• The Effects Of Maternal Substance Use On Gestational Development And Neonates

      Burnett, Paula; Nowka, Scott; Fraley, Hannah; McElligott, Kelly (2017-04-23)
      This paper will focus on the effects of maternal substance use on the gestational development of neonates. The research for this paper will be gathered through a systematic review of the literature, which will include both quantitative and qualitative peer-reviewed articles published within the last six years. The articles will be gathered using databases including CINAHL and EBSCO. The research will include many substances that can have an effect on gestational development including alcohol, cannabis, amphetamines and opioids. The articles will not be limited to a specific maternal age range or ethnic or racial background, but rather all of the articles will include women who used substances at any point during their pregnancies. The demographics of the women and their socioeconomic status will be taken into consideration when analyzing the outcomes of the fetuses. For the purposes of this article, there will be a zero tolerance of substance use allowed during pregnancy and any use above zero would be considered abuse. The research will look into the roles of the women, their existing families and the physicians. The research will also explore the relationship between previous substance use and use during pregnancy. Some current research supports that there is a definite risk in healthy development of a fetus when substance use occurs during pregnancy. There are many outside factors, such as marital status, socioeconomic status and social class, that play a role in the resources available as well as the treatment provided to these women and fetuses. The goal of this study is to spread awareness of the effects of substance use during pregnancy and to help not only health care providers, but also women become more educated in the area, and therefore make more knowledgeable choices.
    • An Evaluation Of Knowledge And Perception Amongst Nursing Students Pertaining To Ibuprofen

      Ebersole, Nancy; Nowka, Scott; Pelletier, Jacqueline (2020-05-01)
      Ibuprofen is one of the most common over-the-counter pain medications accessible to consumers. It is known that ibuprofen can be dangerous to certain individuals (Curfman, 2015). This includes people who take this drug over prolonged periods of time, those who do not follow the necessary instructions/precautions, who may have heart disease or gastrointestinal complications, and others who may be at high risk for non-steroidal anti-inflammatory drug use. A 16-item questionnaire was developed to assess: a) how and when the decision is made to take pain medication, b) knowledge of recommendations and precautions related to the use of ibuprofen, c) how the decision is made to determine the amount of medication to take, and d) knowledge of potentially dangerous side effects. The data of this survey showed that a majority of nursing students knew critical components to proper use of ibuprofen. It also demonstrated upperclassmen students to contain more knowledge regarding ibuprofen dosaging than underclassmen. Although there were important educational points that students knew pertaining to ibuprofen, there were also gaps in the necessary knowledge that the survey indicated. With appropriate education and teaching of this common over-the-counter medication, it can decrease the risk for potentially dangerous complications in certain individuals. Due to this drug being so widely used and easily accessible, preventing improper use is essential for protecting our communities.
    • Factors Affecting the Quality of Life of Residents in Nursing Homes: Knowledge and Strategies for the Novice Nurse

      Leger, Robin; Angel, Katelin N (2016-05-01)
      Background and Significance: Quality of Life (QOL) is a major focus of practice in all areas of nursing, including promoting QOL for the elderly. New graduate Registered Nurses (RNs) have the option of working in a nursing home for their first career opportunity. The significant increase in the Baby Boomer population (nearly tripling between 1980-2030) will cause an influx of nursing home residents as they require nursing home services. Review of the Literature: Quality of Life (QOL) is important to providing quality, holistic care. Many factors encompass QOL. It is necessary for the new graduate RN to learn about interventions that positively impact nursing home residents' QOL. The literature review speaks only about first-hand studies focusing on nursing home residents' own interpretations of QOL factors. Several QOL domains were identified including promoting comfort, meaningful relationships, and maintaining autonomy and dignity. Undergraduate nursing education and new graduate orientation programs offer little information on the nurse's role in promoting QOL in the elderly. Implications for Novice Nurse Education: A table was adapted to show the QOL domains for the Elderly and possible RN Interventions to positively impact nursing home residents QOL. Provided with education focused on competencies for promoting QOL in the elderly, the new graduate RN will be able to use the interventions presented in the table to realize ways to positively impact QOL of nursing home residents during their first nursing experience as a novice nurse.
    • Factors That Affect An Adolescent Mother’s Decision To Breastfeed: A Systematic Review Of The Literature

