Rationing of Nursing Care in Intensive Care Units
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Instruments
2.3. Participants
2.4. Data Collection Procedures and Statistic Procedure
2.5. The Ethical Procedure
3. Results
3.1. The Characteristics Features of the Nurses’ Health
3.2. The Characteristics of Working Conditions
3.3. The Nursing Practice Environment and Rationing of Nursing Care
3.4. MFIS and Rationing of Nursing Care
4. Discussions
4.1. The Implication for Nursing Practice
4.2. The Limitation
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- Regulation of the Minister of Health of December 12, 2018 Amending the Regulation on the Organizational Standard of Health Care in the Field of Anesthesiology and Intensive Care (Dz.U. 2018 poz. 2381). Internet System of Legal Acts in Poland. Available online: https://isap.sejm.gov.pl/isap.nsf/DocDetails.xsp?id=WDU20180002381 (accessed on 22 September 2020).
- Gostyńska, A.; Stawny, M.; Dettlaff, K.; Jelińska, A. Clinical Nutrition of Critically Ill Patients in the Context of the Latest ESPEN Guidelines. Medicina 2019, 55, 770. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Preiser, J.-C.; Ichai, C.; Orban, J.-C.; Groeneveld, A.B.J. Metabolic response to the stress of critical illness. Br. J. Anaesth. 2014, 113, 945–954. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kusza, K.; Kübler, A.; Maciejewski, D.; Mikstacki, A.; Owczuk, R.; Wujtewicz, M.; Piechota, M. Guidelines of the Polish Society of Anaesthesiology and Intensive Therapy determining principles, conditions and organisational aspects of anaesthesiology and intensive therapy services. Anestezjol. Intensywna Ter. 2013, 44. [Google Scholar]
- Zhu, X.; Zheng, J.; Liu, K.; You, L.-M. Rationing of Nursing Care and Its Relationship with Nurse Staffing and Patient Outcomes: The Mediation Effect Tested by Structural Equation Modeling. Int. J. Environ. Res. Public Health 2019, 16, 1672. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kalisch, B.J. Missed nursing care: A qualitative study. J. Nurs. Care Qual. 2006, 21, 306–315. [Google Scholar] [CrossRef] [Green Version]
- Ulrich, B.T.; Lavandero, R.; Woods, D.; Early, S. Critical Care Nurse Work Environments 2013: A Status Report. Crit. Care Nurse 2014, 34, 64–79. [Google Scholar] [CrossRef] [PubMed]
- Uchmanowicz, I.; Gotlib, J. What is rationing of nursing care? Mod. Nurs. Health Care 2018, 2, 46–47. [Google Scholar]
- Hessels, A.J.; Flynn, L.; Cimiotti, J.P.; Cadmus, E.; Gershon, R.R. The Impact of the Nursing Practice Environment on Missed Nursing Care. Clin. Nurs. Stud. 2015, 3, 60–65. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zelenikova, R.; Jarosova, D.; Plevová, I.; Janíková, E. Nurses’ Perceptions of Professional Practice Environment and Its Relation to Missed Nursing Care and Nurse Satisfaction. Int. J. Environ. Res. Public Health 2020, 17, 3805. [Google Scholar] [CrossRef]
- Schubert, M.; Glass, T.R.; Clarke, S.P.; Aiken, L.H.; Schaffert-Witvliet, B.; Sloane, D.M.; De Geest, S. Rationing of nursing care and its relationship to patient outcomes: The Swiss extension of the International Hospital Outcomes Study. Int. J. Qual. Health Care 2008, 20, 227–237. [Google Scholar] [CrossRef] [Green Version]
- West, E.; Barron, D.N.; Reeves, R. Overcoming the barriers to patient-centered care: Time, tools and training. J. Clin. Nurs. 2005, 14, 435–443. [Google Scholar] [CrossRef]
- Rochefort, C.M.; Rathwell, B.A.; Clarke, S.P. Rationing of nursing care interventions and its association with nurse-reported outcomes in the neonatal intensive care unit: A cross-sectional survey. BMC Nurs. 2016, 15, 1–8. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Shen, J.; Barbera, J.; Shapiro, C.M. Distinguishing sleepiness and fatigue: Focus on definition and measurement. Sleep Med. Rev. 2006, 10, 63–76. [Google Scholar] [CrossRef] [PubMed]
- Cherny, N.; Werman, B.; Kearney, M. Burnout, compassion fatigue, and moral distress in palliative care. In Oxford Textbook of Palliative Medicine; Oxford University Press: Oxford, UK, 2020; Available online: https://oxfordmedicine.com/view/10.1093/med/9780199656097.001.0001/med−9780199656097-chapter−416 (accessed on 17 September 2020).
