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McHugh A, Miller C, Stewart C. Maslow's Hierarchy of Needs: Achieving Outcomes, Improving Value, and Work Environment - Lessons Learned from the Pandemic. Crit Care Nurs Clin North Am 2024; 36:451-467. [PMID: 39069363 DOI: 10.1016/j.cnc.2024.02.002] [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] [Indexed: 07/30/2024]
Abstract
Health care delivery science, according to Faerber, "focuses on ways to improve health and services to individuals and populations." The triple aim, described as improving population health, enhancing the care experience, and reducing costs; is a model for health care improvement. In 2014, the triple aim expanded to the quadruple aim to include the health and satisfaction of health care professionals.
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Kohanová D, Solgajová A, Cubelo F. The association of teamwork and missed nursing care in acute care setting: A mixed-methods systematic review. J Clin Nurs 2024; 33:3399-3413. [PMID: 38661121 DOI: 10.1111/jocn.17182] [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: 12/19/2023] [Revised: 03/11/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
AIM(S) Teamwork among healthcare professionals is a key aspect of patient safety that influences the prevalence of missed nursing care. The association between teamwork and missed care in acute care hospitals is now well established in the literature. Therefore, this review aimed to synthesise the existing empirical evidence on the association between teamwork and missed care in the acute care setting. DESIGN A mixed-method systematic review study. METHODS The search was carried out in February 2023 in four scientific databases, PubMed, ProQuest, Web of Science and Scopus based on their institutional availability. The search produced 1542 studies. The method of thematic analysis was used in data synthesis. RESULTS A total of 18 studies were selected that revealed the relationship between teamwork and missed care. The teamwork score was weak to moderate but significantly associated with the overall score of missed care and was found to be a statistically significant predictor of missed care in an acute care setting. Additionally, teamwork represented an important reason for missed care, primarily in the context of poor communication, lack of trust and cooperation in the nursing team and lack of leadership. CONCLUSION The review findings contribute to a deeper understanding of the intricate dynamics between teamwork and missed care and provide valuable information to healthcare professionals and institutions looking to optimise teamwork and mitigate instances of missed care in the acute care setting. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Recognising how teamwork influences the occurrence of missed care, healthcare organisations can strategically implement targeted interventions to enhance collaboration, address communication gaps, foster trust, and provide effective leadership. IMPACT This review suggests that improving teamwork seems to be one of the most important strategies focused on mitigating missed care in acute care settings. REPORTING METHOD The reporting of this review followed the PRISMA 2020 checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Dominika Kohanová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic
| | - Andrea Solgajová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic
| | - Floro Cubelo
- School of Wellbeing and Culture, Nursing, Oulu University of Applied Sciences, Oulu, Finland
- Department of Nursing Science, Faculty of Health Sciences, Kuopio, Finland
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Antoszewska A, Gutysz-Wojnicka A. Rationing of nursing care and assessment of work safety and a healthy work environment in intensive care units: A cross-sectional, correlational study. Intensive Crit Care Nurs 2024; 83:103667. [PMID: 38471399 DOI: 10.1016/j.iccn.2024.103667] [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: 09/18/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Rationing of nursing care, whichrefers to the aspects of care not delivered by nurses in an intensive care unit (ICU), has implicationsfor patient outcomes and experiences. OBJECTIVES This study aimed to identify the extent to which nursing care is rationed in intensive care units, as well as asses quality of nursing care, and the level of job satisfaction and its correlation with an assessment of the climate of work safety, teamwork, and a healthy work environment. METHODOLOGY A cross-sectional, correlational study was conducted. The study included 226 ICU nurses. It was conducted with the use of three instruments: the Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on the rationing of nursing care, assessment of patient care quality and job satisfaction, American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) and the Safe Attitudes and Behaviours Questionnaire questionnaire in the version: Teamwork and Safety Climate (BePoZa). SETTINGS Intensive Care Units in Warmia and Mazury Region in Poland. MAIN OUTCOME MEASURES Level of Nursing Care Rationing in Intensive Care Units. RESULTS The majority of participants were women (89.82 %) with a mean age of 42.47 years. The average score for nursing care rationing across all groups was 0.58. The mean score for the HWEAT was 2.7 and BePoZa was 3.72. The scores from the questionnaires were negatively correlated with the nursing care rationing scores, being -0.36 for the HWEAT and -0.45 for BePoZa. All correlation coefficients were statistically significant at a p-value of less than 0.05. CONCLUSIONS It is important to monitor work safety, teamwork climate, and standards of a healthy work environment in ICUs to minimise the risk of rationing nursing care. IMPLICATIONS FOR CLINICAL PRACTICE Interventions that enhance work organisation and teamwork can elevate nursing quality and job satisfaction in ICUs, while underestimating patient care tasks; thus, highlighting the need for further research on the factors influencing nursing performance.
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Affiliation(s)
- Anna Antoszewska
- School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Department of Nursing, Żołnierska 14c Street, 10-561 Olsztyn, Poland.
| | - Aleksandra Gutysz-Wojnicka
- School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Department of Nursing, Żołnierska 14c Street, 10-561 Olsztyn, Poland.
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Antoszewska A, Gutysz-Wojnicka A. Rationing nursing care and organizational factors in intensive care units. PLoS One 2024; 19:e0306313. [PMID: 39052619 PMCID: PMC11271898 DOI: 10.1371/journal.pone.0306313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/16/2024] [Indexed: 07/27/2024] Open
Abstract
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.
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Affiliation(s)
- Anna Antoszewska
- Department of Nursing, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Aleksandra Gutysz-Wojnicka
- Department of Nursing, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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Rivaz M, Abbasi F, Pasyar N. Structural Equation Modeling of Associations Between Nursing Practice Environment And Missed Nursing Care: A Cross-sectional Study. J Nurs Care Qual 2024; 39:E16-E22. [PMID: 37782913 DOI: 10.1097/ncq.0000000000000752] [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: 10/04/2023]
Abstract
BACKGROUND Missed nursing care (MNC) negatively impacts the quality of patient care. There may be a relationship between the nursing practice environment (NPE) and MNC; however, this relationship has not been examined in developing countries during the COVID-19 pandemic. PURPOSE To determine the relationship between the NPE and MNC during the COVID-19 pandemic. METHODS A cross-sectional study of 300 participants was conducted in 4 teaching hospitals in Iran. Data were collected using a demographic and clinical form, the Nursing Professional Practice Environment Questionnaire, and MISSCARE survey and analyzed using structural equation modeling. RESULTS The hypothesized model was well fit, showing that 1 unit improvement of the NPE domains of patient-centered care , effective leadership , and policy transparency decreased MNC by 0.18, 0.12, and 0.05, respectively. CONCLUSION The model confirmed the association between the dimensions of the NPE and MNC. These findings can assist health policymakers and nursing managers in improving the NPE.
