gms | German Medical Science

Background and status of (inter)national research: Multiple studies in acute care have demonstrated that better nurse staffing (i.e. more care hours per client and day and more qualified care teams) is associated with better client outcomes. However, the related evidence on this topic is much more heterogeneous in nursing home settings. Studies that suggest that lower staffing is associated with worse quality of care are mostly based out of the USA 2,3. Older systematic reviews have shown an association between higher total staffing levels and improved quality of care4. But more rigorous reviews have shown that we currently cannot be sure whether staffing predicts quality in LTC 5–7. Overall, the study quality is generally low, and comparability of results is limited due to heterogeneous definitions of staffing and quality. One reason for this may be that considering staffing only may not be sufficient. References in the literature suggest that specific elements of organizational context are associated with positive health outcomes in nursing homes 8. Therefore, staffing resources may interact in complex ways with other features of organizational context, such as the quality of leadership, interactions among care teams, quality of work life, etc.

Question and objective:It may be an important question to ask whether the interaction of organizational context and nurse staffing has had any impact on quality of care. Therefore, this systematic review aims to deepen the knowledge about the mechanisms underlying care staffing, other features of work environments, and resident outcomes in nursing homes. This systematic review aims to identify, analyze and synthesize quantitative research evidence on interactions between care staffing and organizational context, and the effects on resident outcomes.

Method: will conduct a systematic synthesis of research. Our review methods and presentation of results will follow the Cochrane Handbook of Systematic Reviews of Interventions9 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)10 guidelines. This protocol followed the PRISMA-P reporting guidelines for systematic review protocols. We will systematically search the databases MEDLINE, EMBASE, CINAHL, Scopus and PsycINFO. We will include quantitative research studies and systematic reviews that assess the interaction of care staffing, organizational context factors and resident outcomes. No publication date or language filter will be used. The title and abstract of each extracted record will be screened, followed by screening of full text of included papers. Then data extraction and quality assessments will be undertaken. Each stage will be completed independently by pairs of authors. Meta-analysis will be conducted if pooling is possible; otherwise, a critical narrative analysis will be conducted. Sensitivity analysis will be conducted to explore the influence of risk of bias and publication bias on the results.