1
|
Al‐Hammouri F, Hamdan KM, Haymour AM, Ibrahim MO, Malkawi A, Al‐Hiary SS, Albqoor MA, Shaheen AM. Quality of nursing care: Predictors of patient satisfaction in a national sample. Nurs Open 2024; 11:e2252. [PMID: 39166287 PMCID: PMC11336376 DOI: 10.1002/nop2.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 08/22/2024] Open
Abstract
AIM To assess patients' satisfaction with the quality of nursing care and the relationship between patients' characteristics and their level of satisfaction. DESIGN A descriptive correlational cross-sectional design was used in this study. METHODS Convenient sampling was utilized to include 1014 inpatients from six hospitals in Jordan: three private hospitals; two governmental hospitals; and one university-affiliated hospital. The data collection process occurred from September 2022 to January 2023. The data were collected using the Arabic version of the Patients' Satisfaction with Nursing Care Quality Questionnaire. The data were analysed using Pearson correlation, t-test, one-way ANOVA and multiple hierarchal regression. RESULTS The study included 1014 patients with an average age of 51.3 (SD = 18.6), and 59.9% were females. More than two thirds of the sample reported having health insurance, and 62.7% were unemployed. The mean total score of patients' satisfaction with nursing care quality (NCQ) was 68.2 (SD = 12.9), indicating high satisfaction. Higher-income levels (p < 0.001), higher education levels (p = 0.003), having health insurance (p < 0.001), being admitted to private hospitals (p < 0.001), being admitted to critical care units (p = 0.002), being in a single room (p = 0.001), excellent perceived health status (p < 0.001) and willingness to recommend the hospital to family and friends (p < 0.001) were significant predictors of patients' satisfaction with NCQ. CONCLUSIONS Patient and hospital environment characteristics affected patients' satisfaction with NCQ. Hospital management should consider these characteristics to improve patient satisfaction and outcomes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Policymakers and hospital management should consider improving the physical environment of their facilities to improve patients' satisfaction. Continuous professional development should emphasize nurses' communication skills to enhance their abilities to deliver information to their patients. IMPACT This study examined levels and predictors of patients' satisfaction with the quality of nursing care. The results indicated that improving patients' satisfaction can be achieved by focusing on areas of nurses' communication skills and explaining information to patients. REPORTING METHOD The study adhered to STORBE guidelines for reporting observational studies. PATIENT OR PUBLIC CONTRIBUTION Hospitalized patients contributed to the data of this study. Hospital administrators facilitated its implementation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Abeer M. Shaheen
- Community Health Nursing Department, School of NursingThe University of JordanAmmanJordan
| |
Collapse
|
2
|
Kohanová D, Zrubcová D, Bartoníčková D, Solgajová A. Unmet care needs in psychiatric healthcare context: A systematized literature review. J Psychiatr Ment Health Nurs 2024. [PMID: 39016194 DOI: 10.1111/jpm.13083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/11/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT Missed, rationed or unfinished nursing care represents a global problem that jeopardizes the provision of quality and safe care. This phenomenon is frequently observed in adult, paediatric and child healthcare facilities and various care units. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE The findings of this review contribute valuable information to inform evidence-based practices, foster organizational improvements and ultimately optimize the overall quality of care in psychiatric healthcare settings. In addition, the review illuminates the far-reaching consequences of care on both patient and nurse outcomes, emphasizing the urgent need for tailored strategies to mitigate these effects. WHAT ARE THE IMPLICATIONS FOR PRACTICE Based on the synthesis of the literature, a thorough and continuous assessment of patient care needs in the physical, psychological and social domains is needed, primarily utilizing standardized instruments designed for psychiatric settings to ensure a comprehensive understanding of unmet needs. Based on identified unmet needs, nurses should develop individualized care plans and tailor interventions to address them. In addition, nurse managers must adopt and implement regular monitoring mechanisms to track the prevalence of unmet care needs and at the same time establish reporting systems that capture the proportion of unmet needs, allowing timely interventions and adjustments to care delivery. Lastly, nurse managers must not only emphasize the importance of ethical care practices and dignity-focused interventions but also educate healthcare providers, especially nurses, on the potential threats to patient dignity arising from unmet care needs. ABSTRACT INTRODUCTION: Despite frequent observations of unmet care needs in acute care adult settings, there are a limited number of studies that focus on investigating this phenomenon in the psychiatric setting. AIM To synthesize the existing empirical research on unmet care needs in psychiatric healthcare settings. METHODS The search was carried out in August 2023 in four scientific databases, PubMed, ProQuest, Web of Science and OVID Nursing, based on their institutional availability. The search produced 1129 studies. The search and retrieval process reflected the recommendations of the Preferred Reporting Items for systematic reviews and meta-analyses. RESULTS This review included 14 studies investigating unmet care needs in the psychiatric healthcare setting. Unmet care needs included three domains: physical, psychological and social. The analysis of the factors revealed factors related to the characteristics of the organization, nurse and patient. DISCUSSION The classification of unmet needs provides a comprehensive understanding of the various challenges facing people in psychiatric healthcare settings. IMPLICATION FOR PRACTICE Identified factors that influence the occurrence of unmet care needs will help prevent the occurrence of unmet care needs and timely assessment. The resolution of needs helps to achieve patient and nurse outcomes, increase the quality of care provided and patient satisfaction in a psychiatric healthcare setting.
Collapse
Affiliation(s)
- Dominika Kohanová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University, Nitra, Slovakia
| | - Dana Zrubcová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University, Nitra, Slovakia
| | - Daniela Bartoníčková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czechia
| | - Andrea Solgajová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University, Nitra, Slovakia
| |
Collapse
|
3
|
Cohen M, Drach-Zahavy A, Srulovici E. The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design. J Clin Nurs 2024. [PMID: 38923756 DOI: 10.1111/jocn.17322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
AIMS To examine a novel moderated-mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress. DESIGN Nested diary study. METHODS Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium-sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse-patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated-mediation model. RESULTS Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses. CONCLUSION The study highlights accountability's dual role-safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff. IMPACT By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes. REPORTING METHOD The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Mirit Cohen
- Department of Nursing, The University of Haifa, Haifa, Israel
- Baruch Padeh Medical Center, Poriya, Israel
| | | | - Einav Srulovici
- Department of Nursing, The University of Haifa, Haifa, Israel
| |
Collapse
|
4
|
Kitson A, Carr D, Feo R, Conroy T, Jeffs L. The ILC Maine statement: Time for the fundamental care [r]evolution. J Adv Nurs 2024. [PMID: 38379317 DOI: 10.1111/jan.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
AIM The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice. DESIGN Position paper. METHODS This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice. RESULTS The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action-oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non-nursing tasks: reclaim and protect time to provide high-value fundamental care. Accentuate the positive: change from deficit-based to affirmative language when describing fundamental care. Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research. Advocate for interprofessional collaboration: support high-quality, transdisciplinary fundamental care delivery via strong nursing leadership. CONCLUSION The ILC Maine Statement calls for ongoing action - [r]evolution - from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We outline four action-oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered. Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems. IMPACT Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability. This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally. PATIENT OR PUBLIC CONTRIBUTION Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers. By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey.
Collapse
Affiliation(s)
- Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Devin Carr
- The International Learning Collaborative, Adelaide, South Australia, Australia
- Maine Medical Center, Portland, Maine, USA
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Lianne Jeffs
- The International Learning Collaborative, Adelaide, South Australia, Australia
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Hendy A, Abdel Fattah HA, Abouelela MA, Atia GAE, Alshammari MSS, Hables RMM, Alzahrani NS, Hendy A, Almarwani AM. Nursing Professional Commitment as a Mediator of the Relationship Between Work Environment and Missed Nursing Care Among Nurses: A Cross-Sectional Analysis. SAGE Open Nurs 2024; 10:23779608231226063. [PMID: 38250456 PMCID: PMC10798127 DOI: 10.1177/23779608231226063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Nursing care plays a pivotal role in promoting patient well-being and optimizing health outcomes. The nursing profession is characterized by its commitment to delivering high-quality care to patients. Objective The purpose of the study was to explore the role of nursing professional commitment as a mediator between the work environment and missed nursing care. Methods A cross-sectional analysis study "STROBE guideline" used an online structured questionnaire to collect data. It was conducted on a sample of 813 nurses who worked at seven governmental hospitals in Egypt, in the hospital wards, operating rooms, intensive care unit (ICU) or outpatient clinics, during a 4-month period from April to August 2022. Researchers used Characteristics of nurses, Nursing Work Index-Revised, Nursing Professional Commitment Scale, and MISSCARE Questionnaire to collect the data. Structural equation modeling by AMOS was used for testing nursing professional commitment as a mediator between the work environment and missed nursing care. Nurses' professional commitment was used as a mediator between work environment and missing nursing care. Results The working environment has a direct impact of -0.175, an indirect impact of -0.139, and a total impact of -0.314. Furthermore, professional commitment has a direct impact of -0.421. Additionally, when the working environment increases by 1, professional commitment increases by 0.33. Similarly, when the working environment increases by 1, missed care decreases by 0.175. Moreover, when professional commitment, as a mediating factor, increases by 1, missed care decreases by 0.421. Conclusion In conclusion, the findings of this study highlight the significant role of professional commitment as an intermediary factor between the working environment and missed nursing care. According to these results, it is necessary to formulate and implement intervention strategies to improve nurses' professional commitment and working environment, which is the key to reducing their missed nursing care.
Collapse
Affiliation(s)
- Abdelaziz Hendy
- Pediatric Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt
| | | | | | - Gehan Abd elfattah Atia
- Medical-Surgical Nursing Department, Faculty of Nursing, Jouf University, Sakākā, Saudi Arabia
- Medical-Surgical Nursing Department, Faculty of Nursing, Menoufia University, Menoufia, Egypt
| | | | - Reda Mhmoud Mohamed Hables
- Department of Obstetrics and Gynecology Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
- College of Applied Medical Science, University of Hafar Albatin, Hafar Albatin, Saudi Arabia
| | - Naif S. Alzahrani
- Department of Medical – Surgical Nursing, College of Nursing, Taibah University, Medina, Saudi Arabia
| | - Ahmed Hendy
- Department of Computational Mathematics and Computer Science, Institute of Natural Sciences and Mathematics, Ural Federal University, Yekaterinburg, Russian Federation
| | | |
Collapse
|
6
|
McGillis Hall L, Reali V, Canzian S, Johnston L, Hatcher C, Hayward-Murray K, Layton M, Merkley J, Richards J, Taggar R, Woollard S. Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study. BMJ Open Qual 2023; 12:e002353. [PMID: 38135301 DOI: 10.1136/bmjoq-2023-002353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The emergence of the COVID-19 pandemic led to an increased demand for hospital beds, which in turn led to unique changes to both the organisation and delivery of patient care, including the adoption of adaptive models of care. Our objective was to understand staff perspectives on adaptive models of care employed in intensive care units (ICUs) during the pandemic. METHODS We interviewed 77 participants representing direct care staff (registered nurses) and members of the nursing management team (nurse managers, clinical educators and nurse practitioners) from 12 different ICUs. Thematic analysis was used to code and analyse the data. RESULTS Our findings highlight effective elements of adaptive models of care, including appreciation for redeployed staff, organising aspects of team-based models and ICU culture. Challenges experienced with the pandemic models of care were heightened workload, the influence of experience, the disparity between model and practice and missed care. Finally, debriefing, advanced planning and preparation, the redeployment process and management support and communication were important areas to consider in implementing future adaptive care models. CONCLUSION The implementation of adaptive models of care in ICUs during the COVID-19 pandemic provided a rapid solution for staffing during the surge in critical care patients. Findings from this study highlight some of the challenges of implementing redeployment as a staffing strategy, including how role clarity and accountability can influence the adoption of care delivery models, lead to workarounds and contribute to adverse patient and nurse outcomes.
