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BACKGROUND: The rising cost of healthcare is a concerning issue for healthcare systems. The Diagnosis Related Group (DRG) system lacks direct consideration for costs related to nursing care. Therefore, to date there is no clear picture of billing models that consider also nursing activity when evaluating healthcare service costs or what factors related to nursing care affect the costs of healthcare services and would therefore need to be considered in billing models. METHODS: A scoping review was conducted. We searched articles published from January 2000 to September 2023, in English, Italian and Spanish. We consulted MEDLINE (Pubmed), CINAHL (EBSCOhost), Web of Science (Clarivate), SCOPUS (Elsevier), ProQuest and Google Scholar, government sites and major international bodies (e.g., National Health Service NHS, World Health Organization WHO). RESULTS: We included a total of 31 studies. The results highlighted 3 categories of factors related to nursing costs, which involve the organisation (e.g., nurse-to-patient ratio), nurses (e.g., skill mix, interventions), and patients (e.g., patient complexity, patient outcomes). All the billing models reported in the literature considered one or more of these categories to estimate nursing costs. The results also showed that appropriate management of organisational and nursing factors, such as staffing and skill mix, could improve healthcare service costs, nursing care or practice, and patient outcomes. CONCLUSIONS: This study sheds light on the multifaceted aspects of nursing care that should be considered in a specific, comprehensive, billing model. Additional testing of existing models to verify their effectiveness, as well as the organisation of a permanent committee (or Task Force) that develops a comprehensive billing model, are necessary to guide the formulation of new policies.
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Cuidados de Enfermagem , Humanos , Assistência Ambulatorial/economia , Pacientes Internados/estatística & dados numéricosRESUMO
Artificial intelligence (AI) has the potential to revolutionize nursing practice and care delivery by streamlining workflows, enhancing patient insights, and reducing cognitive burden. However, leaders must recognize that the adoption of AI introduces both promise and uncertainty. Nurse leaders must navigate the tension between driving innovation and addressing concerns about ethical implications, reliability, and the need to preserve high-quality, person-centered care. This article examines how leaders can thoughtfully integrate AI to support the core mission of nursing: to protect, promote, and optimize health for patients and communities.
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Inteligência Artificial , Humanos , Liderança , Enfermeiros Administradores , Assistência Centrada no Paciente , Cuidados de EnfermagemRESUMO
BACKGROUND: Effective bowel preparation is critical for successful colonoscopy, yet inadequate preparation frequently impairs outcomes. PURPOSE: This study evaluated personalized nursing care (PNC) against standard care in improving bowel preparation quality for colonoscopy. METHODS: A prospective, 2-phase, single-center trial was conducted from July 2023 to July 2024. In phase 1, patients received standard care; in phase 2, personalized preparations were used. RESULTS: Among 1057 patients, PNC significantly improved bowel preparation quality ( P < .001). Adequate preparation was achieved by 79% of the PNC group vs 64.3% of the control group. Adherence to bowel preparation was higher in the PNC group (84.0% vs 70.4%, P < .001), as were polyp detection rates (38.2% vs 28.1%, P = .003). Patient satisfaction increased with PNC interventions. CONCLUSION: PNC enhances colonoscopy preparation, boosting clinical effectiveness and patient satisfaction and advocating for its integration into routine protocols.
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Catárticos , Colonoscopia , Satisfação do Paciente , Humanos , Colonoscopia/enfermagem , Colonoscopia/métodos , Masculino , Estudos Prospectivos , Feminino , Pessoa de Meia-Idade , Catárticos/administração & dosagem , Idoso , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/normas , AdultoRESUMO
INTRODUCTION: In the contemporary landscape, the use of artificial intelligence (AI) in nursing care has sparked ongoing debates regarding its merits and drawbacks. AIM: This study endeavored to elucidate the perceptions of nurses regarding whether AI should be construed as an opportunity or a threat in the context of patient care delivery. METHODS: A qualitative, descriptive, phenomenological design was used. The study was conducted at a university hospital from December 15, 2023, to January 1, 2024. Employing a purposive sampling method, the study achieved data saturation after interviews with 13 nurses. Qualitative data were gathered using a semi-structured interview form, and content analysis was conducted following the procedural steps outlined in Colaizzi's phenomenological data analysis. RESULTS: In the course of the study, four distinct categories emerged: "Nursing Care Practices", "Diagnosis and Treatment Processes", "Management in Nursing", and "Nursing Education and Research". Within the category of "Nursing Care Practices", a detailed examination revealed three overarching themes, each encompassing 15 sub-themes. These themes were "ethical and legal dimensions", "positive thoughts", and "negative thoughts". CONCLUSION: This study reveals that the nurses believed that "AI can support, facilitate, and enhance nursing care when implemented within defined parameters and under appropriate oversight." The same participants conceptualized AI as a positive tool that augments clinical decision-making processes. These findings suggest that the integration of AI, when guided by ethical considerations and patient safety protocols, is a promising avenue for advancing the delivery of nursing care.