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Affiliation(s)
- Mozhgan Rivaz
- Author Affiliations: Department of Nursing (Dr Rivaz) and Community Based Psychiatric Care Research Center (Dr Pasyar), School of Nursing and Midwifery (Ms Abbasi), Student Research Committee of Shiraz University of Medical Sciences, Shiraz, Iran
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Vincelette C, D'Aragon F, Stevens LM, Rochefort CM. Development and Validation Process of the Intensive Care Unit Omitted Nursing Care (ICU-ONC) Instrument Among French Canadian Nurses. J Nurs Meas 2024; 32:95-105. [PMID: 37348884 DOI: 10.1891/jnm-2022-0030] [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] [Indexed: 06/24/2023]
Abstract
Background and Purpose: The purpose of this article is to document the development and validation process of an instrument adapted for French-speaking nurses and to measure the occurrence of omitted nursing care (ONC) in the intensive care unit (ICU). Methods: An electronic Delphi panel, involving ICU nursing experts from the province of Quebec (Canada), was used to develop the intensive care unit omitted nursing care (ICU-ONC) instrument. For the validation process, an electronic cross-sectional survey was conducted. Results: A total of 564 nurses participated in the validation study. Exploratory factor analysis performed on 478 complete observations supports the presence of a single-factor structure for the 22-item ICU-ONC instrument. Coefficient alpha for the scale was .93, 95% confidence interval (CI) was [0.92, 0.94], item-partial total correlations ranged from .49 and .68, and the mean/median interitem correlations were .38 and .37, respectively. Moderate negative correlations were found between the ICU-ONC instrument overall score and two related constructs: nurses' perception of the quality as well as the safety of care. Conclusions: Our current understanding of ONC in the ICU is based on the results drawn from the administration of generic instruments to ICU nurses. The novel 22-item ICU-ONC instrument can help better estimate the occurrence of the phenomena in the ICU.
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Affiliation(s)
- Christian Vincelette
- School of Nursing, Université de Sherbrooke, Longueuil, Quebec, Canada
- Research Center Charles-LeMoyne, Longueuil, Quebec, Canada
- Research Center du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Frédérick D'Aragon
- Research Center du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Anesthesiology, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Louis-Mathieu Stevens
- Department of Surgery, Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
- Research Center Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Christian M Rochefort
- School of Nursing, Université de Sherbrooke, Longueuil, Quebec, Canada
- Research Center Charles-LeMoyne, Longueuil, Quebec, Canada
- Research Center du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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Yang L, Zhou W, Gao Y, Wu T, Zhang H, Gan X. Development and validation of the missed intensive nursing care scale. BMC Nurs 2024; 23:165. [PMID: 38454469 PMCID: PMC10919009 DOI: 10.1186/s12912-024-01805-3] [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: 10/30/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Missed nursing care is a pervasive issue in hospitals, nursing homes, and communities, posing a significant threat to patient safety and the quality of nursing care. It has adverse effects on patient satisfaction and the motivation of nursing staff. Understanding the causes and nature of these care omissions in clinical settings is essential for implementing effective interventions. This study aims to develop and validate a tool for assessing missed nursing care in adult intensive care units. METHODS Semi-structured interviews, expert consultations conducted via the Delphi method and item analysis were used to develop the initial scale. Our analysis involved data collected from 400 nurses and employed correlation coefficient analysis, critical ratio assessment, Cronbach's α coefficient evaluation, discrete trend analysis, and factor analysis, which were grounded in both classical test theory and item response theory, allowing us to scrutinize and refine the items in the scale. To validate the scale, we conveniently sampled 550 nurses and assessed structural validity, internal reliability, split-half reliability, and test-retest reliability to ensure the scale's robustness and accuracy. RESULTS The Missed Intensive Nursing Care Scale (MINCS) comprises three distinct components. Part A serves to collect general information about the participants. In Part B, the missed care elements are categorized into five domains, following the framework of Maslow's hierarchy of needs theory: physiology, safety, belongingness, esteem, and cognition. Part C is dedicated to detailing the reasons behind missed care, which encompass labor resources, material resources, communication factors, and managerial factors. Remarkably, the Cronbach's α coefficient for the MINCS stands at an impressive 0.951, with S-CVI values of 0.988 and 0.977 in Part B and C, respectively, underscoring the scale's exceptional reliability and validity. This demonstrates the scale's effectiveness in measuring missed nursing care while upholding rigorous standards of quality. CONCLUSIONS The MINCS emerges as a robust and dependable instrument for quantifying instances of missed care within the ICU. Its efficacy makes it a valuable resource for informing the development of strategies aimed at averting and mitigating the adverse effects associated with missed nursing care.
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Affiliation(s)
- Li Yang
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Wen Zhou
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Yan Gao
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Taiqin Wu
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Huan Zhang
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Xiuni Gan
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China.
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El-Gazar HE, Abousoliman AD, Shawer M, Coelho P, Zoromba MA. How nursing practice environments limit implicit rationing of care and nurse-assessed adverse events: the role of flow at work. BMC Nurs 2024; 23:19. [PMID: 38172826 PMCID: PMC10765756 DOI: 10.1186/s12912-023-01644-8] [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: 06/12/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The nursing practice environment is beneficial in curbing implicit rationing of nursing care and adverse patient events. However, the underlying mechanisms of these relationships remain unexplored. AIM To test whether flow at work mediates the relationship between the nursing practice environment, implicit rationing of nursing care, and nurse-assessed adverse patient events. METHODS This cross-sectional study involved 231 nurses from five hospitals in Port Said, Egypt. The participants completed Arabic-translated versions of the Practice Environment Scale of the Nursing Work Index, the Work-Related Flow Inventory, the Perceived Implicit Rationing of Nursing Care instrument, and the Adverse Patient Events scale. Structural equation modeling was used to test the hypothetical model. RESULTS The favorable nursing practice environment positively predicted nurses' flow at work (β = 0.64, p < 0.001), while inversely predicting implicit rationing of nursing care (β = -0.23, p = 0.014) and adverse patient events (β = -0.35, p < 0.001). Nurses' flow at work inversely predicted implicit rationing of nursing care (β = -0.30, p = 0.002) and adverse patient events (β = -0.29, p = 0.002). Moreover, nurses' flow at work acted as a mediator, linking the nursing practice environment to the rationing of nursing care and adverse patient events, with 500 bootstrap results for the indirect effects (β = -0.24, p = 0.001, 95% CI: -0.43 to -0.09; and β = -0.44, p = 0.003, 95% CI: -0.79 to -0.16, respectively). CONCLUSION Nurses working in a favorable nursing practice environment are more likely to experience flow at work, limiting implicit rationing of nursing care and adverse patient events. IMPLICATIONS FOR NURSING MANAGEMENT Nursing administrators should strive to create a healthy nursing practice environment to foster nurses' flow and thereby reduce the frequency of implicit rationing of nursing care and adverse patient events.
