Rationing of Nursing Care and Patient Safety

Grzegorz Kubielas,Izabella Uchmanowicz,Agnieszka Młynarska,Piotr Karniej,Izabela Witczak,Łukasz Rypicz

doi:10.3389/fpsyg.2021.676970

Abstract

Background: Nursing care has a significant impact on patient safety, which affects clinical outcomes, patients’ satisfaction with the care received and nursing personnel’s satisfaction with the care provided. This study aimed to determine the extent of nursing care rationing and its relationship with patient safety including identification of the specific reasons.Methods: This cross-sectional study involved 245 nurses and was performed between April–June 2019 in four hospitals in Wrocław, Poland. The standardized and relevant research tools such as Hospital Survey on Patient Safety Culture (HSOPSC) and the Perceived Implicit Rationing of Nursing Care (PIRNCA) were used. The data was submitted to hierarchical multiple regression analysis. The study was approved by the Bioethics Committee and was followed with the STROBE guidelines.Results: The PIRNCA scores were negatively correlated with the HSOPSC subscales, which indicates that more frequent rationing of nursing care was associated with lower levels of patient safety parameters. It was shown that the highest level of unfinished nursing care was associated with decreases in patient safety factors linked with supervisor manager expectations actions promoting safety (rs = −0.321, p < 0.001), teamwork within hospital units (rs = −0.377, p < 0.001), feedback and communication about error (rs = −0.271, p < 0.001), teamwork across hospital units (rs = −0.221, p < 0.01), and hospital handoffs transitions (rs = −0.179, p < 0.01). Moreover, the strongest association was observed between the PIRNCA scores with patient safety grade (rs = 0.477, p < 0.001). Also, the PIRNCA scores among the internal unit were significantly higher than in the intensive care and surgical units.Conclusion: Our study indicated the presence of nursing care rationing. Regarding patient safety, we found insufficient numbers of medical personnel and excessive personnel workload for providing safe care to patients, a lack of transparency in handling adverse event reports and analyses, and a lack of cooperation between hospital units regarding patient safety.

Highlights

According to the Global Patient Safety Action Plan 2021–2030 by World Health Organization (WHO), patient safety is defined as “a framework of organized activities that creates cultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely and reduce its impact when it does occur” (World Health Organization, 2021).Ensuring patient safety is an international challenge, as it affects every country in the world
The strongest association was observed between the Perceived Implicit Rationing of Nursing Care (PIRNCA) scores with patient safety grade
The present study demonstrated that PIRNCA scores were negatively correlated with the Hospital Survey on Patient Safety Culture (HSOPSC) subscales, which indicates that more frequent rationing of nursing care was associated with lower levels of patient safety parameters

Summary

Introduction

According to the Global Patient Safety Action Plan 2021–2030 by World Health Organization (WHO), patient safety is defined as “a framework of organized activities that creates cultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely and reduce its impact when it does occur” (World Health Organization, 2021).Ensuring patient safety is an international challenge, as it affects every country in the world. The global challenge of ensuring health care safety and consolidating efforts associated with it is echoed in the current vision of the WHO, which refers to “a world where every patient receives safe health care, without risks and harm, every time, everywhere” (World Health Organization, 2017). Contemporary theories of patient safety point to new types of risks associated with the near-constant pressure on health care organizations, staff shortages, excessive workload, large numbers of complex cases, the use of new technologies, and other factors. These stressors put middle management and first-line personnel in a tough position, at risk of breaching their standards and failing to provide optimum health care quality and safety (Thomas, 2020). This study aimed to determine the extent of nursing care rationing and its relationship with patient safety including identification of the specific reasons

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