Inadequate number of staff and other reasons for implicit rationing of nursing care across hospital types and units.

AIM: The aim of the study was to find differences in perceived reasons for implicit rationing of nursing care across hospital types and units. DESIGN: A descriptive multicentre study. METHODS: The study in 14 Czech acute care hospitals was conducted from September 2019 to October 2020. The sample consisted of 8316 nurses working in medical and surgical units. Items for rating the reasons for implicit rationing of nursing care were selected from the MISSCARE Survey. Nurses were asked to rate each item on a scale from 0 (a not significant reason) to 10 (the most significant reason). RESULTS: The most significant reasons for implicit rationing of nursing care were 'Inadequate number of staff', 'Inadequate number of assistive personnel' and 'Unexpected patient admission and discharge'. Most reasons were rated as more significant by nurses from non-university hospitals. Nurses from medical units perceived all reasons for implicit rationing of nursing care as more significant.

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

AIMS AND OBJECTIVES: The study aimed to investigate differences in assessing implicit rationing of nursing care by Czech nurses with respect to the type of unit and type of hospital. BACKGROUND: Implicit rationing of nursing care may differ across different types of hospitals and hospital units. DESIGN: This study used a multicentre cross-sectional study design. METHODS: The STROBE checklist for observational cross-sectional studies was followed for reporting of the research study. The sample included 8209 nurses providing direct care to medical and surgical patients in 14 acute care Czech hospitals. The main outcome was implicit rationing of nursing care as measured with a Czech version of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument. Data were collected from September 2019 to October 2020. RESULTS: The most frequently rationed nursing care activity was timely response to patient or family request/need, followed by emotional or psychological support and adequate supervision of delegated tasks. More implicitly rationed nursing care was reported in medical units. Statistical differences were found in rating 25 items and the PIRNCA total score. Nurses from middle-sized hospitals reported implicitly rationed care more frequently than those from large hospitals. CONCLUSION: More rationed care was reported by nurses from medical units and nurses from middle-sized hospitals. Organisational variables (the type of unit and type of hospital) influence the implicit rationing of nursing care in our study. RELEVANCE TO CLINICAL PRACTICE: The findings call for nursing managers to pay attention to organisational variables which may affect the implicit rationing of nursing care.

Rationed nursing care as one of the indicators of the occurrence of medication errors.

AIM: The aim was to analyze selected studies on rationed nursing care as one of the indicators that influence the occurrence of medication errors. METHODS: A descriptive review study. Articles and studies were searched in the following selected electronic databases: EBSCO (Academic Search Ultimate, Academic Search Complete), CINAHL Plus with Full Text, MEDLINE Complete, ScienceDirect and Central & Eastern European Academic Source. The search for relevant sources was based on the following English keywords: unfinished care, omitted care, rationing care, missed care, nursing care, medication errors. RESULTS: Total of 86 contributions found. After duplicit and irrelevant publications were the analysis comprised 8 primary studies and 2 systematic reviews. The studies were concerned with rationed or otherwise defined non-standard nursing care not merely related to medication errors. Each study described selected activities most frequently omitted by nurses with respect to medication: assessment of drug efficacy, medication errors, administration of incorrect drugs or doses, wrong time of administration, high-risk drug protocols and adhering to rules with each administration. The most frequently reported factor influencing the occurrence of missed care was understaffing and the related number of patients per nurse, resulting in a lack of time for selected patient activities. CONCLUSION: Despite difference in methods, all studies consistently claimed that rationed, unfinished, missed or omitted nursing care has or may have a negative impact on both patients and nurses. Some of the recommendations were increasing the number of nurses, improving team collaboration and work organization including setting systemic and preventive measures.

Reporting of workplace violence towards nurses in 5 European countries - a cross-sectional study.

OBJECTIVES: This study aimed to assess country-specific evidence of physical and non-physical acts of workplace violence towards nurses working in the health sector in 5 European countries, and then to identify reasons for not reporting violence experienced at work. MATERIAL AND METHODS: This retrospective cross-sectional study was conducted in 5 participating countries (Poland, the Czech Republic, the Slovak Republic, Turkey, and Spain). All registered nurses working in selected healthcare settings for at least 1 year were invited to participate in the study. A questionnaire adapted from the Workplace Violence in the Health Sector Country Case Study - Questionnaire, developed jointly by the International Labour Office, the International Council of Nurses, the World Health Organization and Public Services International, was used. The selection of healthcare settings and the distribution of the questionnaire were conducted according to the recommendations of the questionnaire authors. RESULTS: In total, 1089 nurses submitted completed questionnaires which could be included in the study. Of these, 54% stated that they had been exposed to non-physical violence and 20% had been exposed to physical violent acts. A total of 15% of the surveyed nurses experienced both forms of workplace violence. In addition, 18% of the respondents confirmed having witnessed physical violence in their workplace. The most common perpetrators were patients and patients' relatives. In about 70% of these cases, no actions were taken after the act of violence to investigate its causes. About half of the study group did not report workplace violence as they believed it was useless or not important. The most common consequences of workplace violence included being "superalert" or watchful and on guard. CONCLUSIONS: Nurses internationally are both victims of and witnesses to workplace violence. Workplace violence is often seen by nurses as an occupational hazard and, as such, it remains not reported. The first step in preventing workplace violence is not only to acknowledge its existence but also to ensure the appropriate reporting of violent acts. Int J Occup Med Environ Health. 2020;33(3):325-38.