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Inteligência Artificial , Cuidados de Enfermagem , Pesquisa Qualitativa , Humanos , Cuidados de Enfermagem/psicologia , Feminino , Adulto , Masculino , Atitude do Pessoal de Saúde , Entrevistas como Assunto , Pessoa de Meia-IdadeRESUMO
The aim of this study is to determine the mediating role of moral sensitivity in the effect of nurses' professional values on missed nursing care. A descriptive and correlational study was conducted with 640 nurses working in the inpatient units of a public and a private hospital with the MISSCARE Survey-Turkish, the Moral Sensitivity Questionnaire, and the Revised Nursing Professional Values Scale. Data analyses were performed using the Statistical Package for Social Sciences 26.0, Hayes' PROCESS macro for SPSS v4.0, and the Analysis of Moment Structures 24.0. It was determined that nurses' professional values had a significant and positive effect on moral sensitivity, and nurses' moral sensitivity had a significant and negative effect on missed nursing care. In addition, the direct and indirect effects of nurses' professional values on missed nursing care were statistically significant. The research model showed that increasing nurses' professional values and moral sensitivity decreased missed nursing care, and moral sensitivity significantly mediated the interaction between nurses' professional values and missed nursing care.
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Princípios Morais , Humanos , Feminino , Adulto , Masculino , Inquéritos e Questionários , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Atitude do Pessoal de Saúde , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/normas , Cuidados de Enfermagem/estatística & dados numéricos , Cuidados de Enfermagem/psicologia , Psicometria/instrumentação , Psicometria/métodosRESUMO
A global nursing shortage necessitates innovative care models to mitigate burnout, turnover, and supply-demand mismatches. This mixed-methods pilot study assessed the impact of a technology-integrated nursing care model on workload and patient outcomes in a surgical-orthopedic unit. Following IRB approval and training, the integrated care model was piloted for 6 months. The model included integration of virtual nurses, LPNs, and delivery robots. Workload perception, quality and safety, and nurse satisfaction were monitored using a time-series design. Data analysis employed correlated t-tests, comparison of means over time, and statistical process control charts (Shewhart charts). The integrated care model yielded mixed results. Hospital Acquired Conditions remained stable, while average length of stay and falls decreased. The robots have made 615 deliveries and saved staff 377 640 stjpg and 415.8 hours. After an initial low utilization, virtual nurses completed 82% admissions and discharges by the end of the pilot. However, RNs reported increased workload, staffing concerns, and teamwork challenges. This integrated care model shows promise, but further research is needed to fully assess its impact. The findings underscore the importance of continued exploration and refinement of novel approaches to address the challenges facing the nursing profession.
