Předkládaný příspěvek se věnuje problematice přidělované ošetřovatelské péče (rationing), která se v důsledku nastaveného systému poskytování zdravotních služeb dostává do popředí v odborných diskusích. Přidělovanou ošetřovatelskou péči můžeme definovat jako proces alokace omezených zdrojů, která by měla být v ideálním stavu naprosto spravedlivá a efektivní. Ve zdravotnictví je aplikována přidělovaná péče ve formě explicitní nebo ve formě implicitní. Explicitní přidělovaná péče je prováděna na úrovni administrativní a je založena na podkladě otevřeného přijetí nedostatečných zdrojů. Implicitní přidělovaná péče je aplikována na úrovni zdravotnického pracovníka a konkrétního pacienta, kdy v důsledku limitace zdrojů dochází k omezení péče, o kterém rozhodne samotný zdravotnický pracovník. Tento stav je velkým sociálním a morálním problémem, jelikož nejsou přesně stanovená pravidla a hranice na základě, kterých k omezení péče dochází. V rámci provedených zahraničních studií je doložitelný negativní vliv implicitní přidělované péče na poskytování ošetřovatelské péče. Má negativní dopad na bezpečí a zdraví pacienta. Dále ovlivňuje pracovní prostředí a firemní kulturu zdravotnických zařízení. Základními faktory implicitní přídělové péče v důsledku, kterých dochází k negativnímu vlivu na ošetřovatelskou péči, jsou nedostatečné personální zdroje, špatné pracovní prostředí, týmová spolupráce, nadměrný pracovní stres a samotný systém nastavení priorit.
The presented document deals with the rationing in nursing care, which due to current system of providing health care services comes to the fore in professional discussions. Allocation of nursing care can be defined as the allocation process of the limited resources, which should be in ideal condition absolutely fair and effective. The allocated care is applied in an explicit or an implicit form in the healthcare. Explicit allocating care is performed on the administrative level and is based on an open acceptance of inadequate resources. Implicit allocated care is applied at the level of the healthcare worker and the individual patient. Due to the limitation of resources, the healthcare is limited too and healthcare worker himself decides about restrictions on treatment. This state is a major social and moral problem, because they are not well-defined rules and limits, under which the limitation care is performed. The negative impact of the implicit allocated care on nursing care is documented in the performed foreign studies. Has a negative impact on the safety and health of the patient. Also affects the working environment and corporate culture of health facilities. The basic factors of implicit rationing care, for which there is a negative impact on nursing care, are insufficient personnel resources, poor working environment, teamwork, excessive work stress and the very system of setting priorities.
AIM: To examine Croatian nurses' perception of implicit nursing care rationing and the patient safety culture from the perspective of acute care hospital staff. BACKGROUND: In the past three decades, the Croatian health system has undergone numerous transformations driven by geopolitical, legal, financial, demographic, scientific and technological progress. These changes have led to systemic changes in the structure, organisation, financing and delivery of health care, and thus, of nursing care. METHODS: A cross-sectional study of 438 nurses was conducted at four university hospitals in Croatia, based on the Perceived Implicit Rationing of Nursing Care Questionnaire. RESULTS: A lower assessment of the quality of care in the unit is associated with a higher score on the Perceived Implicit Rationing of Nursing Care Questionnaire, r = -.379, p < .001. A lower satisfaction with the current workplace is associated with a higher score on the Perceived Implicit Rationing of Nursing Care Questionnaire, r = -.432, p < .001. CONCLUSION: The perception of nurses in Croatia indicates that the implications of nursing care rationing and dissatisfaction with their post in acute care hospital units are closely related to poor quality of nursing care provided to patients. IMPLICATIONS FOR NURSING MANAGEMENT: Based on these results, nurse managers should take their nurses' perceptions of implicit nursing care rationing into consideration in order to develop strategies to improve nursing care delivery, nursing satisfaction and, consequently, better nursing care quality.
- MeSH
- Humans MeSH
- Nursing Care * MeSH
- Perception MeSH
- Nursing Staff, Hospital * MeSH
- Health Care Rationing MeSH
- Cross-Sectional Studies MeSH
- Surveys and Questionnaires MeSH
- Nurse Administrators * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Croatia MeSH
AIMS: 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. DESIGN: A cross-sectional study. METHODS: 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. RESULTS: 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. CONCLUSION: 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. IMPACT: 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.
- MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Nursing Care organization & administration statistics & numerical data MeSH
- Nursing Staff, Hospital organization & administration statistics & numerical data MeSH
- Health Care Rationing organization & administration statistics & numerical data MeSH
- Cross-Sectional Studies MeSH
- Surveys and Questionnaires MeSH
- Psychometrics MeSH
- Reproducibility of Results MeSH
- Social Validity, Research * MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Slovakia MeSH
AIM: The aim of the study was to find differences in perceived reasons for implicit rationing of nursing care across hospital types and units. DESIGN: A descriptive multicentre study. METHODS: The study in 14 Czech acute care hospitals was conducted from September 2019 to October 2020. The sample consisted of 8316 nurses working in medical and surgical units. Items for rating the reasons for implicit rationing of nursing care were selected from the MISSCARE Survey. Nurses were asked to rate each item on a scale from 0 (a not significant reason) to 10 (the most significant reason). RESULTS: The most significant reasons for implicit rationing of nursing care were 'Inadequate number of staff', 'Inadequate number of assistive personnel' and 'Unexpected patient admission and discharge'. Most reasons were rated as more significant by nurses from non-university hospitals. Nurses from medical units perceived all reasons for implicit rationing of nursing care as more significant.
Cieľ: Cieľom tejto štúdie bolo identifikovať hlavné faktory, ktoré prispievajú k implicitne prideľovanej ošetrovateľskej starostlivosti v Slovenskej republike. Dizajn: Zmiešaná štúdia. Metódy: Do našej štúdie sme zahrnuli 504 sestier z dvoch univerzitných a troch fakultných nemocníc. Respondenti, ktorí odpovedali na otvorenú otázku boli zahrnutí do ďalšej analýzy. Nástroj The Perceived Implicit Rationing of Nursing Care (PIRNCA) bol použitý pre meranie implicitne prideľovanej ošetrovateľskej starostlivosti. V tejto štúdii bola otvorená otázka v dotazníku predmetom tematickej analýzy. Výsledky: Boli identifikované štyri hlavné témy týkajúce sa personálu, materiálového zabezpečenia, dokumentácie a manažmentu. Okrem toho sa objavili aj ďalšie problémy, ktoré sa netýkali priamo problematiky. Záver: Identifikované faktory boli považované za významné. V rámci našej štúdie bol dôraz kladený na tri hlavné faktory, ktoré boli opísané vo vzťahu k ošetrovateľskej profesii. Tieto faktory môže zlepšiť len manažment. Preto prezentujeme výsledky vo vzťahu k manažmentu nemocníc.
Objective: This study aimed to identify the main contributing factors to the implicit rationing of nursing care in the Slovak Republic. Design: A mixed-method study. Methods: In our study, we included 504 registered nurses from two university hospitals and three teaching hospitals. Respondents who answered the open-ended question were involved in the further analysis. The Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument was used for measuring the implicit rationing of nursing care. The open-ended question in the questionnaire was the subject of the thematic analysis in this study. Results: Four major topics were identified regarding staffing issues, material resources, documentation, and management issues. Moreover, other problems unrelated to the issues emerged. Conclusions: Identified factors were considered to be significant. Within our study, the emphasis was placed on three main factors which were described concerning the nursing profession. Only management can improve these conditions. Therefore we present the results for further consideration by hospital management.
- MeSH
- Nursing Care MeSH
- Health Care Rationing MeSH
- Surveys and Questionnaires MeSH
- Nurses MeSH
- Geographicals
- Slovakia MeSH
- NML Publication type
- studie
AIMS AND OBJECTIVES: 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. BACKGROUND: Implicit rationing of nursing care may differ across different types of hospitals and hospital units. DESIGN: This study used a multicentre cross-sectional study design. METHODS: 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. RESULTS: 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. CONCLUSION: 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. RELEVANCE TO CLINICAL PRACTICE: The findings call for nursing managers to pay attention to organisational variables which may affect the implicit rationing of nursing care.
- MeSH
- Hospital Units MeSH
- Humans MeSH
- Hospitals MeSH
- Nursing Care * MeSH
- Nursing Staff, Hospital * MeSH
- Health Care Rationing methods MeSH
- Cross-Sectional Studies MeSH
- Nurses * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
AIM: The aim of the study was to adapt and validate the perceived implicit rationing of nursing care instrument in the Slovak nurse work environment and to evaluate the prevalence of unfinished nursing care in acute care hospitals. BACKGROUND: The measurement of unfinished nursing care could be assumed as a proxy indicator of nurse staffing adequacy or higher risk of adverse events. METHODS: A cross-sectional survey design was used. The sample of 1,429 registered nurses from 21 hospitals in Slovakia was recruited. Exploratory factor analysis, confirmatory factor analysis and internal reliability were performed. RESULTS: The instrument is essentially rather an inventory than scale per se. Concurrent validity of the Slovak version was supported by the significant associations between unfinished nursing care and clinically relevant variables. CONCLUSIONS: The prevalence of unfinished nursing care based the percentage of positive responses was higher than prevalence based on composite mean scores. Findings from the study raise questions about a unidimensional structure of nursing tasks reflected in most commonly used survey instruments of unfinished nursing care internationally. IMPLICATIONS FOR NURSING MANAGEMENT: The periodical measurement of unfinished nursing care based on the percentage of positive responses should be assumed as a key strategy to increase patient safety and quality of nursing care.
