2026-09-21T13:36:16Zhttps://digital.library.adelaide.edu.au/server/oai/request

oai:digital.library.adelaide.edu.au:2440/1351372022-05-18T01:30:40Zcom_2440_14759col_2440_14760

Wiechula, Richard Schultz, Timothy J. Feo, Rebecca Assaye, Ashagre Molla Adelaide Nursing School 2021 https://hdl.handle.net/2440/135137 Patient safety is a global concern and the risks to this safety are higher in low- and middle-income countries (LMICs). The high rates of both communicable and non-communicable diseases, low numbers in the workforce, poor distribution of qualified professionals, and constraints in medical supplies and resources make the provision of quality health care challenging. There is a shortage of empirical evidence on nurses’ contribution to the quality of care generally, and patient safety outcomes particularly, in Ethiopia: a low-income country. The main aim of this study was to identify the determinants of nursing-sensitive patient safety outcomes among admitted patients in acute medical/surgical settings in Ethiopia. Specific objectives of the study were determining the level of nurse staffing, missed nursing care and associated factors, and exploring the experience and perception of nurses working in acute care units of the study hospitals. The results of the study will generate evidence to help redesign healthcare systems to improve patient outcomes associated with nursing practice. A parallel explanatory mixed-methods study was conducted. First, a systematic review was conducted to determine the impact of nurse staffing on patient and nursing workforce outcomes in LMICs. Simultaneously, a prospective observational study was conducted comprising a survey of 517 nurses at two time points, and a medical record review to assess nursing-sensitive patient safety outcomes in two hospitals in Ethiopia. An exploratory descriptive qualitative study using in-depth semi-structured interviews was also conducted among nurses who were working in the medical and surgical acute care settings of the two study hospitals. The interviews were designed to explore the experience and perceptions of nurses about patient safety and quality of care in their respective units of the study hospitals. The systematic review found that low nurse-to-patient ratios and high nurses’ workload were associated with higher rates of in-hospital mortality, hospital-acquired infection, medication errors, falls and abandonment of treatment in LMICs. Extended work hours, lesser experience, and working night or weekend shifts all significantly increased medication errors. Higher nurses’ workload was linked to higher levels of nurses’ burnout, needlestick and sharps injuries, intent to leave, and absenteeism. The quantitative study demonstrated that nurses working in acute care settings of the study hospitals typically work more than 40 hours per week and care for many patients per shift, which has the potential to impact patient safety. The level of missed nursing care in the study units was very high. The mean number of patients a nurse provided care for per shift was significantly associated with in-hospital mortality. For every extra patient per nursing shift, the odds of a patient dying increased by 27 percent. The qualitative study showed that nurses were very concerned for the safety of patients, the quality of care provided, as well as their own health and wellbeing, while providing care. Providing care for a high number of patients per shift, longer shift hours during night and weekend shifts, being responsible for non-nursing tasks, unfavourable work environments, inadequate resources to provide care, unclear job descriptions, inadequate financial compensation, and scant opportunities for training and capacity development were concerns routinely raised by nurses. Despite the reality of working in a poorly resourced working environment, nurses in this study could achieve positive changes through improved staff management practices that better align patient acuity with individual nurses’ education and expertise. Further, they believed that it was important that management listened to and valued clinicians’ views about models of nursing care delivery. This had the potential to not only improve patient outcomes but also the environment in which these nurses worked. Thesis (Ph.D.) -- University of Adelaide, Adelaide Nursing School, 2021 en Patient Safety Acute care Medical Surgical Nursing -sensitive Mixed-methods Determinants of Nursing-Sensitive Patient Safety Outcomes Among Patients Admitted to Medical and Surgical Acute Care Settings in Ethiopia: A Mixed-Methods Study Thesis This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals Copyright material has been removed from digital thesis.open.access