      Ebersole, Nancy; Faranna, Lena; Guillen, Ashley (2020-05-01)
      Adolescent mothers do not breastfeed for the recommended duration of six months in comparison to the general population of those who are actively breastfeeding. Two systematic reviews of the literature were conducted to identify the factors that lead to breastfeeding cessation and the types of social support that healthcare providers implement when caring for adolescent mothers. Adolescent mothers’ decision to stop breastfeeding is to due to intrinsic and extrinsic reasons. Support from health care providers is essential in resolving any factors that lead to breastfeeding cessation. Health care providers should consider informational, instrumental, emotional, appraisal/esteem, and network support, when responding to the needs of adolescent mothers. The results of this systematic review provides healthcare professionals with evidence to support adolescent mothers with strategies to breastfeed for the recommended duration of six months.
    • Health Benefits Of Breastfeeding For Infants, Leading To Developmental Differences Between Breast-fed And Formula-fed Infants

      Burnett, Paula; Holloway, Heidi (2017-03-01)
      This systematic literature review of health benefits of breastfeeding for infants serves to educate mothers about any potential developmental differences between breast-fed and formula-fed infants. Many factors go into a mother’s decision regarding feeding methods, but there may be gaps in knowledge that are important and significant between feeding methods. Breastfeeding vs. formula feeding has become a controversial social issue in our society. Other literature reviews as well as qualitative and quantitative studies were reviewed in order to clarify which method is better, specifically in terms of infant development and why. Analysis and review of data from these studies may clarify the answer to this question and may support the hypothesis that breastfeeding is more beneficial developmentally for infants than formula feeding. From this review, it can be concluded that the differences in development between breastfed and formula-fed infants are not significant, but there appear to be more benefits and advancements in infants who were breastfed, even for short periods. In yielding these results, it is possible that more mothers will choose breastfeeding and more healthcare providers, particularly nurses, will better educate about the differences and benefits of both methods. This may lead to healthier infant development in the future.
    • How Stigma and Negative Attitudes Towards the Mentally Ill Affect Patients' Quality of Care: Moving Towards a Better Understanding for Change

      Fraley, Hannah; Shanahan, Molly (2015-05-01)
      Background: 1 out of every 4 American adults currently have a form of mental illness, while 50% of others will develop a mental disorder at some point in time. Mental illness not only emotionally deteriorates a person; it impairs one’s ability to function daily. Mental illness is highly correlated with other chronic diseases, such as diabetes, cardiac conditions and obesity, as well as homelessness and drug and alcohol dependency. The mentally ill are less likely to access healthcare for treatment due to experienced stigmatization, negative attitudes and stereotypes due to their diagnosis. The aim of this study is to detect and understand the negative attitudes towards the mentally ill, and to recognize how to work towards facilitating change in health care. Methods: CINAHL databases were searched to identify studies performed relating to the stigmatization of mental illnesses and how negative stereotypes affected patients’ quality of care. Results included data from qualitative and quantitative studies. Out of 171 reviewed papers, 11 met the criteria to perform this literature analysis. Results: Stigma towards the mentally ill is a prominent theme identified within the literature. Evidence based changes to eliminate stigma and negative attitudes towards mental disorders must be taken to improve quality of care. Understanding experienced stigma among the mentally ill is a first step to promote much-needed changes to health care delivery.
    • The Impact Of Disparate Treatment On Pregnancy Outcomes In Minority Women

      Ebersole, Nancy; Pueyo-Garcia, Claudia (2022-05-01)
      Pregnancy is one of the most vulnerable and important events in a woman’s life, however this experience can differ for minority women from disadvantaged backgrounds. The Center for Disease Control and Prevention reports that 700 women die each year in the US because of pregnancy or delivery complications while also reporting that Black women are three times more likely to die from pregnancy than white women. More than half of these deaths and near-deaths are the result of preventable causes, and a disproportionate number of the women suffering are Black women. A review of the literature was done using the CINAHL database, and the articles that were collected will be used to find common themes across multiple author’s findings that link directly to causative factors and their outcomes. The themes are (a) minority women experiencing lower-quality care; (b) minority women experiencing biases in communities; (c) minority women experiencing implicit bias within the health care delivery system; (d) minority women experiencing the effects of systemic oppression. Each of these elements have contributed to the rising prevalence of pregnancy-related morbidities and deaths. Nurses must advocate for high-quality, safe treatment and care for every patient to dismantle racial health disparities and decrease maternal morbidity and mortality rates. The desire to learn and to be aware of the variables influencing racial inequalities in pregnant minority women is the first step to improve health care standards and work to dismantle this growing racial health disparity.
    • Implementation Of Oral Care Guidelines To Reduce Incidences Of Ventilator-Associated Pneumonia: A Systematic Review Of The Literature