Collapse
Affiliation(s)
| | - Vanessa Reali
- Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Linda Johnston
- Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Mikki Layton
- Toronto East Health Network Michael Garron Hospital, Toronto, Ontario, Canada
| | | | - Joy Richards
- University Health Network, Toronto, Ontario, Canada
| | - Ru Taggar
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | |
Collapse
|
7
|
Jędrzejczyk M, Guzak B, Czapla M, Ross C, Vellone E, Juzwiszyn J, Chudiak A, Sadowski M, Uchmanowicz I. Rationing of nursing care in Internal Medicine Departments-a cross-sectional study. BMC Nurs 2023; 22:455. [PMID: 38044434 PMCID: PMC10694866 DOI: 10.1186/s12912-023-01617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Implicit rationing of nursing care refers to a situation in which necessary nursing care is not performed to meet all of the patients' needs. PURPOSE To examine the factors influencing the rationing of nursing care, nurses' assessment of the quality of patient care, and their job satisfaction in Internal Medicine Departments. METHODS A cross-sectional descriptive study was undertaken. The study included 1164 nurses working in the Internal Medicine Departments in 8 hospitals (Lower Silesia, Poland). The Perceived Implicit Rationing of Nursing Care instrument was used. RESULTS Respondents rarely ration nursing care, with a mean score of 1.12 (SD = 0.68). The mean score for quality of patient care was 6.99 (SD = 1.92). In contrast, the mean job satisfaction score was 6.07 points (SD = 2.22). The most important predictors of high rates of rationing of nursing care were work experience of 16-20 years (regression parameter: 0.387) and a Bachelor's degree in nursing (regression parameter: 0.139). Nurses' assessment of the quality of patient care ratings were increased by having a Master's degree in nursing (regression parameter: 0.41), and significantly decreased by work experience of 16-20 years (regression parameter: -1.332). Independent predictors of job satisfaction ratings in both univariate and multivariate analysis were Master's degree and long-shift working patterns. CONCLUSION The factors that influence an increased level of nursing care rationing on medical wards are nurse seniority, exceeding 16 years and female gender. Obtaining a Master's degree in nursing indicates improved nurses' assessment of the quality of patient care.
Collapse
Affiliation(s)
- Maria Jędrzejczyk
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Guzak
- Center of Postgraduate Education for Nurses and Midwives, Warsaw, Poland
| | - Michał Czapla
- Institute of Heart Diseases, University Hospital, Wroclaw, 50-566, Poland.
- Department of Emergency Medical Service, Wroclaw Medical University, ul. Parkowa 34, Wroclaw, 51-616, Poland.
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logroño, 26006, Spain.
| | - Catherine Ross
- The Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - Ercole Vellone
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
- Department of Biomedicine and Prevention, University of Roma Tor Vergata, Rome, Italy
| | - Jan Juzwiszyn
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Chudiak
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Mikołaj Sadowski
- Department of Anaesthesiology and Intensive Care, University Hospital, Wrocław, 50-556, Poland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
8
|
Heng LMT, Rajasegeran DD, See AMT, Kannusamy P, Lim SH, Aloweni FBAB, Ang SY. Original Research: Nurse-Reported Missed Care and Its Association with Staff Demographics and the Work Environment. Am J Nurs 2023; 123:28-36. [PMID: 37615466 DOI: 10.1097/01.naj.0000978144.33445.5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Nurses have primary responsibility for many of the care processes and interventions intended to improve patients' health during hospital stays. Accordingly, missed nursing care can negatively impact patient safety and lead to negative clinical outcomes. Missed nursing care is standard care that is not completed, incomplete, or seriously delayed. PURPOSE There is scant literature on nurse-reported missed care (NRMC) in Singapore. Identifying the prevalence of, types of, and reasons for missed care, including staff-related factors, is imperative to understanding the implications of missed care and identifying opportunities for improvement. METHODS Ours is a correlation study of NRMC using convenience sampling. Nurses working on all inpatient units in an acute care hospital in Singapore were recruited to complete the MISSCARE survey, a quantitative tool measuring missed nursing care and the reasons for it. Descriptive statistics was applied to analyze demographics, types of NRMC, and reasons for NRMC. The Pearson χ2 test was used to analyze the correlation between demographics and satisfaction variables and NRMC. RESULTS A total of 314 participants out of 1,944 eligible nurses (response rate, 16%) were recruited. The most commonly reported missed care activities were setting up meals for patients who can feed themselves (87.3%), ambulation (70.1%), attending interdisciplinary conferences (64.3%), providing emotional support to patients and/or family (58%), and turning patients every two hours (56.7%). The most cited reasons for missed care were inadequate number of staff (84.4%), caregiver not in unit or unavailable (76.1%), heavy admission and discharge activity (75.5%), urgent patient situations (74.2%), and unexpected rise in patient volume and/or acuity (73.2%). Younger age, greater experience in role and current unit, inadequate staffing and teamwork, low satisfaction with current role and with being a nurse, and planning to leave the current position were factors significantly associated with greater levels of missed care. CONCLUSION This study demonstrated evidence of NRMC and its associated factors within the local setting. In addition to expanding nursing resources, analyzing nursing work processes, providing support for younger nurses, and improving nursing satisfaction are possible mitigating factors in preventing missed care. Strategies targeting workforce and resource management, greater support for new and younger nurses, and job satisfaction should be considered to address missed care.
Collapse
Affiliation(s)
- Laura Mun Tze Heng
- Laura Mun Tze Heng is a staff nurse, Darshini Devi Rajasegeran and Siew Hoon Lim are nurse clinicians, Alicia Min Ting See is a senior staff nurse, and Fazila Binte Abu Bakar Aloweni is senior nurse manager, all at Singapore General Hospital, Singapore. Premarani Kannusamy is deputy director and head of nursing, Youth Preventive Services, and head of nursing, Health Promotion Board, Singapore. Shin Yuh Ang is deputy director of nursing innovation, quality and research, Singapore General Hospital, and director of nursing, National Dental Centre, Singhealth, Singapore. Contact author: Darshini Devi Rajasegeran, . The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | | | | | | | | | |
Collapse
|
9
|
Berezowski J, Czapla M, Manulik S, Ross C. Rationing in healthcare-a scoping review. Front Public Health 2023; 11:1160691. [PMID: 37415702 PMCID: PMC10319992 DOI: 10.3389/fpubh.2023.1160691] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/19/2023] [Indexed: 07/08/2023] Open
Abstract
Healthcare rationing has been the subject of numerous debates and concerns in the field of health economics in recent years. It is a concept which refers to the allocation of scarce healthcare resources and involves the use of different approaches to the delivery of health services and patient care. Regardless of the approach used, healthcare rationing fundamentally involves withholding potentially beneficial programs and/or treatments from certain people. As the demands placed on health services continue to rise and with that significant increases to the cost, healthcare rationing has become increasingly popular and is deemed necessary for the delivery of affordable, patient-care services. However, public discourse on this issue has largely been centered on ethical considerations with less focus on economic rationality. Establishing the economic rationality of healthcare rationing is essential in healthcare decision-making and consideration of its adoption by healthcare authorities and organizations. This scoping review of seven articles demonstrates that the economic rationality of healthcare rationing is the scarcity of healthcare resources amidst increased demand and costs. Therefore, supply, demand, and benefits are at the core of healthcare rationing practices and influence decisions on its suitability. Given the increased costs of care and resource scarcity, healthcare rationing is a suitable practice towards ensuring healthcare resources are allocated to people in a rational, equitable, and cost-effective manner. The rising costs and demands for care place significant pressure on healthcare authorities to identify suitable strategies for the allocation of healthcare resources. Healthcare rationing as a priority-setting strategy would support healthcare authorities identify mechanisms to allocate scarce resources in a cost-effective manner. When used in the context of a priority-setting approach, healthcare rationing helps healthcare organizations and practitioners to ensure that patient populations achieve maximum benefits at reasonable costs. It represents a fair allocation of healthcare resources to all populations, especially in low-income settings.
Collapse
Affiliation(s)
- Jakub Berezowski
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Michał Czapla
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logroño, Spain
| | - Stanisław Manulik
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Catherine Ross
- The Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| |
Collapse
|
10
|
Li HQ, Xie P, Huang X, Luo SX. The experience of nurses to reduce implicit rationing of nursing care: a phenomenological study. BMC Nurs 2023; 22:174. [PMID: 37208756 DOI: 10.1186/s12912-023-01334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/10/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Implicit rationing of nursing care can adversely affect patient safety and the quality of care, and increase nurses' burnout and turnover tendency. Implicit rationing care occurs at the nurse-to-patient level (micro-level), and nurses are direct participants. Therefore, the strategies based on experience of nurses to reduce implicit rationing care have more reference value and promotion significance. The aim of the study is to explore the experience of nurses to reduce implicit rationing care, thereby to provide references for conducting randomized controlled trials to reduce implicit rationing care. METHODS This is a descriptive phenomenological study. Purpose sampling was conducted nationwide. There are 17 nurses were selected and semi-structured in-depth interviews were conducted. The interviews were recorded, transcribed verbatim and analyzed via thematic analysis. RESULTS Our study found that nurses' reported experience of coping with implicit rationing of nursing care contained three aspects: personal, resource, and managerial. Three themes were extracted from the results of the study: (1) improving personal literacy; (2) supplying and optimizing resources and (3) standardizing management mode. The improvement of nurses' own qualities are the prerequisites, the supply and optimization of resources is an effective strategy, and clear scope of work has attracted the attention of nurses. CONCLUSION The experience of dealing with implicit nursing rationing includes many aspects. Nursing managers should be grounded in nurses' perspectives when developing strategies to reduce implicit rationing of nursing care. Promoting the improvement of nurses' skills, improving staffing level and optimizing scheduling mode are promising measures to reduce hidden nursing rationing.
