A Retrospective Cohort Study of patient education programs in hospitalized elderly patients with nurse burnout
DOI:
https://doi.org/10.5281/zenodo.22815004Keywords:
patient education, elderly patients, nurse burnout, retrospective cohort, hospital dischargeAbstract
Background: Hospitalized elderly patients depend on structured education for new diagnoses and discharge instructions, yet the nurses delivering that teaching increasingly report burnout that may erode its delivery.
Objective: This review synthesizes retrospective cohort and observational evidence on patient education programs for hospitalized elderly patients, examined alongside nurse burnout, to characterize their intersection.
Methods: We synthesized retrospective cohort studies, cross-sectional surveys, and quasi-experimental evaluations addressing inpatient education for older adults, burnout measurement, staffing, and outcomes.
Findings: Structured teach-back and discharge-education programs are associated with improved comprehension and lower readmission, while units with higher burnout show reduced education completeness and lower understanding; staffing and workload predict both burnout and education fidelity.
Conclusions: Burnout appears to function as a structural barrier to consistent patient education in geriatric inpatient care, and protecting nursing workload may be as important to education outcomes as program content.
References
Jack, B.W., Chetty, V.K., Anthony, D., Greenwald, J.L., Sanchez, G.M., Johnson, A.E., et al. (2009) A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Annals of Internal Medicine, 150(3): 178-187. DOI: 10.7326/0003-4819-150-3-200902030-00007
Naylor, M.D., Brooten, D.A., Campbell, R.L., Maislin, G., McCauley, K.M., Schwartz, J.S. (2004) Transitional care of older adults hospitalized with heart failure: a randomized controlled trial. Journal of the American Geriatrics Society, 52(5): 675-684. DOI: 10.1111/j.1532-5415.2004.52202.x
Coleman, E.A., Parry, C., Chalmers, S., Min, S.J. (2006) The care transitions intervention: results of a randomized controlled trial. Archives of Internal Medicine, 166(17): 1822-1828. DOI: 10.1001/archinte.166.17.1822
Maslach, C., Schaufeli, W.B., Leiter, M.P. (2001) Job burnout. Annual Review of Psychology, 52: 397-422. DOI: 10.1146/annurev.psych.52.1.397
Woo, T., Ho, R., Tang, A., Tam, W. (2020) Global prevalence of burnout symptoms among nurses: a systematic review and meta-analysis. Journal of Psychiatric Research, 123: 9-20. DOI: 10.1016/j.jpsychires.2019.12.015
Halbesleben, J.R.B., Rathert, C. (2008) Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Management Review, 33(1): 29-39. DOI: 10.1097/01.HMR.0000304493.87898.72
Baker, D.W., Wolf, M.S., Feinglass, J., Thompson, J.A., Gazmararian, J.A., Huang, J. (2007) Health literacy and mortality among elderly persons. Archives of Internal Medicine, 167(14): 1503-1509. DOI: 10.1001/archinte.167.14.1503
Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., et al. (2002) Association of health literacy with diabetes outcomes. JAMA, 288(4): 475-482. DOI: 10.1001/jama.288.4.475
Cutilli, C.C. (2007) Health literacy in geriatric patients: an integrative review of the literature. Orthopaedic Nursing, 26(1): 43-48. DOI: 10.1097/00006416-200701000-00014
Speros, C. (2005) Health literacy: concept analysis. Journal of Advanced Nursing, 50(6): 633-640. DOI: 10.1111/j.1365-2648.2005.03448.x
Inouye, S.K., Bogardus, S.T., Charpentier, P.A., Leo-Summers, L., Acampora, D., Holford, T.R., et al. (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340(9): 669-676. DOI: 10.1056/NEJM199903043400901
Greysen, S.R., Cenzer, I.S., Auerbach, A.D., Covinsky, K.E. (2015) Functional impairment and hospital readmission in Medicare seniors. JAMA Internal Medicine, 175(4): 559-565. DOI: 10.1001/jamainternmed.2014.7756
Kripalani, S., LeFevre, F., Phillips, C.O., Williams, M.V., Basaviah, P., Baker, D.W. (2007) Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA, 297(8): 831-841. DOI: 10.1001/jama.297.8.831
Negarandeh, R., Mahmoodi, H., Noktehdan, H., Heshmat, R., Shakibazadeh, E. (2013) Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes. Primary Care Diabetes, 7(2): 111-118. DOI: 10.1016/j.pcd.2012.11.001
White, M., Garbez, R., Carroll, M., Brinker, E., Howie-Esquivel, J. (2013) Is "teach-back" associated with knowledge retention and hospital readmission in hospitalized heart failure patients? Journal of Cardiovascular Nursing, 28(2): 137-146. DOI: 10.1097/JCN.0b013e31824987bd
Kornburger, C., Gibson, C., Sadowski, S., Maletta, K., Klingbeil, C. (2013) Using "teach-back" to promote a safe transition from hospital to home: an evidence-based approach to improving the discharge process. Journal of Pediatric Nursing, 28(3): 282-291. DOI: 10.1016/j.pedn.2012.10.007
