Unfinished nursing care in four central European countries

Clinical supervisor's experiences of peer group clinical supervision during COVID-19: a mixed methods study

BACKGROUND

Providing positive and supportive environments for nurses and midwives working in ever-changing and complex healthcare services is paramount. Clinical supervision is one approach that nurtures and supports professional guidance, ethical practice, and personal development, which impacts positively on staff morale and standards of care delivery. In the context of this study, peer group clinical supervision provides allocated time to reflect and discuss care provided and facilitated by clinical supervisors who are at the same grade/level as the supervisees.

METHODS

To explore the clinical supervisor's experiences of peer group clinical supervision a mixed methods study design was utilised within Irish health services (midwifery, intellectual disability, general, mental health). The Manchester Clinical Supervision Scale was used to survey clinical supervisors (n = 36) and semi-structured interviews (n = 10) with clinical supervisors were conducted. Survey data were analysed through SPSS and interview data were analysed utilising content analysis. The qualitative and quantitative data's reporting rigour was guided by the CROSS and SRQR guidelines.

RESULTS

Participants generally had a positive encounter when providing clinical supervision. They highly appreciated the value of clinical supervision and expressed a considerable degree of contentment with the supervision they provided to supervisees. The advantages of peer group clinical supervision encompass aspects related to self (such as confidence, leadership, personal development, and resilience), service and organisation (including a positive working environment, employee retention, and safety), and patient care (involving critical thinking and evaluation, patient safety, adherence to quality standards, and elevated levels of care).

CONCLUSION

There are many benefits of peer group clinical supervision at an individual, service, organisation, and patient level. Nevertheless, there is a need to address a lack of awareness and misconceptions surrounding clinical supervision to create an environment and culture conducive to realising its full potential. It is crucial that clinical supervision be accessible to nurses and midwives of all grades across all healthcare services, with national planning to address capacity and sustainability.

Rationing nursing care and organizational factors in intensive care units

INTRODUCTION

Rationing nursing care is a term that applies to various aspects of the required patient care that are omitted or their performance is delayed.

AIM

This study aimed to identify the extent of rationing of nursing care in intensive care units (ICUs) in different types of hospitals and determine the relationship between rationing of nursing care and hospital and staff characteristics.

METHODS

This quantitative, cross-sectional, multicenter study was performed. The sample comprised 226 nurses working in ICUs in a North-East part of Poland. The Polish version of the PRINCA questionnaire methods was applied. The survey was conducted between 15 January and 31 May 2023.

RESULTS

There were statistically significant differences between rationing of nursing care in university/provincial hospitals and district hospitals t = 6.92 p<0.001. In provincial and university hospitals, nursing care is often omitted, leading to a lower perceived quality of nursing care (t = -3.0 p = 0.003). This is further compounded by the fact that nursing care is more likely to be rationed in units with a larger number of beds. The level of rationing of nursing care was significantly correlated with the perceived work quality and job satisfaction in both types of hospitals. The most frequently omitted aspects of nursing care included providing emotional support (university/provincial 1.27 vs. district 0.89), patient and family education (1.11 vs. 0.74), communication with external entities (1.11 vs. 0.84), and observing safe patient-handling practices (1.01 vs. 0.99).

CONCLUSION

The type of hospital and organizational factors influence the rationing of nursing care. Improvements in working conditions can improve nursing care quality in ICUs.

Unmet care needs in psychiatric healthcare context: A systematized literature review

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.

Nursing students' perceptions of unfinished nursing care: A cross-sectional study

AIM

To investigate the prevalence, patterns and reasons for unfinished nursing care as perceived by nursing students.

BACKGROUND

Unfinished nursing care (UNC) is a frequently observed phenomenon in the acute care setting. To date, studies have focused primarily on the perspective of nurses or patients, but another important perspective is that of nursing students who provide nursing care in all healthcare settings.

DESIGN

A descriptive cross-sectional study.

