Rationierung von Pflege Assoziationen mit der Patientensicherheit und der Betreuungsqualität in Spitälern

Abstract

On the basis of nurse reports indicating the occurrence of implicit rationing of nursing care in Swiss hospitals, the Swiss Federal Office of Public Health asked the Institute of Nursing Science of the University of Basel to conduct the Rationing of Nursing Care in Switzerland Study (RICH Nursing Study). The resulting study is an extension of the International Hospital Outcomes Study (IHOS), an international study of the organization of nursing care in hospitals and its impact on patient outcomes [1-3]. The IHOS study is led by the Center for Health Outcomes and Policy Research at the University of Pennsylvania (USA). The RICH Nursing study, and with it the research program of this dissertation, extended the IHOS research protocol by developing a new empirical measure of implicit rationing of nursing care. This thesis is comprised of ten chapters. Chapters 3 and 5-9 have been published or submitted as individual articles. Therefore, some repetition in the description of the background and methodology could not be avoided. The first three chapters describe the thesis’ background, its aims, and the available evidence on effects of cost saving strategies and changes in staffing levels and skill mixes on patient and nurse outcomes. • Chapter 1 gives a literature based overview of relevant developments in the healthcare system, including cost saving strategies, reductions of nursing resources, and their effects on patient and nurse outcomes • Chapter 2 describes the aims of this research program • Chapter 3 is a literature review and analysis, examining the available evidence on the effects of cost saving strategies and changes in staffing levels and skill mix in the inpatient care setting on selected patient and nurse outcomes. Chapters 4 and 5 explore the first two aims of this research program – to develop a conceptual framework of implicit rationing of nursing care, as well as an instrument to measure it as an empirical factor, and to evaluate the psychometric properties of the newly developed instrument. • Chapter 4 presents the definition and conceptual framework of implicit rationing of nursing care, upon which the proposed measurement tool was based. • Chapter 5 explores the development of the Basel Extent of Rationing of Nursing Care (BERNCA) instrument and its validity and reliability along lines of evidence suggested in Standards for educational and psychological testing. The central aim of this research program, ‘to explore the association between implicit rationing of nursing care in Swiss acute care hospitals and patient outcomes, with consideration for major organisational variables’, and the related aim, ‘to examine the levels of rationing in Swiss acute care hospitals, identifying clinically meaningful rationing thresholds for selected patient outcomes using a standardized rationing tool’ are explored in chapters 5 and 6. • Chapter 6 explores the associations between implicit rationing of nursing care and its relationships with patient outcomes as a new empirical factor, as well as with major organisational system factors. • Chapter 7 discusses the identified clinically meaningful rationing thresholds and their implications for clinical nursing practice. • Chapter 8 Discusses the mechanism of implicit rationing of nursing care, the occurrence of rationing in Swiss acute care hospitals and its consequences. • Chapter 9 explores the additional aim of this research program – ‘to compare sharp-device injuries rates among hospital staff nurses across four Western countries’ using data from the IHOS study. • To conclude, Chapter 10 discusses the findings of the program as a whole, identifying related methodological issues, implications for research and clinical practice, and possible future steps to explore the causes, processes and effects of the rationing of nursing care.