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Carga de Trabalho , Humanos , Projetos Piloto , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricos , Carga de Trabalho/psicologia , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Satisfação no Emprego , Masculino , Feminino , Modelos de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/psicologia , Adulto , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/estatística & dados numéricos , Cuidados de Enfermagem/normas , Hospitais/estatística & dados numéricos , Hospitais/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricosRESUMO
OBJECTIVE: To assess the frequency, types and contributing factors of missed nursing care among registered nurses in a tertiary care setting. METHODS: The analytical cross-sectional study was conducted from May to November 2022 at the Dow University Hospital, Karachi, and Dr Ruth Katherina Martha Pfau Civil Hospital, Karachi, and comprised nurses registered with the Pakistan Nursing and Midwifery Council. Data was collected using a validated tool. Data was analysed using SPSS 23. RESULTS: Of the 232 nurses, 127(54.7%) were males, 105(45.3%) were females, 123(53%) were aged 30-39 years, and 73(31.5%) had work experience of 1-5 years. Nursing care components neglected by the nurses were patient bathing 127(54.7%), attending care conference 108(46.6%) and focussed reassessment 100(43.1%). Factors responsible for missed care were manpower resources identified by 152(65.5%) nurses, material resources by 141(60.8%), and communication factors identified by 84(36.2%). CONCLUSIONS: Various nursing care components were found missing during patient hospitalisation. Major reason for missed care was identified by the nurses as lack of manpower resources.
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Recursos Humanos de Enfermagem Hospitalar , Centros de Atenção Terciária , Humanos , Paquistão , Feminino , Adulto , Masculino , Estudos Transversais , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Cuidados de Enfermagem/estatística & dados numéricosRESUMO
In this article, I discuss the implications of the neoliberal transformations on healthcare that are justified under the aegis of economic efficiency. Drawing on the work of German critical philosopher Axel Honneth, I present a critical-social and philosophical perspective that reinterprets these transformations as pathological consequences with devastating impacts on how we understand what human beings and social relations are. I argue that in a neoliberal context, nursing care becomes a form of reification defined as 'forgetfulness of recognition' of the human identity of the patient which contradicts the assumed ethical foundations of nursing. The article provides a detailed account on how neoliberal rationality that governs nursing performance promotes an objective and a 'neutral stance' of care that neglects emotional engagement and deals with the patient as an object or a thing which violates all dimensions of patient recognition. I also emphasize that neoliberalism must rather be understood as a specific form of governmentality that goes beyond mere economization and structures a specific way of understanding people in the healthcare context. Neoliberal rationality, as conceptualized in this article, not only considers human being as homo economicus, where decisions are based on economic ideals, but also neutralizes relationships and disseminates an 'objective' and purely scientific stance in caring interactions. This leads to the detachment of nurses and reification of patients. Thus, nursing care is reduced to an instrumental rationality that focuses on technical care, which diminishes any possibility for nurses to engage with patients and understand their unique phenomenological world necessary for coping and recognition. Finally, nurses are urged to raise their voices against neoliberal rationality that programs their ideas of what 'good care' is. A critical emancipatory mode of thinking provides an opportunity to challenge neoliberal rationality and revitalize nursing agency to resist the devastating transformations taking place in health care.
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Cuidados de Enfermagem , Humanos , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/psicologia , Política , Filosofia em EnfermagemRESUMO
This article reflects on the concepts of health, well-being, gender, and dignity when providing nursing care to older adults, focusing on their wisdom and the phenomena that can affect their health or improve their quality of life. These concepts are analyzed based on the current health conditions of older adults and their needs, on the perspectives of authors in this field of research, and on Patricia Benner's philosophy: the integration of science, clinical wisdom, and ethics in nursing practice. Furthermore, this article aims at contributing to the health, well-being, gender, and dignity of older adults, despite the discrimination that they may face, as well as to the reality of nursing practice. As such, this study stems from the observed reality, experiences as caregivers and reflection of nurses committed to the values of the profession. Therefore, the article begins with the conceptualization of health, well-being, gender, and dignity, subsequently analyzing the health-disease status of older adults from a gender perspective, addressing nursing care for older adults based on Patricia Benner's philosophy and concluding with reflections on nursing practice for a better future for older adults.