METHODS

The study included 738 undergraduate nursing students from nine Slovak universities. Data were collected between September 2022 and February 2023 using the Slovak version of the Unfinished Nursing Care Survey tool (UNCS). Data were analyzed using descriptive and inferential statistics.

RESULTS

The mean composite score of UNCS was 2.48 (SD=0.68). In general, 100% of nursing students reported that nurses missed at least one or more nursing care activities during their last clinical placement. The average number of missed nursing care activities was 11.2 per nurse as perceived by nursing students during their last clinical placement. Nursing students reported that the most frequently omitted nursing care activity was spending time with patients and their caregivers (3.15 ± 1.11; 92.9%). The most frequently reported reason for UNC was an inadequate number of nurses on the ward (4.31 ± 1.01; 98.1%). In the study, reported UNC could be predicted by previous experience in healthcare, previous clinical rotation, number of patients per shift, perceived staff adequacy and outcome expectations (p <0.05).

CONCLUSIONS

The findings reveal that UNC is a widespread phenomenon and all nursing students report this phenomenon during their clinical placements. Spending time with patients and their caregivers emerged as the most frequently omitted nursing care activity, highlighting the importance of patient-centered care. The primary reason cited for UNC was an inadequate number of nurses, highlighting staffing issues as a significant contributing factor. These findings emphasize the need for targeted interventions to address staff shortages and improve nursing education to prepare students to address UNC in their future practice.

Rationing of nursing care in Internal Medicine Departments-a cross-sectional study

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.

The experience of nurses to reduce implicit rationing of nursing care: a phenomenological study

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.

Cultivating support during COVID-19 through clinical supervision: A discussion article

AIM

This article aims to discuss how clinical supervision is an important approach in supporting frontline nurses and students during and post COVID-19 through the lens of the nursing metaparadigms.

DESIGN

Discussion article.

METHODS

Discourse of the literature considering the importance of working collaboratively with healthcare and educational organisations in operationalising clinical supervision.

RESULTS

The evidence base supporting clinical supervision as an effective support strategy for nurses exists, however, its implementation and practice has become sporadic. A resurgence is required to support student's and nurse's during this pandemic. It is timely for nurse educators to creatively engage with clinical partners in supporting clinical supervision to enhance both nurses and students pandemic practice experiences. Clinical supervision is proposed as one strategy to support and guide both nurses and students to develop, strengthen and challenge the effectiveness of their care during COVID-19.

Implicit rationing of nursing care reported by nurses from different types of hospitals and hospital units

AIMS AND OBJECTIVES

The study aimed to investigate differences in assessing implicit rationing of nursing care by Czech nurses with respect to the type of unit and type of hospital.

BACKGROUND

Implicit rationing of nursing care may differ across different types of hospitals and hospital units.

DESIGN

This study used a multicentre cross-sectional study design.

METHODS

The STROBE checklist for observational cross-sectional studies was followed for reporting of the research study. The sample included 8209 nurses providing direct care to medical and surgical patients in 14 acute care Czech hospitals. The main outcome was implicit rationing of nursing care as measured with a Czech version of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument. Data were collected from September 2019 to October 2020.

RESULTS

The most frequently rationed nursing care activity was timely response to patient or family request/need, followed by emotional or psychological support and adequate supervision of delegated tasks. More implicitly rationed nursing care was reported in medical units. Statistical differences were found in rating 25 items and the PIRNCA total score. Nurses from middle-sized hospitals reported implicitly rationed care more frequently than those from large hospitals.

CONCLUSION

More rationed care was reported by nurses from medical units and nurses from middle-sized hospitals. Organisational variables (the type of unit and type of hospital) influence the implicit rationing of nursing care in our study.

RELEVANCE TO CLINICAL PRACTICE

The findings call for nursing managers to pay attention to organisational variables which may affect the implicit rationing of nursing care.

