Implicit Rationing Of Nursing Care Research Articles

Unfinished nursing care in healthcare settings during the COVID-19 pandemic: a systematic review

BackgroundUnfinished 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.MethodsSystematic 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.ResultsTwenty-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.ConclusionsTwo 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.

Rationing of nursing care and assessment of work safety and a healthy work environment in intensive care units: A cross-sectional, correlational study

IntroductionRationing of nursing care, whichrefers to the aspects of care not delivered by nurses in an intensive care unit (ICU), has implicationsfor patient outcomes and experiences. ObjectivesThis study aimed to identify the extent to which nursing care is rationed in intensive care units, as well as asses quality of nursing care, and the level of job satisfaction and its correlation with an assessment of the climate of work safety, teamwork, and a healthy work environment. MethodologyA cross-sectional, correlational study was conducted. The study included 226 ICU nurses. It was conducted with the use of three instruments: the Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on the rationing of nursing care, assessment of patient care quality and job satisfaction, American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) and the Safe Attitudes and Behaviours Questionnaire questionnaire in the version: Teamwork and Safety Climate (BePoZa). SettingsIntensive Care Units in Warmia and Mazury Region in Poland. Main Outcome MeasuresLevel of Nursing Care Rationing in Intensive Care Units. ResultsThe majority of participants were women (89.82 %) with a mean age of 42.47 years. The average score for nursing care rationing across all groups was 0.58. The mean score for the HWEAT was 2.7 and BePoZa was 3.72. The scores from the questionnaires were negatively correlated with the nursing care rationing scores, being −0.36 for the HWEAT and −0.45 for BePoZa. All correlation coefficients were statistically significant at a p-value of less than 0.05. ConclusionsIt is important to monitor work safety, teamwork climate, and standards of a healthy work environment in ICUs to minimise the risk of rationing nursing care. Implications for Clinical PracticeInterventions that enhance work organisation and teamwork can elevate nursing quality and job satisfaction in ICUs, while underestimating patient care tasks; thus, highlighting the need for further research on the factors influencing nursing performance.

Validation of a Chinese Version of Perceived Implicit Rationing of Nursing Care (CPIRNCA) Scale in Taiwan

Validation of a Chinese Version of Perceived Implicit Rationing of Nursing Care (CPIRNCA) Scale in Taiwan

Implicit rationing of nursing care reported by nurses from different types of hospitals and hospital units.

The study aimed to investigate differences in assessing implicit rationing of nursing care by Czech nurses with respect to the type of unit and type of hospital. Implicit rationing of nursing care may differ across different types of hospitals and hospital units. This study used a multicentre cross-sectional study design. The STROBE checklist for observational cross-sectional studies was followed for reporting of the research study. The sample included 8209 nurses providing direct care to medical and surgical patients in 14 acute care Czech hospitals. The main outcome was implicit rationing of nursing care as measured with a Czech version of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument. Data were collected from September 2019 to October 2020. The most frequently rationed nursing care activity was timely response to patient or family request/need, followed by emotional or psychological support and adequate supervision of delegated tasks. More implicitly rationed nursing care was reported in medical units. Statistical differences were found in rating 25 items and the PIRNCA total score. Nurses from middle-sized hospitals reported implicitly rationed care more frequently than those from large hospitals. More rationed care was reported by nurses from medical units and nurses from middle-sized hospitals. Organisational variables (the type of unit and type of hospital) influence the implicit rationing of nursing care in our study. The findings call for nursing managers to pay attention to organisational variables which may affect the implicit rationing of nursing care.

The Impact of Sociodemographic Factors on the Rationing of Nursing Care in Urology Wards

The problem of care rationing is widespread all over the world and results from many factors affecting nurses. These factors may result from the environment in which the nurses work, e.g., the atmosphere at work, or may not be related to work, e.g., place of residence. The aim of this study was to examine the impact of sociodemographic factors (place of residence, satisfaction with the financial situation, number of forms of postgraduate education, work system, number of patients per nurse, number of diseases) on care rationing, job satisfaction and quality of nursing care. The study is a cross-sectional study which includes 130 nurses from all over Poland who work in urology wards. The criteria for inclusion were consent to the examination, practicing the profession of a nurse, work in the urology department and work experience of at least 6 months, regardless of the number of hours worked (full-time/part-time). The study was conducted using the standardized PIRNCA (Perceived Implicit Rationing of Nursing Care) questionnaire. The average rationing nursing care was 1.11/3 points which means nursing care was rarely rationed. The average job satisfaction was 5.95/10 points, and the assessment of the quality of patient care was 6.88/10 points, which means a medium level of the job satisfaction and the quality of patient care. The rationing of care was affected by the number of nurse illnesses; job satisfaction was influenced by the place of residence and satisfaction with the financial situation, while the quality of care was not influenced by any of the analyzed factors. The result of care rationing is at a similar level as the results in Poland and abroad. Despite the rare rationing of care, employers should take corrective action, especially in terms of increasing the staff and health prevention of nurses.