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Affiliation(s)
- Heba E El-Gazar
- Nursing Administration Department, Faculty of Nursing, Port Said University, Port Said, Egypt
| | - Ali D Abousoliman
- Nursing Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Nursing Administration Department, Faculty of Nursing, Kafrelsheikh University, Kafr el-sheikh, Egypt
| | - Mona Shawer
- High Institution of Nursing, Mansoura, Egypt
- Nursing Education and Training, King's College Hospital London, Jeddah, Saudi Arabia
| | - Paulo Coelho
- Nursing Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mohamed A Zoromba
- Nursing Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt.
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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.
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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
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Haegdorens F. Commentary: Cultural adaptation of the revised Basel Instrument for Rationing of Care to the Turkish context: a study of validity and reliability. J Res Nurs 2023; 28:352-353. [PMID: 37885956 PMCID: PMC10599307 DOI: 10.1177/17449871231178929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Affiliation(s)
- Filip Haegdorens
- Principal Research Fellow, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
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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.
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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
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Moradi T, Adib-Hajbaghery M, Dianati M, Moradi F. Rationing of nursing care: A concept analysis. Heliyon 2023; 9:e15861. [PMID: 37180901 PMCID: PMC10172910 DOI: 10.1016/j.heliyon.2023.e15861] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
Rationing of nursing care (RONC) refers to necessary nursing tasks that nurses refuse or fail to do because of limited time, staffing level, or skill mix. As an important process factor, it affects the quality of patient care. The concept of rationing of nursing care has not yet been clearly defined and analyzed and there are different views regarding this issue. Using Walker and Avant's eight-step method, this concept analysis was conducted to analyze the meaning, attributes, dimensions, antecedents, and consequences of nursing care rationing. The literature was collected by searching in electronic databases including PubMed, ScienceDirect, Web of Science, Scopus, and Google Scholar with no date limitation. Both qualitative and quantitative studies on rationing of nursing care, which were open-access and published in English, were included in this study. Thirty-three articles were investigated in the present study. The four defining attributes of RONC included the duty of performing nursing care, dealing with problems of doing nursing care, decision-making and prioritizing, and outcome. The antecedents included nurse-related, organization-related, care-related, and patient-related antecedents. A theoretical definition and a conceptual model of RONC were developed. The attributes, antecedents, and consequences of RONC identified in this study can be used in nursing education, research, and managerial and organizational planning.
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Affiliation(s)
- Tayebeh Moradi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Adib-Hajbaghery
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Corresponding author.
| | - Mansour Dianati
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Moradi
- Department of English Language and Literature, Allameh Tabataba'i University, Tehran, Iran
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Zeleníková R, Jarošová D, Polanská A, Mynaříková E. Implicit rationing of nursing care reported by nurses from different types of hospitals and hospital units. J Clin Nurs 2023. [PMID: 36945137 DOI: 10.1111/jocn.16695] [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: 10/24/2022] [Revised: 02/16/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
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.
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Affiliation(s)
- Renáta Zeleníková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Darja Jarošová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Andrea Polanská
- Department of Nursing Care, University Hospital Ostrava, Ostrava, Czech Republic
| | - Eva Mynaříková
- Department of Nursing Care, University Hospital Ostrava, Ostrava, Czech Republic
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14
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Jarosz K, Młynarska A. The Impact of Sociodemographic Factors on the Rationing of Nursing Care in Urology Wards. NURSING REPORTS 2023; 13:561-572. [PMID: 36976703 PMCID: PMC10051577 DOI: 10.3390/nursrep13010051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
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.
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Affiliation(s)
- Katarzyna Jarosz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland
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15
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Wagner-Łosieczka B, Kolarczyk E, Młynarska A, Owczarek D, Sadowski M, Kowalczuk K, Guzak B, Czapla M, Uchmanowicz I. The variables in the rationing of nursing care in cardiology departments. BMC Nurs 2023; 22:59. [PMID: 36869327 PMCID: PMC9983219 DOI: 10.1186/s12912-023-01222-y] [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: 08/24/2022] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND The rationing of nursing care is a complex process that affects the quality of medical services. PURPOSE An assessment of the impact of nursing care rationing on burnout and life satisfaction in cardiology departments. METHODS The study included 217 nurses working in the cardiology department. The Perceived Implicit Rationing of Nursing Care, the Maslach Burnout Inventory, and the Satisfaction with Life Scale were used. RESULTS A greater emotional exhaustion, the more frequently the rationing of nursing care (r = 0.309, p < 0.061) and the lower the job satisfaction (r=-0.128, p = 0.061). Higher life satisfaction was associated with less frequent rationing of nursing care (r=-0.177, p = 0.01), better quality of care provided (r = 0.285, p < 0.001), and higher job satisfaction (r = 0.348, p < 0.01). CONCLUSION Higher levels of burnout contribute to more frequent rationing of nursing care, poorer evaluation of the quality of care provided, and lower job satisfaction. Life satisfaction is associated with less frequent rationing of care, better evaluation of the quality of care provided, and greater job satisfaction.
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Affiliation(s)
- Barbara Wagner-Łosieczka
- grid.4495.c0000 0001 1090 049XDepartment of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Ewelina Kolarczyk
- grid.411728.90000 0001 2198 0923Department of Gerontology and Geriatric Nursing, Faculty of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Młynarska
- grid.411728.90000 0001 2198 0923Department of Gerontology and Geriatric Nursing, Faculty of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Darek Owczarek
- grid.412700.00000 0001 1216 0093Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Mikołaj Sadowski
- grid.412700.00000 0001 1216 0093Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Krystyna Kowalczuk
- grid.48324.390000000122482838Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Beata Guzak
- Center of Postgraduate Education for Nurses and Midwives, Warsaw, Poland
| | - Michał Czapla
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland. .,Department of Emergency Medical Service, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland. .,Group of Research in Care (GRUPAC), Faculty of Nursing, University of La Rioja, Logroño, Spain.
| | - Izabella Uchmanowicz
- grid.4495.c0000 0001 1090 049XDepartment of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland ,grid.412700.00000 0001 1216 0093Institute of Heart Diseases, University Hospital, Wroclaw, Poland
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16
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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.
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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
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17
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Rationing Care, Job Satisfaction, Fatigue and the Level of Professional Burnout of Nurses in Urology Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148625. [PMID: 35886482 PMCID: PMC9321796 DOI: 10.3390/ijerph19148625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
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.
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18
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Chiappinotto S, Papastavrou E, Efstathiou G, Andreou P, Stemmer R, Ströhm C, Schubert M, de Wolf-Linder S, Longhini J, Palese A. Antecedents of unfinished nursing care: a systematic review of the literature. BMC Nurs 2022; 21:137. [PMID: 35698217 PMCID: PMC9195215 DOI: 10.1186/s12912-022-00890-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach. RESULTS Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability). CONCLUSIONS At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.
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Affiliation(s)
| | - Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Georgios Efstathiou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.,Nursing Services, Ministry of Health, Nicosia, Cyprus
| | | | | | | | - Maria Schubert
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Susanne de Wolf-Linder
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy.
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19
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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.