Nurses' perception of implicit nursing care rationing in Croatia-A cross-sectional multicentre study.

AIM: To examine Croatian nurses' perception of implicit nursing care rationing and the patient safety culture from the perspective of acute care hospital staff. BACKGROUND: In the past three decades, the Croatian health system has undergone numerous transformations driven by geopolitical, legal, financial, demographic, scientific and technological progress. These changes have led to systemic changes in the structure, organisation, financing and delivery of health care, and thus, of nursing care. METHODS: A cross-sectional study of 438 nurses was conducted at four university hospitals in Croatia, based on the Perceived Implicit Rationing of Nursing Care Questionnaire. RESULTS: A lower assessment of the quality of care in the unit is associated with a higher score on the Perceived Implicit Rationing of Nursing Care Questionnaire, r = -.379, p < .001. A lower satisfaction with the current workplace is associated with a higher score on the Perceived Implicit Rationing of Nursing Care Questionnaire, r = -.432, p < .001. CONCLUSION: The perception of nurses in Croatia indicates that the implications of nursing care rationing and dissatisfaction with their post in acute care hospital units are closely related to poor quality of nursing care provided to patients. IMPLICATIONS FOR NURSING MANAGEMENT: Based on these results, nurse managers should take their nurses' perceptions of implicit nursing care rationing into consideration in order to develop strategies to improve nursing care delivery, nursing satisfaction and, consequently, better nursing care quality.

Unfinished nursing care in four central European countries.

AIM: The main aim of the research was to describe and compare unfinished nursing care in selected European countries. BACKGROUND: The high prevalence of unfinished nursing care reported in recently published studies, as well as its connection to negative effects on nurse and patient outcomes, has made unfinished care an important phenomenon and a quality indicator for nursing activities. METHODS: A cross-sectional descriptive study was undertaken. Unfinished nursing care was measured using the Perceived Implicit Rationing of Nursing Care questionnaire (PIRNCA). The sample included 1,353 nurses from four European countries (Croatia, the Czech Republic, Poland and Slovakia). RESULTS: The percentage of nurses leaving one or more nursing activities unfinished ranged from 95.2% (Slovakia) to 97.8% (Czech Republic). Mean item scores on the 31 items of the PIRNCA in the total sample ranged from 1.13 to 1.92. Unfinished care was significantly associated with the type of hospital and quality of care. CONCLUSION: The research results confirmed the prevalence of unfinished nursing care in the countries surveyed. IMPLICATIONS FOR NURSING MANAGEMENT: The results are a useful tool for enabling nurse managers to look deeper into nurse staffing and other organizational issues that may influence patient safety and quality of care.

Understanding the concept of missed nursing care from a cross-cultural perspective.

AIMS: To investigate how nursing experts and experts from other health professions understand the concept of rationing/missed/unfinished nursing care and how this is compared at a cross-cultural level. DESIGN: The mixed methods descriptive study. METHODS: The semi-structured questionnaires were sent to the sample of 45 scholars and practitioners from 26 countries. Data were collected from November 2017-February 2018. RESULTS: Assigning average cultural values to participants from each country revealed three cultural groups: high individualism-high masculinity, high individualism-low masculinity and low individualism-medium masculinity. Content analysis of the findings revealed three main themes, which were identified across cultural clusters: (a) projecting blame for the phenomenon: Blaming the nurse versus blaming the system; (b) intentionality versus unintentionality; and (c) focus on nurses in comparison to focus on patients. CONCLUSION: Consistent differences in the understanding of missed nursing care can be understood in line with the nation's standing on two main cultural values: individualism and masculinity. IMPACT: The findings call for scholars' caution in interpreting missed nursing care from different cultures, or in comparing levels and types of missed nursing tasks across nations. The findings further indicated that mimicking interventions to limit missed nursing care from one cultural context to the other might be ineffective. Interventions to mitigate the phenomenon should be implemented thoughtfully, considering the cultural aspects.

Quality of life in patients with diabetic foot ulcer in Visegrad countries.

AIMS AND OBJECTIVES: To identify the quality of life of patients with diabetic foot ulcers in the Visegrad countries. BACKGROUND: The diabetics with foot ulcers are principally evaluated on the basis of physical parameters, but this does not always reveal much about the patient's experience of life with ulceration. DESIGN: The cross-sectional study. METHODS: The standardised generic questionnaire World Health Organization Quality of Life-BREF was used. The sample was made up of 525 participants and the calculations were performed using the IBM spss statistical program. RESULTS: The significant negative correlations between demographic data such as age, duration of diabetes mellitus, duration of diabetic ulceration treatment and a lower level of quality of life were found across the sample. The statistically significant differences according to clinical characteristics such as Wagner classification, frequency of foot ulcers, present peripheral vascular disease and pain in terms of quality of life were also revealed. Significant differences of quality of life among Visegrad countries were revealed: Hungary's participants had a worse quality of life than others, while Slovak participants expressed lower satisfaction with their health than Czech. CONCLUSIONS: Socio-demographic factors and clinical characteristics influence the quality of life of patients with diabetic foot ulcer. Significant differences between patients of Visegrad countries were found in all domains of quality of life: physical, psychological, social and environmental. RELEVANCE TO CLINICAL PRACTICE: The quality of life of patients with diabetic foot ulcer reflects the conditions and healthcare system in each of the Visegrad countries. We have to respect socio-demographic factors and clinical characteristics in nursing care. This could have an impact on managing patient care not only with regard to their diabetic foot ulcer but also with regard to the patient as a personality with their own problems in relation to physical, psychosocial and environmental conditions.