Collapse
Affiliation(s)
- Hui Qin Li
- Mental Health Center, West China School of Nursing, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan Province, 610041, P.R. China
| | - Peng Xie
- Surgical Anesthesia Center, West China School of Nursing, West China Hospital, Sichuan University, No. 28 Telecom South Street, Chengdu, Sichuan Province, 610041, P.R. China
| | - Xia Huang
- Mental Health Center, West China School of Nursing, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan Province, 610041, P.R. China.
| | - Shan Xia Luo
- Mental Health Center, West China School of Nursing, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan Province, 610041, P.R. China.
| |
Collapse
|
11
|
Lund SB, Skolbekken JA, Mosqueda L, Malmedal W. Making Neglect Invisible: A Qualitative Study among Nursing Home Staff in Norway. Healthcare (Basel) 2023; 11:healthcare11101415. [PMID: 37239698 DOI: 10.3390/healthcare11101415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Research shows that nursing home residents' basic care needs are often neglected, potentially resulting in incidents that threaten patients' safety and quality of care. Nursing staff are at the frontline for identifying such care practices but may also be at the root of the problem. The aim of this study was to generate new knowledge on reporting instances of neglect in nursing homes based on the research question "How is neglect reported and communicated by nursing home staff?" METHODS A qualitative design guided by the principles of constructivist grounded theory was used. The study was based on five focus-group discussions (20 participants) and 10 individual interviews with nursing staff from 17 nursing homes in Norway. RESULTS Neglect in nursing homes is sometimes invisible due to a combination of personal and organizational factors. Staff may minimize "missed care" and not consider it neglect, so it is not reported. In addition, they may be reluctant to acknowledge or reveal their own or colleagues' neglectful practices. CONCLUSION Neglect of residents in nursing homes may continue to occur if nursing staff's reporting practices are making neglect invisible, thus proceeding to compromise a resident's safety and quality of care for the foreseeable future.
Collapse
Affiliation(s)
- Stine Borgen Lund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - John-Arne Skolbekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Laura Mosqueda
- Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| |
Collapse
|
12
|
Li QL, Li YM, Ma JY, Liu HL. A complete algebraic solution to the optimal dynamic rationing policy in the stock-rationing queue with two demand classes. JOURNAL OF COMBINATORIAL OPTIMIZATION 2023; 45:83. [PMID: 36968846 PMCID: PMC10024528 DOI: 10.1007/s10878-023-01014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
In this paper, we study a stock-rationing queue with two demand classes by means of the sensitivity-based optimization, and develop a complete algebraic solution to the optimal dynamic rationing policy. We show that the optimal dynamic rationing policy must be of transformational threshold type. Based on this finding, we can refine three sufficient conditions under each of which the optimal dynamic rationing policy is of threshold type (i.e., critical rationing level). To do this, we use the performance difference equation to characterize the monotonicity and optimality of the long-run average profit of this system, and thus establish some new structural properties of the optimal dynamic rationing policy by observing any given reference policy. Finally, we use numerical experiments to demonstrate our theoretical results of the optimal dynamic rationing policy. We believe that the methodology and results developed in this paper can shed light on the study of stock-rationing queue and open a series of potentially promising research.
Collapse
Affiliation(s)
- Quan-Lin Li
- School of Economics and Management, Beijing University of Technology, Beijing, 100124 China
| | - Yi-Meng Li
- School of Economics and Management, Yanshan University, Qinhuangdao, 066004 China
| | - Jing-Yu Ma
- Business School, Xuzhou University of Technology, Xuzhou, 221018 China
| | - Heng-Li Liu
- School of Economics and Management, Yanshan University, Qinhuangdao, 066004 China
| |
Collapse
|
13
|
Imam A, Obiesie S, Gathara D, Aluvaala J, Maina M, English M. Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review. HUMAN RESOURCES FOR HEALTH 2023; 21:19. [PMID: 36918941 PMCID: PMC10015781 DOI: 10.1186/s12960-023-00807-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Missed nursing care undermines nursing standards of care and minimising this phenomenon is crucial to maintaining adequate patient safety and the quality of patient care. The concept is a neglected aspect of human resource for health thinking, and it remains understudied in low-income and middle-income country (LMIC) settings which have 90% of the global nursing workforce shortages. Our objective in this review was to document the prevalence of missed nursing care in LMIC, identify the categories of nursing care that are most missed and summarise the reasons for this. METHODS We conducted a systematic review searching Medline, Embase, Global Health, WHO Global index medicus and CINAHL from their inception up until August 2021. Publications were included if they were conducted in an LMIC and reported on any combination of categories, reasons and factors associated with missed nursing care within in-patient settings. We assessed the quality of studies using the Newcastle Ottawa Scale. RESULTS Thirty-one studies met our inclusion criteria. These studies were mainly cross-sectional, from upper middle-income settings and mostly relied on nurses' self-report of missed nursing care. The measurement tools used, and their reporting were inconsistent across the literature. Nursing care most frequently missed were non-clinical nursing activities including those of comfort and communication. Inadequate personnel numbers were the most important reasons given for missed care. CONCLUSIONS Missed nursing care is reported for all key nursing task areas threatening care quality and safety. Data suggest nurses prioritise technical activities with more non-clinical activities missed, this undermines holistic nursing care. Improving staffing levels seems a key intervention potentially including sharing of less skilled activities. More research on missed nursing care and interventions to tackle it to improve quality and safety is needed in LMIC. PROSPERO registration number: CRD42021286897.
Collapse
Affiliation(s)
- Abdulazeez Imam
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK.
| | - Sopuruchukwu Obiesie
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Jalemba Aluvaala
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Michuki Maina
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
| |
Collapse
|
14
|
Abdelhadi N, Drach-Zahavy A, Srulovici E. Toward understanding nurses' decisions whether to miss care: A discrete choice experiment. Int J Nurs Stud 2023; 139:104448. [PMID: 36746011 DOI: 10.1016/j.ijnurstu.2023.104448] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Studies of missed nursing care suggest that it results from ward-level, patient-related, and task-type factors, while nurses' decision-making style was scarcely studied. Studying the effect of nurses' decision-preference structures, namely a pattern of joint ward and patient factors, on missed care may also contribute to understanding the phenomenon. OBJECTIVES To examine the relationships between decision-preference structures and missed care and the moderating effects of decision-making styles and task type in these links. DESIGN A discrete choice experiment with a between- and within-participants design. PARTICIPANTS A sample of 387 registered nurses working in acute medical surgical wards in Israel. METHODS Based on the protocol for discrete choice experiments, a survey was developed to assess the decision-preference structure, considering five factors: overload, presence of head nurse, clinical complexity, difficult patient, and presence of relatives. Participants were randomly assigned to four task-type conditions and completed a survey regarding their task. Decision-making style was assessed using a validated questionnaire. RESULTS Extensive workload (b = -0.46; p = 0.001), difficult patient (b = -0.20; p = 0.001), and patient clinical complexity (b = -0.10; p = 0.006) were negatively linked to the probability of missed care. The interaction between workload and task type (b = 0.252; p = 0.017) indicated that the probability of missed care under extensive compared with regular workload was lowest for developing a discharge plan and highest for providing emotional support. The interaction of patient complexity and task type (b = 0.230; p = 0.013) indicated that the probability of missed care in developing a discharge plan and medication administration was lower for patients having high compared with low clinical complexity. The interaction between difficult patient and task type (b = -0.219; p = 0.044) indicated that the probability of missed care in emotional support, developing a discharge plan, and patient's mobility was lower for difficult than for non-difficult patients. Finally, the interaction between workload and decision-making style (b = -0.48; p = 0.001) indicated that the probability of missed care under heavy compared with regular workloads was lower for the dual-preference or the dominantly intuitive styles. CONCLUSIONS This design enabled examining the prioritizing processes nurses use when deciding about whether to miss care. The likelihood of missing more in structured tasks is lower under a heavy overload and when patients appear difficult or clinically complex. Dual-preference styles or dominantly intuitive styles are more suitable for the routine high workload.
Collapse
Affiliation(s)
- Nasra Abdelhadi
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
| | - Anat Drach-Zahavy
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
| | - Einav Srulovici
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
| |
Collapse
|
15
|
Schneider-Matyka D, Świątoniowska-Lonc N, Polański J, Szkup M, Grochans E, Jankowska-Polańska B. Assessment of The Effect of Stress, Sociodemographic Variables and Work-Related Factors on Rationing of Nursing Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2414. [PMID: 36767779 PMCID: PMC9915080 DOI: 10.3390/ijerph20032414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
(1) Rationing of nursing care is withholding, limiting or not fulfilling the necessary nursing activities for patients. It may have a negative effect on patient safety and the quality of care. The aim of the present paper is the assessment of the effect of stress on the rationing of nursing care. (2) The current research has a cross-sectional, observational design. The study sample comprised 567 nurses. The following questionnaires were used in the study PIRNCA and PSS-10. (3) It was demonstrated that nurses with a high level of perceived stress rationed nursing care to a greater extent and showed lower assessment of nursing care and lower job satisfaction in comparison with nurses with average and low levels of perceived stress. (4) 1. Stress in nurses has a negative effect on rationing of nursing care and job satisfaction. It is recommended that actions aimed at developing effective stress coping skills be implemented as early as at the stage of training to become a nurse. 2. Factors such as marital status, sex, form of employment, place of employment and the level of professional burnout syndrome may have an influence on the level of experienced stress. In turn, the level of experienced stress, marital status, education, place of work as well as the place of residence may have an effect on rationing of nursing care and, consequently, affect the quality of care.
Collapse
Affiliation(s)
- Daria Schneider-Matyka
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland
| | | | - Jacek Polański
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska Street, 50-556 Wrocław, Poland
| | - Małgorzata Szkup
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland
| | - Beata Jankowska-Polańska
- Center for Research and Innovation, 4th Military Hospital, 5 Weigla Street, 50-981 Wrocław, Poland
| |
Collapse
|
16
|
Jakobsen L, Olsen RM, Brinchmann BS, Devik SA. Developing and Testing Digital Ethical Reflection in Long-Term Care: Nurses' Experiences. SAGE Open Nurs 2023; 9:23779608221150725. [PMID: 36654853 PMCID: PMC9841835 DOI: 10.1177/23779608221150725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/17/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Nurses working in municipal long-term care face ethical challenges that can lead to moral distress and discomfort for the nurse and affect the quality of patient care. Tools and methods that contribute to increased ethical awareness and support for nurses dealing with moral issues are lacking. Technological innovations may be suitable for ethics work, but little research has been conducted on how such solutions could be designed or their potential benefit. Therefore, this study contributes knowledge about the development and testing of a digital tool for ethics support among nurses. Objective To investigate how digital ethical reflection can support ethics work among nurses working in long-term care. Methods A digital ethical reflection tool was designed and tested in nursing homes and home nursing care in collaboration with two Norwegian municipalities. The study used sequential explanatory mixed-methods design. Over a 6-week period, at the end of each shift, nurses digitally reported the ethical challenges they had experienced. Their responses and experiences were described using descriptive statistics. Additionally, focus group interviews were conducted and analyzed using reflexive thematic analysis (TA). Results During the study period, 17 nurses reported a total of 223 registrations, with 24.8% stating that they had been in an ethically difficult situation. The digital reporting was perceived as practically applicable and helped to increase nurses' awareness of morally charged situations. The value of the registrations was found to depend on manager participation and the application of the obtained information. The participating nurses become aware that they lacked an arena for meaningful dialogue with and recognition from their manager. Conclusions Information obtained through digital reflection can form the basis for ethical reflections at the departmental level. Digital reflection has the potential to become a tool for managers in their support for employees facing ethical challenges when providing long-term care.
