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.
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.
Multiple myeloma is a complex disease and supportive care is important for improving quality of life. Management of disease treatment symptoms, bone disease, renal dysfunction, infection, anemia, ...pain, and coagulation disorder are specific issues. Spirituality, or spiritual well-being, is one of the most fundamental and essential concepts for coping with the difficulties and stress caused by cancer.
This study explores whether spiritual well-being, pain, and other demographic factors predict the physical and mental components of quality of life in MM subjects.
This cross-sectional descriptive study was conducted with 92 multiple myeloma patients registered with the Cancer Warriors Association in Turkey. The data were collected using the Personal Information Form, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12, the Numeric Rating Scale for Pain, and the Short Form-12 Health-Related Quality of Life Scale.
The mean age of the patients was 54.4 ± 10.7 years. It was found that the mean total pain score in the previous week was 3.9 ± 2.6, while the mean total The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 score was 28.1 ± 9.8. Their mean Short Form-12 total physical component score was 39.1 ± 25.4; whereas the Short Form-12 total mental component score was 45.5 ± 24.8. According to this model, 56.7% of the physical component score was explained by vertebroplasty, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 total score and subscale of peace and the pain intensity experienced in the previous week. According to multiple linear regression analysis, bone-sparing therapy and FACIT-Sp-12-Total and subscale peace significantly predicted the Mental component score (p < .05).
Cancer pain remains undertreated, and patients with myeloma are no exception. Pain and spiritual well-being scores were significant predictors of physical and mental component scores of quality of life in this group of patients. According to this result, pain-reducing practices should be implemented to improve the quality of life in MM patients and the spiritual needs of the patients should be met.
Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon.
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.
Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study.
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.
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.
Exposure to hazardous drugs (HDs) poses many significant risks to healthcare workers. Side effects range from gastrointestinal and respiratory complaints to infertility and miscarriages. Research has ...shown that HD contamination can spread from pharmacy areas and administration areas to other clinical and non-clinical locations within the healthcare facility. As a part of a comprehensive HD plan, the United States Pharmacopeia chapter 800 (USP ) recommends regular surface wipe testing to assess vulnerabilities in compounding and administration and highlight areas for improvement. Sequential wipe testing was performed in an ambulatory comprehensive cancer center to test for HD residue in 4 pharmacy compounding areas and 2 administration areas. Tested drugs included paclitaxel, 5-FU, cyclophosphamide, methotrexate, and doxorubicin. Testing occurred between December 2020 and June 2021 and was performed at baseline, 3 months and at 6 months using the sampling technique specified by ChemoGLO. The authors sampled the interior of a biological safety cabinet (BSC), air grate of BSC, floor in front of the BSG, floor of the personal protective equipment (PPE) doffing area in the compounding room, and the mixing bin for staging items needed for sterile HD compounding. In the administration area, the legs of one marked IV pole was tested along with the handle of a designated telephone at a nursing station. The identical locations and procedures were used by the authors for all 3 testing periods. The majority of the IV HD compounding, and all administrations were performed using the GhemoLock GSTD. Test number one revealed two areas above the level of detection (LOD); the mixing bin (5FU) and the IV pole (paclitaxel). Tests 2 and 3 were below the LOD for all drugs in all areas. USP requires a 4-step cleaning/decontamination process for sterile compounding of HDs. The process was not utilized consistently for the mixing bins and could explain initial HD residue. Decontamination frequency was increased after the first results. While the IV pole was wiped down with an antimicrobial cloth between each patient, the legs were not included in the cleaning procedure, nor is it known how long the paclitaxel contamination had been there. This project demonstrated effectiveness of the CSTD and the need for improvement in cleaning the IV poles. Process changes and cleaning products are currently being discussed.
At Karmanos Cancer Center nursing care is delivered using the principles of the Relationship-Based care model. One of the principles in the model is care of self; one way organizations can promote a ...caring environment is by providing self-care initiatives through education. The COVID pandemic has placed additional stressors on staff not only at work, but also at home. Staff expressed an interest in learning more about self-care and requested additional information. At the time, the organization/unit did not have self-care specific information available for the staff. The purpose of this process improvement project was to provide staff resources on self-care initiatives and heighten the awareness of the importance of self-care. A wellness board was created next to the time clock for staff to view. The wellness board has areas to place information related to mindfulness, exercise, and healthy eating with a goal of changing out information monthly. Once created all staff were educated on development and purpose of the wellness board through email communication. The wellness board is updated by various members of the team and all team members are encouraged to add information they find helpful. After the wellness board was created, the staff were encouraged to discuss self-care throughout the day. Some staff have found the board helpful, but unfortunately it has not been as engaging as originally thought. It has been difficult to have additional staff members providing resources for the board as originally thought. The placement of the board is being evaluated to see if it includes all staff (including those that do not punch in with a time clock). Other units throughout the healthcare system are also looking at the use of a wellness board. Self-care is an important part of an oncology nurse's day especially as they deal with the complexity of care related to GOVID and restrictions. A wellness board is a method to be able provide education related to self-care and can easily be replicated in other areas. With proper placement the wellness board can encourage staff to think about wellness and how it can easily be integrated into their busy lives. The wellness board can also promote an environment in which the staff feel supported and valued by leadership and other colleagues.
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