      Frost, Marion; Pechilis, Kelly (2019-05-01)
      Background/Purpose: Ventilator-Associated Pneumonia (VAP) is a disease process that can arise during the use of mechanical ventilation in the critical care setting. VAP can be prevented if adequate oral care practices are followed. The purpose of this study was to investigate how the implementation of oral care guidelines impact incidence rates of VAP in the Intensive Care Unit (ICU) and to determine specific oral care practices that are useful in the prevention of this disease process. Method: A systematic review of English-language literature was conducted of articles that were published after 2009. The CINAHL Plus Full Text database was used to determine suitable articles based on specific inclusion criteria. Results: Six articles were found to be relevant and were included in this systematic literature review. This systematic review of the literature investigated specific oral care practices that are recommended to prevent VAP. The American Association of Critical-Care Nurses (AACN) has oral care recommendations in place for nurses to follow however there have yet to be recommendations in place specific to patients undergoing mechanical ventilation. Additionally, this review concluded that facility implementation of oral care guidelines is found to increase nursing adherence to these recommendations. Conclusion: Implementation of oral care guidelines is encouraged to decrease incidences of VAP in the ICU. Interventions included in these protocols provide education and direction to guide nursing care and increase nursing compliance, resulting in decreased VAP incidences in the ICU. Further research is suggested to enhance evidence based nursing practices to determine oral care guidelines that are specific to the prevention of VAP in critical care settings.
    • Information Available to Patients Diagnosed with Dementia: Interviews With Caregivers and Their Experiences

      Fraley, Hannah; Williams, Leigh (2015-05-01)
      Purpose: Dementia is a prevalent problem for older adults and their families. Early intervention and a multidisciplinary approach for treatment have been linked to better quality of life. The primary objective of this study was to discover what information is available to patients with dementia upon diagnosis and how beneficial the information given is perceived by the primary caregivers. Secondary objectives included types of resources most utilized by the caregiver and how caregivers found out about such resources. Methods: A qualitative study design was employed using snowball sampling methods and semi-structured interviews among primary caregivers (n= 5) of patients with Alzheimer’s Disease (n= 3), Lewy Body Dementia (n= 1), and Dementia Unspecified (n= 1) respectively. Thematic coding methods were used to identify potential barriers to accessing timely information regarding disease prognosis and optimal resources. Results: Several themes emerged from caregiver interviews. Central themes found among the caregivers include: 1.) chronic grief 2.) chronic frustrations 3.) chronic guilt 4.) total responsibility of care. Several subthemes emerged that compound upon these caregiver experiences including provider related parries such as lack of quality information, and access barriers including difficulty finding community resources. Conclusion: Caregivers interviewed in this study perceive support from their health care team in general, yet have limited perceived support in navigating how to access community resources. Patients and their families need guidance and support from the health care team upon diagnosis, yet also need ongoing support and education while caring for a loved one with Dementia.
    • Knowledge of HIV screening in Women of Childbearing Age: 18-50

      Leger, Robin; Najjar, Alexandra (2015-05-01)
      Background and Significance: Today across the globe, children are still being born with Human Immunodeficiency Virus (HIV) contracted from their mothers. Although the Center for Disease Control and Prevention (CDC) recommends that all women be screened for HIV during each pregnancy, women are still failing to meet this goal. Research shows that women who understand the benefits of HIV screening for their developing child in utero are more likely to receive an HIV screen during pregnancy. Furthermore, research has shown that women who perceive themselves as “low-risk” are less likely to receive and HIV screen prenatally. Methodology: The nursing student and faculty advisor composed a survey with questions on demographics, HIV transmission knowledge and a self-evaluation tool to assess women’s perception on their own knowledge of HIV transmission, screening, and benefits of screening. Results: Nearly 70% of women indicated of how much they themselves believed to known about HIV transmission with a range of scores from 27 to 100. Women’s responses to the VAS for knowledge of benefits of prenatal treatment for the developing fetus were much more discouraging than the previous VAS scale results. For this scale, there was a mean of only 34.1 with a range of 0-93. The standard deviation among responses was 27.1, meaning there was high variability among samples. Finally, the last VAS scale asked women to rate their knowledge of the fact that HIV transmission from mother to child can be prevented over 98% with the proper treatment. Women’s mean for this scale was only 44.7 with a range of 0-96 and the standard deviation among responses was 30.8, meaning there was also high variability among responses. Education level had absolutely no correlation to women’s knowledge of HIV transmission, screening, or treatment benefits during pregnancy. Of equal importance, results show that the majority of HIV transmission questions that were answered incorrectly were related to oral transmission. Implications: Education about HIV transmission and screening during pregnancy needs to be spread to women of all educational levels. Further research can focus on how best to educate women and how to promote prenatal HIV screening for all women during every pregnancy.
    • The Learning Needs of Newly Licensed Registered Nurses