Symptoms as the Main Predictors of Caregivers' Perception of the Suffering of Patients With Primary Malignant Brain Tumors.

BACKGROUND: The perception of suffering causes distress. Little is known about what predicts the perception of suffering in caregivers. OBJECTIVE: The aims of this study were to determine the predictors of caregivers' perceptions of the suffering of patients with a primary malignant brain tumor and to find to what extent perceived suffering predicts the caregivers' burden and depression. METHODS: Data were obtained as part of a descriptive longitudinal study of adult family caregivers of persons with a primary malignant brain tumor. Recruitment took place in outpatient neuro-oncology and neurosurgery clinics. Caregiver perception of care recipient suffering was measured by 1 item on a scale from 1 to 6. RESULTS: The sample of caregiver interviews 4 months after recipients were diagnosed consisted of 86 dyads. While controlling for age, years of education, tumor type, being a spousal caregiver, spiritual well-being, and anxiety, perception of overall suffering was predicted by such symptoms as difficulty understanding, difficulty remembering, difficulty concentrating, feeling of distress, weakness, and pain. Caregivers' perception of the patient's degree of suffering was the main predictor of caregiver burden due to schedule 4 months following diagnosis. CONCLUSIONS: Care recipient symptoms play an important role in caregivers' perception of the care recipients' suffering. Perception of care recipient suffering may influence caregiver burden. IMPLICATIONS FOR PRACTICE: Identifying specific predictors of overall suffering provides meaningful information for healthcare providers in the field of neuro-oncology and neurosurgery.

Development and psychometric evaluation of patient needs assessment in palliative care (PNAP) instrument.

OBJECTIVE: Although assessment of palliative patients' needs is a key issue in palliative care, a suitable instrument for identification of such needs is not available in Central European countries. Our objectives were to produce an adequate tool for identifying the importance and satisfaction of palliative patients' needs and to verify its psychometric properties. METHOD: The patient needs assessment in palliative care (PNAP) instrument was constructed based on a literature review and qualitative research (focus groups, n = 5). The psychometric properties of the questionnaire were verified by a cross-sectional study. The convergent validity of the questionnaire was determined by confirmatory factor analysis. Furthermore, internal consistency, test-retest reliability, and construct validity were also tested. The qualitative research group comprised 30 participants (27 experts in palliative care, 1 patient, and 2 family members). Psychometric properties were evaluated in a group of 349 hospital inpatients terminally ill with chronic disease or cancer and receiving palliative care. RESULTS: Based on the qualitative data analysis, a questionnaire was constructed that contained 42 items grouped into 5 domains. When testing the psychometric properties of the questionnaire, a new model containing 40 items in 7 domains was produced. Cronbach's α for the entire PNAP questionnaire was 0.89 on the importance scale and 0.80 on the satisfaction scale. Test-retest reliability was higher than 0.7 for all domains in both scales. SIGNIFICANCE OF RESULTS: The results of tests on the psychometric properties of the PNAP questionnaire showed at least satisfactory validity and reliability, and it can be employed to assess the needs of palliative care patients in Central European countries.

Comparison of three screening tools for nutritional status assessment of the elderly in their homes.

BACKGROUND: The prevailing recommendation for the elderly is to live in their own homes as long as conditions allow. With this emphasis on the natural living environment, it is imperative to closely monitor both the general health and nutritional needs of the elderly in community settings. AIM: The aim of the study was to compare three nutritional status screening and evaluation tools of the elderly in their homes. METHODS: Testing of measuring instruments, MNA, SGA, and MUST took place in the homes of 120 seniors in selected areas of the Czech and Slovak Republics. The study included 120 seniors. For testing of the relationships and dependencies, Pearson's correlation coefficient, t and Fisher tests were used. The level of statistical significance was α = 0.05. RESULTS: All tests were to a large degree correlated (p(MNA) = 0.0049; p(MUST) = -0.537; p(SGA) = -0.578) with the body mass index of the seniors. Simultaneously, it was confirmed that the tools for assessing nutritional status in the study showed significant differences regarding the classification of patients at risk of malnutrition and/or malnourished patients. CONCLUSIONS: Based on the findings, we conclude that MNA appeared to be a more appropriate tool for nutritional assessment of the elderly living in their homes. SGA and MUST provided rather subjective evaluation of the nutritional status and did not furnish an in-depth categorization of malnutrition.