Background
Rationing of care in nursing is nurses' inability to complete all care activities for patients because of scarcity in time and resource. Literature suggests that rationing of care is ...closely related to patient safety and quality of care. The phenomena have been defined and studied from varied perspectives and contexts. A systematic review of studies related to the concept was aimed at identifying and synthesizing the finding.
Methods
The review followed Preferred Reporting Items for Systematic Reviews and Meta‐analysis guidelines, and literature searches were conducted in MEDLINE, CINAHL, PsycInfo, Web of Science and EMBASE databases. Fifty‐seven quantitative studies were included in the review.
Findings
The review observed that nursing activities addressing the emotional, educational, mobility and hygiene needs of the patients were commonly rationed. Antecedents of rationing included resource inadequacy and organizational work environment. Rationing influenced patient satisfaction, mortality and a number of adverse events and was associated with decreased job satisfaction, increased intention to leave and high turnover among nurses.
Discussions
This review concludes that rationing in nursing is ubiquitous, embedded in the work environment and poses a threat to the professional health and philosophical base of nursing in addition to having serious implications on patients' safety. Strategies to reframe and reconsider organizational traits, and open discussion with other healthcare stakeholders can reduce rationing of nursing care. The review suggests future researchers adopt different methodological layout to study rationing.
Aims and objectives
To generate a standardised definition for fundamental care and identify the discrete elements that constitute such care.
Background
There is poor conceptual clarity surrounding ...fundamental care. The Fundamentals of Care Framework aims to overcome this problem by outlining three core dimensions underpinning such care. Implementing the Framework requires a standardised definition for fundamental care that reflects the Framework's conceptual understanding, as well as agreement on the elements that comprise such care (i.e., patient needs, such as nutrition, and nurse actions, such as empathy). This study sought to achieve this consensus.
Design
Modified Delphi study.
Methods
Three phases: (i) engaging stakeholders via an interactive workshop; (ii) using workshop findings to develop a preliminary definition for, and identify the discrete elements that constitute, fundamental care; and (iii) gaining consensus on the definition and elements via a two‐round Delphi approach (Round 1 n = 38; Round 2 n = 28).
Results
Delphi participants perceived both the definition and elements generated from the workshop as comprehensive, but beyond the scope of fundamental care. Participants questioned whether the definition should focus on patient needs and nurse actions, or more broadly on how fundamental care should be delivered (e.g., through a trusting nurse–patient relationship), and the outcomes of this care delivery. There were also mixed opinions whether the definition should be nursing specific.
Conclusions
This study has initiated crucial dialogue around how fundamental care is conceptualised and defined. Future work should focus on further refinements of the definition and elements with a larger, international group of practising nurses and service users.
Relevance to clinical practice
The definition and elements, through ongoing refinement, will contribute to a robust evidence base that will underpin policy development and the systematic and effective teaching, delivery, measurement and evaluation of fundamental care.
There is no agreed minimum standard with regard to what is considered safe, competent nursing care. Limited resources and organizational constraints make it challenging to develop a minimum standard. ...As part of their everyday practice, nurses have to ration nursing care and prioritize what care to postpone, leave out, and/or omit. In developed countries where public healthcare is tax-funded, a minimum level of healthcare is a patient right; however, what this entails in a given patient’s actual situation is unclear. Thus, both patients and nurses would benefit from the development of a minimum standard of nursing care. Clarity on this matter is also of ethical and legal concern. In this article, we explore the case for developing a minimum standard to ensure safe and competent nursing care services. Any such standard must encompass knowledge of basic principles of clinical nursing and preservation of moral values, as well as managerial issues, such as manpower planning, skill-mix, and time to care. In order for such standards to aid in providing safe and competent nursing care, they should be in compliance with accepted evidence-based nursing knowledge, based on patients’ needs and legal rights to healthcare and on nurses’ codes of ethics. That is, a minimum standard must uphold a satisfactory level of quality in terms of both professionalism and ethics. Rather than being fixed, the minimum standard should be adjusted according to patients’ needs in different settings and may thus be different in different contexts and countries.
Aims and objectives
To investigate how fundamental aspects of nursing care have been defined in the literature from 2010–2016.
Background
A 2010 narrative review of nursing texts identified little ...consensus on what constitutes the fundamental aspects of nursing care. Since then there has been a proliferation of policies, strategic frameworks and research teams dedicated to investigating such care. It is unclear whether this increased activity has led to greater conceptual clarity.
Design
Scoping review using the Joanna Briggs Institute methodology.
Methods
A search of published and grey literature was undertaken using CINAHL, Scopus, PubMed and ProQuest. Documents providing a definition for fundamental aspects of nursing care were included for review. Definitions were identified and mapped.
Results
Forty‐nine documents were included. Two ways of constructing the discourse around fundamental aspects of nursing care were identified: compassionate care (n = 25) and fundamentals of care (n = 24). The literature on compassionate care focused primarily on the moral attributes of nurses and their ability to establish meaningful connections with patients. The literature on fundamentals of care was split between describing such care as a list of nursing activities and describing it as a complex, multidimensional construct.
