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.
Aim
To propose a hypothesized theoretical model and apply it to examine the structural relationships among work environment, patient‐to‐nurse ratio, job satisfaction, burnout, intention to leave and ...quality nursing care.
Background
Improving quality nursing care is a first consideration in nursing management globally. A better understanding of factors influencing quality nursing care can help hospital administrators implement effective programmes to improve quality of services. Although certain bivariate correlations have been found between selected factors and quality nursing care in different study models, no studies have examined the relationships among work environment, patient‐to‐nurse ratio, job satisfaction, burnout, intention to leave and quality nursing care in a more comprehensive theoretical model.
Design
A cross‐sectional survey.
Methods
The questionnaires were collected from 510 Chinese nurses in four Chinese tertiary hospitals in January 2015. The validity and internal consistency reliability of research instruments were evaluated. Structural equation modelling was used to test a theoretical model.
Results
The findings revealed that the data supported the theoretical model. Work environment had a large total effect size on quality nursing care. Burnout largely and directly influenced quality nursing care, which was followed by work environment and patient‐to‐nurse ratio. Job satisfaction indirectly affected quality nursing care through burnout.
Conclusions
This study shows how work environment past burnout and job satisfaction influences quality nursing care. Apart from nurses’ work conditions of work environment and patient‐to‐nurse ratio, hospital administrators should pay more attention to nurse outcomes of job satisfaction and burnout when designing intervention programmes to improve quality nursing care.
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.
Tennessee Oncology is a multi-site practice with more than 30 locations across Tennessee and northern Georgia. Tennessee Oncology has a high percentage of patients with implanted central venous ...access devices (ports). These devices were routinely accessed for reasons beyond chemo-immunotherapy infusions, including but not limited to blood draws, supportive care medications administration, and scans. Time studies completed in 2020 showed that port access for blood collection increased the time to obtain lab results by 7 minutes per draw. In some cases, delays up to 45 minutes occurred if troubleshooting was required during the access. An increase in incidence of compromised specimen integrity due to the presence of flush solution or other medications in the lumen or from poor specimen collection technique was also seen. This was quantified through number of hemolyzed specimens, increased/inaccurate clotting times, and diluted sam- pies. Impaired specimen integrity impacted the providers' ability to make accurate treatment decisions and caused treatment delays because of repeat collection and processing. A review of literature supported the process change by validating an increased risk of central line associated bloodstream infections (GLABSI) with repeated/frequent port access. Risk for catheter associated clots was also a consideration for making a change. To increase efficiency of patient throughput and reduce port access frequency, the decision was made to pilot transitioning lab specimen collection from the port to venipuncture or fingerstick. The goals of the pilot were to expedite lab results and reduce risk for GLABSI and clot formation by reserving port use for infusion therapy. Each clinic was tasked with shifting the port access from the laboratory staff to nursing staff in the infusion suite. Patients were only accessed after the determination was made to proceed with treatment. Data was gathered throughout the transition on compliance with the change, patient time through the clinics and integrity of lab specimens. The outcome of the pilot was positive. Some clinics were able to reduce total port draws by as much as 20% in the first four months and preliminary data showed improved efficiency of workflows in the clinics. The pilot was extended into an enterprise-wide process change. It is projected that ongoing data collection will show impact on quality and efficiency of care and a reduction in port complications across the practice.
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.
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