The Impact of Sociodemographic Factors on the Rationing of Nursing Care in Urology Wards

BACKGROUND

The problem of care rationing is widespread all over the world and results from many factors affecting nurses. These factors may result from the environment in which the nurses work, e.g., the atmosphere at work, or may not be related to work, e.g., place of residence. The aim of this study was to examine the impact of sociodemographic factors (place of residence, satisfaction with the financial situation, number of forms of postgraduate education, work system, number of patients per nurse, number of diseases) on care rationing, job satisfaction and quality of nursing care.

METHODS

The study is a cross-sectional study which includes 130 nurses from all over Poland who work in urology wards. The criteria for inclusion were consent to the examination, practicing the profession of a nurse, work in the urology department and work experience of at least 6 months, regardless of the number of hours worked (full-time/part-time). The study was conducted using the standardized PIRNCA (Perceived Implicit Rationing of Nursing Care) questionnaire.

RESULTS

The average rationing nursing care was 1.11/3 points which means nursing care was rarely rationed. The average job satisfaction was 5.95/10 points, and the assessment of the quality of patient care was 6.88/10 points, which means a medium level of the job satisfaction and the quality of patient care. The rationing of care was affected by the number of nurse illnesses; job satisfaction was influenced by the place of residence and satisfaction with the financial situation, while the quality of care was not influenced by any of the analyzed factors.

CONCLUSIONS

The result of care rationing is at a similar level as the results in Poland and abroad. Despite the rare rationing of care, employers should take corrective action, especially in terms of increasing the staff and health prevention of nurses.

Doživljanje neizvedene zdravstvene nege pri medicinskih sestrah

Uvod: Stiske zaradi zdravstvene nege, ki ostaja zaradi različnih razlogov neizvedena, so pri medicinskih sestrah pogosto spregledane in neprepoznane. Namen integrativnega pregleda literature je pregledati najnovejše raziskave, ki opisujejo, kako se neizvedena zdravstvena nega izraža na duševnem počutju medicinskih sester.Metode: Uporabili smo integrativni pregled literature, izveden v skladu s PRISMA smernicami v podatkovnih bazah PubMed, CINAHL, Wiley, COBISS.SI in Google Učenjak. Potek iskanja in analize literature je prikazan s pomočjo PRISMA diagrama. Zadetke smo razvrstili glede na raven dokazov. Uporabili smo tematsko analizo vsebine.Rezultati: Skupaj je bilo identificiranih 175 in v končno analizo vključenih 11 virov. Identificirano je bilo 96 kod združenih v 4 kategorije: (1) Telesno, duševno in čustveno počutje, (2) Moralno etične dileme, (3) Sprejemanje odločitev pri delu – prilagajanje, (4) Poklicne in osebne vrednote.Diskusija in zaključek: Neizvedena zdravstvena nega je za medicinske sestre pomemben izvor stisk in stresa, saj zaradi neizvajanja vseh potrebnih aktivnosti v zdravstveni negi prihajajo v neskladje s svojimi osebnimi in poklicnimi vrednotami. Naši rezultati dodajajo vsebinski kontekst in boljše razumevanje posledic neizvedene zdravstvene nege pri medicinskih sestrah. Vsakodnevno odločanje, katere aktivnosti bo potrebno izpustiti, vpliva ne samo na slabše počutje, nezadovoljstvo in izgorelost, ampak celo na zapuščanje delovnih mest in poklica.

Toward understanding nurses' decisions whether to miss care: A discrete choice experiment

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.

Assessment of The Effect of Stress, Sociodemographic Variables and Work-Related Factors on Rationing of Nursing Care

(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.

Consequences of understaffing on type of missed community care- a cross-sectional study

BACKGROUND

Resource cuts to primary and community care in combination with a decline of those working in community settings is compromising quality of care and patient safety in the UK. It is reported that the negative consequences of understaffing and underfunding have worsened due to the COVID-19 pandemic.

OBJECTIVE

This is a cross-sectional study that aimed to examine short and long-term District and Community nursing working conditions. The objectives were to assess the prevalence of understaffing and missed care and the relationship between individual and organisational factors and their association with missed care outcome. We further explored the relationship between additional caseload, staffing levels and missed care.