Collapse
Affiliation(s)
- Lena Jakobsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway,Lena Jakobsen, Faculty of Nursing and Health Sciences, Nord University, PO Box 1490, 8049 Bodø, Norway.
| | - Rose Mari Olsen
- Centre for Care Research Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
| | - Berit Støre Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, Norway and Nordland Regional University, Bodø, Norway
| | - Siri Andreassen Devik
- Centre for Care Research Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
| |
Collapse
|
17
|
An Overview of Missed Nursing Care and Its Predictors in Saudi Arabia: A Cross-Sectional Study. Nurs Res Pract 2022; 2022:4971890. [PMID: 36278115 PMCID: PMC9581685 DOI: 10.1155/2022/4971890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Nursing care is holistic, and missing any aspect of care can be critical to patients' health. However, due to the complex and intense nature of the nursing practice, nurses have to unintentionally prioritize some activities, forcing them to omit some aspects of nursing care. Aim To explore the dimensions of missed nursing care and its predictors within the Saudi Arabian healthcare system. Methods Quantitative, cross-sectional study used the MISSCARE survey by utilizing nonprobability convenience sampling to collect the data of 604 staff nurses working in inpatient wards in Jazan, Saudi Arabia. Results The overall mean of missed nursing care is (m = 1.37, SD = 0.45). Missed nursing care activities were mostly failure to attend interdisciplinary care conferences (m = 1.66, SD = 0.96) and patient ambulation thrice a day (m = 1.63, SD = 0.97). Missed nursing care was mainly caused by human resource shortage (m = 3.53, SD = 0.88). Missed nursing care is predicted by the turnover intention (B = 2.380, t = 3.829, p < 001) and job satisfaction (B = −0.864, t = −4.788, p < 001). Conclusion Although missed nursing care is evident in Saudi Arabia, it is significantly lower than the international rates, and it is mainly caused by labor resource shortage which directly influences nurses' job satisfaction and intention to leave. Optimizing the recruitment process, resource allocation and effective nurses' retention programs are proposed solutions that may be beneficial to mitigate missed nursing care.
Collapse
|
18
|
van der Mark CJEM, Kraan J, Hendriks PHJ, Vermeulen H, Oostveen CJV. Defining adequacy of staffing in general hospital wards: a Delphi study. BMJ Open 2022; 12:e058403. [PMID: 35918122 PMCID: PMC9351332 DOI: 10.1136/bmjopen-2021-058403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To gain consensus on the items that determine adequacy of shift staffing. DESIGN This was a three-round Delphi study to establish consensus on what defines adequacy of shift staffing in a general hospital ward. A literature review, focus group and five semistructured expert interviews were used to generate items for the Delphi study. SETTING Multicentre study in The Netherlands. PARTICIPANTS Nurses, head nurses, nursing managers, and capacity consultants and managers working for Dutch hospitals. RESULTS Twenty-six items were included in the Delphi study. One hundred and sixty-eight, 123 and 93 participants were included in the first, second and third round, respectively. After three rounds, six items were included (mostly related to direct patient care) and nine items were excluded. No consensus was reached on 12 items, including one item that was added after the first round. CONCLUSIONS This is the first study to specify items that determine adequacy of staffing. These items can be used to measure adequacy of staffing, which is crucial for enhancing nurse staffing methods. Further research is needed to refine the items of staffing adequacy and to further develop and psychometrically test an instrument for measuring staffing adequacy.
Collapse
Affiliation(s)
- Carmen J E M van der Mark
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboudumc, Nijmegen, The Netherlands
- Department of Capacity Management, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jocelynn Kraan
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul H J Hendriks
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboudumc, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Catharina J van Oostveen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp and Haarlem, The Netherlands
| |
Collapse
|
19
|
Renner A, Ausserhofer D, Zúñiga F, Simon M, Serdaly C, Favez L. Increasing implicit rationing of care in nursing homes: A time-series cross-sectional analysis. Int J Nurs Stud 2022; 134:104320. [PMID: 35868214 DOI: 10.1016/j.ijnurstu.2022.104320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/20/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Implicit rationing of nursing care is a socio-ecological problem where care workers, due to lack of resources, have to leave necessary nursing care activities undone. Cross-sectional studies on implicit rationing of nursing home care revealed associations with organizational and work environment characteristics. However, little is known on how implicit rationing of nursing care varies over time in nursing homes. OBJECTIVE This study's purpose was to describe changes in levels and patterns of implicit rationing of nursing care in Swiss nursing homes over time, while accounting for key explanatory factors related to organizational, work environment, and individual characteristics. DESIGN Time-series cross-sectional analysis. SETTING Nursing homes in Switzerland. PARTICIPANTS A convenience sample of 47 nursing homes and 3269 care workers from all educational levels participating in two multicenter cross-sectional studies (the Swiss Nursing Home Human Resources Project) conducted in 2013 and 2018. METHODS To quantify implicit rationing of nursing care, care workers' data were collected via the nursing home version of the Basel Extent of Rationing of Nursing Care instrument. To control for leadership ability, staffing and resource adequacy, we used the Nursing Work Index-Practice Environment Scale. Objective measures including turnover, staffing and skill mix levels were aggregated at the nursing home level. Our analyses included multiple linear mixed models, using time as a fixed effect and nursing home as a random effect. RESULTS We found overall increases of rationing of care activities over the five-year period studied, with documentation and social activities most rationed at both measurement points (overall coefficients varied between 0.11 and 0.23, as well as the 95%-confidence intervals between 0.05 and 0.30). Moreover, a considerable increase in rationing of activities of daily living (coefficient of 0.47 in 2013 and 0.63 in 2018) was observed. CONCLUSIONS Alongside long-term deterioration of staff resources, increases in rationing of nursing care are a worrying development, particularly given their potential negative impacts both on residents and on care workers. To assess nursing home care quality and to determine adequate staffing levels and skill mixes, policy makers and nursing home managers should consider regular monitoring of rationing of nursing care. TWEETABLE ABSTRACT Time-series cross-sectional analysis reveals increasing rationing of nursing care activities in Swiss nursing homes from 2013 to 2018.
Collapse
Affiliation(s)
- Anja Renner
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Dietmar Ausserhofer
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Claudiana Research, College of Health Care-Professions Claudiana, Lorenz-Böhler-Strasse 13, 39100 Bozen, Italy.
| | - Franziska Zúñiga
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Christine Serdaly
- serdaly&ankers snc, 210 route de Florissant, 1231 Conches, Switzerland.
| | - Lauriane Favez
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| |
Collapse
|
20
|
Stemmer R, Bassi E, Ezra S, Harvey C, Jojo N, Meyer G, Özsaban A, Paterson C, Shifaza F, Turner MB, Bail K. A systematic review: Unfinished nursing care and the impact on the nurse outcomes of job satisfaction, burnout, intention-to-leave and turnover. J Adv Nurs 2022; 78:2290-2303. [PMID: 35533090 DOI: 10.1111/jan.15286] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/17/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022]
Abstract
AIM To investigate the association of unfinished nursing care on nurse outcomes. DESIGN Systematic review in line with National Institute for Health and Care Excellence guideline. DATA SOURCES CINAHL, the Cochrane Library, Embase, Medline, ProQuest and Scopus databases were searched up until April 2020. REVIEW METHODS Two independent reviewers conducted each stage of the review process: screening eligibility, quality appraisal using Mixed Methods Appraisal Tool; and data extraction. Narrative synthesis compared measurements and outcomes. RESULTS Nine hospital studies were included, and all but one were cross-sectional multicentre studies with a variety of sampling sizes (136-4169 nurses). Studies had low internal validity implying a high risk of bias. There was also a high potential for bias due to non-response. Only one study explicitly sought to examine nurse outcomes as a primary dependent variable, as most included nurse outcomes as mediating variables. Of the available data, unfinished nursing care was associated with: reduced job satisfaction (5/7 studies); burnout (1/3); and intention-to-leave (2/2). No association was found with turnover (2/2). CONCLUSION Unfinished nursing care remains a plausible mediator of negative nurse outcomes, but research is limited to single-country studies and self-reported outcome measures. Given challenges in the sector for nurse satisfaction, recruitment and retention, future research needs to focus on nurse outcomes as a specific aim of inquiry in relation to unfinished nursing care. IMPACT Unfinished nursing care has previously been demonstrated to be associated with staffing, education and work environments, with negative associations with patient outcomes (patient satisfaction, medication errors, infections, incidents and readmissions). This study offers new evidence that the impact of unfinished nursing care on nurses is under investigated. Policymakers can prioritize the funding of robust observational studies and quasi-experimental studies with a primary aim to understand the impact of unfinished nursing care on nurse outcomes to better inform health workforce sustainability.
Collapse
Affiliation(s)
| | - Erika Bassi
- University of Eastern Piedmont, Novara, Italy
| | - Sigal Ezra
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Clare Harvey
- Massey University, Wellington, New Zealand.,Central Queensland University, Rockhampton, Queensland, Australia
| | | | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Halle-Wittenberg, Germany
| | | | | | | | | | - Kasia Bail
- University of Canberra, Canberra, Australia
| |
Collapse
|
21
|
Nursing Leadership – Transforming the Work Environment in Nursing Homes. Nurs Clin North Am 2022; 57:299-314. [DOI: 10.1016/j.cnur.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
22
|
Junck LD, George G. Giving condoms to school children: educators' views on making condoms available in South African schools. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:58-64. [PMID: 35361058 DOI: 10.2989/16085906.2022.2040550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
One of the policy goals of the South African Department of Basic Education's National Policy on HIV, STIs and TB of 2017 is to reduce the incidence of HIV and pregnancy among learners. This is expected to be achieved by improving access to prevention services, including the provision of condoms in schools. This study uses street- level bureaucracy theory to explain how educators can play a more productive role in ensuring that policy goals are achieved. Educators provide their views on their role as condom promotion agents, their perception of demand and utilisation among learners, as well as their insights on suitable distribution mechanisms in the school setting. Trepidation exists among educators about their roles in the promotion and education of condoms. Educator statements suggest that they see the value in their policy-ascribed role to deliver sexual health messages and are also open to performing a role in the distribution of condoms at schools. However, our findings reveal that their role as policy communicators or "street-level bureaucrats" is complicated by inadequate policy guidance. We therefore conclude that to achieve optimal outcomes in terms of safer sexual practices among learners, condom messaging and distribution mechanisms in school settings require evidence-informed implementation strategies.
Collapse
Affiliation(s)
- Leah D Junck
- Institute for Humanities in Africa (HUMA), University of Cape Town, Cape Town, South Africa
| | - Gavin George
- Health Economics & HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
23
|
Assaye AM, Wiechula R, Schultz TJ, Feo R. Missed nursing care, nurse staffing levels and patient safety outcomes in low-income country acute care settings: An observational study. Int J Nurs Pract 2021; 28:e13031. [PMID: 34970817 DOI: 10.1111/ijn.13031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 05/14/2021] [Accepted: 11/20/2021] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to measure the level of missed nursing care and determine its relationship with nurse staffing and patient safety outcomes in acute care settings in Ethiopia. BACKGROUND Missed nursing care in hospitals increases the likelihood of patient adverse events, complications, disability and death. However, little is known about the level of missed nursing care and its impact on patient outcomes in low-income countries. METHODS An observational study was conducted comprising of a survey of nurses at two time points (n = 74 and 80, respectively) and a medical record review of 517 patients in four units across two hospitals between September 2018 and March 2019. RESULTS The level of missed nursing care in the study units was very high. The hospital type and hours nurses worked during the last week were significantly associated with missed nursing care. A unit increase in missed nursing care score increased the incidence of adverse patient outcomes by 10%. CONCLUSION There was a higher level of missed nursing care in the study units compared with similar studies from high-income countries. Higher level of missed nursing care was significantly associated with higher incidence of adverse patient safety outcomes.