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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
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20
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Imam A, Obiesie S, Aluvaala J, Maina M, Gathara D, English M. Missed nursing care in acute care hospital settings in low-middle income countries: a systematic review protocol. Wellcome Open Res 2022; 6:359. [PMID: 35495089 PMCID: PMC9020529 DOI: 10.12688/wellcomeopenres.17431.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Missed nursing care (care left undone or task incompletion) is viewed as an important early predictor of adverse patient care outcomes and is a useful indicator to determine the quality of patient care. Available systematic reviews on missed nursing care are based mainly on primary studies from developed countries, and there is limited evidence on missed nursing care from low-middle income countries (LMICs). We propose conducting a systematic review to identify the magnitude of missed nursing care and document factors and reasons associated with this phenomenon in LMIC settings. Methods and analysis: This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). We will conduct literature searching across the Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, from inception to 2021. Two independent reviewers will conduct searches and data abstraction, and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be determined using the Newcastle-Ottawa Scale (NOS). Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals PROSPERO registration number: CRD42021286897 (27 th October 2021).
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Affiliation(s)
- Abdulazeez Imam
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, 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
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike English
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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21
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Factors Contributing to Rationed Nursing Care in the Slovak Republic-A Secondary Analysis of Quantitative Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020702. [PMID: 35055524 PMCID: PMC8775605 DOI: 10.3390/ijerph19020702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/01/2022] [Accepted: 01/07/2022] [Indexed: 02/04/2023]
Abstract
Rationed nursing care is a significant problem in healthcare facilities worldwide. Awareness of contributing factors to rationed care might support the development and implementation of strategies for reducing this phenomenon from clinical practice. The study examined the association between selected hospital, unit, and staff variables and the prevalence of rationed nursing care. Secondary analysis of cross-sectional data collected between December 2017 and July 2018 from 895 registered nurses in seven acute care hospitals in the Slovak Republic was performed. Data were collected using the questionnaire Perceived Implicit Rationing of Nursing and analyzed by descriptive and inferential statistics in the statistical program SPSS 25.0. Statistically significant associations were found between rationed nursing care and unit type, education, shift type, nurses' experience in the current unit, overtime hours, missed shifts, intention to leave the position, perceived staff adequacy, quality of patient care, and job satisfaction. Differences in rating rationed nursing care, quality of patient care, and job satisfaction were identified based on hospital type. Together with top hospital management, nurse managers should develop targeted interventions focusing on mitigating rationed nursing care from the clinical practice with a focus placed on university hospitals. Quality and safe care might be ensured through constant monitoring of the quality of patient care and job satisfaction of nurses as these factors significantly predicted the estimates of rationed nursing care.
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22
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Abdelhadi N, Drach‐Zahavy A, Srulovici E. Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability. Nurs Open 2022; 9:309-319. [PMID: 34612602 PMCID: PMC8685781 DOI: 10.1002/nop2.1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
AIM To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC). DESIGN A qualitative descriptive design. METHODS Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis. RESULTS A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.
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Affiliation(s)
- Nasra Abdelhadi
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Anat Drach‐Zahavy
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Einav Srulovici
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
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23
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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.
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24
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Kołtuniuk A, Witczak I, Młynarska A, Czajor K, Uchmanowicz I. Satisfaction With Life, Satisfaction With Job, and the Level of Care Rationing Among Polish Nurses-A Cross-Sectional Study. Front Psychol 2021; 12:734789. [PMID: 34650492 PMCID: PMC8505674 DOI: 10.3389/fpsyg.2021.734789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/27/2021] [Indexed: 01/07/2023] Open
Abstract
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.
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Affiliation(s)
- Aleksandra Kołtuniuk
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Izabela Witczak
- Department of Health Care Economics and Quality, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Karolina Czajor
- Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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25
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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.
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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
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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
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Palese A, Chiappinotto S, Canino E, Martinenghi G, Sist R, Milani L, Marcomini I, Grassetti L, Destrebecq A. Unfinished Nursing Care Survey for Students (UNCS4S): A multicentric validation study. NURSE EDUCATION TODAY 2021; 102:104908. [PMID: 33894594 DOI: 10.1016/j.nedt.2021.104908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Unfinished Nursing Care (UNC) indicates required interventions that are delayed or omitted. Nursing students are also exposed to UNC during their clinical rotations. However, no tools have been validated to date to collect UNC as perceived by them. OBJECTIVES To validate a tool measuring UNC as perceived by nursing students. DESIGN A validation study in 2018 by following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. SETTING Three nursing programmes in Northern Italy. PARTICIPANTS All 1190 students who were attending their clinical rotation in hospital or community settings, were eligible. To assess the criterion validity, 30 clinical nurse supervisors in a random sample of units were involved. METHODS Content and face validity of the Unfinished Nursing Care Survey tool (UNCS) were assessed; then the tool, divided into part A (unfinished interventions) and B (reasons) was administered via Google and paper-pencil. Acceptability, construct validity (Mokken Scale Analysis, Exploratory and Confirmatory Factor Analyses), hypothesis testing, and criterion validity were assessed. RESULTS 737 students (61.9%) and 30 (100%) clinical nurse supervisors participated. On the Mokken Scale, with regard to part A, nursing interventions were ordered in higher and lower priority, reflecting different degrees of difficulty in terms of leaving the interventions unfinished. In the Confirmatory Factor Analyses, reasons for UNC were categorised into 'Communication', 'Priority setting', 'Nurses' aides' supervision', 'Material resources', 'Human resources', and 'Workload unpredictability'. Students in the second year perceived higher UNC occurrence; only some individual and nursing programme variables were significantly correlated with the UNC. No statistical differences emerged between the UNC perceptions of students and that of their clinical supervisors. CONCLUSION The Unfinished Nursing Care Survey for Students is composed of part A (22 items) and part B (18 items) seems to be valid in terms of acceptability, construct validity, hypothesis testing, and criterion validity.
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Saar L, Unbeck M, Bachnick S, Gehri B, Simon M. Exploring omissions in nursing care using retrospective chart review: An observational study. Int J Nurs Stud 2021; 122:104009. [PMID: 34298321 DOI: 10.1016/j.ijnurstu.2021.104009] [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: 11/22/2020] [Revised: 05/30/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Omissions in nursing care can compromise patient safety. To date, this phenomenon has been investigated almost exclusively via nurse surveys. However, such surveys restrict the range of activities which can be assessed for omissions, and patient level analysis. As an alternative, retrospective chart review methodology has been used successfully in other research fields, but not yet for omitted nursing care. OBJECTIVES To describe characteristics and frequency of omitted nursing care using a retrospective chart review methodology. DESIGN, SETTING AND PARTICIPANTS Observational single center study in two German neurological inpatient units. A random sample of 100 patient admissions was used. METHODS A structured chart review protocol to detect nursing omissions was developed and applied. The full range of expected nursing care activities were assessed regarding the importance of documenting them and whether they had been fully or partially omitted. Vital sign measurements were assessed regarding both the measurement target number and the number of measurements recorded. RESULTS In total, 1885 activities-a mean of 19 per patient-were identified. Of the reviewed activities, 52% (n = 971) were fully or partially omitted. Patients experienced between one and 22 omitted nursing care activities during their hospital stay (8-84% of expected care activities). Ranging from 6% to 100% some activities were more commonly omitted than others during admission. The most frequently omitted nursing activity was giving emotional care (88%, n = 66); the least frequently omitted was teaching (10%, n = 29). Vital signs were recorded only 50% (n = 141) of the targeted number of times. CONCLUSIONS Using a retrospective chart review protocol to identify omissions in nursing care allows the assessment of a broad range of nursing activities. Additionally, this is the first-time patient-level data on a broad range of activities have been analyzed. The newly developed chart review methodology can complement established survey methods and provide a new perspective on the phenomenon of omitted nursing care.