The variables in the rationing of nursing care in cardiology departments

BackgroundThe rationing of nursing care is a complex process that affects the quality of medical services.PurposeAn assessment of the impact of nursing care rationing on burnout and life satisfaction in cardiology departments.MethodsThe study included 217 nurses working in the cardiology department. The Perceived Implicit Rationing of Nursing Care, the Maslach Burnout Inventory, and the Satisfaction with Life Scale were used.ResultsA greater emotional exhaustion, the more frequently the rationing of nursing care (r = 0.309, p < 0.061) and the lower the job satisfaction (r=-0.128, p = 0.061). Higher life satisfaction was associated with less frequent rationing of nursing care (r=-0.177, p = 0.01), better quality of care provided (r = 0.285, p < 0.001), and higher job satisfaction (r = 0.348, p < 0.01).ConclusionHigher levels of burnout contribute to more frequent rationing of nursing care, poorer evaluation of the quality of care provided, and lower job satisfaction. Life satisfaction is associated with less frequent rationing of care, better evaluation of the quality of care provided, and greater job satisfaction.

Rationing of Nursing Care and Patient Safety

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.

CROATIAN ADAPTATION AND VALIDATION OF THE PERCEIVED IMPLICIT RATIONING OF NURSING CARE (PIRNCA) QUESTIONNAIRE: A CROSS-SECTIONAL STUDY.

SUMMARYThe aim was to perform adaptation and validation of the Perceived Implicit Rationing of Nursing Care. Implicit delaying of nursing care is an intermediate step, linking nurses with the quality of outcomes for patients and nurses, and it is the result of prioritization of health care measures within the assigned group of patients cared for by nurses. The Perceived Implicit Rationing of Nursing Care instrument is a tool used to assess the rationing of care in nursing practice. Study participants were nurses working at hospital wards in 4 university hospitals in the Republic of Croatia. The questionnaire was filled-in by 438 nurses. Data were collected between April and November 2018. After principal axis factoring, a single factor solution based on the correlation matrix was adopted. The measured construct is one-dimensional, and the extracted factor explains 47.2% of its variance. Additionally, the reliability of the whole questionnaire was determined by using the internal consistency coefficient Cronbach alpha on the Perceived Implicit Rationing of Nursing Care with 31 of 0.96 particles, which is extremely high internal consistency reliability. In conclusion, the study found a high level of reliability and validity of the translated Perceived Implicit Rationing of Nursing Care questionnaire, fully comparable to that of the original. The questionnaire can be used to assess the phenomenon of implicit care rationing in Croatian hospitals.

The Relationship Between the Implicit Rationing of Nursing Care and Emotionally Intelligent Leadership Style.

The study examined relationships between nurses' perceptions of implicit rationing of nursing care and leadership style in the nursing work environment. Nurses' perceptions of higher amounts of implicit rationing of nursing care relate to perceptions of lower quality of care and poorer patient outcomes. This study was the 1st to examine leadership style and implicit rationing of nursing care. Using a cross-sectional survey study design, 35 039 RNs were randomly sampled during September 2017 to March 2018. Findings support an association between nurses' perceptions of an emotionally intelligent leadership style and lower amounts of implicit rationing of nursing care. Implicit rationing of nursing care in the nursing work environment is significantly associated with emotionally intelligent leadership style. Nurse executives, and nursing faculty in administrative-focused graduate programs, can provide development and education in emotionally intelligent leadership skills.

To what extent Unfinished Nursing Care tools coincide with the discrete elements of The Fundamentals of Care Framework? A comparative analysis based on a systematic review.

To establish whether, and to what extent, tools measuring Unfinished Nursing Care (UNC) that have been validated to date have the ability to detect the discrete elements of the 'Integration of care' dimension of The Fundamentals of Care Framework (The Framework). UNC and The Framework have been established as two separate research lines, focused on (a) omitted care and related tools, and (b) on how to improve patient care, respectively. However, no attempts have been made to date to establish whether, and to what extent, tools measuring UNC have the ability to represent the discrete elements of The Framework. A two-step study: (a) a secondary analysis of a systematic review up to June 2018 later updated in May 2020, followed by (b) a comparative analysis. A systematic review of studies on validated tools measuring UNC was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysesguideline. Then, researchers independently performed a comparative analysis between the extracted (a) discrete elements of The Framework and (b) items of the UNC tools retrieved. A total of 14 tools were analysed. The physical dimension of The Framework was the one mostly covered by UNC tools (up to 87.5% with the Perceived Implicit Rationing of Nursing Care). The Norwegian Basel Extent of Rationing of Nursing Care showed the highest level of representation (41.6%) for the psychosocial dimension. Only the Perceived Implicit Rationing of Nursing Care and the Unfinished Care tool measure the relational dimension (22.2%, respectively). By considering all elements of the 'Integration of care' dimension, the Perceived Implicit Rationing of Care had the highest percentage of convergence (41%). Not all UNC tools have the same ability to represent the discrete elements of The Framework. Moreover, physical needs are more often detected in UNC tools compared to the relational and psychological ones. Unfinished care tools validated to date can represent a body of knowledge on which to build The Framework metrics, especially for the physical dimensions.