METHODS

We developed a questionnaire based on the validated MISSCARE survey. Outcome measures were, number of vacancies per team, staffing levels, reported incidence of missed care, type of missed care, length of shift and overtime.

RESULTS

Only 23% of teams reported having no vacancies. The mean staffing ratio was reported at 60%, including agency/bank staff (0.59±1.5). Prevalence of missed care was relatively high (60%≈). The distribution of types of missed care was spread evenly across all types of nursing care. A backward stepwise regression analysis showed that the Proportion of Permanent staff capacity OR=7.9 (95% CI 0.09-0.65), Active Caseload Size OR= 5.5 (95% CI: 1.0 - 1.003), Number of RNs on the team (OR 4.8 (95% CI:1.003-1.058) and Amount of Overtime worked (OR= 3.9 (95% CI:0.98-1.0) variable are statistically significant predictors of missed care. The analysis showed an increase in additional allocated cases per RN as the permanent staff proportion decreased to 70%, at which point the likelihood of reported Missed Care outcome peaks.

CONCLUSION

The compromised quality of care related to human resources and organisational aspects of the nursing process. Where RNs worked longer hours to make up for the backlog of cases, the prevalence of missed care was more likely. Longer working hours in the community increased the risk of compromised care and sub-optimal patient care. The aspects of the nursing process identified as 'missed' related to The World Health Organisation's three main pillars of community nursing (health promotion, patient education and screening). As such, significant components of the two first pillars are, according to these data, being undermined.

Rationing Care, Job Satisfaction, Fatigue and the Level of Professional Burnout of Nurses in Urology Departments

The problem of rationing nursing care is common and present all over the world, which is a direct threat to the health and life of patients. The aim of the study was to assess the level of rationing care, fatigue, job satisfaction and occupational burnout and to assess the relationship between them and age, length of service and the number of jobs. A survey was performed among 130 Polish nurses in urology departments using the following questionnaires: Link Burnout Questionnaire, Job Satisfaction Scale, Nursing Care Rationing Scale and Modified Fatigue Impact Scale. Nursing care is rarely rationed-1.11 points; the experience of fatigue ranges between sometimes and often-52.58 points; and job satisfaction is at an average level-17.23 points. The level of rationing nursing care in urology departments is similar to that in other departments. This requires minor changes to the work of nurses to reduce the workload. Employers should develop implementation programs for young workers in order to avoid burnout and also invest in factors increasing nurses' satisfaction, such as the atmosphere at work.

Determinants Affecting the Rationing of Nursing Care and Professional Burnout among Oncology Nurses

Rationing of nursing care (RNC) is characterized by the omission of any aspect of the required patient care, resulting in incomplete or delayed nursing activities. Oncology nurses are exposed to a very high psychological burden, which can lead to the development of professional burnout syndrome (PBS). The level of PBS might be related to life and job satisfaction. This study aimed to identify determinants affecting RNC and reveal the relationship between RNC, life and job satisfaction, and the PBS levels among oncology nurses. The sample was a hundred oncology nurses from four hospitals in Poland with a mean age of 43.26 ± 10.69 years. The study was conducted from March 2019 to February 2020. The self-administered sociodemographic questionnaire and validated scales determining missed nursing care, job and life satisfaction, and life orientation were used: Basel Extent of Rationing of Nursing Care-Revised (BERNCA-R), Satisfaction with Job Scale (SWJS), Satisfaction with Life Scale (SWLS), Life Orientation Test-Revised (LOT-R), and Maslach Burnout Inventory (MBI). The mean BERNCA score was 1.55 ± 0.15, which indicates the frequency of RNC was between “never” and “rarely”. The mean SWJS score was 11.71 ± 5.97, which showed that nurses were “dissatisfied” and “rather dissatisfied” with their job. A low SWLS score was reported by 59% of nurses, which means that more than half of the respondents described their life satisfaction as low. In LOT-R, 66% of nurses reported pessimistic and 31% neutral life orientation. The mean overall MBI score was 49.27 ± 19.76 points (EE = 63.56 ± 25.37, DEP = 37.2 ± 24.95, and lack of PA = 47.05 ± 22.04), which means that half of the nurses perceived burnout and half did not. Additionally, the higher the job satisfaction (SWJS), the more frequent the RNC (BERNCA) (p < 0.05). The greater the EE, the stronger the sense of lack of PA, and the higher the PBS (MBI) level, the less frequent the RNC (BERNCA). In conclusion, there is a phenomenon of omission of some aspects of care among oncology nurses, but it is not frequent and concerns areas not directly related to therapeutic tasks, but requiring effort and not resulting in quick noticeable effects. It depends only little on life satisfaction and more on job satisfaction and PBS level. The results may indicate the professionalism of Polish nurses, their responsibility towards their patients’ life and health, and the sense of mission that enables them to perform their duties regardless of the external and internal difficulties. The presence of the PBS phenomenon in oncology nurses highlights the need for continued research in this area.