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Affiliation(s)
- Lili Saar
- Department of Neurology, Universitätsklinik Freiburg, Breisacherstrasse 64, Freiburg im Breisgau D-79106, Germany.
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun SE-791 88, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm SE-171 77, Sweden.
| | - Stefanie Bachnick
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Nursing Science, University of Applied Sciences (hsg Bochum), Bochum, Germany.
| | - Beatrice Gehri
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Psychiatry, University Hospital Basel, University of Basel, Basel CH- 4002, Switzerland.
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Nursing, Nursing Research Unit, Inselspital Bern University Hospital, Bern 3010, Switzerland.
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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.
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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
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The Relationship Between the Implicit Rationing of Nursing Care and Emotionally Intelligent Leadership Style. J Nurs Adm 2020; 50:623-628. [PMID: 33181524 DOI: 10.1097/nna.0000000000000949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study examined relationships between nurses' perceptions of implicit rationing of nursing care and leadership style in the nursing work environment. BACKGROUND Nurses' perceptions of higher amounts of implicit rationing of nursing care relate to perceptions of lower quality of care and poorer patient outcomes. This study was the 1st to examine leadership style and implicit rationing of nursing care. METHODS Using a cross-sectional survey study design, 35 039 RNs were randomly sampled during September 2017 to March 2018. RESULTS Findings support an association between nurses' perceptions of an emotionally intelligent leadership style and lower amounts of implicit rationing of nursing care. CONCLUSION Implicit rationing of nursing care in the nursing work environment is significantly associated with emotionally intelligent leadership style. Nurse executives, and nursing faculty in administrative-focused graduate programs, can provide development and education in emotionally intelligent leadership skills.
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Palese A, Longhini J, Danielis M. To what extent Unfinished Nursing Care tools coincide with the discrete elements of The Fundamentals of Care Framework? A comparative analysis based on a systematic review. J Clin Nurs 2020; 30:239-265. [PMID: 33113209 DOI: 10.1111/jocn.15543] [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: 06/16/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To establish whether, and to what extent, tools measuring Unfinished Nursing Care (UNC) that have been validated to date have the ability to detect the discrete elements of the 'Integration of care' dimension of The Fundamentals of Care Framework (The Framework). BACKGROUND UNC and The Framework have been established as two separate research lines, focused on (a) omitted care and related tools, and (b) on how to improve patient care, respectively. However, no attempts have been made to date to establish whether, and to what extent, tools measuring UNC have the ability to represent the discrete elements of The Framework. DESIGN A two-step study: (a) a secondary analysis of a systematic review up to June 2018 later updated in May 2020, followed by (b) a comparative analysis. METHODS A systematic review of studies on validated tools measuring UNC was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Then, researchers independently performed a comparative analysis between the extracted (a) discrete elements of The Framework and (b) items of the UNC tools retrieved. RESULTS A total of 14 tools were analysed. The physical dimension of The Framework was the one mostly covered by UNC tools (up to 87.5% with the Perceived Implicit Rationing of Nursing Care). The Norwegian Basel Extent of Rationing of Nursing Care showed the highest level of representation (41.6%) for the psychosocial dimension. Only the Perceived Implicit Rationing of Nursing Care and the Unfinished Care tool measure the relational dimension (22.2%, respectively). By considering all elements of the 'Integration of care' dimension, the Perceived Implicit Rationing of Care had the highest percentage of convergence (41%). CONCLUSION Not all UNC tools have the same ability to represent the discrete elements of The Framework. Moreover, physical needs are more often detected in UNC tools compared to the relational and psychological ones. RELEVANCE TO CLINICAL PRACTICE Unfinished care tools validated to date can represent a body of knowledge on which to build The Framework metrics, especially for the physical dimensions.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Matteo Danielis
- Department of Medical Sciences, University of Udine, Udine, Italy
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Palese A, Navone E, Danielis M, Vryonides S, Sermeus W, Papastavrou E. Measurement tools used to assess unfinished nursing care: A systematic review of psychometric properties. J Adv Nurs 2020; 77:565-582. [PMID: 33074561 DOI: 10.1111/jan.14603] [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: 04/19/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Different tools have been developed and validated to measure unfinished nursing care. However, no systematic review of the psychometric properties has been performed describing the quality of the methods used to estimate their validity. AIMS (a) To identify tools measuring unfinished nursing care that have undergone validation processes; (b) to evaluate critically the quality of the methods used in ascertaining their psychometric properties; and (c) to compare the estimated psychometric properties of these tools. DESIGN A systematic review of the psychometric properties also evaluating their methodological quality was performed by following the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guideline for systematic reviews. DATA SOURCES The databases Medline, the Cumulative Index to Nursing and Allied Health Literature, PubMed, Google and Google Scholar were searched up to 30 June 2018. REVIEW METHODS Data extraction was performed following the predetermined eligibility criteria. Eight properties and their methodological quality were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments criteria. RESULTS A total of 20 studies reported validation data regarding three family of tools: the Missed Care Survey (MISSCARE), the Basal Extent of Rationing of Nursing Care (BERNCA) and the Task Undone scale (TU-7). The most estimated psychometric properties across studies were internal consistency, followed by structural validity, content validity, and cross-cultural validity. The less evaluated psychometric properties were reliability, hypothesis testing and convergent and criterion validity. CONCLUSION The psychometric properties of the investigated tools showed a more than acceptable quality, as did the methodologies used to estimate these properties. IMPACT The MISSCARE survey is the most widely used tool validated across countries to date. Evaluating the concurrent reliability of the tools available is strongly recommended to assess their effectiveness in measuring the same phenomenon.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Elena Navone
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Matteo Danielis
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Stavros Vryonides
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Leuven, Belgium
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Bassi E, Tartaglini D, Valpiani G, Grassetti L, Palese A. Unfinished Nursing Care Survey: A development and validation study. J Nurs Manag 2020; 28:2061-2071. [DOI: 10.1111/jonm.13170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Erika Bassi
- Nursing Care Service S. Anna University Hospital Ferrara Italy
| | | | - Giorgia Valpiani
- Research Innovation Office S. Anna University Hospital Ferrara Italy
| | - Luca Grassetti
- Department of Statistics and Economics Udine University Udine Italy
| | - Alvisa Palese
- Department of Medical Science Udine University Udine Italy
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Willis E, Zelenikova R, Bail K, Papastavrou E. The globalization of missed nursing care terminology. Int J Nurs Pract 2020; 27:e12859. [PMID: 32656900 DOI: 10.1111/ijn.12859] [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: 03/10/2019] [Revised: 03/08/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Abstract
AIM To determine if there are cross-national differences in nurse understandings of the terms: missed care, rationed care and care left undone. BACKGROUND Nurse researchers from a number of countries have published studies on missed and rationed care. It is not clear if there are differences in understanding the key terms across various language groups. DESIGN A mixed method questionnaire was distributed to 26 member countries of a nursing research consortium in 2017. METHODS Forty-five responses to a qualitative questionnaire were received; 80% were nurse researchers. These responses were categorized into language groups and analysed for congruence and differences. FINDINGS There was congruence across all language groups in interpreting the three terms. Giddens' theory of globalization provides an explanation for this congruence. CONCLUSION Shared understandings are explained by the fact that the majority of participants are nurse researchers with knowledge of English and the research literature. Shared understanding within the globalized academic community does not necessarily translate for clinical or nurse managers, nor does it predetermine solutions.