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Pessoalidade , Respeito , Humanos , Idoso , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/psicologia , Cuidados de Enfermagem/ética , Cuidados de Enfermagem/tendências , Qualidade de Vida/psicologia , Feminino , MasculinoRESUMO
BACKGROUND: The evolving nature of nursing practice necessitates the development and implementation of contemporary models of care; however, inconsistent definitions hinder this. With the increasing demand for nurse-led models of care, it is crucial to establish a consistent understanding to ensure the efficacy of implemented models. AIM: We aim to provide a working definition for nursing models of care, then using this, present the key features that nurse-led models of care should consider. SOURCES OF EVIDENCE: An unstructured literature review was used to explore the research aim. DISCUSSION: We propose that nursing models of care be defined as involving three interrelated domains: (1) a theoretical basis that underpins conceptualisation of care, (2) organisational work methods that direct task delegation, organisational governance, and care responsibility and (3) practical methods for care delivery that describes practical care methodologies. Extrapolating from this framework, nurse-led models of care are defined as having an evidence-based and person-centred theoretical basis, an organisational work method driven by nurses, and practical methods of care delivery supported by the creation of holistic care plans. CONCLUSION: As the design and implementation of a model of care is influenced by unique contextual considerations, the definitions provided in this paper should be considered as a starting point for further refinement, consideration and discussion. IMPLICATIONS FOR NURSING POLICY: Standardisation in how models of care are defined enables greater understanding and improved comparability between disparate sources of evidence and can aid stakeholders by providing a common language. Creating standardisation in the terminology of nurse-led models of care specifically supports the continued advocacy efforts for these models of care and assists policymakers and health providers in their design and implementation.
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Modelos de Enfermagem , Humanos , Papel do Profissional de Enfermagem , Cuidados de Enfermagem/organização & administração , Padrões de Prática em Enfermagem/organização & administraçãoRESUMO
BACKGROUND: While numerous studies have quantified the prevalence of reasons for missed care, a comprehensive synthesis of evidence across various health systems remains lacking. AIM: To estimate the pooled prevalence of the reasons reported by nurses for missed care, using data from the MISSCARE surveys. INTRODUCTION: Missed nursing care, which refers to any aspect of essential patient care that is omitted or delayed, presents substantial risks to patient safety and the quality of care. METHODOLOGY: Four databases (PubMed, Web of Science, Embase, and Scopus) were searched, without language restrictions. Study quality was assessed using Joanna Briggs Institute's critical appraisal tool. A random-effects meta-analysis was used to calculate prevalence estimates and evaluate heterogeneity via prediction intervals. Subgroup analyses were conducted to assess potential sources of heterogeneities. Time trends were estimated using linear regression modeling. RESULTS: Twenty-eight studies (2011-2024) totaling 20768 nurses from 121 hospitals from 14 countries were included. The raw prevalence of missed care ranged from 6.8% to 98.1%, with a median of 56.4% (IQR: 41.0-75.4). The most frequently reported reasons were "unexpected rise in patient volume and/or acuity on the unit" (78.1%; 95% confidence intervals (CI) 71.5-54.1), "inadequate number of staff" (76.5%; 95% CI, 68.7-83.5), and "urgent patient situation" (73.5%; 95% CI, 66.6-79.9). Most of the investigated reasons for missed nursing care showed no significant changes over time. CONCLUSION: This meta-analysis provides valuable insights that can inform interventions and policies aimed at mitigating missed nursing care, ultimately improving patient safety and healthcare outcomes. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study underscores the global prevalence reasons for missed nursing care. The findings call for comprehensive strategies to address this crucial challenge, regardless of geographic region and economic status of countries. However, special attention should be given to non-university hospitals and hospitals with specific demographic characteristics of nurses.
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Cuidados de Enfermagem , Humanos , Saúde Global/estatística & dados numéricos , Cuidados de Enfermagem/estatística & dados numéricos , Cuidados de Enfermagem/normas , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/psicologia , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricosRESUMO
AIM: This study aimed to determine the effect of nurses' work environment, individual and work schedule features on the rationing of nursing care. INTRODUCTION: Rationing of nursing care is a concern in healthcare settings worldwide, as it is associated with negative outcomes for both patients and nursing staff. BACKGROUND: Little is known about the precursors of rationing of nursing care in developing countries. METHODS: This descriptive, correlational and cross-sectional study was conducted with 405 nurses in Türkiye. Data were collected Nurse Information Form, Basel Extent of Rationing of Nursing Care-R and Nursing Work Index-The Practice Work Environment Scale. The study was reported following the STROBE and RANCARE guideline. RESULTS: Nurses' mean rationing of nursing care score was 1.58 ± 0.59, and the mean work environment perception score was 2.58 ± 0.47, with no statistically significant relationship between the scale scores. However, working ward, working hours and working schedule significantly affected the total rationing of nursing care scores. DISCUSSION: In this study, contrary to the literature, no relationship was found between the rationing of nursing care and the perception of the work environment. Supporting the literature, nurses' individual/work schedule features affected the rationing of nursing care. CONCLUSION: Improving nurses' work schedule features and nurse staffing may help reduce the rationing of nursing care. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study emphasised the importance of nurses' work schedule features and nurse staffing in the rationing of nursing care. The data from this study can guide nurse managers in identifying factors related to work schedules that may affect the rationing of nursing care and strategies to follow to make the necessary improvements.