Conclusions
There appears to be a lack of consensus around how fundamental aspects of nursing care are defined. Compassionate care and fundamentals of care have commonalities in terms of emphasising the nurse–patient relationship; however, only the literature on fundamentals of care addresses patients’ physical care needs. Despite their commonalities, it seems the two bodies of work are being developed largely independent of one another.
Relevance to clinical practice
This scoping review identified areas of convergence and divergence around fundamental aspects of nursing care. An agreed definition for such care is needed to enable the development of a robust evidence base to underpin the coherent and consistent development of nursing practice.
In dieser werden die Empfehlungen zusammengefasst und mit markanten Überschriften oder Slogans sowie humorvollen Bildern kombiniert. Beteiligt waren daran 25 Pflegeexpertinnen und -experten bzw. ...erfahrene Pflegerpersonen, das Department für Evidenzbasierte Medizin und Evaluation mit Cochrane Österreich an der Universität für Weiterbildung Krems, sowie das Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung (IAMEV) der Medizinischen Universität Graz. The association between nurse staffing and omissions in nursing care: A systematic review.
Introduction: The sizable population of people with respiratory conditions places a significant demand on healthcare services and a need for specialized nursing care.
Aim: The ERS Nursing Group ...recognized the need for harmonized curricula for respiratory nurses. The following steps incorporate the knowledge and experience of academic and clinical experts.
Methodology: Steps in the Delphi Process for ICRN (Cantrill, et al. Int. J Pharm. Prac, 1996):
1) 2020 - Choose Facilitator; ERS chair & 2 researchers (Sajnic A, Narsavage G, Kelly C),
2) 2020 - Identify Experts; ICRN Advisory Group, in 2021, a group was added to support patient involvement,
3) 2021 - Define the Problem; ICRN Global Needs Survey (Narsavage et al.) confirmed the need for ICRN and assessed the status of respiratory nursing in 25 countries worldwide,
4) Review the literature; scoping review in process (2022) for a starting point for survey questions,
5) Round One Questions; country-based focus groups and literature summarized by the advisory group will form survey for global group. Common items will constitute a Round Two survey,
6) Round Two Questions; a survey will identify ICRN items and summarize common areas,
7) Round Three Questions; what the experts are all agreed upon will be answered,
8) Act on Findings; a consensus document for the core curriculum will be published.
Conclusion: Worldwide recognition of respiratory nursing as a speciality with a harmonized ICRN based on the Delphi process can be effective in improving the quality of care and patients' outcomes in active partnerships with other healthcare professionals
Background Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon. Aim The aim of this study is to describe the prevalence and patterns of nursing ...care left undone across European hospitals and explore its associations with nurse-related organisational factors. Methods Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study. Results Across European hospitals, the most frequent nursing care activities left undone included ‘Comfort/talk with patients’ (53%), ‘Developing or updating nursing care plans/care pathways’ (42%) and ‘Educating patients and families’ (41%). In hospitals with more favourable work environments (B=−2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone. Conclusions Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.
Assessing the right number and type of nursing staff to meet patient care needs is fundamental to inpatient care. Correctly identifying specific patient care needs per shift and equally balancing ...nursing workload increases nurse satisfaction and optimizes resources needed to provide appropriate levels of care. Subjective acuity grading results in perception of unbalanced assignments, increased nursing workload, frustration, and inaccurate representation of patient needs per shift on a stem cell transplant (SCT) inpatient unit. The goal of this project was to develop and implement an objective acuity tool to accurately define patient acuity based on specific needs and care required for SCT patients, appropriately balance nursing workload, and increase nurse satisfaction with patient acuity in their assignments. Observation and pre-survey feedback on the existing process and tool supported the need for a more defined grading approach. An objective acuity tool was designed to the needs of the SCT population. Educational materials were created for staff in-services and a bulletin board was displayed in the break room. Paper copies of the tool were completed by every nurse and collected each shift by the charge nurse. The total number for acuity was utilized by the charge nurse when creating assignments. Revisions were made based on staff feedback and a post survey was completed following initial roll out. 87% of staff perceived the objective acuity tool as accurately reflecting their patient care needs, compared to 26% with the subjective tool. 74% of staff felt there was an equal distribution and balanced nursing workload, compared to 26% with the subjective tool. 65% satisfaction with the patient acuity in assignments was also seen, an increase of 45%. The development and implementation of an objective patient needs-based acuity tool was successful on the SCT inpatient unit, with 97% of staff feeling the new acuity tool has been beneficial, and 94% rating they would like to continue using the tool. Literature supports the use of a tailored tool in specialized patient populations for it more accurately reflects necessary levels of care and leads to improved patient outcomes. Since the SCT population comes with its own specific set of needs that creates complexity in care, it is vital that they are accurately represented to provide the safest and highest quality nursing care.
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