      Fraley, Hannah; Goodwin, Paige Allison (2016-05-01)
      Nurses are on the frontline of healthcare delivery. The learning needs of newly licensed registered nurses are poorly understood. The aim of this study is to identify the specific learning needs of these newly licensed nurses so that they are able to confidently provide excellent care to culturally, ethnically, and racially diverse patients. A qualitative approach was used to complete this study. Convenience sampling was used to recruit ten newly licensed registered nurses who were interviewed by phone. The interviews were transcribed. Questions targeted working nurses experiences with nursing skills, interdisciplinary interactions, and documentation. Data was analyzed and coded for the identification of themes. Gaps in the literature exist regarding the specific learning needs of newly licensed registered nurses. Understanding their learning needs can provide insight into how to better transition student nurses to registered nurses so that they are able to adequately and safely take care of a diverse patient population and work successfully as new nurses.
    • Literature Review of Kennedy Terminal Ulcers: Identification, Diagnosis, Nursing Goals, and Interventions

      Hills, Donna; Vera, Rachel (2014-05-17)
      Although not greatly researched, the paucity of available literature theorizes that Kennedy Terminal Ulcers (KTUs) are clinical indications of skin failure. Through a review of the literature, the topics of: (1) methods of KTU identification, (2) how to make a proper nursing diagnosis, and (3) suggested nursing interventions will be discussed. Included in this literature review are anecdotal articles written by experienced healthcare professionals working in the hospice and palliative care fields. Case studies which focus on the development and treatment of KTUs incurred by end-of-life patients receiving hospice or palliative care services are also presented. The available literature corroborates that there are five characteristic wound criteria that serve to identify and diagnose KTUs. Though clinical professionals have different approaches on how to treat KTUs, the current literature concurs that nursing interventions should include: adequate pain control, hemorrhage prophylaxis, effective wound dressings, exudate management, infection prophylaxis, effective debridement methods, and odor control. Limitations encountered by the clinicians studying the development and treatment of KTUs include ethical dilemmas (i.e. inducing patient fatigue, inflicting emotional distress, or occupying the patient's valuable time as they approach end of life) and limited awareness of the existence of KTUs. Further research is needed to raise awareness of the existence of KTUs and how they are indicative of skin failure, for they must be identified, diagnosed, and treated accordingly so nurses are able to better advocate for the patient and ensure quality comfort care is provided as the patient approaches end of life.
    • A Literature Review of the Negative Impact of Dementia on the Nutritional Status of Hospitalized Elderly Patients

      Frost, Marion; Geary, Jennifer (2014-05-17)
      Dementia is a progressive psychological disorder in the elderly population that leads to cognitive impairment and can have an impact on many areas of their life, especially nutrition. It is very common to see hospitalized dementia patients not receiving proper nutrition because they are unable to feed themselves, and often are not provided with the help they need. Nutrition is often a topic that is overlooked in the hospital setting because of the narrow focus on the patient’s diagnosis that caused their admission. Dementia is also a disease that may not be diagnosed until it has progressed to later stages, with the person suffering for many years before interventions take place. This is a very important issue in nursing because malnutrition can lead to further illness and a delay of healing in the elderly, leading to prolonged hospital stays, readmissions, and reoccurring health problems in these patients. This thesis will be a review of medical and nursing journals that look at the impact of dementia on proper nutrition in the hospitalized patients and the different nursing interventions that are used to improve nutrition in these patients. I will also make suggestions for changes in these nursing interventions to improve their effectiveness. A review of the epidemiology of dementia and nutrition requirements of the elderly person will also be included in this thesis.
    • A Literature Review of the Onset of Social Media and its Effect on HIPPA Violations