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Países em Desenvolvimento , Alocação de Recursos para a Atenção à Saúde , Recursos Humanos de Enfermagem Hospitalar , Humanos , Estudos Transversais , Adulto , Feminino , Masculino , Recursos Humanos de Enfermagem Hospitalar/provisão & distribuição , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Cuidados de Enfermagem/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Local de TrabalhoRESUMO
The concept of family management has gained increasing acceptance in the United States for over two decades and is today applied in care worldwide. However, this concept is still largely novel to clinical professionals in Taiwan. This article was written to present the history and current application of family management to promote greater recognition of the related opportunities and potentials in the nursing field. Understanding the family management style framework helps nursing professionals better grasp the dynamic situation in families while dealing with the primary health issues of patients. Awareness of adjustability and regulation of the family allows nursing professionals to understand and provide care to the entire family unit rather than to individual family members. Adapting family management measures and identifying the typology of family management may also be an efficient approach to conducting family evaluations and developing appropriate interventions. We reflect on these issues and offer suggestions on family management to inspire nursing professionals to pursue related research and clinical practicums to improve family nursing capabilities in the nursing field.
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Família , Humanos , Família/psicologia , Cuidados de Enfermagem , Enfermagem FamiliarRESUMO
During transfer tasks, the dual-arm nursing-care robot require a human-robot mechanics model to determine the balance region to support the patient safely and stably. Previous studies utilized human-robot two-dimensional static equilibrium models, ignoring the human body volume and muscle torques, which decreased model accuracy and confined the robot ability to adjust the patient's posture in three-dimensional spatial. Therefore, this study proposes a three-dimensional spatial mechanics modeling method based on individualized human musculoskeletal multibody dynamics. Firstly, based on the mechanical features of dual-arm support, this study constructed a foundational three-dimensional human-robot mechanics model including body posture, contact position and body force. With the computed tomography data from subjects, a three-dimensional femur-pelvis-sacrum model was reconstructed, and the individualized musculoskeletal dynamics was analyzed using the ergonomics software, which derived the human joint forces and completed the mechanic model. Then, this study established a dual-arm robot transfer platform to conduct subject transfer experiments, showing that the constructed mechanics model possessed higher accuracy than previous methods. In summary, this study provides a three-dimensional human-robot mechanics model adapting to individual transfers, which has potential application in various scenarios such as nursing-care and rehabilitating robots.
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Robótica , Humanos , Fenômenos Biomecânicos , Postura , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Pelve , Cuidados de Enfermagem , Ergonomia , Sistema Musculoesquelético , FêmurRESUMO
INTRODUCTION: Heart failure is a common chronic illness associated with high readmission rates and death. Comprehensive nursing care, management of symptoms, and psychological support are increasingly seen as critical components of successful heart failure therapy. OBJECTIVE: This systematic review and meta-analysis aimed to determine the effect of comprehensive nursing care on clinical outcomes and quality of life in heart failure patients. METHODS: We searched electronic databases (PubMed, PROSPERO, and Web of Science) for randomised controlled trials and observational studies on comprehensive nursing care treatments for heart failure patients. Data on readmission rates, mortality rates, and quality of life were obtained and examined. RESULTS: A total of 693 studies satisfied the inclusion criteria. A meta-analysis found that comprehensive nursing care reduced heart failure-related readmissions considerably when compared to conventional therapy (odds ratio [OR]: 0.77; 95% CI: 0.66-0.88, p = 0.0002). There was a significant difference in all-cause mortality (OR: 0.76; 95% CI: 0.60-0.97, p = 0.03), but comprehensive treatment enhanced quality of life and functional status (standardised mean difference -0.05, 95% CI: -0.21 to 0.10, p = 0.49). CONCLUSION: Comprehensive nursing care improves clinical outcomes and quality of life for heart failure patients. This study stresses the need to add comprehensive nurse interventions in normal heart failure treatment programmes.