Collapse
Affiliation(s)
- Ashagre Molla Assaye
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia.,College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Richard Wiechula
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia.,Centre for Evidence-based Practice South Australia: an Affiliate Centre of the Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy J Schultz
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Feo
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
24
|
Self-assessment of Rationing and Quality of Nursing Care. J Nurs Care Qual 2021; 37:E48-E53. [PMID: 34775421 DOI: 10.1097/ncq.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nursing care rationing has been a widespread problem in everyday nursing practice for many years. PURPOSE The aim of this research study was to assess the prevalence of care rationing among nurses working in Poland. METHODS The study was conducted among a population of 1310 nurses. To examine the dependencies between the sociodemographics and unfinished nursing care, the Polish adaptation of the Perceived Implicit Rationing of Nursing Care questionnaire and an investigator-developed questionnaire were used. RESULTS The mean level of missed care was 1.16 (SD = 0.7). The significant predictors of care rationing were associated with the quality of patient care (βstd = -.43, P < .001) and general work satisfaction (βstd = -.15, P < .001). CONCLUSIONS Job satisfaction and the quality of nursing care should be constantly monitored as these factors are significantly associated with the levels of care rationing.
Collapse
|
25
|
The factors contributing to missed care and non-compliance in infection prevention and control practices of nurses: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
26
|
Lyons GCE, Summers MJ, Marshall AP, Chapple LAS. Systematic review of clinicians' knowledge, attitudes, and beliefs about nutrition in intensive care. Nutr Clin Pract 2021; 37:825-842. [PMID: 34617630 DOI: 10.1002/ncp.10785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Nutrition is a key component of care for critically ill patients; yet nutrition delivery is below international recommendations. In order to improve nutrition delivery to critically ill patients, an understanding of the barriers that prevent guideline adherence is required. It is known that clinicians' knowledge, attitudes, and beliefs of the role of nutrition may act as a potential barrier to nutrition delivery, but whether this remains true in critical care is unknown. The aim of this systematic scoping review was to summarize the literature exploring the knowledge, attitudes, and beliefs of clinicians around nutrition support in critically ill patients. A search of four online databases (MEDLINE via Ovid, Emcare via Ovid, PsycINFO, and CINAHL via EBSCOhost) was conducted on August 14, 2020, to identify literature that reported on clinicians' knowledge, attitudes, and beliefs of nutrition in adult intensive care patients. Data were extracted on study and participant characteristics, methodology, and key study outcomes related to nutrition. Eighteen articles met eligibility criteria and were included in the review. Key findings included the following: nutrition was seen as a priority that ranked below life-saving interventions; differences in perceived clinician responsibilities exist; common barriers to nutrition delivery included inadequate resourcing, lack of nutrition protocols, and gastrointestinal intolerance; and identified facilitators included nutrition education and the presence of a supportive multidisciplinary team. The implementation of nutrition protocols, enhanced clinical nutrition education, and further clarification of roles and responsibilities pertaining to nutrition may assist in improving nutrition delivery in critical care.
Collapse
Affiliation(s)
- Gemma C E Lyons
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Matthew J Summers
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrea P Marshall
- Gold Coast University Hospital, Southport, Queensland, Australia
- Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
27
|
Kirby L, Basu S, Close E, Jansen M. Rationing in the Pediatric Intensive Care Unit-ethical or unethical? Transl Pediatr 2021; 10:2836-2844. [PMID: 34765505 PMCID: PMC8578748 DOI: 10.21037/tp-20-334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/29/2021] [Indexed: 01/17/2023] Open
Abstract
Rationing in health care is controversial, and even more so in pediatrics. Children are an inherently vulnerable group because they are reliant on their parents and caregivers to make decisions in their best interests and have no political voice. Historically, there has been general acceptance of the need to ration healthcare at a systems level, however there is controversy over whether healthcare professionals should be involved in rationing at the bedside. The COVID-19 pandemic has highlighted that bedside rationing is unavoidable, at least in times of extreme resource scarcity. Internationally, there has been significant ethical analysis and guideline development to guide intensive care rationing decisions in the event that resources are overwhelmed. This paper explores the principles underlying distributive justice in healthcare rationing and discusses how these were operationalized in ethical guidelines for the COVID-19 pandemic. In fact, rationing is unavoidable and occurs constantly in everyday nursing and medical ICU practice, often in mundane and uncontroversial ways. Some argue that these everyday decisions are not true rationing decisions, but resource allocation, or stewardship decisions. We argue there are no clear lines between resource allocation and rationing decisions, rather that they occur on a spectrum. These everyday rationing decisions are particularly susceptible to personal biases that are often implicit. Due to the subtle and constant nature of most everyday rationing decisions, specific guideline development will rarely be practical or appropriate. However, it is possible to develop other processes to improve decision making. There are a variety of strategies we recommend for this including, encouraging reflective practice; developing explicit frameworks that promote collaborative decision making; being transparent about resource allocation and rationing decisions with colleagues, patients, and families; and promoting a workplace culture of speaking up and accessing support in identifying and managing everyday rationing decisions.
Collapse
Affiliation(s)
- Lynette Kirby
- Pediatric Intensive Care Unit, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Shreerupa Basu
- Pediatric Intensive Care Unit, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Eliana Close
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melanie Jansen
- Pediatric Intensive Care Unit, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| |
Collapse
|
28
|
Witczak I, Rypicz Ł, Karniej P, Młynarska A, Kubielas G, Uchmanowicz I. Rationing of Nursing Care and Patient Safety. Front Psychol 2021; 12:676970. [PMID: 34566757 PMCID: PMC8458807 DOI: 10.3389/fpsyg.2021.676970] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/11/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Nursing care has a significant impact on patient safety, which affects clinical outcomes, patients’ satisfaction with the care received and nursing personnel’s satisfaction with the care provided. This study aimed to determine the extent of nursing care rationing and its relationship with patient safety including identification of the specific reasons. Methods: This cross-sectional study involved 245 nurses and was performed between April–June 2019 in four hospitals in Wrocław, Poland. The standardized and relevant research tools such as Hospital Survey on Patient Safety Culture (HSOPSC) and the Perceived Implicit Rationing of Nursing Care (PIRNCA) were used. The data was submitted to hierarchical multiple regression analysis. The study was approved by the Bioethics Committee and was followed with the STROBE guidelines. Results: The PIRNCA scores were negatively correlated with the HSOPSC subscales, which indicates that more frequent rationing of nursing care was associated with lower levels of patient safety parameters. It was shown that the highest level of unfinished nursing care was associated with decreases in patient safety factors linked with supervisor manager expectations actions promoting safety (rs = −0.321, p < 0.001), teamwork within hospital units (rs = −0.377, p < 0.001), feedback and communication about error (rs = −0.271, p < 0.001), teamwork across hospital units (rs = −0.221, p < 0.01), and hospital handoffs transitions (rs = −0.179, p < 0.01). Moreover, the strongest association was observed between the PIRNCA scores with patient safety grade (rs = 0.477, p < 0.001). Also, the PIRNCA scores among the internal unit were significantly higher than in the intensive care and surgical units. Conclusion: Our study indicated the presence of nursing care rationing. Regarding patient safety, we found insufficient numbers of medical personnel and excessive personnel workload for providing safe care to patients, a lack of transparency in handling adverse event reports and analyses, and a lack of cooperation between hospital units regarding patient safety.
Collapse
Affiliation(s)
- Izabela Witczak
- Department of Economics and Quality in Health Care, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Łukasz Rypicz
- Department of Economics and Quality in Health Care, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Piotr Karniej
- Department of Organisation and Management, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Agnieszka Młynarska
- Department of Electrocardiology, Upper Silesian Medical Centre, Katowice, Poland.,Department of Gerontology and Geriatric Nursing, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Kubielas
- Department of Clinical Nursing, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| |
Collapse
|
29
|
Gurková E, Blackman I, Bartoníčková D, Jarošová D, Machálková L, Šáteková L. Adaptation and Psychometric Testing of the Czech and Slovak Version of the Missed Nursing Care in Infection Prevention and Control Survey. J Nurs Meas 2021; 30:56-74. [PMID: 34518410 DOI: 10.1891/jnm-d-20-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Only a limited number of items involved in missed nursing care inventories specifically focused on infection control practices. The study aimed to adapt and evaluate psychometric properties of the Czech and Slovak version of the Infection Control Missed Care survey; and to assess and compare the amount, type, and reasons for missed nursing care in infection prevention and control among Czech and Slovak nurses. METHODS The convenience sample of 1459 nurses from the Czech and Slovak republic was recruited. Analysis of the nurses' responses to both subscales of the surveys and validation of their data was undertaken using the item response theory (Rasch scaling). RESULTS The now-modified Czech version consists only of 20 items measuring the type and frequency of missed care and 11 items focusing on the reasons for missed care. The now modified Slovak version consists of 34 items measuring the type and frequency of missed care and 17 items measuring the reasons for missed care. Reliability estimates with the removal of unreliable items showed acceptable reliability estimates for both sub-scales of the instrument. CONCLUSIONS With modification to the two subscales used in the survey (removal of poorly fitting items) it should be reliable, and the resulting data could be used for further investigation such as factor analysis or modelling. The modified Infection Control Missed Care survey could be useful in further research investigating a relationship between nurse staffing, skill mix, and infection control outcomes in acute care hospitals.
Collapse
|
30
|
Gurková E, Bartoníčková D, Mikšová Z. Nursing work environment and unfinished nursing care in hospital settings - a scoping review. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2021.12.0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
31
|
Gurková E, Mikšová Z, Šáteková L. Missed nursing care in hospital environments during the COVID-19 pandemic. Int Nurs Rev 2021; 69:175-184. [PMID: 34433226 PMCID: PMC8653289 DOI: 10.1111/inr.12710] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 08/02/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Studies performed in Central European countries showed a high prevalence of missed nursing care in various clinical settings before the COVID-19 pandemic. AIMS The aim of the study was to investigate which domains of the work environment were significant predictors of missed nursing care activities in Czech hospitals during the COVID-19 pandemic. METHODS A cross-sectional study was used. The RANCARE guideline and STROBE checklist were followed for reporting in the study. The sample consisted of 371 nurses from four acute care hospitals. The MISSCARE Survey and the Practice Environment Scale of the Nursing Work Index questionnaires were used to collect data. The data were analyzed using multiple linear and logistic regression analyses. RESULTS Nurses reporting unfavorable environments consistently describe a higher frequency of episodes of missed care. Prevalence estimates of missed care in Czech acute care hospitals during the COVID-19 pandemic was predicted from the overtime work, the nurses' perception of the "Nursing foundations for the quality of care," and their satisfaction with their current position. CONCLUSIONS Missed nursing care could be mitigated by improving the nurses' work environment. Domains of the nurse work environment are known as structural modifiable factors and their refinement could be a cornerstone for interventions to reduce the prevalence of missed nursing care. IMPLICATIONS FOR NURSING POLICY Monitoring the conditions and aspects of the nurse work environment in hospitals and considering nurses' concerns about the work environment on an ongoing basis are important strategies for nurse supervision as well as for policymakers.