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Affiliation(s)
- Eileen Willis
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Renata Zelenikova
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Kasia Bail
- Synergy Nursing and Midwifery Research Centre and Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Evridiki Papastavrou
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Hübsch C, Müller M, Spirig R, Kleinknecht‐Dolf M. Performed and missed nursing care in Swiss acute care hospitals: Conceptual considerations and psychometric evaluation of the German MISSCARE questionnaire. J Nurs Manag 2020; 28:2048-2060. [DOI: 10.1111/jonm.13026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Christine Hübsch
- Centre of Clinical Nursing Science University Hospital Zürich Zürich Switzerland
- Department of Nursing Science Faculty for Health University Witten/Herdecke Witten Germany
| | - Marianne Müller
- Institute of Data Analysis and Process Design School of Engineering Zurich University of Applied Sciences Winterthur Switzerland
| | - Rebecca Spirig
- Department of Nursing Science Faculty for Health University Witten/Herdecke Witten Germany
- Institute of Nursing Science University of Basel Basel Switzerland
| | - Michael Kleinknecht‐Dolf
- Directorate of Nursing and Allied Health Care Professionals University Hospital Zürich Zürich Switzerland
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Friganovic A, Režić S, Kurtović B, Vidmanić S, Zelenikova R, Rotim C, Konjevoda V, Režek B, Piškor S. Nurses' perception of implicit nursing care rationing in Croatia—A cross‐sectional multicentre study. J Nurs Manag 2020; 28:2230-2239. [DOI: 10.1111/jonm.13002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Adriano Friganovic
- University Hospital Centre Zagreb Zagreb Croatia
- University of Applied Health Sciences Zagreb Croatia
| | - Slađana Režić
- University Hospital Centre Zagreb Zagreb Croatia
- University of Applied Health Sciences Zagreb Croatia
| | | | | | - Renata Zelenikova
- Faculty of Medicine Department of Nursing and Midwifery University of Ostrava Ostrava Czech Republic
| | - Cecilija Rotim
- University of Applied Health Sciences Zagreb Croatia
- Teaching Institute of Public Health Andrija Stampar Zagreb Croatia
| | | | - Biserka Režek
- University Hospital Centre Sestre milosrdnice Zagreb Croatia
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Uchmanowicz I, Kołtuniuk A, Młynarska A, Łagoda K, Witczak I, Rosińczuk J, Jones T. Polish adaptation and validation of the Perceived Implicit Rationing of Nursing Care (PIRNCA) questionnaire: a cross-sectional validation study. BMJ Open 2020; 10:e031994. [PMID: 32265239 PMCID: PMC7245423 DOI: 10.1136/bmjopen-2019-031994] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
| | - Aleksandra Kołtuniuk
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Łagoda
- Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Izabela Witczak
- Department of Economics and Quality in Health Care, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Terry Jones
- Department of Adult Health and Nursing Systems, Virginia Commonwealth University School of Nursing, Richmond, Virginia, USA
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Campbell CM, Prapanjaroensin A, Anusiewicz CV, Baernholdt M, Jones T, Patrician PA. Variables associated with missed nursing care in Alabama: A cross‐sectional analysis. J Nurs Manag 2020; 28:2174-2184. [DOI: 10.1111/jonm.12979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Marianne Baernholdt
- School of Nursing University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Terry Jones
- School of Nursing Virginia Commonwealth University Richmond Virginia
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Kalánková D, Kirwan M, Bartoníčková D, Cubelo F, Žiaková K, Kurucová R. Missed, rationed or unfinished nursing care: A scoping review of patient outcomes. J Nurs Manag 2020; 28:1783-1797. [DOI: 10.1111/jonm.12978] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dominika Kalánková
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
| | - Marcia Kirwan
- School of Nursing and Human Sciences Dublin City University in Dublin Glasnevin, Dublin Ireland
| | - Daniela Bartoníčková
- Department of Nursing 2nd Faculty of Medicine Charles University in Prague Prague Czech Republic
| | - Floro Cubelo
- School of Health and Social Studies Jyväskylä University of Applied Sciences Jyväskylä Finland
| | - Katarína Žiaková
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
| | - Radka Kurucová
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
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Kalánková D, Suhonen R, Stolt M, Kurucová R, Katajisto J, Žiaková K, Gurková E. Psychometric testing of perceived implicit rationing of nursing care (PIRNCA). J Adv Nurs 2020; 76:1469-1482. [PMID: 32180252 DOI: 10.1111/jan.14351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/27/2020] [Accepted: 03/04/2020] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the psychometric properties of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument and to report the prevalence of rationed care at university and faculty hospitals. DESIGN A cross-sectional study. METHODS The study was carried out at two university and five faculty hospitals in the Slovak Republic. Participants were 895 Registered Nurses recruited by the purposive sampling method between December 2017-July 2018. Data were collected using the PIRNCA instrument. Construct validity and reliability of the instrument were tested. RESULTS The prevalence of rationed care at university and faculty hospitals was identified as being 42.1%. Furthermore, 87.6% of nurses reported rationing one or more nursing care activities. Using both statistical methods when evaluating the PIRNCA resulted in the confirmation that the tool is valid and reliable. CONCLUSION Rationed care is a common phenomenon at university and faculty hospitals. The PIRNCA is a suitable instrument to measure the phenomenon in adult acute care units because of its high reliability and validity. We recommend using the instrument in different contexts, not only for specific conditions that were presented for this study. IMPACT Rationed care at university and faculty hospitals has never been reported. Psychometric properties of the instrument that measures nurses´ perception of rationed care have never been evaluated by using different approaches. The most frequently rationed nursing care activities are those that nurses are competent to initiate on the basis of their knowledge and skills - the independent ones. The PIRNCA is a valid and reliable instrument. Hospital management can use the instrument to explore the prevalence of rationed care, followed by the application of prevention strategies. Our findings represent the base for further exploration of rationed care using the PIRNCA.
