The Impact of Rationing Nursing Care on Patient Safety: A Systematic Review.

BACKGROUND Rationing of nursing care (RONC) has been associated with poor patient outcomes and is a growing concern in healthcare. The aim of this systematic study was to investigate the connection between patient safety and the RONC. MATERIAL AND METHODS A thorough search of electronic databases was done to find research that examined the relationship between restricting nurse services and patient safety. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers (M.L. and A.P.) independently screened the titles and abstracts, and full-text articles were assessed for eligibility. Data were extracted, and a quality assessment was performed using appropriate techniques. RESULTS A total of 15 studies met the inclusion criteria. The studies included in the review demonstrated a correlation between rationing of nursing care and patient safety. The results of these studies revealed that there is an inverse relationship between rationing of nursing care and patient safety. The review found that when nursing care is rationed, there is a higher incidence of falls, medication errors, pressure ulcers, infections, and readmissions. In addition, the review identified that the work characteristics of nurses, such as workload, staffing levels, and experience, were associated with RONC. CONCLUSIONS RONC has a negative impact on patient safety outcomes. It is essential for healthcare organizations to implement effective strategies to prevent the RONC. Improving staffing levels, workload management, and communication amo0ng healthcare providers are some of the strategies that can support this.

Frailty in patients with acute coronary syndrome: comparison between tools for comprehensive geriatric assessment and the Tilburg Frailty Indicator.

PURPOSE: It is a known fact that age is a strong predictor of adverse events in acute coronary syndrome (ACS). In this context, the main risk factor in elderly patients, ie, frailty syndrome, gains special importance. The availability of tools to identify frail people is relevant for both research and clinical purposes. The purpose of this study was to investigate the correlation of a scale for assessing frailty - the Tilburg Frailty Indicator (TFI) and its domains (mental and physical) - with other research tools commonly used for comprehensive geriatric assessment in patients with ACS. PATIENTS AND METHODS: The study covered 135 people and was carried out in the cardiology ward at T Marciniak Lower Silesian Specialist Hospital in Wroclaw, Poland. The patients were admitted with ACS. ST segment elevation myocardial infarction and non-ST segment elevation myocardial infarction were defined by the presence of certain conditions in reference to the literature. The Polish adaptation of the TFI was used for the frailty syndrome assessment, which was compared to other single measures used in geriatric assessment: the Mini-Mental State Examination (MMSE), the Hospital Anxiety and Depression Scale (HADS), and Katz Index of Independence in Activities of Daily Living (ADLs). RESULTS: The mean TFI value in the studied group amounted to 7.13±2.81 (median: 7, interquartile range: 5-9, range [0, 14]). Significant correlations were demonstrated between the values of the TFI and other scales: positive for HADS (r=0.602, P<0.001) and the reverse for MMSE (r=-0.603, P<0.001) and IADL (r=-0.462, P<0.001). Patients with a TFI score ≥5 revealed considerably higher values on HADS (P<0.001) and considerably lower values on the MMSE (P<0.001) and IADL scales (P=0.001). CONCLUSION: The results for the TFI comply with the results of other scales (MMSE, HADS, ADL, IADL), which confirm the credibility of the Polish adaptation of the tool. Stronger correlations were observed for mental components and the mental scales turned out to be independently related to the TFI in a multidimensional analysis.