Collapse
Affiliation(s)
- Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Zdeňka Mikšová
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Lenka Šáteková
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic
| |
Collapse
|
32
|
The Impact of Nursing on Trauma Patient Satisfaction: An Analysis of HCAHPS From 112,283 Patients. J Trauma Nurs 2021; 28:219-227. [PMID: 34210939 DOI: 10.1097/jtn.0000000000000589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Assessment of patient satisfaction is central to understanding and improving system performance with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) national standard survey. However, no large, multi-institutional study exists, which examines the role of nurses in trauma patient satisfaction. OBJECTIVE To assess the impact of nurses on trauma patient satisfaction. METHODS This retrospective, descriptive study of Level I-IV trauma centers in a multistate hospital system evaluated patients 18 years and older admitted with at least an overnight stay. Data were obtained electronically for patients discharged in 2018-2019 who returned an HCAHPS survey. Surveys were linked by an honest broker to demographic and injury data from the trauma registry, and then anonymized prior to analysis. Patients were categorized as "trauma" per the National Trauma Data Standard (NTDS) definition or as "medical" or "surgical" per the HCAHPS definition. RESULTS Of 112,283 surveys from 89 trauma centers, "trauma" patients (n = 5,126) comprised 4.6%, "surgical" 39.0% (n = 43,763), and "medical" 56.5% (n = 63,394). Nurses had an overwhelming impact on "trauma" patient satisfaction, accounting for 63.9% (p < .001) of the variation (adjusted R2) in the overall score awarded the institution-larger than for "surgery" (59.6%; p < .001) or "medical" (58.4%; p < .001) patients. The most important individual domain contributor to the overall rating of a facility was "nursing communication." CONCLUSIONS The magnitude of the effect of trauma nurses was noteworthy, with their communication ability being the single biggest driver of institutional ratings. These data provide insight for future performance benchmark development and emphasize the critical impact of trauma nurses on the trauma patient experience.
Collapse
|
33
|
Tonkikh O, Zisberg A, Shadmi E. The role of nurse staffing in the performance of function-preserving processes during acute hospitalization: A cross-sectional study. Int J Nurs Stud 2021; 121:103999. [PMID: 34242978 DOI: 10.1016/j.ijnurstu.2021.103999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Performance of function-preserving hospitalization processes related to patient mobility, use of continence aids and food intake is significantly associated with outcomes in older adults. Nurses are the front-line personnel responsible for promoting performance of such processes. The degree to which nurse staffing is related to this performance is unclear. OBJECTIVE To identify nurse-staffing characteristics and nursing-related care needs associated with older patients' mobility, continence care and food intake during acute hospitalization. DESIGN Cross-sectional study using survey data from the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR) cohort study combined with day-level administrative nurse staffing data and clinical day-level aggregated data for all patients hospitalized during the HoPE-FOR study period. SETTING Internal medicine units in two medical centers in Israel. PARTICIPANTS Eight hundred seventy-three older adults. METHODS Mobility, continence care and food intake were assessed within 2 days of admission using validated questionnaires. Nurse-to-patient ratios and nursing-skill mix (i.e. registered nurses (RNs), nurse aides, nurses with advanced clinical training and RNs with an academic degree) were assessed using administrative data. Decision trees were developed for mobility, continence care and food intake, applying classification and regression-tree analysis. RESULTS The mobility decision tree identified three characteristics subdividing patients into six nodes: pre-admission functioning, pre-admission activity level and percentage of nurses with advanced training. The percentage of nurses with advanced training classified low-functioning patients into those walking in corridors versus walking or sitting only inside the room. The continence-care classification decision tree identified two characteristics that subdivided the patients into four nodes: pre-admission functioning and bladder control. Nurse-to-patient-ratio variables and patients' nursing-related care needs did not contribute to this classification. The food-intake decision tree identified four characteristics-pre-admission functioning, gender, percentage of nurses with advanced training and percentage of nurse aides-subdividing patients into eight nodes. Low-functioning patients exposed to a higher percentage of nurses with advanced training had food-intake scores 14% higher than patients exposed to a lower percentage of nurses with advanced training. Independent men exposed to a higher percentage of nurse aides had a 14% higher habitual daily in-hospital food-intake score than independent men exposed to a lower percentage of nurse aides. CONCLUSIONS A higher percentage of nurses with post-graduate education is associated with better performance of mobility and food intake of hospitalized older adults. To maintain the potential benefits of highly trained staff, education levels should be considered in scheduling and assignment decision-making processes in internal medicine units. Tweetable abstract: A higher percentage of nurses with post-graduate education is associated with better mobility and food intake of hospitalized older adults.
Collapse
Affiliation(s)
- Orly Tonkikh
- The Cheryl Spencer Department of Nursing, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
| |
Collapse
|
34
|
How to fairly allocate scarce medical resources? Controversial preferences of healthcare professionals with different personal characteristics. HEALTH ECONOMICS POLICY AND LAW 2021; 17:398-415. [PMID: 34108069 DOI: 10.1017/s1744133121000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The scarcity of medical resources is widely recognized, and therefore priority setting is inevitable. This study examines whether Portuguese healthcare professionals (physicians vs nurses): (i) share the moral guidance proposed by ethicists and (ii) attitudes toward prioritization criteria vary among individual and professional characteristics. A sample of 254 healthcare professionals were confronted with hypothetical prioritization scenarios involving two patients distinguished by personal or health characteristics. Descriptive statistics and parametric analyses were performed to evaluate and compare the adherence of both groups of healthcare professionals regarding 10 rationing criteria: waiting time, treatment prognosis measured in life expectancy and quality of life, severity of health conditions measured in pain and immediate risk of dying, age discrimination measured in favoring the young over older and favoring the youngest over the young, merit evaluated positively or negatively, and parenthood. The findings show a slight adherence to the criteria. Waiting time and patient pain were the conditions considered fairer by respondents in contrast with the ethicists normative. Preferences for distributive justice vary by professional group and among participants with different political orientations, rationing experience, years of experience, and level of satisfaction with the NHS. Decision-makers should consider the opinion of ethicists, but also those of healthcare professionals to legitimize explicit guidelines.
Collapse
|
35
|
Andersson I, Bååth C, Nilsson J, Eklund AJ. A scoping review-Missed nursing care in community healthcare contexts and how it is measured. Nurs Open 2021; 9:1943-1966. [PMID: 34033697 PMCID: PMC9190696 DOI: 10.1002/nop2.945] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
Aim To examine the extent and nature of missed nursing care in elderly care in community healthcare contexts from the perspective of healthcare staff, and to identify instruments used to measure missed nursing care and the content of these instruments. Design Scoping review. Methods Searches were conducted in the CINAHL, PubMed, Scopus and Google Scholar databases in March 2020. The selection process followed the PRISMA flow diagram. Results Sixteen research papers were found from nine countries. The instruments used in the studies were Basel Extent of Rationing of Nursing Care for nursing homes (BERNCA‐NH), modified MISSCARE survey and study‐specific instruments or items. The item content differed, as did the number of items, which was between one and 44. The studies reported values for missed nursing care, as well as described reasons for and/or the relation between missed nursing care and organization, working climate and patient outcomes.
Collapse
Affiliation(s)
- Ingrid Andersson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anna Josse Eklund
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| |
Collapse
|
36
|
Harmon J, Summons P, Higgins I. Disjunction, tension and dissonance within nursing pain care provision for the older hospitalized person: A focused ethnographic insight. J Adv Nurs 2021; 77:3458-3471. [PMID: 33942354 DOI: 10.1111/jan.14878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/14/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
AIMS This study presents an ethnographic insight into the older hospitalized persons' experiences on how nurses provide pain care provision. The older persons' perceptions of culturally mediated barriers and facilitators are presented. DESIGN Focused ethnography. METHODS Multi-site across eight acute care units within two tertiary referral hospitals on the east coast of Australia collected over a one-year period from 2014 to 2015. Semi-structured interviews (n = 12) of older persons (11 hr). Twenty-three (23) semi-structured interviews with nine (9) registered nurses (12 hr 38 min). Participant observation (1,041 hr) during day, night and evening shifts. RESULTS The older person experienced disjunction within pain assessment by the reliance of nurses on objective measurement gained during functional task completion. Tension emerged during pain management when the older person was not included and/or options provided were not deemed effective. For some older persons this meant they undertook a decision to exclude their nurse from involvement in pain management. A thread woven throughout was a lack of communication, continuity of care and input from the older person. CONCLUSION This study has implications for the provision of nursing care of the older hospitalized person. Dissonance within pain care provision for the older person occurs during episodes of missed pain care. Understanding and insight is gained into aspects of missed communication opportunities between nurses and the experiences of missed pain care of the older person.
Collapse
Affiliation(s)
- Joanne Harmon
- UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | | | | |
Collapse
|
37
|
Evripidou M, Merkouris A, Charalambous A, Karanikola M, Zavrou R, Papastavrou E. Missed Nursing Care Among Patients With Dementia During Hospitalization: An Observation Study. Res Gerontol Nurs 2021; 14:150-159. [PMID: 34039149 DOI: 10.3928/19404921-20210326-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Patients with dementia (PwD) are characterized as a vulnerable group as they are unable to communicate their needs, putting them at risk for care omissions. The current study aimed to explore care toward PwD and detect if any aspects of care are omitted. An observation study was conducted in three medical-surgical adult wards of an acute general hospital. Data were collected by an observer, through field notes, and were analyzed with content analysis. A face scale was used to assess PwD's mood. Thirteen PwD were observed for 90 hours. Four thematic areas were identified: (a) Unmet Fundamental Patient Needs, (b) Human Right to Dignity and Respect, (c) Communication Deficiencies, and (d) Implementation of Nursing Interventions. Nurse-patient contact lasted from 5 to 7 minutes and numerous care omissions were noted. The face scale assessment revealed that most PwD looked very sad after nursing care. This study enriches insight for the care of PwD during hospitalization and emphasizes the need for health care workers' education and support. [Research in Gerontological Nursing, 14(3), 150-159.].
