Recent Research About Nursing, April 2014

Apr 7, 2014, 9:00 AM

This is part of the April 2014 issue of Sharing Nursing’s Knowledge.

ICU Staffing’s Impact on Patient Outcomes

A nurse-led study from the United Kingdom has found that higher numbers of doctors and nurses in intensive care units (ICUs) have a positive effect on survival rates for high-risk patients.

A research team led by Elizabeth West, PhD, MSc, RN, Director of Research in the School of Health and Social Care at the University of Greenwich, used data on 38,000 patients in 65 ICUs in the United Kingdom, correlating patient outcomes with staffing levels for doctors, nurses, and support staff. They found that “higher numbers of nurses per bed ... and higher numbers of ‘consultants’ [senior hospital-based physicians or surgeons] were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death.”

“It seems reasonable to argue,” the researchers conclude, “that skilled nurses, who have the time to observe patients closely, to intervene or mobilise the team if they begin to deteriorate, would be most important to patients who are at the greatest risk. This study is the first to produce evidence that this is the case.” Their findings are published in the May 2014 issue of the International Journal of Nursing Studies.

The ‘White Coat Effect’ and Its Impact on Hypertension Treatment

A new meta-analysis of existing research on hypertension suggests that the so-called “white coat effect”—elevated blood pressure readings attributed to patient anxiety about visiting a doctor’s office or other health care setting—is more pronounced when doctors take blood pressure readings than when nurses operate the sphygmomanometer. Nevertheless, the readings doctors take are more frequently used as the basis for decisions about treating hypertension.

A research team led by Christopher Clark, PhD, FRCP, FRCGP, of the University of Exeter Medical School in Britain, examined 15 studies on hypertension, publishing their findings on the website of the British Journal of General Practice. They write that the “white coat” phenomenon affects 75 percent of hypertension patients who visit specialists for the problem. But the effect is more pronounced, they say, when doctors take the readings than nurses. On average, doctors’ diastolic readings were about 7.0 mmHG higher than nurses’; and their systolic readings averaged 4.6 mmHG higher.

Nevertheless, the readings taken by doctors are more likely to be used for diagnosis and treatment decisions, the team found.

The researchers conclude that “the risk of misclassification and inappropriate treatment with inaccurate initial blood pressure readings remains a clinical concern if doctors are systematically recording higher blood pressures than nurses.”

More Coverage of Recent Research About Nursing on the Human Capital Blog

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This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.