      Magazzu, Tammi; Bogosian, Jamie (2014-05-17)
      Social media has become increasingly popular in the United States and is accessed daily. It consists of different websites such as Facebook and Twitter. Access to these websites is easy and fast, allowing users to frequently network. In many situations, social media can be utilized in a positive manner. However, in fields such as nursing, social media can be detrimental. The Health Insurance Portability and Accountability Act, HIPAA, provides specific and strict regulations regarding the use of social media in the medical field. Breaching patient confidentiality can jeopardize a nurse’s job and future career. With the onset of social media, HIPAA violations have increased. This thesis will provide a literature review of social media and its onset, and how it affected HIPAA. I will show how these websites have caused more violations of HIPAA, and provide interventions and suggestions to decrease the violations. Specific methods will be included to show how the problem can be fixed. In addition, a brief history of social media will be provided to illustrate how it is extremely prevalent.
    • Living With Cardiovascular Disease: The Connection Between Mental Health And Quality Of Life

      Ebersole, Nancy; Desir, Pascale (2022-05-01)
      Cardiovascular disease is the leading cause of death worldwide. Depression and anxiety have been identified as common factors occurring with advanced heart disease. An unhealthy lifestyle, such as poor dietary habits or improper coping mechanisms is correlated with the onset of anxiety and depression. Patients with cardiovascular disease that are faced with various stressors as well as depression and anxiety are at risk for poor prognosis of their disease and an overall decreased quality of life. A systematic review was conducted using the CINAHL PLUS database to determine what mental health factors affect the outcome for individuals with cardiovascular disease. The results of this systematic review of seven academic articles outlined five themes that influence the quality of life for individuals with cardiovascular disease. The themes are (a) life satisfaction; (b) socioeconomic status and emotional state; (c) anxiety and fear; (d) stress and distress; and (e) depressive disorders. These results help to identify specific interventions that health care providers should implement when caring for patients with cardiovascular disease. Healthcare professionals should continuously monitor the mental status of their patients with cardiovascular disease, in order to treat their patients. By doing so this has the potential to reduce the progression of heart disease and improve their overall quality of life.
    • Managing Pain In Children: Barriers To Effective Care

      Ebersole, Nancy; Agno, Sandrei (2022-05-01)
      This thesis focuses upon pain management in a healthcare setting and at home, specifically within the population of children. The purpose of this research is to understand why assessment and pain management of children is difficult for healthcare providers and caregivers. This study covers the influencing factors that act as barriers in the direct care of healthcare providers to children. The aim is to understand why these barriers affect successful pain assessment and management. A systematic literature review was conducted to investigate the challenges that affect successful care for children. There were four themes that were identified in the eight articles that met the criteria for the barriers of pain assessment and management. The themes identified were the healthcare worker’s ability to collect subjective and objective data, communication within staff and family, forgotten priorities by healthcare providers and a child’s inability to rate their own pain. Recognizing these challenges and how they hinder optimal childcare will promote good patient outcomes and support child growth and development.
    • Minimizing The Risk Of Orthopedic Surgical Site Infections In The Pediatric Population: Using Evidence To Inform Practice

      Ebersole, Nancy; Gridley, Alaina (2021-05-01)
      Surgical site infections are some of the most common hospital-acquired infections and are associated with higher rates of morbidity and mortality for patients. Surgical site infections can also increase length of hospital stay for patients and elevate healthcare costs. There is extensive literature exploring risk factors associated with acquiring surgical site infections in adults undergoing orthopedic surgery, however, literature exploring this topic in the pediatric population is limited. Additionally, many interventions and assumed risks within the pediatric population are extrapolated from data collected from adults. A systematic review of the literature was done using the CINAHL database to identify risk factors associated with acquiring surgical site infections in the pediatric orthopedic patient population and interventions to help mitigate these risks. The result of these studies showed that both weight and nutritional status played a role in predicting the incidences of acquiring a surgical site infection. Additionally, prophylactic antibiotic selection and dosing needs to be specific to both the possible pathogen and the patient. A bundle approach to interventions can help to reduce the rate of surgical site infections, however, strict compliance amongst staff can be difficult to ensure. It is imperative as healthcare professionals that we work lo identify associated risk factors for developing surgical site infections within the pediatric population undergoing orthopedic surgery. The identification of these risk factors can guide evidence-based practice to establish interventions that can mitigate these risks and promote health and safety for the pediatric population.
    • The Mirena Migraine - A Review of the Pharmacodynamics of Levonorgestrel and Its Implications in Women's Health