Collapse
|
38
|
Ludlow K, Churruca K, Mumford V, Ellis LA, Testa L, Long JC, Braithwaite J. Unfinished Care in Residential Aged Care Facilities: An Integrative Review. THE GERONTOLOGIST 2021; 61:e61-e74. [PMID: 31773131 DOI: 10.1093/geront/gnz145] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES When workload demands are greater than available time and resources, staff members must prioritize care by degree of importance and urgency. Care tasks assigned a lower priority may be missed, rationed, or delayed; collectively referred to as "unfinished care." Residential aged care facilities (RACFs) are susceptible to unfinished care due to consumers' complex needs, workforce composition, and constraints placed on resource availability. The objectives of this integrative review were to investigate the current state of knowledge of unfinished care in RACFs and to identify knowledge gaps. RESEARCH DESIGN AND METHODS We conducted a search of academic databases and included English-language, peer-reviewed, empirical journal articles that discussed unfinished care in RACFs. Data were synthesized using mind mapping techniques and frequency counts, resulting in two categorization frameworks. RESULTS We identified 17 core studies and 27 informing studies (n = 44). Across core studies, 32 types of unfinished care were organized under five categories: personal care, mobility, person-centeredness, medical and health care, and general care processes. We classified 50 factors associated with unfinished care under seven categories: staff member characteristics, staff member well-being, resident characteristics, interactions, resources, the work environment, and delivery of care activities. DISCUSSION AND IMPLICATIONS This review signifies that unfinished care in RACFs is a diverse concept in terms of types of unfinished care, associated factors, and terminology. Our findings suggest that policymakers and providers could reduce unfinished care by focusing on modifiable factors such as staffing levels. Four key knowledge gaps were identified to direct future research.
Collapse
Affiliation(s)
- Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| |
Collapse
|
39
|
Similarities and Differences in Nurse-Reported Care Rationing Between Critical Care, Surgical, and Medical Specialties. J Patient Saf 2021; 16:e162-e168. [PMID: 27811591 DOI: 10.1097/pts.0000000000000295] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine the similarities and differences in elements of nursing care that are commonly rationed in the critical care, medical, and surgical specialties within an acute hospital environment. METHODS Registered nurses who provide bedside nursing care within the medical, surgical, and critical specialties at a single center were invited to anonymously complete the self-administered MISSCARE questionnaire. The frequency of rationing for each individual care element within the 4 broader care groups (assessment, intervention-individual needs, intervention-basic care, and planning) of the MISSCARE questionnaire was determined. A mean score for each care group was also determined, and multiple regression analysis was undertaken to determine the demographic predictors of care rationing. RESULTS Interventions related to basic care was the most frequently rationed care group in the critical care/emergency specialty (missed care mean of 50.1%), whereas planning was the most frequently rationed care group among both the medical (missed care mean of 43.6%) and surgical (missed care mean of 44.8%) specialties. Assessment was the least frequently rationed care group among all 3 specialties (missed care mean of 19.7%-26.7%). Length of time practicing as a registered nurse was an independent predictor of care rationing in the critical care/emergency specialty, and age older than 50 was an independent predictor in the medical specialty. CONCLUSIONS There are numerous similarities and differences in care rationing between critical care, surgical, and medical nurses. The development and implementation of specialty-based strategies should be undertaken to reduce the incidence of nursing care rationing.
Collapse
|
40
|
Racy S, Davidson PM, Peeler A, Hager DN, Street L, Koirala B. A review of inpatient nursing workload measures. J Clin Nurs 2021; 30:1799-1809. [PMID: 33503306 DOI: 10.1111/jocn.15676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fiscal constraints, an ageing populations and the increasing burden of chronic conditions are stressing health systems internationally. Nurses are the linchpin of effective healthcare delivery and their success is dependent on adequate staffing models, which must align knowledge, skills and competencies with workload. OBJECTIVES To compare measures of nursing workload in adult inpatient settings. DESIGN, DATA SOURCES AND REVIEW METHOD A review of published studies characterising nursing workload measures was undertaken. Databases-PubMed and CINHAL-were used to identify published studies. A description of the psychometric properties of each measure and its use in an inpatient setting was required for inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to guide and report the review. RESULTS Of the 1,422 studies identified, 15 met the inclusion criteria. Nursing workload was measured in the intermediate care unit (n = 6), overall hospital (n = 7), emergency department (n = 1) and burn unit (n = 1) settings and also by mailed survey (n = 1). Eleven different workload measures were identified. The National Aeronautics and Space Administration Task Load Index (n = 3), Therapeutic Intervention Scoring System (n = 3) and Nursing Activities Score (n = 2) were the most common nursing workload measures identified with reported psychometric properties. CONCLUSION Researchers, clinicians and hospital administrators should carefully identify and assess the psychometric properties of nursing workload measures before using these in routine practice. RELEVANCE TO CLINICAL PRACTICE Gaining a consensus on effective nursing workload measures is a crucial step in designing appropriate staffing models and policies, improving nurse productivity and well-being, as well as enhancing patient health outcomes in inpatient settings.
Collapse
Affiliation(s)
- Stepney Racy
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Anna Peeler
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - David N Hager
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Binu Koirala
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| |
Collapse
|
41
|
Kalánková D, Bartoníčková D, Kirwan M, Gurková E, Žiaková K, Košútová D. Undergraduate nursing students' experiences of rationed nursing care - A qualitative study. NURSE EDUCATION TODAY 2021; 97:104724. [PMID: 33348299 DOI: 10.1016/j.nedt.2020.104724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Nursing students are required to spend a significant portion of their educational preparation in clinical practice. Because of the prevalence of missed or rationed care, it seems irrefutable that students are exposed to rationed care during their practice placement, or that they contribute to its prevalence either actively or passively. OBJECTIVES The study aimed to discover how nursing students interpret the concept of rationed care, and their experiences of rationing in practice. DESIGN A descriptive qualitative study. PARTICIPANTS Eighteen final year nursing students from three universities within the Slovak Republic. METHODS Semistructured face-to-face interviews were conducted (n = 18). Data were analyzed using thematic analysis which resulted in the development of themes and subthemes. RESULTS We identified three meaningful themes focused on the phenomenon of rationed care from the perspective of nursing students, namely Incomplete care is normalized; Provision of impersonal patient care; and the Existence of a hidden curriculum for practice placements. CONCLUSIONS Student nurses were quite demanding about the learning experience during their clinical training. They are often frustrated by inconsistencies between their theoretical preparation and the realities of practice. They recognise difficulties for registered nurses in providing safe, high quality care in constrained circumstances, and although they are critical of this, they acknowledge their own acceptance of the situation. Based on this, students must establish an understanding of the theory behind, and reasons for rationed care before commencing clinical placement. A greater understanding would enable students to develop strategies for coping with inconsistencies and voicing concerns.
Collapse
Affiliation(s)
- Dominika Kalánková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovak Republic.
| | - Daniela Bartoníčková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovak Republic; Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Czech Republic
| | - Marcia Kirwan
- School of Nursing and Human Sciences, Dublin City University in Dublin, Ireland.
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Czech Republic.
| | - Katarína Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovak Republic.
| | - Dominika Košútová
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovak Republic
| |
Collapse
|
42
|
Jarošová D, Gurková E, Zeleníková R, Plevová I, Janíková E. Hospital and unit variables of missed nursing care in acute care hospitals: A cross-sectional study. J Clin Nurs 2021; 30:1099-1110. [PMID: 33434291 DOI: 10.1111/jocn.15655] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/23/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate hospital, unit and staff variables as the correlates of missed nursing care (MNC) in Czech hospitals. BACKGROUND There is a considerable variability in patterns of MNC across different hospital, unit and staff characteristics. DESIGN A cross-sectional study was conducted. The STROBE guidelines for reporting observational studies were followed for reporting of the research study. METHODS A sample of 513 nurses working in nine acute care hospitals was recruited. MNC activities were measured with the MISSCARE Survey. Data were analysed using descriptive statistics and univariate logistic regression. RESULTS Type of unit was confirmed as a significant predictor of MNC. Staff characteristics (nurses' work position, level of education and perceived adequacy of unit staff) and hospital variables did not contribute significantly to MNC. CONCLUSIONS The study replicated the patterns of MNC across different conceptual approaches. MNC was influenced by work environment characteristics rather than individual staff variables. RELEVANCE TO CLINICAL PRACTICE The results of this research showed that missed nursing care is influenced by work environment characteristics rather than individual staff variables.
Collapse
Affiliation(s)
- Darja Jarošová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Renáta Zeleníková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ilona Plevová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Eva Janíková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| |
Collapse
|
43
|
Achilleos M, Merkouris A, Charalambous A, Papastavrou E. Medication adherence, self-efficacy and health literacy among patients with glaucoma: a mixed-methods study protocol. BMJ Open 2021; 11:e039788. [PMID: 33472775 PMCID: PMC7818806 DOI: 10.1136/bmjopen-2020-039788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION As the world population ages, glaucoma is becoming an increasingly significant cause of blindness. A key component in the management of glaucoma is the use of prescribed medications and the adherence to treatment. However, there is evidence of low adherence to prescribed medication in chronic diseases, such as glaucoma. This study aims to explore the level of medication adherence, self-efficacy, social support and health literacy among the patients with glaucoma and to determine if there are any correlations between them. The ultimate aim is to use the information to develop an educational programme for patients with glaucoma at a later stage. METHODS AND ANALYSIS This is a mixed-methods study which includes two stages: a descriptive study (stage 1) and focus group discussions (stage 2). SAMPLE Patients with glaucoma or ocular hypertension, using at least one kind of drops, from two ophthalmology clinics. Selected measures include: The Glaucoma Treatment Compliance Assessment Tool, The European Health Literacy Survey Questionnaire, The Glaucoma Medication Self-Efficacy Questionnaire and The Multidimensional Scale of Perceived Social Support. Two focus groups will be used for the collection of qualitative data, aiming to enrich the study with the patients' experiences. The data will be analysed with SPSS, using descriptive and inferential statistics for stage 1 whereas content analysis will be used for the data from the focus group discussions (stage 2). ETHICS AND DISSEMINATION Permission to conduct the study was received from the National Bioethics Committee and the board of management of the two ophthalmology clinics. All participants will be informed fully on the purpose and methods of the study. Consent forms will be signed and at any time participants will have the right to withdraw. Confidentiality and the protection of data will be respected at all times.
Collapse
Affiliation(s)
- Maria Achilleos
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Anastasios Merkouris
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andreas Charalambous
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
- Nursing, Turun Yliopisto, Turku, Finland
| | - Evridiki Papastavrou
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| |
Collapse
|
44
|
Liu X, Liu J, Liu K, Baggs JG, Wang J, Zheng J, Wu Y, Li M, You L. Association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care: A panel study. Int J Nurs Stud 2020; 115:103860. [PMID: 33517080 DOI: 10.1016/j.ijnurstu.2020.103860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Strengthening quality of care without compromising nurse job outcomes by building a safer health care system is a common concern worldwide including in China. Most of the current evidence comes from cross-sectional studies conducted in western countries, which limits inferences of causality and generalization. OBJECTIVE The objectives of this longitudinal study were to compare changes in quality of care, nurse job outcomes, nursing work environment, non-professional tasks, and nursing care left undone in acute hospitals in China between 2014 and 2018. Secondly, we wanted to determine the association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care. DESIGN, SETTINGS, AND PARTICIPANTS A prospective two-stage panel study conducted in 108 adult medical and surgical units from 23 hospitals in Guangdong province, China in 2014 and repeated in 2018. METHODS Work environment was measured by the Practice Environment Scale of the Nursing Work Index. Non-professional tasks were measured with a seven-item scale surveying the performance of and time spent on non-professional tasks. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse job outcomes included burnout, dissatisfaction, and retention. Quality of care was measured by four items indicating overall quality of care as assessed by nurses (three items) and patients (one item). Generalized estimating equations with linear regression were employed to analyze data. RESULTS In 2018, compared with 2014, the nursing work environment had improved, and non-professional workloads had decreased minimally. The average number of the 12 nursing care tasks left undone had increased to 6.5 from 5.6 in 2014. Fewer nurses reported job dissatisfaction or intention to leave. Quality of care was improved slightly as assessed by nurses and patients. As for the changes of hospital organizational factors on quality of care, a better nursing work environment was related to better nurse job outcomes and quality of care. More non-professional tasks were related to higher levels of nurse job burnout. Less nursing care left undone was associated with better nurse-assessed quality of care. Units with more nurses experiencing job burnout and dissatisfaction were likely to have poorer nurse-assessed quality of care. CONCLUSIONS Improving nursing work environment and supporting nurses to engage in professional and direct patient care as opposed to non-professional work may be beneficial to nurse job outcomes and promote quality of care.