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Affiliation(s)
- Dominika Kalánková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland.,Welfare Division, Turku University Hospital, Turku, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Radka Kurucová
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Katarína Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
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Riklikiene O, Blackman I, Bendinskaite I, Henderson J, Willis E. Measuring the validity and reliability of the Lithuanian missed nursing care in infection prevention and control scales using Rasch analysis. J Nurs Manag 2020; 28:2025-2035. [DOI: 10.1111/jonm.12918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Olga Riklikiene
- Department of Nursing and Care Faculty of Nursing Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania
| | - Ian Blackman
- College of Nursing and Health Sciences Flinders University Adelaide South Australia
| | - Irmina Bendinskaite
- Department of Nursing and Care Faculty of Nursing Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania
| | - Julie Henderson
- College of Nursing and Health Sciences Flinders University Adelaide South Australia
| | - Eileen Willis
- College of Nursing and Health Sciences Flinders University Adelaide South Australia
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Norman RM, Sjetne IS. Adaptation, modification, and psychometric assessment of a Norwegian version of the Basel extent of rationing of nursing care for nursing homes instrument (BERNCA-NH). BMC Health Serv Res 2019; 19:969. [PMID: 31842833 PMCID: PMC6916531 DOI: 10.1186/s12913-019-4817-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/09/2019] [Indexed: 01/08/2023] Open
Abstract
Background To our knowledge, no instrument has been developed and tested for measuring unfinished care in Norwegian nursing home settings. The Basel Extent of Rationing of Nursing Care for Nursing Homes instrument (BERNCA-NH) was developed and validated in Switzerland to measure the extent of implicit rationing of nursing care in nursing homes. The BERNCA-NH comprises a list of nursing care activities in which a care worker reports the frequency to which activities were left unfinished over the last 7 working days as a result of lack of time. The aim of this study was to adapt and modify a Norwegian version of the BERNCA-NH intended for all care workers, and assess the instruments’ psychometric properties in a Norwegian nursing home setting. Methods The BERNCA-NH was translated into Norwegian and modified to fit the Norwegian setting with inputs from individual cognitive interviews with informants from the target population. The instrument was then tested in a web-based survey with a final sample of 931 care workers in 162 nursing home units in different parts of Norway. The psychometric evaluation included score distribution, response completeness and confirmatory factor analysis (CFA) of a hypothesised factor structure and evaluation of internal consistency. Hypothesised relation to other variables was assessed through correlations between the subscale scores and three global ratings. Results The Norwegian version of BERNCA-NH comprised four subscales labelled: routine care, ‘when required’ care, documentation and psychosocial care. All subscales demonstrated good internal consistency. The CFA supported the four-factor structure with fit statistics indicating a robust model. There were moderate to strong bivariate associations between the BERNCA-NH subscales and the three global ratings. Three items which were not relevant for all care workers were not included in the subscales and treated as single items. Conclusions This study found good psychometric properties of the Norwegian version BERNCA-NH, assessed in a sample of care workers in Norwegian nursing homes. The results indicate that the instrument can be used to measure unfinished care in similar settings.
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Affiliation(s)
- Rebecka Maria Norman
- Norwegian Institute of Public Health, PO Box 222 Skøyen, NO-0213, Oslo, Norway. .,Department of Health Management and Health Economics, University of Oslo, Faculty of Medicine, Institute of Health and Society, PO Box 1130 Blindern, NO-0318, Oslo, Norway. .,Lovisenberg Diaconal University College, Lovisenberggata 15b, NO-0456, Oslo, Norway.
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Vincelette C, Thivierge-Southidara M, Rochefort CM. Conceptual and methodological challenges of studies examining the determinants and outcomes of omitted nursing care: A narrative review of the literature. Int J Nurs Stud 2019; 100:103403. [DOI: 10.1016/j.ijnurstu.2019.103403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/30/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
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44
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Zeleníková R, Gurková E, Friganovic A, Uchmanowicz I, Jarošová D, Žiaková K, Plevová I, Papastavrou E. Unfinished nursing care in four central European countries. J Nurs Manag 2019; 28:1888-1900. [PMID: 31680373 PMCID: PMC7754486 DOI: 10.1111/jonm.12896] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 12/02/2022]
Abstract
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.
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Affiliation(s)
- Renáta Zeleníková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacky University in Olomouc, Olomouc, Czech Republic
| | - Adriano Friganovic
- University Hospital Zagreb, Zagreb, Croatia.,University of Applied Health Sciences, Zagreb, Croatia
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Darja Jarošová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Katarína Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ilona Plevová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Gurková E, Zeleníková R, Friganovic A, Uchmanowicz I, Jarošová D, Papastavrou E, Žiaková K. Hospital safety climate from nurses' perspective in four European countries. Int Nurs Rev 2019; 67:208-217. [PMID: 31742691 DOI: 10.1111/inr.12561] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/13/2019] [Accepted: 09/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nursing shortages, the substitution of practical nurses for registered nurses, an ageing workforce, the decreasing number of nurse graduates and the increasing migration of young nurses are important factors associated with the hospital safety climate in Central European countries. AIMS The aim of the study was to investigate nurses' perceptions of the safety climate in four selected central European countries (Croatia, the Czech Republic, Poland and Slovakia) and to determine the relationship between safety climate and unfinished nursing care. METHODS A cross-sectional study was used. The sample consisted of 1353 European nurses from four countries. Instruments used were the Hospital Survey on Patient Safety Culture and the Perceived Implicit Rationing of Nursing Care. Data were analysed using descriptive statistics and multiple regression analyses. RESULTS Significant differences were found between countries in all unit/hospital/outcome dimensions. 'Perceived Patient Safety' and 'Reporting of Incident Data' were associated with aspects of 'Organizational Learning' and 'Feedback and Communication about Error'. Higher prevalence of unfinished nursing care is associated with more negative perceptions of patient safety climate. CONCLUSIONS Cross-cultural comparisons allow us to examine differences and similarities in safety dimensions across countries. The areas with potential for initiating strategies for improvement in all four countries are 'Staffing', 'Non-punitive Response to Error' and 'Teamwork across Hospital Units'. IMPLICATIONS FOR NURSING AND HEALTH POLICY: 'Feedback and Communicating about Error' and 'Organizational Learning - Continuous Improvement' were the main predictors of 'Overall Perception of Patient Safety' and 'Reporting of Incident Data'. Therefore, nurse managers should focus on how to empower nurses in these areas in order to foster a no-blame culture and effective reporting. In addition, it is important for policymakers to update nursing education standards in order to address patient safety.