Guiding Nurse Managers in Supporting Nurses in Dealing with the Ethical Challenge of Caring

AIM(S)

To present the theory of resigning in supporting nurse managers in dealing with nurses' ethical challenge of caring.

BACKGROUND

In a COVID-19 era, nurses continue to be ethically challenged in maintaining safe patient care. Nurse Managers play a critical role supporting staff in responding to the complexities of working in, under resourced environments.

EVALUATION

Literature suggests care delivery is compromised in times of staff shortages, lack of resources and increased demands on nurses. Examining caring behaviours through the theoretical lens of the theory of resigning enables nurse managers to understand nurses' behaviours, cultivating supportive working environments.

KEY ISSUE(S)

Nurses strive to provide quality, safe care but are sometimes unable to give the level or type of care they wish, due to the presence of constraints.

CONCLUSION(S)

This paper provides suggestions for nurse managers in dealing with nurses' daily moral distress arising from working within constraints while still trying to provide safe care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse Managers need to develop greater insights into the ethical dilemmas nurses experience and support them to temporarily realign beliefs and values, while continuing to work within constraints. Understanding ethical dilemmas of prioritising care is required to address and manage this concern.

Patients' and Nurses' Perceptions of Importance of Caring Nurse-Patient Interactions: Do They Differ?

Nurse−patient interaction is a professional and therapeutic relationship created to enable nurses to assess, plan, and deliver health care aimed at meeting patients’ basic human needs. The main aim of this study was to identify distinctive characteristics and differences in perceptions between patients and nurses related to the importance of caring interactions and to examine the contribution of independent variables in explaining their perceptions. A total of 446 respondents were included in the research (291 patients and 155 registered nurses). Data were collected using the translated and standardized 70-item version of the Caring Nurse−Patient Interactions Scale (CNPI-70) version for patients and version for nurses. According to the overall CNPI-70 scale, there was a significant difference in patients’ and nurses’ perception (p < 0.001). Patients assessed caring nurse−patient interactions significantly higher (4.39) than nurses (4.16). Additionally, nurses assessed all subscales significantly lower than patients who assessed them high (p < 0.05), except for the subscales for “environment” (p = 0.123) and “spirituality” (p = 0.132). Independent variables did not contribute to an explanation of respondents’ perceptions. Providing quality physical assistance in meeting human needs through effective communication and teaching is crucial for promoting a holistic patient approach, improving psychosocial support and nurse−patient interaction, and attaining greater satisfaction with health care provided without additional financial investments.

Strategies for Reducing Rationed Nursing Care: Qualitative Secondary Analysis

Introduction: Nursing students spend a meaningful part of their professional training in clinical practice. However, to a significant extent, they actively or passively contribute to the occurrence of rationed nursing care in clinical practice. Therefore, it is crucial that they actively participate in implementing targeted strategies to reduce rationed nursing care.

Aim: To explore nursing students′ experience with strategies focusing on the reduction of rationed nursing care.

