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Having more graduate nurses boost post-surgical outcomes in dementia patients

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Having more nursing staff educated to degree level providing treatment is linked to better outcomes in surgical patients with dementia, according to US researchers.

The study is the latest to associate higher nurse education levels with better patient outcomes, as previously reported by Nursing Times.

A high profile study, published in 2014 and involving 30 NHS hospitals, found that a 10% increase in the proportion of nurses holding a bachelor degree was associated with 7% lower surgical death rates.

The researchers behind the new study noted that surgical patients with co-existing Alzheimer’s disease and related dementias were more likely to die within 30 days of admission and to die following a complication than other patients.

They found that having more nurses with at least a bachelor’s nursing degree at the bedside improved the likelihood of good outcomes for all patients, but it had a much greater effect for patients with dementia.

The study, published in the Journal of the American Geriatrics Society, is the first to specifically examine the effects of clinician education on surgical outcomes for patients with dementia.

It included 353,333 patients who underwent general, orthopedic, or vascular surgery in one of 531 hospitals in California, Florida, New Jersey, and Pennsylvania.

“Nurses must be able to think critically, problem solve, and work well within interdisciplinary teams”

Elizabeth White

Controlling for hospital, procedure, and individual characteristics, each 10% increase in the proportion of graduate nurses at a hospital was associated with 4% lower odds of death for individuals without Alzheimer’s or dementia, but 10% lower odds of death for those with such conditions.

Each 10% increase in the proportion of nurses holding a bachelor’s degree or higher was associated with 5% lower odds of failure to rescue for individuals without Alzheimer’s disease and related dementias, but 10% lower odds of failure to rescue for those with the conditions.

Lead author Elizabeth White, from the University of Pennsylvania school of nursing, said: “Patients with dementia are clinically complex and vulnerable, and nurses play a key role in monitoring and protecting these individuals from unwanted complications such as delirium and pneumonia after surgery.

“To do this, nurses must be able to think critically, problem solve, and work well within interdisciplinary teams,” she said. “These are all competencies emphasised in bachelor degree nursing programmes.”

“We are confident that the hospital measure reflects what we see on the individual units”

Elizabeth White

Ms White also explained to Nursing Times why the researchers had chosen mostly to look at the proportion of registered nurses holding bachelor degrees for the hospital overall, rather than specific units.

”The reason for this is because surgical patients are usually cared for across multiple units over the course of their stay (operating room, recovery room, ICU, medical-surgical units, etc.) so the hospital-level measure gives a better picture of the overall quality of nursing care,” she said.

She added: “We did look at the relationship between the proportion of bachelor degree nurses on some of those specific units compared to the hospital overall, and found that the measures were highly correlated so we are confident that the hospital measure reflects what we see on the individual units.”

Attacks have continued to dog nursing since it became a graduate profession during the 1960s and ultimately degree-only entry in England in 2013 – though it was preceded by the rest of the UK.

The argument has often centred around the former use of state enrolled nurses, but the debate has also been reawakened by government policy to introduce nursing associates and apprenticeships.

In January this year, nurse leaders, educators and researchers came to the defence of nursing as a degree-only entry profession, following controversial views on compassion aired in a newspaper by a surgeon.

Robert Jackson, a fellow of the Royal College of Surgeons, had claimed in the Daily Telegraph that making nursing degree-only entry had led to the “demise of the traditional hands-on compassionate nurse”.

A report from an expert group set up by the Royal College of Nursing, which was published in 2012, concluded that the move to degree-only entry to nursing was unlikely to affects nurses’ “ability or desire to care with compassion”.

It said a key theme from its review was the “need to dispel the myth” that better educated nurses are less able to care, and to promote an accurate public image of nursing education.

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