Weiss, B.D., Mays, M.Z., Martz, W., Castro, K.M., DeWalt, D.A., Pignone, M.P., et al. (2005) Quick assessment of literacy in primary care: the newest vital sign. Annals of Family Medicine, 3(6): 514-522. DOI: 10.1370/afm.405
Maben, J., Bridges, J. (2020) Covid-19: Supporting nurses' psychological and mental health. Journal of Clinical Nursing, 29(15-16): 2742-2750. DOI: 10.1111/jocn.15307
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., Silber, J.H. (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16): 1987-1993. DOI: 10.1001/jama.288.16.1987
Aiken, L.H., Sermeus, W., Van den Heede, K., Sloane, D.M., Busse, R., McKee, M., et al. (2012) Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344: e1717. DOI: 10.1136/bmj.e1717
Lasater, K.B., Aiken, L.H., Sloane, D.M., French, R., Martin, B., Reneau, K., et al. (2021) Chronic hospital nurse understaffing meets COVID-19: an observational study. BMJ Quality and Safety, 30(8): 639-647. DOI: 10.1136/bmjqs-2020-011512
Van Bogaert, P., Timmermans, O., Weeks, S.M., van Heusden, D., Wouters, K., Franck, E. (2014) Nursing unit teams matter: impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse-reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey. International Journal of Nursing Studies, 51(8): 1123-1134. DOI: 10.1016/j.ijnurstu.2013.12.009
Dall'Ora, C., Ball, J., Reinius, M., Griffiths, P. (2020) Burnout in nursing: a theoretical review. Human Resources for Health, 18: 41. DOI: 10.1186/s12960-020-00469-9
Vahey, D.C., Aiken, L.H., Sloane, D.M., Clarke, S.P., Vargas, D. (2004) Nurse burnout and patient satisfaction. Medical Care, 42(2 Suppl): II57-II66. DOI: 10.1097/01.mlr.0000109126.50398.5a
Poghosyan, L., Clarke, S.P., Finlayson, M., Aiken, L.H. (2010) Nurse burnout and quality of care: cross-national investigation in six countries. Research in Nursing and Health, 33(4): 288-298. DOI: 10.1002/nur.20383
McHugh, M.D., Kutney-Lee, A., Cimiotti, J.P., Sloane, D.M., Aiken, L.H. (2011) Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Affairs, 30(2): 202-210. DOI: 10.1377/hlthaff.2010.0100
Ausserhofer, D., Zander, B., Busse, R., Schubert, M., De Geest, S., Rafferty, A.M., et al. (2014) Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study. BMJ Quality and Safety, 23(2): 126-135. DOI: 10.1136/bmjqs-2013-002318
Cimiotti, J.P., Aiken, L.H., Sloane, D.M., Wu, E.S. (2012) Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40(6): 486-490. DOI: 10.1016/j.ajic.2012.02.029
Tourangeau, A.E., Doran, D.M., McGillis Hall, L., O'Brien Pallas, L., Pringle, D., Tu, J.V., et al. (2007) Impact of hospital nursing care on 30-day mortality for acute medical patients. Journal of Advanced Nursing, 57(1): 32-44. DOI: 10.1111/j.1365-2648.2006.04084.x
Shever, L.L. (2011) The impact of nursing surveillance on failure to rescue. Research and Theory for Nursing Practice, 25(2): 107-126. DOI: 10.1891/1541-6577.25.2.107
Kutney-Lee, A., McHugh, M.D., Sloane, D.M., Cimiotti, J.P., Flynn, L., Neff, D.F., et al. (2013) Nursing: a key to patient satisfaction. Health Affairs, 28(4): w669-w677. DOI: 10.1377/hlthaff.28.4.w669
Leiter, M.P., Maslach, C. (2009) Nurse turnover: the mediating role of burnout. Journal of Nursing Management, 17(3): 331-339. DOI: 10.1111/j.1365-2834.2009.01004.x
Shepperd, S., Lannin, N.A., Clemson, L.M., McCluskey, A., Cameron, I.D., Barras, S.L. (2013) Discharge planning from hospital to home. Cochrane Database of Systematic Reviews, (1): CD000313. DOI: 10.1002/14651858.CD000313.pub4
Courtney, M., Edwards, H., Chang, A., Parker, A., Finlayson, K., Hamilton, K. (2009) Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. Journal of the American Geriatrics Society, 57(3): 395-402. DOI: 10.1111/j.1532-5415.2009.02138.x
Mudge, A.M., Kasper, K., Clair, A., Redfern, H., Bell, J.J., Barras, M.A., et al. (2011) Recurrent readmissions in medical patients: a prospective study. Journal of Hospital Medicine, 6(2): 61-67. DOI: 10.1002/jhm.811
Forster, A.J., Clark, H.D., Menard, A., Dupuis, N., Chernish, R., Chandok, N., et al. (2004) Adverse events among medical patients after discharge from hospital. CMAJ, 170(3): 345-349.
Moss, M., Good, V.S., Gozal, D., Kleinpell, R., Sessler, C.N. (2016) An official critical care societies collaborative statement: burnout syndrome in critical care healthcare professionals. Critical Care Medicine, 44(7): 1414-1421. DOI: 10.1097/CCM.0000000000001885
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Orla Walsh, et al.

This work is licensed under a Creative Commons Attribution 4.0 International License.
