Abstract
BackgroundTo 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.MethodsThe 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.ResultsThe 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.ConclusionsThis 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.
Highlights
To our knowledge, no instrument has been developed and tested for measuring unfinished care in Norwegian nursing home settings
The response format was the same as the original BERNCA-NH but due to our heterogeneous sample, the response option “Not within my field of responsibility” was included for all items to assess the suitability of the items for all care workers
This study has presented a rigorous cross-cultural translation and adaptation process and evidence of the internal structure and consistency of the Norwegian version of the Basel Extent of Rationing of Nursing Care for Nursing Homes instrument (BERNCA-NH), assessed in a sample of care workers in Norwegian nursing homes
Summary
No instrument has been developed and tested for measuring unfinished care in Norwegian nursing home settings. 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 cost of care is expected to increase while there will be problems recruiting and retaining a qualified workforce [5]. Against this background, a widening gap between healthcare demands and available resources in the coming years could be anticipated. Unfinished care adversely affects the quality of care [8] and have serious consequences for patient safety as they may not receive adequate treatment and care [9]
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