Psychometric testing of perceived implicit rationing of nursing care (PIRNCA).

To evaluate the psychometric properties of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument and to report the prevalence of rationed care at university and faculty hospitals. A cross-sectional study. The study was carried out at two university and five faculty hospitals in the Slovak Republic. Participants were 895 Registered Nurses recruited by the purposive sampling method between December 2017-July 2018. Data were collected using the PIRNCA instrument. Construct validity and reliability of the instrument were tested. The prevalence of rationed care at university and faculty hospitals was identified as being 42.1%. Furthermore, 87.6% of nurses reported rationing one or more nursing care activities. Using both statistical methods when evaluating the PIRNCA resulted in the confirmation that the tool is valid and reliable. Rationed care is a common phenomenon at university and faculty hospitals. The PIRNCA is a suitable instrument to measure the phenomenon in adult acute care units because of its high reliability and validity. We recommend using the instrument in different contexts, not only for specific conditions that were presented for this study. Rationed care at university and faculty hospitals has never been reported. Psychometric properties of the instrument that measures nurses´ perception of rationed care have never been evaluated by using different approaches. The most frequently rationed nursing care activities are those that nurses are competent to initiate on the basis of their knowledge and skills - the independent ones. The PIRNCA is a valid and reliable instrument. Hospital management can use the instrument to explore the prevalence of rationed care, followed by the application of prevention strategies. Our findings represent the base for further exploration of rationed care using the PIRNCA.

Polish adaptation and validation of the Perceived Implicit Rationing of Nursing Care (PIRNCA) questionnaire: a cross-sectional validation study

ObjectivesTo develop a Polish adaptation of the Perceived Implicit Rationing of Nursing Care (PIRNCA)questionnaire.DesignCross-sectional validation study.SettingsNurses working in surgical and cancer wards in Poland.ParticipantsA sample of 513 professionally active nurses...

Approaches to understanding the phenomenon of missed/rationed/unfinished care - a literature review

Aim: This literature review aims to describe, analyze and compare approaches to the phenomenon of missed/rationed/unfinished nursing care, in order to better our understanding of it. Design: A narrative literature review. Methods: A method of content analysis of studies published in the scientific databases PubMed, ScienceDirect, ProQuest, and Wiley Library Online was used. Studies were selected using a set of criteria and keywords for the period 2000-2018. Twenty-one studies were analyzed in the processing of the literature review. Results: We identified the four most common approaches or conceptual frameworks used to describe the phenomenon from the available literature - Missed Care, Implicit Rationing of Nursing Care, Task Undone and the theoretical proposition, Failure to Maintain, each of which explicitly describes a particular aspect of the phenomenon, and provides us with a theoretical framework and structure. Conclusion: This review contributes to the overview of particular approaches or theoretical frameworks used to understand the phenomenon. It is necessary to understand the terminology, and to use it appropriately. All approaches identified associations between the phenomenon and negative outcomes for patients as a quality-of-care indicator.

Validation of the Perceived Implicit Rationing of Nursing Care (PIRNCA) Instrument

An inverse relationship between implicit rationing and quality patient outcomes has been demonstrated in European hospitals, but this relationship has not been explored in the United States. To evaluate the psychometric properties of a new measure of implicit rationing, the Perceived Implicit Rationing of Nursing Care (PIRNCA). A cross-sectional survey design with a stratified random sample of 226 medical surgical nurses was used to evaluate the PIRNCA. The internal structure was evaluated using exploratory factor analysis. Pearson correlations were used to assess the associations between implicit rationing and three related constructs: work environment, overall job satisfaction, and quality of care. A single-factor solution explaining 55% of the total variance and excellent reliability, Cronbach's alpha = 0.97, was supported for the PIRNCA. Moderate inverse relationships with related constructs provided evidence of concurrent validity: work environment (-0.44), overall job satisfaction (-0.48), and quality of care (-0.56). The majority of nurses (97%) reported rationing at least one of the 30 care activities listed; however, mean scores reflected a low frequency ("rarely") of rationing overall. The phenomenon of implicit rationing is experienced by nurses in U.S. hospitals, and the PIRNCA instrument is a valid and reliable measure of this phenomenon.

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

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.