Collapse
Affiliation(s)
- Xu Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - Jiali Liu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Department of Nursing, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Ke Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| | - Judith Gedney Baggs
- School of Nursing, Oregon Health & Science University, Portland, Oregon, U.S..
| | - Jun Wang
- School of Nursing, Guangzhou Medical University, China.
| | - Jing Zheng
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China.
| | - Yan Wu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Mengqi Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
45
|
Zúñiga F, Frei IA. Zwischen Anspruch und Wirklichkeit - Perspektive von fallverantwortlichen Pflegefachpersonen zur Rationierung in der spitalexternen Pflege. Pflege 2020; 34:23-30. [PMID: 33238817 DOI: 10.1024/1012-5302/a000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Between demand and reality - Perspectives of case-leading nurses on rationing in home care Abstract. Background: The demand for home care services in Switzerland (Spitex) is growing at an annual rate of 8 %. With increasingly complex client situations, lack of time and professional resources, the risk of rationing care is rising. Objective: This study explores how case-leading nurses (CLNs) experience rationing of care and how they deal with this in their daily practice. Methods: We chose a qualitative approach with an interpretative description. Between September and December 2018, we conducted semi-structured interviews with 12 CLNs from seven Spitex organisations in the German-speaking part of Switzerland. The data were analysed according to the thematic analysis of Brown and Clarke. Results: CLNs often experience not having enough time to fully oversee a client's care plan from the assessment to the evaluation of care needed. They show a high level of commitment to providing good quality of care, but have to walk a tightrope between demand and reality. Additionally, they are under pressure to defend the financing of needed services from health insurance companies. Conclusions: Rationing is an everyday experience of CLNs' practice and they invest a lot of effort in reducing its effects for their clients. CLNs work under pressure, thus targeted measures are necessary both at the political and Spitex organizational level, to reduce rationing of care.
Collapse
Affiliation(s)
- Franziska Zúñiga
- Ressort Pflege / MTT, Universitätsspital Basel.,Pflegewissenschaft - Nursing Science (INS), Universität Basel
| | | |
Collapse
|
46
|
Lake ET, Riman KA, Sloane DM. Improved work environments and staffing lead to less missed nursing care: A panel study. J Nurs Manag 2020; 28:2157-2165. [PMID: 32017302 PMCID: PMC7590500 DOI: 10.1111/jonm.12970] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
AIM To document how changes in the hospital work environment and nurse staffing over time are associated with changes in missed nursing care. BACKGROUND Missed nursing care is considered an indicator of poorer care quality and has been associated with worse patient care experiences and health outcomes. Several systematic reviews of cross-sectional studies report that nurses in hospitals with supportive work environments and higher staffing miss less care. Causal evidence demonstrating these relationships is needed. METHODS This panel study utilized secondary data from 23,650 nurses surveyed in 2006 and 14,935 surveyed in 2016 in 458 hospitals from a four-state survey of random samples of licensed nurses. RESULTS Over the 10-year period, most hospitals exhibited improved work environments, better nurse staffing and more missed care. In hospitals with improved work environments or nurse staffing, the prevalence and frequency of missed care decreased significantly. The effect on missed care of changes in the work environment was greater than that of nurse staffing. CONCLUSIONS Changes in the hospital work environment and staffing influence missed care. IMPLICATIONS FOR NURSING MANAGEMENT Modifications in the work environment and staffing are strategies to mitigate care compromise. Nurse managers should investigate work settings in order to identify weaknesses.
Collapse
Affiliation(s)
- Eileen T Lake
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathryn A Riman
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
47
|
Lake ET, French R, O'Rourke K, Sanders J, Srinivas SK. Linking the work environment to missed nursing care in labour and delivery. J Nurs Manag 2020; 28:1901-1908. [PMID: 31449691 PMCID: PMC7042061 DOI: 10.1111/jonm.12856] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/14/2019] [Accepted: 08/23/2019] [Indexed: 12/01/2022]
Abstract
AIM To measure the association between the nurse work environment (NWE) and missed nursing care on labour and delivery (L&D) units. BACKGROUND L&D units provide a sizable fraction of acute hospital services to a unique population that is a national and global priority. L&D nurses are the frontline providers during labour. Maternal morbidity and mortality may be influenced by the NWE and missed care. METHODS This cross-sectional study utilized secondary data from 1,313 L&D staff nurses in 247 hospitals from a four-state nurse survey collected in 2005-2008. RESULTS Half of nurses missed care (range: zero to 100% across hospitals). Nurses on average missed 1.25 of 10 activities. The most commonly missed activities were comforting/talking with patients and teaching/counselling. In better as compared to poor NWEs, the odds and frequency of missed care were significantly lower. CONCLUSIONS L&D nurses routinely miss necessary nursing activities. Labouring women's psychosocial, comfort and educational needs are compromised most often, likely impacting quality and outcomes. Nurse communication with colleagues and managers about missed care is warranted. IMPLICATIONS FOR NURSING MANAGEMENT The L&D NWE is modifiable and appears to influence missed care. Managers should discuss missed care with staff and measure their NWE to identify actionable weaknesses.
Collapse
Affiliation(s)
- Eileen T Lake
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel French
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen O'Rourke
- Nursing Department, Women's Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jordan Sanders
- Nursing Department, University of Vermont Medical Center, Burlington, Vermont
| | - Sindhu K Srinivas
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
48
|
Schubert M, Ausserhofer D, Bragadóttir H, Rochefort CM, Bruyneel L, Stemmer R, Andreou P, Leppée M, Palese A. Interventions to prevent or reduce rationing or missed nursing care: A scoping review. J Adv Nurs 2020; 77:550-564. [PMID: 33089553 DOI: 10.1111/jan.14596] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/15/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Abstract
AIMS To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions. BACKGROUND Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes. DESIGN Scoping review. DATA SOURCES We searched for eligible studies, published between 1980-2019, in six electronic databases. REVIEW METHODS Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based. RESULTS The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care. CONCLUSIONS The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions. IMPACT Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.
Collapse
Affiliation(s)
- Maria Schubert
- School of Health Professions, ZHAW - Zurich University of Applied Science, Institute of Nursing, Winterthur, Switzerland
| | - Dietmar Ausserhofer
- Nursing Science, Faculty of Medicine, Department of Public Health, University of Basel, Basel, Switzerland.,Claudiana College of Health-Care Professions, Bolzano, Italy
| | - Helga Bragadóttir
- Faculty of Nursing, School of Health Sciences and Landspítali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Christian M Rochefort
- School of Nursing, Faculty of Medicine and Health Sciences - Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CR-CHUS), University of Sherbrooke, Longueuil, Canada
| | - Luk Bruyneel
- Department for Public Health and Primary Care, KU Leuven - University of Leuven, Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Renate Stemmer
- Faculty of Health and Nursing, Catholic University of Applied Sciences Mainz, Mainz, Germany
| | | | - Marcel Leppée
- Project Department, Institute for Healthy Ageing, Zagreb, Croatia
| | - Alvisa Palese
- Department of Medical Science, University Udine, Udine, Italy
| | | |
Collapse
|
49
|
Lake ET, Staiger DO, Cramer E, Hatfield LA, Smith JG, Kalisch BJ, Rogowski JA. Association of Patient Acuity and Missed Nursing Care in U.S. Neonatal Intensive Care Units. Med Care Res Rev 2020; 77:451-460. [PMID: 30362882 PMCID: PMC6739170 DOI: 10.1177/1077558718806743] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study of missed care in a U.S. NICU sample adds national scope and an important explanatory variable, patient acuity. Using 2016 NICU registered nurse survey responses (N = 5,861) from the National Database of Nursing Quality Indicators, we found that 36% of nurses missed one or more care activities on the past shift. Missed care prevalence varied widely across units. Nurses with higher workloads, higher acuity assignments, or in poor work environments were more likely to miss care. The most common activities missed involved patient comfort and counseling and parent education. Workloads have increased and work environments have deteriorated compared with 8 years ago. Nurses' assignments should account for patient acuity. NICU nurse staffing and work environments warrant attention to reduce missed care and promote optimal infant and family outcomes.
Collapse
Affiliation(s)
- Eileen T. Lake
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Emily Cramer
- University of Kansas School of Nursing, Kansas City, KS, USA
| | | | - Jessica G. Smith
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | | |
Collapse
|
50
|
Uchmanowicz I, Witczak I, Rypicz Ł, Szczepanowski R, Panczyk M, Wiśnicka A, Cordeiro R. A new approach to the prevention of nursing care rationing: Cross-sectional study on positive orientation. J Nurs Manag 2020; 29:317-325. [PMID: 32894887 DOI: 10.1111/jonm.13156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022]
Abstract
AIMS To assess the effects of nurses' life satisfaction and life orientation on the level of nursing care rationing. BACKGROUND Best practice within human resource management argues that striving for a positive orientation within the workforce may create a friendly work environment that could promote the employee's development and job satisfaction in a health care organisation. METHODS A total of 547 nurses were enrolled and assessed using three self-report scales: the Basel Extent of Rationing of Nursing Care-R (BERCA-R), the Satisfaction with Life Scale (SWLS) and the Life Orientation Test (LOT-R). Then, the data were submitted into bivariate analyses. RESULTS More pessimistic nurses with low and moderate levels of life satisfaction, and those with a neutral life orientation, presented with significantly higher BERCA-R scores than those who were more optimistic and who had high levels of life satisfaction. CONCLUSIONS Nursing care rationing depends on psychological factors of life satisfaction and life orientation. Low levels of satisfaction with life and a more pessimistic life orientation negatively contribute towards a higher prevalence of nursing care rationing. IMPLICATIONS FOR NURSING MANAGEMENT Nursing management policies, including intervention management, should consider ensuring positive orientation is in place to increase job satisfaction and optimism in health care workers.
Collapse
Affiliation(s)
| | - Izabela Witczak
- Division of Economics and Quality in Health Care, Wroclaw Medical University, Wroclaw, Poland
| | - Łukasz Rypicz
- Division of Economics and Quality in Health Care, Wroclaw Medical University, Wroclaw, Poland
| | | | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Alicja Wiśnicka
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Raul Cordeiro
- Comprehensive Health Research Centre (CHRC), Nova University of Lisbon, Lisbon, Portugal.,VALORIZA-Research Centre for Endogenous Resource Valorization, Portalegre, Portugal.,Polytechnic Institute of Portalegre (IPP), Portalegre, Portugal
| |
Collapse
|