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The latest evidence for practice

Q. What is the relationship between
nurse staffing and quality of care
in nursing homes?

The nursing home population is likely to continue to increase as more frail and ill elderly people require higher levels of care. As with any health care provider, there is concern to ensure that the quality of care in nursing homes is of a sufficiently high standard.

This systematic review sought research studies which examined the quality of care in nursing homes. The review found 83 studies with a variety of methodologies but despite the very large number of slides included in the review, no relationship between staffing levels and quality was detected.

A commentary notes that although it was surprising that no association was identified, this might be due to the challenges of conducting research in this field. Nursing homes care for very diverse populations which can make meaningful comparisons difficult.

The recording of staffing levels is difficult, particularly in relation to skill mix, and quality may be associated with how hard or how efficiently staff work rather than how many are on duty. Training and experience may also be a factor. Overall, it is important to remember that the absence of evidence does not equate to evidence of optimal care.  

Spilsbury K, et al. The relationship between nurse staffing and quality of care
in nursing homes: a systematic review. Int J Nurs Stud 2011;48:732-50.

Castle NG. Reviewing the evidence base for nurse staffing
and quality of care in nursing homes. Evidence-Based Nursing

Q. Does real time monitoring of blood glucose levels improve glycaemic control for patients with type 1 diabetes?

Patients with type 1 diabetes who maintain tight control over their glycaemic levels have a much lower risk of developing long term complications.

Achieving this usually requires intensive insulin therapy accompanied by frequent self monitoring of blood glucose (SM-BG). Real-time continuous blood glucose monitoring (RT-CGM) is an approach that uses sensors to continuously measure the glucose concentration in the interstitial fluids for between three to seven days. An alarm can alert the wearer to take appropriate action to maintain their glucose levels within normal limits and thus possible achieve better glycaemic control that achieved using SM-BG.

A commentary notes that although RT-CGM has been available for some years, until this review there has been an absence of evidence for its effectiveness. It is particularly noteworthy that the patients who benefitted most were those with poor glycaemic control. RT-CGM would appear to offer such patients considerable benefits.


Pickup JC, Freeman SC, Sutton AJ. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self-monitoring of blood glucose: meta-analysis of randomised controlled trials
using individual patient data. BMJ 2011;343:d3805.

Fritschi C. Use of real-time continuous glucose monitoring versus traditional self-monitoring of blood glucose levels improves glycaemic control in patients with type 1 diabetes. Evidence-Based
Nursing 2012;15(1)7-8.