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Insuficiência Cardíaca , Readmissão do Paciente , Qualidade de Vida , Insuficiência Cardíaca/enfermagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Readmissão do Paciente/estatística & dados numéricos , Cuidados de EnfermagemRESUMO
Workplace bullying, commonly known as mobbing, persists as a significant problem across various industries, including the healthcare sector. To establish effective interventions and protocols for enhancing the well-being of healthcare workers and patients, it is vital to fully grasp the link between workplace bullying and the quality of nursing care. The analysis highlights the complex link between workplace bullying and nursing care quality, stressing the urgency of addressing this issue due to its wide-reaching impact on individuals and healthcare organizations, ultimately affecting patient safety. Emphasizing the significance of addressing workplace bullying across different professional settings is crucial for protecting the mental health and well-being of employees. The research identifies various forms of aggression and emphasizes the need to understand how these behaviors affect patient outcomes. Further investigation is needed to clarify nurses' responses to workplace violence, particularly in specialized settings like mental health facilities. The studies underscore the numerous challenges nurses encounter when trying to report incidents of workplace bullying. This insight is vital for developing effective reporting mechanisms and targeted interventions to combat bullying behaviors in medical environments. Ultimately, establishing a safer working environment for nurses is paramount. This article aims to review the associations between workplace bullying and the quality of nursing care.
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Bullying , Qualidade da Assistência à Saúde , Local de Trabalho , Humanos , Bullying/psicologia , Local de Trabalho/psicologia , Cuidados de Enfermagem , Enfermeiras e Enfermeiros/psicologia , Agressão/psicologia , Violência no Trabalho/psicologia , Segurança do PacienteRESUMO
BACKGROUND: The global variable of missed nursing care and practice environment are widely recognized as two crucial contextual factors that significantly impact the quality of nursing care. This study assessed the current status of missed nursing care and the characteristics of the nursing practice environment in Iran. Additionally, this study aimed to explore the relationship between these two variables. METHODS: We conducted an across-sectional study from May 2021 to January 2022 in which we investigated 255 nurses. We utilized the Missed Nursing Care Survey, the Nursing Work Index-Practice Environment Scale, and a demographic questionnaire to gather the necessary information. We used the ShapiroâWilk test, Pearson correlation coefficient test, and multiple linear regression test in SPSS version 20 for the data analyses. RESULTS: According to the present study, 41% of nurses regularly or often overlooked certain aspects of care, resulting in an average score of 32.34 ± 7.43 for missed nursing care. It is worth noting that attending patient care conferences, providing patient bathing and skin care, and assisting with toileting needs were all significant factors contributing to the score. The overall practice environment was unfavorable, with a mean score of 2.25 ± 0.51. Interestingly, 'nursing foundations for quality of care' was identified as the sole predictor of missed nursing care, with a ß value of -0.22 and a p-value of 0.036. CONCLUSIONS: This study identified attending patient care interdisciplinary team meetings and delivering basic care promptly as the most prevalent instances of missed nursing care. Unfortunately, the surveyed hospitals exhibited an undesirable practice environment, which correlated with a higher incidence of missed nursing care. These findings highlight the crucial impact of nurses' practice environment on care delivery. Addressing the challenges in the practice environment is essential for reducing instances of missed care, improving patient outcomes, and enhancing overall healthcare quality.
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Cuidados de Enfermagem , Qualidade da Assistência à Saúde , Humanos , Feminino , Estudos Transversais , Masculino , Irã (Geográfico) , Adulto , Cuidados de Enfermagem/normas , Inquéritos e Questionários , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Local de TrabalhoRESUMO
BACKGROUND: Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care. METHODS: This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985). RESULTS: In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword". CONCLUSIONS: The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.