Methods: We chose a qualitative secondary analysis to address unpublished data related to nursing students′ experience with strategies focusing on reducing rationed nursing care. The data included a set comprising of 148 pages with transcribed verbatim of 18 semi-structured interviews. The data were analyzed by a deductive content analysis.

Results: Based on the outcome of the secondary analysis, we identified two meaningful categories: Preventive strategies in clinical practice and Importance and meaning of preventive strategies. These two categories reflected nursing students′ experience with targeted strategies to reduce rationed nursing care in clinical practice.

Conclusion: Proposal and subsequent implementation of preventive strategies are essential for reducing rationed nursing care phenomenon from the clinical practice environment. The perspective of nursing students is vital due to their intensive perception of rationed nursing care in clinical practice. Students may identify areas that work-place staff may not explicitly focus on and consider important but jeopardize the quality of care or patient safety.

Self-assessment of Rationing and Quality of Nursing Care

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.

Satisfaction With Life, Satisfaction With Job, and the Level of Care Rationing Among Polish Nurses-A Cross-Sectional Study

Background: Rationing of nursing care is a serious issue that has been widely discussed throughout recent years in many countries. The level of satisfaction with life and of satisfaction with job as the nurse-related factors may significantly affect the level of care rationing. Aim: To assess the rationing of nursing care among the Polish nurses and the impact of nurse-related variables, i.e., satisfaction with life and satisfaction with job on the level of nursing care rationing. Materials and Methods: A cross-sectional study was conducted among 529 Polish registered nurses employing in two University Hospitals. Three self-report scales in the Polish version were used in this study, namely, Basel Extent of Rationing of Nursing Care-revised version (BERNCA-R), Satisfaction with Life Scale (SWLS), and Satisfaction with Work Scale (SWWS). Results: The respondents indicated that the most frequently rationed activity is studying the situation of individual patients and care plans at the beginning of the shift. The least frequently rationed activity indicated by the respondents was adequate hand hygiene. The patient-to-nurse ratio and the level of satisfaction with job are significant independent factors affecting the level of care rationing. Conclusions: The assessment of the level of satisfaction with life and identification of factors affecting this assessment will enable reducing the occurrence of care rationing.

Missed nursing care in hospital environments during the COVID-19 pandemic

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.

Hospital and unit variables of missed nursing care in acute care hospitals: A cross-sectional study

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.

Are data on missed nursing care useful for nursing leaders? The RN4CAST@IT cross-sectional study

AIM

To describe nurses' reported missed nursing care activities among hospitalized adult patients medical and surgical wards and explore gaps in service provision.

BACKGROUND

In 2015, Italy replicated the RN4CAST study, which heralded the exposition of missed care as an international phenomenon. In Italy, nurse-patient workload is high, with high levels of burnout and dissatisfaction reported, all factors associated with missed care.

METHODS

A cross-sectional study (n = 3,590) was conducted using the 13-item online Task Left Undone Tool aimed at collecting data on missed nursing care.

RESULTS

The frequency of omission of activities ranged between 7% and 50%. There were significant differences between morning, afternoon and night shifts and the various clinical settings. Oral care was the most frequently missed care activity.

CONCLUSIONS

This study takes step forward in identifying and reducing missed care on medical and surgical wards, both in Italy and also internationally, which needs to take into account the specific organisational characteristics of each setting.

IMPLICATIONS FOR NURSING MANAGEMENT

Although more essential activities are missed less frequently, much is known about the relational deficits such as information giving, education, communication and discharge advice, which managers ought to spearhead through local initiatives to improve these practices.

Dignity, privacy, respect and choice-A scoping review of measurement of these concepts within acute healthcare practice

AIMS AND OBJECTIVES

To synthesise and review literature related to instruments that measure psychosocial aspects of fundamental care in acute hospital care settings.