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Affiliation(s)
- E Gurková
- Faculty of Health Sciences, Palacky University in Olomouc, Olomouc, Czech Republic
| | - R Zeleníková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - A Friganovic
- University Hospital Centre Zagreb, Zagreb, Croatia.,University of Applied Health Sciences, Zagreb, Croatia
| | - I Uchmanowicz
- FESC5, Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - D Jarošová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - E Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - K Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University Bratislava, Martin, Slovakia
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Gurková E, Adamkovič M, Jones T, Kurucová R, Kalánková D, Žiaková K. Factor analysis, validity of the perceived implicit rationing of nursing care instrument and prevalence and patterns of unfinished nursing care in Slovakia. J Nurs Manag 2019; 28:2036-2047. [PMID: 31596988 DOI: 10.1111/jonm.12887] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022]
Abstract
AIM The aim of the study was to adapt and validate the perceived implicit rationing of nursing care instrument in the Slovak nurse work environment and to evaluate the prevalence of unfinished nursing care in acute care hospitals. BACKGROUND The measurement of unfinished nursing care could be assumed as a proxy indicator of nurse staffing adequacy or higher risk of adverse events. METHODS A cross-sectional survey design was used. The sample of 1,429 registered nurses from 21 hospitals in Slovakia was recruited. Exploratory factor analysis, confirmatory factor analysis and internal reliability were performed. RESULTS The instrument is essentially rather an inventory than scale per se. Concurrent validity of the Slovak version was supported by the significant associations between unfinished nursing care and clinically relevant variables. CONCLUSIONS The prevalence of unfinished nursing care based the percentage of positive responses was higher than prevalence based on composite mean scores. Findings from the study raise questions about a unidimensional structure of nursing tasks reflected in most commonly used survey instruments of unfinished nursing care internationally. IMPLICATIONS FOR NURSING MANAGEMENT The periodical measurement of unfinished nursing care based on the percentage of positive responses should be assumed as a key strategy to increase patient safety and quality of nursing care.
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Affiliation(s)
- Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Matúš Adamkovič
- Institute of Psychology, Faculty of Art, University of Prešov in Prešov, Prešov, Slovak Republic
| | - Terry Jones
- Department of Adult Health and Nursing Systems, Virginia Commonwealth University, Richmond, Virginia
| | - Radka Kurucová
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Dominika Kalánková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Katarína Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovak Republic
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Palese A, Bassi E, Tommasini C, Vesca R, Di Falco A, De Lucia P, Mulloni G, Paoletti F, Rissolo R, Sist L, Sanson G, Guardini I, Bressan V, Mesaglio M, Papastavrou E, Blackman I. Developing policies and actions in response to missed nursing care: A consensus process. J Nurs Manag 2019; 27:1492-1504. [DOI: 10.1111/jonm.12835] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/20/2019] [Accepted: 07/21/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences University of Udine Udine Italy
| | | | | | - Roberta Vesca
- Azienda Sanitaria Universitaria Integrata di Udine Udine Italy
| | | | - Paola De Lucia
- Azienda per l’Assistenza Sanitaria nr. 5 Friuli Occidentale di Pordenone Pordenone Italy
| | | | - Flavio Paoletti
- Presidente Coordinamento Regionale Ordine Professioni Infermieristiche Trieste Italy
- Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | | | | | | | - Ilario Guardini
- Azienda Sanitaria Universitaria Integrata di Udine Udine Italy
| | | | - Maura Mesaglio
- Azienda Sanitaria Universitaria Integrata di Udine Udine Italy
| | - Evridiki Papastavrou
- Chair of the RANCARE Consortium COST Action – CA 15208, Cyprus University of Technology Limassol Cyprus
| | - Ian Blackman
- Flinders University Adelaide South Australia Australia
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Kalánková D, Žiaková K, Kurucová R. Approaches to understanding the phenomenon of missed/rationed/unfinished care - a literature review. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Barrientos‐Trigo S, Gil‐García E, Romero‐Sánchez J, Badanta‐Romero B, Porcel‐Gálvez A. Evaluation of psychometric properties of instruments measuring nursing‐sensitive outcomes: a systematic review. Int Nurs Rev 2018; 66:209-223. [DOI: 10.1111/inr.12495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- S. Barrientos‐Trigo
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry Universidad de Sevilla Seville Spain
- Research Group under the Andalusian Research CTS 1050 Complex Care Chronic and Health Outcomes Seville Universidad de Sevilla Seville Spain
| | - E. Gil‐García
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry Universidad de Sevilla Seville Spain
- Research Group under the Andalusian Research CTS 1050 Complex Care Chronic and Health Outcomes Seville Universidad de Sevilla Seville Spain
| | - J.M. Romero‐Sánchez
- Research Group under the Andalusian Research, Development, and Innovation Scheme CTS‐391 University of Cádiz Cádiz Spain
| | - B. Badanta‐Romero
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry Universidad de Sevilla Seville Spain
| | - A.M. Porcel‐Gálvez
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry Universidad de Sevilla Seville Spain
- Research Group under the Andalusian Research CTS 1050 Complex Care Chronic and Health Outcomes Seville Universidad de Sevilla Seville Spain
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VanFosson CA, Jones TL, Yoder LH. Monthly variation of unfinished nursing care at the US Army Burn Center. Burns 2018; 44:1910-1919. [PMID: 30314849 DOI: 10.1016/j.burns.2018.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the monthly variation in the prevalence and patterns of unfinished nursing care and to determine the relationships between the system of nursing care and unfinished nursing care at the US Army Burn Center. METHODS This was a repeated measures, descriptive study. For one week per month for six months, all nurses providing direct patient care on two inpatient burn units (intensive care and progressive care) were asked to complete an anonymous paper survey, which contained the Perceived Implicit Rationing of Nursing Care instrument, to estimate the prevalence of unfinished nursing care on their unit. Unit administrative data also were collected from the unit nursing leaders each month. Descriptive statistics and multilevel modeling were used in the analysis. RESULTS Most (80.5%) eligible nurses participated at least once; 46.6% participated three or more times. A high proportion (85.7-100%) of nurses left at least one element of care unfinished; the mean number of activities left unfinished over each 7 shift period per nurse was 16.2. Only nursing care hours provided by float staff significantly predicted nurse estimates of unfinished nursing care, β=.008, SE=.001, p<.05. CONCLUSIONS The prevalence of unfinished nursing care at the US Army Burn Center was high and generally consistent with other studies of unfinished nursing care in non-burn settings. The inability to meet the demand for nursing care, as evidenced by the presence of unfinished nursing care, may be the result of a limited surge capacity. Implications for research, policy, and practice were discussed.
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Affiliation(s)
- Christopher A VanFosson
- United States Army Institute of Surgical Research, 3698 Chambers Road, San Antonio, TX 78234, United States.
| | - Terry L Jones
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, Richmond, VA 23298, United States.
| | - Linda H Yoder
- The University of Texas at Austin School of Nursing, 1710 Red River St., Austin, TX 78712, United States.
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