality of care they are given in the hospital is linked to low incidences of missed nursing care. Subsequently, their study found that low incidences of missed care are strongly attributed to better nurse staffing where more nurses are hired ergo more nurses are available for patients per shift, making nurse workloads less and optimizing nurse performance. Low patient-nurse ratios have been proven to be linked to ensuring patient safety. A low patient-nurse ratio corresponds to a high nurse-patient ratio where a nurse is working optimally per shift because he/she is handling the proper number of patients in his/her care. Greenberg (2006) described in his study that working conditions achieved by satisfactory nurse-patient ratios are more cost-effective and safer for the patients due to the decreased risks of errors in providing care. PATIENT SAFETY According to Tourangeau and colleagues (2006), patient safety is another main concern of healthcare institutions worldwide. The increasing number of issues regarding global health can be attributed to the adverse effects inadequate care brings to the patient. Nursing is a source of patient care and providing for their welfare is the main mission of healthcare industries. Establishing good nurse-patient ratios can be considered an act geared toward patient safety as it entails many positive effects on the quality of care provided (RinaldiFuller, 2008). Sufficient nursing staffing and acceptable nurse-patient ratios are also predictors of better care quality and patient safety in addition to high nurse job satisfaction ratings. The relationships of these factors are established in many published studies stating that good nurse-patient ratios decrease the risk of patient condition deterioration which directly affects the outlook and job attitude of the nurses leading to better performance and increased job satisfaction (Sheward et al., 2005). PATIENT MORBIDITY AND MORTALITY Patient morbidity and mortality are unfortunate but common events in medicine and healthcare. Patient morbidity is defined as the occurrence of complications in the patient as a result of a certain disease or condition (Morgan and Summer, 2008) while patient mortality is the death of a patient in the care of a hospital or healthcare institution (Tourangeau, Cranley, and Jeffs, 2006). There are a number of reasons why patient morbidity and mortality can occur in healthcare. Missed care may be directly or indirectly involved in instances of morbidity and mortality. Kagansky and Berner (2005) described that delayed or missed feedings may cause undernutrition causing the deterioration of the patient’s condition and in extreme cases, oversights in feeding leading to death for older patients. Better nurse-patient ratios can decrease risks of patient morbidity and mortality. This is because the risks of mistakes and omitted care are decreased. Elimination of instances of missed care isolated the major causes of patient mortality because errors are no longer a factor to be considered in assessing a patient’s deteriorating status. Aiken et al. (2014) reported in their study that in Europe, an increased number of patients assigned per nurse per shift increases the odds of patient mortality within 30 days of admission after surgery. This is supported by the review Kane et al. ...
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