Ethical climate and missed nursing care in cancer care units.

BACKGROUND: Previous research has linked missed nursing care to nurses' work environment. Ethical climate is a part of work environment, but the relationship of missed care to different types of ethical climate is unknown. RESEARCH OBJECTIVES: To describe the types of ethical climate in adult in-patient cancer care settings, and their relationship to missed nursing care. RESEARCH DESIGN: A descriptive correlation design was used. Data were collected using the Ethical Climate Questionnaire and the MISSCARE survey tool, and analyzed with descriptive statistics, Pearson's correlation and analysis of variance. Participants and research context: All nurses from relevant units in the Republic of Cyprus were invited to participate. Ethical considerations: The research protocol has been approved according to national legislation, all licenses have been obtained, and respondents participated voluntarily after they have received all necessary information. FINDINGS: Response rate was 91.8%. Five types identified were as follows: caring (M = 3.18, standard deviation = 1.39); law and code (M = 3.18, standard deviation = 0.96); rules (M = 3.17, standard deviation = 0.73); instrumental (M = 2.88, standard deviation = 1.34); and independence (M = 2.74, standard deviation = 0.94). Reported overall missed care (range: 1-5) was M = 2.51 (standard deviation = 0.90), and this was positively (p < 0.05) related to instrumental (r = 0.612) and independence (r = 0.461) types and negatively (p < 0.05) related to caring (r = -0.695), rules (r = -0.367), and law and code (r = -0.487). DISCUSSION: The reported levels of missed care and the types of ethical climates present similarities and differences with the relevant literature. All types of ethical climate were related to the reported missed care. CONCLUSION: Efforts to reduce the influence of instrumental and independence types and fostering caring, law and code, and rules types might decrease missed nursing care. However, more robust evidence is needed.

A Cost-Effectiveness and Budget Impact Analysis of AbobotulinumtoxinA in Greece.

This study aimed to assess the cost-effectiveness of abobotulinumtoxinA (aboBoNT-A) plus Best Supportive Care (BSC) compared with BSC alone for managing limb spasticity in adult patients in Greece, as well as to conduct a budget impact analysis of the introduction of aboBoNT-A in the Greek healthcare system compared to onabotulinumtoxinA (onaBoNT-A). Clinical studies were utilized to extract data on drug efficacy and patients' utility, while cost data were collected from Greek sources. The results of the study showed that aboBoNT-A plus BSC was a cost-effective treatment option for both upper and lower limb spasticity in adult patients compared to BSC. Additionally, introducing aboBoNT-A into the Greek healthcare system resulted in cost savings in pharmaceutical spending over a 5-year period. The findings suggest that incorporating aboBoNT-A into the Greek healthcare system could improve patient access to treatment and healthcare resource efficiency, as it is a more economical option compared to onaBoNT-A.

To what extent are patients' needs met on oncology units? The phenomenon of care rationing.

PURPOSE: Evidence suggests that when resources are not sufficient to provide all the care needed by their patients, nurses are forced to ration their attention between care activities. The aim of this study is to examine care omissions and their causes in oncology units. METHODS: Participants were recruited from all of the hospitals in the Republic of Cyprus with oncology in-patient units. The data were collected with the MISSCARE questionnaire consisting of demographics, part A related to the elements of missed care and part B asking the reasons why nurses omit care. RESULTS: One hundred and fifty seven registered nurses participated in the study (Response Rate = 91.8%). The mean value for part A of the MISSCARE survey was moderate (2.31 from 4). The elements of care described as frequently or always missed were: turning the patient every 2 h (66.9%); ambulation three times a day or as needed (49.1%); mouth care (61.1%); patient teaching (37.6%); emotional support (32.5%); and attend any interdisciplinary conferences (87.9%). Reported causes included inadequate number of staff, urgent patient situations and unexpected rise in patient volume/unit acuity. Spearman correlations showed that there is a relationship between care rationing and job satisfaction (r = 0.469, p < 0.05), with the less satisfied nurses reporting higher incidences of care omissions. CONCLUSION: The results of this study may facilitate a better understanding of this phenomenon and its impact on patients and nurses, but more research is needed at an international level so as to create more robust evidence that could support nursing practice.