- MeSH
- Factor Analysis, Statistical MeSH
- Humans MeSH
- Nursing Care * MeSH
- Prevalence MeSH
- Health Care Rationing MeSH
- Cross-Sectional Studies MeSH
- Surveys and Questionnaires MeSH
- Reproducibility of Results MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Slovakia MeSH
Cieľ: Cieľom tejto štúdie bolo identifikovať hlavné faktory, ktoré prispievajú k implicitne prideľovanej ošetrovateľskej starostlivosti v Slovenskej republike. Dizajn: Zmiešaná štúdia. Metódy: Do našej štúdie sme zahrnuli 504 sestier z dvoch univerzitných a troch fakultných nemocníc. Respondenti, ktorí odpovedali na otvorenú otázku boli zahrnutí do ďalšej analýzy. Nástroj The Perceived Implicit Rationing of Nursing Care (PIRNCA) bol použitý pre meranie implicitne prideľovanej ošetrovateľskej starostlivosti. V tejto štúdii bola otvorená otázka v dotazníku predmetom tematickej analýzy. Výsledky: Boli identifikované štyri hlavné témy týkajúce sa personálu, materiálového zabezpečenia, dokumentácie a manažmentu. Okrem toho sa objavili aj ďalšie problémy, ktoré sa netýkali priamo problematiky. Záver: Identifikované faktory boli považované za významné. V rámci našej štúdie bol dôraz kladený na tri hlavné faktory, ktoré boli opísané vo vzťahu k ošetrovateľskej profesii. Tieto faktory môže zlepšiť len manažment. Preto prezentujeme výsledky vo vzťahu k manažmentu nemocníc.
Objective: This study aimed to identify the main contributing factors to the implicit rationing of nursing care in the Slovak Republic. Design: A mixed-method study. Methods: In our study, we included 504 registered nurses from two university hospitals and three teaching hospitals. Respondents who answered the open-ended question were involved in the further analysis. The Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument was used for measuring the implicit rationing of nursing care. The open-ended question in the questionnaire was the subject of the thematic analysis in this study. Results: Four major topics were identified regarding staffing issues, material resources, documentation, and management issues. Moreover, other problems unrelated to the issues emerged. Conclusions: Identified factors were considered to be significant. Within our study, the emphasis was placed on three main factors which were described concerning the nursing profession. Only management can improve these conditions. Therefore we present the results for further consideration by hospital management.
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:Anarrative literature review. Methods:Amethod 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 Undoneand thetheoretical 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 aquality-of-care indicator.
- MeSH
- Medical Errors * MeSH
- Quality of Health Care MeSH
- Humans MeSH
- Meta-Analysis as Topic MeSH
- Nursing Care * MeSH
- Health Care Rationing MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
Rationed nursing care is a significant problem in healthcare facilities worldwide. Awareness of contributing factors to rationed care might support the development and implementation of strategies for reducing this phenomenon from clinical practice. The study examined the association between selected hospital, unit, and staff variables and the prevalence of rationed nursing care. Secondary analysis of cross-sectional data collected between December 2017 and July 2018 from 895 registered nurses in seven acute care hospitals in the Slovak Republic was performed. Data were collected using the questionnaire Perceived Implicit Rationing of Nursing and analyzed by descriptive and inferential statistics in the statistical program SPSS 25.0. Statistically significant associations were found between rationed nursing care and unit type, education, shift type, nurses' experience in the current unit, overtime hours, missed shifts, intention to leave the position, perceived staff adequacy, quality of patient care, and job satisfaction. Differences in rating rationed nursing care, quality of patient care, and job satisfaction were identified based on hospital type. Together with top hospital management, nurse managers should develop targeted interventions focusing on mitigating rationed nursing care from the clinical practice with a focus placed on university hospitals. Quality and safe care might be ensured through constant monitoring of the quality of patient care and job satisfaction of nurses as these factors significantly predicted the estimates of rationed nursing care.
- MeSH
- Humans MeSH
- Nursing Staff, Hospital * MeSH
- Job Satisfaction MeSH
- Health Care Rationing * MeSH
- Cross-Sectional Studies MeSH
- Surveys and Questionnaires MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Slovakia MeSH