      Magazzu, Tammi; Earl, Lexus (2014-05-17)
      The new progestin, levonorgestrel, delivered via an intrauterine system or subdermal implant is showing promising signs of preventing pregnancy, decreasing excessive bleeding with menstruation, and returning fertility when removed (Backman, 2004). As promising as the levonorgestrel parental systems are, side effects are a common cause for concern and are a large reason for premature removal (Coukell & Balfour, 1998). Other than prolonged bleeding from insertion, and heavier periods for some women, other side effects have been observed such as weight gain, mood changes, dizziness and persistent, headache (Backman, 2004). With headache being one of the primary reasons for premature removal, previous literature has shown strong antiestrogenic activity among the pharmacodynamics of levonorgestrel (Schindler, 2003), which in turn may be the causative agent for the headache experienced among users. Given that headaches are mediated by vasodilation and vasoconstriction, the antiestrogenic activity of levonorgestrel is hypothesized to affect estrogen mediated vasodilation (Schindler, 2003). As one of the strongest antagonist of estrogen, levonorgestrel has also been discussed to affect the oxidation of low-density lipoprotein (LDL) cholesterol impacting the endothelium of the cardiac vasculature (Zhu, Bonet, & Knopp, 2000). This review aims to identify how levonorgestrel could be the causative agent for the physiologic phenomenon of a headache experienced among users so that medical professionals and drug manufacturers can be guided towards developing and prescribing a more effective and tolerable birth control option.
    • Nonpharmacologic Interventions For Neonatal Abstinence Syndrome: A Systematic Review Of The Literature

      Orelup-Fitzgerald, Courtney; Scanlan, Kathleen (2019-05-01)
      The incidence of Neonatal Abstinence Syndrome (NAS) is increasing due to the current opioid epidemic. The foundation of NAS treatment has been pharmacotherapy but nonpharmacologic interventions are increasingly used to alleviate symptoms, reduce the amount of pharmacotherapy needed, and decrease the hospital length of stay (LOS). A systematic review of the literature was performed to identify nonpharmacologic interventions (NPI) that effectively improve NAS treatment outcomes and to identify gaps in current knowledge about NPI. Eight NPI were used as key words in literature searches: infant massage, parental presence, breastfeeding, Reiki, vibrotactile stimulation, acupuncture, non-nutritive sucking, and auditory stimulation. Results found nine studies that met the inclusion criteria: one study investigating the effect of infant massage, three studies on outcomes of parental presence, two studies on the effects of breastfeeding, one study on outcomes of Reiki, one study on vibrotactile stimulation, and one study on laser acupuncture. No studies assessed non-nutritive sucking or auditory stimulation interventions. NPI found to be effective in reducing NAS symptoms were infant massage (one study), parental presence (one study), and breastfeeding (one study). Decreased LOS was associated with parental presence (three studies), breast feeding (one study), and laser acupuncture (one study). Laser acupuncture also reduced the length of time the infant required medication (one study). Parental presence and breastfeeding each had one study where decreased amounts of medication were needed. Reiki and vibrotactile stimulation were not found to be effective interventions. A gap identified is the scarcity of research on the effectiveness of NPI.
    • Nurse To Patient Ratios: Government Mandated Or Evidence Based?

      Ebersole, Nancy; Robitaille, Jessica (2019-05-01)
      Nurse to patient ratios are currently controversial in health care. The central issue is what is a safe limit to the number of patients for whom an RN is responsible in the acute care setting? Some states require a committee at each facility to determine ratios whereas in other states, the legislature has established what the ratio must be. A systematic review of the literature was conducted using CINAHL to identify the major factors being used to determine a safe nurse to patient ratio. Criteria for inclusion in this study were (a) published between 2013 and September 2018; (b) peer reviewed; (c) published in English and (d) had at least one nurse as an author. A combination of the following keywords were nurse to patient ratios, safety, patient outcomes and quality of care. Thirteen studies qualified for inclusion in this systematic review. Five major factors identified as determining nurse to patient ratios are the educational levels of the nursing staff, patient acuity, patient outcomes, cost and the staffing method of the institution based upon cost/budget, nurse to patient ratio or patient acuity. The staffing method chosen is a decision between administrators and the nursing leadership. Cost is more heavily weighted by administrators than by the nursing leadership. These five factors are not constants and the dynamic environment of acute care nursing does not lend itself to staffing that does not consider these factors. Government mandated nurse to patient staffing ratios cannot provide the work environment that provides for the nursing needs of today’s patient populations.