- Registered Nurses’ Association of Ontario. Preventing and Mitigating Nurse Fatigue in Health Care Healthy Work Environments Best Practice Guideline; Registered Nurses’ Association of Ontario: Toronto, ON, Canada, 2011; Available online: https://sigma.nursingrepository.org/bitstream/handle/10755/347143/Preventing_and_Mitigating_Nurse_Fatigue_in_Health_Care.pdf;jsessionid=363ACEB3A53DF2D058432CDB45FBECE7? (accessed on 16 September 2020).
- Kalisch, B.J.; Xie, B. Errors of omission: Missed nursing care. West J. Nurs. Res. 2014, 36, 875–890. [Google Scholar] [CrossRef] [PubMed]
- Kalisch, B.J.; Landstrom, G.L.; Hinshaw, A.S. Missed nursing care: A concept analysis. J. Adv. Nurs. 2009, 65, 1509–1517. [Google Scholar] [CrossRef]
- Uchmanowicz, I.; Kołtuniuk, A.; Młynarska, A.; Łagoda, K.; Witczak, I.; Rosińczuk, J.; Jones, T. Polish adaptation and validation of the Perceived Implicit Rationing of Nursing Care (PIRNCA) questionnaire: A cross-sectional validation study. BMJ Open 2020, 10, e031994. [Google Scholar] [CrossRef] [Green Version]
- Smets, E.; Garssen, B.; Bonke, B.; De Haes, J. The multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J. Psychosom. Res. 1995, 39, 315–325. [Google Scholar] [CrossRef] [Green Version]
- D’Souza, E. Modified Fatigue Impact Scale–5-item version (MFIS−5). Occup. Med. 2016, 66, 256–257. [Google Scholar] [CrossRef] [Green Version]
- Ausserhofer, D.; Zander, B.; Busse, R.; Schubert, M.; De Geest, S.; Rafferty, A.M.; Ball, J.; Scott, A.; Kinnunen, J.; Heinen, M.; et al. Prevalence, patterns and predictors of nursing care left undone in European hospitals: Results from the multicountry cross-sectional RN4CAST study. BMJ Qual. Saf. 2013, 23, 126–135. [Google Scholar] [CrossRef]
- Hobbs, B.B.; Wightman, L. Fatigue and critical care nurses. Nurs. Crit. Care 2018, 13, 6–13. [Google Scholar] [CrossRef]
- Rogers, A.E. The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety. Available online: https://www.ncbi.nlm.nih.gov/books/NBK2645/ (accessed on 16 September 2020).
- Bragadóttir, H.; Kalisch, B.J.; Tryggvadóttir, G.B. Correlates and predictors of missed nursing care in hospitals. J. Clin. Nurs. 2017, 26, 1524–1534. [Google Scholar] [CrossRef]
- Schubert, M.; Ausserhofer, D.; Desmedt, M.; Schwendimann, R.; Lesaffre, E.; Li, B.; De Geest, S. Levels and correlates of implicit rationing of nursing care in Swiss acute care hospitals—A cross sectional study. Int. J. Nurs. Stud. 2013, 50, 230–239. [Google Scholar] [CrossRef] [PubMed]
- Papastavrou, E.; Andreou, P.; Efstathiou, G. Rationing of nursing care and nurse-patient outcomes: A systematic review of quantitative studies. Int. J. Health Plan. Manag. 2013, 29, 3–25. [Google Scholar] [CrossRef] [PubMed]
- Bachnick, S.; Ausserhofer, D.; Baernholdt, M.; Simon, M. Match RN study group Patient-centered care, nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study. Int. J. Nurs. Stud. 2018, 81, 98–106. [Google Scholar] [CrossRef] [PubMed]
- Jaworski, M.; Iwanow, L.; Grochans, E.; Mlynarska, A.; Gurowiec, P.J.; Uchmanowicz, I.; Gotlib, J.; Panczyk, M. Optimistic thinking, satisfaction with life and job and nursing care rationing: Multicentre study in Poland. J. Nurs. Manag. 2020, 2, 20–27. [Google Scholar] [CrossRef]