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Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Humanos , Feminino , Irã (Geográfico) , Qualidade da Assistência à Saúde/normas , Adulto , Masculino , Entrevistas como Assunto , Cuidados de Enfermagem/normas , Atitude do Pessoal de Saúde , Recursos Humanos de Enfermagem Hospitalar/psicologiaRESUMO
BACKGROUND: Unfinished nursing care is becoming increasingly more of a concern in worldwide healthcare settings. Given their negative outcomes, it is crucial to continuously assess those nursing interventions that are commonly postponed or missed, as well as the underlying reasons and consequences. The worldwide COVID-19 pandemic has made it difficult for health facilities to maintain their sustainability and continuity of care, which has also influenced the unfinished nursing care phenomenon. However, no summary of the studies conducted during the COVID-19 pandemic was produced up to now. The main aim of this study was to systematically review the occurrence of, reasons for, and consequences of unfinished nursing care among patients in healthcare settings during the COVID-19 pandemic. METHODS: Systematic review registered in PROSPERO (CRD42023422871). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline and the Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies were used. MEDLINE-PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from March 2020 up to May 2023, using keywords established in the field as missed care, unfinished nursing care, or implicit rationing. RESULTS: Twenty-five studies conducted mainly in European and Asiatic countries were included and assessed as possessing good methodological quality. The following tools were used: the MISSCARE Survey (= 14); the Basel Extent of Rationing of Nursing Care (= 1), also in its revised form (= 2) and regarding nursing homes (= 2); the Perceived Implicit Rationing of Nursing Care (= 4); the Intensive Care Unit-Omitted Nursing Care (= 1); and the Unfinished Nursing Care Survey (= 1). The order of unfinished nursing care interventions that emerged across studies for some countries is substantially in line with pre-pandemic data (e.g., oral care, ambulation). However, some interesting variations emerged at the country and inter-country levels. Conversely, labour resources and reasons close to the emotional state and well-being of nurses were mentioned homogeneously as most affecting unfinished nursing care during the pandemic. None of the studies investigated the consequences of unfinished nursing care. CONCLUSIONS: Two continents led the research in this field during the pandemic: Europe, where this research was already well established, and Asia, where this research is substantially new. While unfinished care occurrence seems to be based on pre-established patterns across Europe (e.g., regarding fundamentals needs), new patterns emerged across Asiatic countries. Among the reasons, homogeneity in the findings emerged all in line with those documented in the pre-pandemic era.
Assuntos
COVID-19 , Cuidados de Enfermagem , Humanos , COVID-19/epidemiologia , COVID-19/enfermagem , SARS-CoV-2 , PandemiasRESUMO
BACKGROUND: The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and elevates the level of patient care. However, a precise definition of conscience in the nursing field is lacking, making it challenging to measure. To address this issue, this study employed the hybrid approach of Schwartz Barcott and Kim to analyze the concept of conscience-based nursing care. METHODS: This approach involves a three-phase process; theoretical, fieldwork, and analytical. A systematic literature review was conducted using electronic databases during the first phase to find relevant papers. The content of 42 articles that met the inclusion criteria was extracted to determine the attributes, antecedents, and consequences of consciousness care using thematic analysis. Based on the working definition as a product of this phase, the plan of doing the fieldwork phase was designed. During this phase, data were collected through interviews with nurses all of whom were responsible for patient care in hospitals. In this phase, 5 participants were chosen for in-depth interviewing by purposeful sampling. Data were analyzed using directed content analysis. The findings of the theoretical and fieldwork phases were integrated and the final definition was derived. RESULTS: The integration of the theoretical and fieldwork phases resulted in identifying four key characteristics of conscience-based nursing care. Firstly, it involves providing professional care with a conscientious approach. Secondly, ethics is at the core of conscience-based care. Thirdly, external spirituality plays a significant role in shaping one's conscience in this context. Finally, conscience-based nursing care is both endogenous and exogenous, with professional commitment being the central focus of care. CONCLUSION: Conscience-based nursing care is an essential component of ethical care, which elevates clinical practice to professional care. It requires the integration of individual and social values, influenced by personal beliefs and cultural backgrounds, and supported by professional competence, resources, and a conducive organizational atmosphere in the healthcare field. This approach leads to the provision of responsive care, moral integrity, and individual excellence, ultimately culminating in the development of professionalism in nursing.