BACKGROUND

Psychosocial aspects of care often receive less priority in terms of care provision in acute care environments. At the same time, if these elements are overlooked, there may be consequences. Despite the availability of many instruments designed to measure specific aspects of care, these concepts are often not studied within the broader context of fundamentals of care, but rather coexist as isolated explorations of specific subelements.

DESIGN

A scoping review was conducted, based on Arksey & O'Malley's (2005) methodological framework and following the PRISMA checklist.

METHODS

Using the five recommended steps-identifying the research question; identifying relevant studies; study selection; charting the data; and summarising and reporting the results-three databases were searched: MEDLINE/PubMed, CINAHL and EMBASE, in February 2019.

RESULTS

Following independent screening by two of the authors, 48 papers were included. From these 48 papers, 33 instruments were identified. Only five of these tools thoroughly assessed psychosocial aspects elements of care (dignity, respect, privacy and patients' choice) through dedicated items.

CONCLUSIONS

This review provides nurses with a synthesis of 33 instruments that assess the psychosocial aspects of care. This provides an important resource to guide measurement of dignity, respect, privacy and patients' choice. The findings also provide guidance to future research in this field.

RELEVANCE TO CLINICAL PRACTICE

This paper reviews and synthesises these instruments to provide a resource to nurses to inform their decisions and practice around measurement and evaluation of these key aspects of care. This provides a useful guide to measure and monitor the improvement of fundamental care delivery in practice and points to strengths and weaknesses of the instruments concerned.

Polish adaptation and validation of the Perceived Implicit Rationing of Nursing Care (PIRNCA) questionnaire: a cross-sectional validation study

OBJECTIVES

To develop a Polish adaptation of the Perceived Implicit Rationing of Nursing Care (PIRNCA)questionnaire.

DESIGN

Cross-sectional validation study.

SETTINGS

Nurses working in surgical and cancer wards in Poland.

PARTICIPANTS

A sample of 513 professionally active nurses was enrolled in the study.

INTERVENTION

To complete a Polish translation of the full original PIRNCA questionnaire.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was translation and adaptation of the full original PIRNCA tool and its validation to the Polish conditions. The secondary outcome was determination of relationships between sociodemographic variables, nurses' assessment of patient care quality and their overall job satisfaction on the one hand, and PIRNCA scores on the other.

RESULTS

The respondents' mean score was 1.27 points (SD=0.68) on a scale from 0 to 3. Cronbach's alpha for the entire instrument was 0.957. All items of the questionnaire were found to have a positive item-total correlation. The developed linear regression model showed that nurses' assessment of patient care quality and their overall job satisfaction were independent predictors of PIRNCA scores (p<0.05). 94.15% of nurses reported rationing at least one of the 31 care activities.

CONCLUSIONS

The present findings indicate a high level of reliability and validity of the translated PIRNCA questionnaire, fully comparable to that of the original. The questionnaire can be used for the assessment of PIRNCA in Polish hospitals.

Unfinished nursing care in four central European countries

Aim

The main aim of the research was to describe and compare unfinished nursing care in selected European countries.

Background

The high prevalence of unfinished nursing care reported in recently published studies, as well as its connection to negative effects on nurse and patient outcomes, has made unfinished care an important phenomenon and a quality indicator for nursing activities.

Methods

A cross‐sectional descriptive study was undertaken. Unfinished nursing care was measured using the Perceived Implicit Rationing of Nursing Care questionnaire (PIRNCA). The sample included 1,353 nurses from four European countries (Croatia, the Czech Republic, Poland and Slovakia).

Results

The percentage of nurses leaving one or more nursing activities unfinished ranged from 95.2% (Slovakia) to 97.8% (Czech Republic). Mean item scores on the 31 items of the PIRNCA in the total sample ranged from 1.13 to 1.92. Unfinished care was significantly associated with the type of hospital and quality of care.

Conclusion

The research results confirmed the prevalence of unfinished nursing care in the countries surveyed.

Implications for Nursing Management

The results are a useful tool for enabling nurse managers to look deeper into nurse staffing and other organizational issues that may influence patient safety and quality of care.