Impact of nurse burnout on patient safety, morbidity and mortality
Occupational burnout and compassion fatigue are well-known hazards in the nursing profession, which have been particularly recognised in recent years. In a systematic review and meta-analysis, Li et al (2024) assessed the association between nurse burnout and patient safety, patient satisfaction and quality of care.
The review referred to occupational burnout syndrome, which the authors noted to be prevalent among nurses, which is characterised by emotional exhaustion, depersonalisation and a diminished sense of personal accomplishment. Meta-analyses looking at this phenomenon are not new; however, this is the first to examine the relationship between occupational burnout syndrome and the quality and safety of healthcare provided, as well as patient morbidity and mortality.
Li et al (2024) searched Web of Science, Scopus, Medline, Embase, PsycINFO, CINAHL and ProQuest databases for studies published between 1 January 1994 and 29 February 2024. Two reviewers independently identified studies that reported a quantifiable link between nurse burnout and any of the outcomes: patient safety, patient satisfaction and quality of care.
In total, 85 studies with 288 581 nurses from across 32 countries were evaluated using the PRISMA 2020 guideline. Of these, 81 studies were cross-sectional and the remaining four were longitudinal. The mean age of the nurses examined were 33.9 years; 82.7% of the nurses included were female. The authors highlighted that burnout among nurses was estimated to range between 11.0–56.0%, with numbers increasing during the COVID-19 pandemic. The prevalence rate of burnout among the nurses included in this meta-analysis was determined to be 30.7%.
The authors ascertained that nurse burnout was associated with a lower safety climate or culture, lower safety grade and more frequent nosocomial infections, patient falls, medication errors and adverse events or patient safety incidents. Burnout was also linked with lower patient satisfaction ratings and lower quality of care as assessed by nurses.
However, no association was observed between nurse burnout and higher levels of patient complaints or patient abuse. There was also no association with a lower standardised mortality rate. In terms of patient safety outcomes, the association was higher for emotional exhaustion and depersonalisation, than for the reduced personal accomplishment component of burnout. The association was also lower among nurses with a college education.
This systematic review and meta-analysis revealed that occupational burnout among nurses is associated with a lower safety climate and grade, lower patient satisfaction, lower nurse-assessed quality of care and a higher rate of adverse events and patient safety incidents. When accounting for variations in age, sex, work experience and geographical location, the associations remained consistent over time. The authors concluded that wider systems-level interventions aimed at addressing nurse burnout may result in improved patient outcomes.
Nutritional care for older adults and community nurses' knowledge, attitudes and practices
It is common for older adults to develop comorbidities as they age, and diet is a known modifiable risk factor for chronic conditions. Community nurses are well placed to positively influence and encourage older adults in their nutritional choices for overall improved patient outcomes. In a study, Shield et al (2024) sought to ascertain the nutritional knowledge, attitudes, practices and training needs of community nurses involved in the care provision of older adults in the UK.
In August 2022, the authors developed an online survey, which was descriptive, cross-sectional and anonymised, in order to evaluate community-based nurses' knowledge, attitudes and practices related to the nutrition of older adults. Community nurses caring for older adults in the UK were recruited to participate via social media using a convenience sampling method. The survey questions were closed with pre-coded responses and included a mix of binary, multiple-choice and scaling questions. They were designed as probing questions in areas where current literature provides limited information. These were then mapped onto knowledge, attitudes and practice, known as the KAP model.
The surveys were completed by 194 nurses working in community settings. The results indicated that nutritional care was viewed as a multidisciplinary responsibility by 62.0% of respondents. An encouraging majority undertook nutritional screening (93.0%), felt confident with the provision of nutritional advice (83.0%), and felt that they were able to easily identify those in need of nutritional guidance (88.0%). However, when evaluating the more particular details of nutrition for older people, respondents were less sure. For example, 60% of participants felt unsure regarding recommended protein intakes and 52% of surveyed nurses felt uncertain around appropriate levels of fibre. The confident attitudes of community nurses around nutritional knowledge and practices was an encouraging finding in this study. However, the uncertainty around more specific aspects of nutrition suggested an opportunity to build on community nurse training related to the nutritional needs of older adults. This is especially important given the significant potential impact of nutrition on the overall health of this population, particularly as they grow older.
Palliative care and homelessness across the UK
There are many challenges associated with healthcare for people experiencing homelessness. This population has uncertain illness trajectories and a high risk of mortality, both related to diseases and to other factors such as drug use and overdose, accidents and trauma. Crooks et al (2024)sought to gain insight into initiatives taking place in palliative care and homelessness across the UK, an area that has not been systematically explored in the past.
The authors drew on the Extension for Community Healthcare Outcomes (ECHO) network to recruit members across a wide range of professional backgrounds. They focused on palliative care and homelessness to represent diverse initiatives and regions. The three main research questions were:
This was an exploratory survey-based study for which all members of the palliative care and homelessness ECHO network were eligible and invited to participate. An online survey was then distributed, with 162 professionals taking part.
A total of 62.0% reported being involved in at least one palliative care and homelessness initiative. The aims, successes and challenges were also collated to improve palliative care for people experiencing homelessness. The majority of initiatives focused on service delivery (59.0%), with the remaining focused on training (28.0%) and research (28.0%). The main successes included improved service engagement, relationship formation, housing provision, honouring end-of-life wishes, upskilling staff and enabling hospital discharge. The main challenges included stigma related to substance misuse, the ability to secure funding, staff capacity, equipment and facilities and the ability to engage communities.
The authors concluded that initiatives across the UK were on the rise, and a range of professionals were engaged in the field of palliative care and homelessness. They suggested that research should be carried out in the future to explore the initiatives identified in further detail.
This would help gain insight into the specific drivers of impact on people experiencing homelessness with advanced ill health, as well as on the staff members and service providers that support this population, in order to understand what is currently working and where there are gaps. They also recommended forging connections between people engaged in such initiatives, with a view to share best practices, promote shared learning and encourage peer support.