Characteristics Feature | Participations (n = 150) | Princa | ||
---|---|---|---|---|
Rationing Care | Quality of Patient Care | Job Satisfaction | ||
Sex, p-value 1 | p 0.739 | p 0.585 | p 0.895 | |
Females, n (%), M ± SD | 139 (92.67%) | 0.81 ± 0.68 | 6.05 ± 1.68 | 7.12 ± 1.74 |
Males, n (%), M ± SD | 11 (7.33%) | 0.7 ± 0.65 | 6 ± 1.61 | 7.27 ± 1.56 |
Age, p-value 2 | p 0.132 | p 0.979 | p 0.822 | |
20–30 years old, n (%) | 31 (20.67%) | r = −0.131 | r = 0.002 | r = 0.019 |
31–40 years old, n (%) | 47 (31.33%) | |||
41–50 years old, n (%) | 63 (42.00%) | |||
51–60 years old, n (%) | 9 (6.00%) | |||
Marital status, p-value 1 | p 0.864 | p 0.923 | p 0.793 | |
Single, n (%), M ± SD | 41 (27.33%) | 0.81 ± 0.67 | 6.02 ± 1.68 | 7.22 ± 1.55 |
Married, n (%), M ± SD | 99 (66.00%) | 0.8 ± 0.68 | 6.06 ± 1.67 | 7.09 ± 1.81 |
Divorcee, n (%) | 6 (4.00%) | |||
Widow, n (%) | 4 (2.67%) | |||
Education, p-value 3 | p 0.263 | p 0.619 | p 0.818 | |
Medium, n (%), M ± SD | 17 (11.33%) | 0.72 ± 0.79 | 5.7 ± 1.44 | 7.24 ± 2.08 |
Bachelor’s degree, n (%), M ± SD | 57 (38.00%) | 0.9 ± 0.66 | 6 ± 1.71 | 7.05 ± 1.8 |
Master’s degree, n (%), M ± SD | 75 (50.00%) | 0.75 ± 0.67 | 6.14 ± 1.69 | 7.17 ± 1.6 |
Doctoral, n (%) | 1 (0.67%) | |||
Continuing professional development education, 1 | ||||
Qualification course of nursing, anesthesia and intensive care, n (%), p-value 4 | 94 (62.67%) | 0.73 ±0.65 p 0.136 | 5.95 ± 1.71 p 0.373 | 7.01 ± 1.76 p 0.321 |
Specialist course, n (%), p-value 4 | 60 (40.00%) | 0.8 ± 0.66 p 0.987 | 6.12 ± 1.66 p 0.578 | 7.13 ± 1.81 p 0.959 |
Specialization of anaesthesiological nursing and intensive care, n (%), p-value 4 | 77 (51.33%) | 0.83 ± 0.74 p 0.995 | 6.13 ± 1.63 p 0.413 | 7.26 ± 1.71 p 0.385 |
Postgraduate education, n (%), p-value 4 | 14 (9.33%) | 0.63 ± 0.57 p 0.489 | 6.64 ± 1.82 p 0.136 | 7.21 ± 1.81 p 0.856 |
Non-applicable, n (%) | 15 (10.00%) | |||
Place of residence, p-value 1 | p 0.698 | p 0.669 | p 0.065 | |
City, n (%), M ± SD | 11 (7.33%) | 0.81 ± 0.68 | 6.04 ± 1.63 | 7.06 ± 1.71 |
Countryside, n (%), M ± SD | 139 (92.67%) | 0.7 ± 0.61 | 6.09 ± 2.17 | 8 ± 1.79 |
Characteristics Nurse’s Work | Participations (n = 150) | Princa | ||
---|---|---|---|---|
Rationing Care | Quality of Patient Care | Job Satisfaction | ||
Seniority as a nurse, p-Value 1 | p 0.175 | p 0.818 | p 0.964 | |
0–10, n (%) | 51 (34%) | r = −0.12 | r = 0.019 | r = −0.004 |
11–20, n (%) | 46 (30.67%) | |||
21–30, n (%) | 43 (28.67%) | |||
31–40, n (%) | 6 (4%) | |||
No answer | 4 (2.67%) | |||
Seniority in the intensive care unit and anesthesiology department, p-value 1 | p 0.299 | p 0.803 | p 0.782 | |
0–5, n (%) | 50 (33.33%) | r =− 0.091 | r =− 0.021 | r = 0.782 |
6–10, n (%) | 28 (18.67%) | |||
11–15, n (%) | 29 (19.33%) | |||
16–25, n (%) | 14 (9.33%) | |||
21–25, n (%) | 15 (10.00%) | |||
26–30, n (%) | 13 (8.67%) | |||
31–35, n (%) | 1 (0.67%) | |||
Number of jobs held, p-Value 2 | p 0.253 | p 0.461 | p 0.076 | |
One, n (%), M ± SD | 65 (43.33%) | 0.7 ± 0.64 | 5.88 ± 1.88 | 7.02 ± 1.62 |
Two, n (%), M ± SD | 70 (46.67%) | 0.92 ± 0.7 | 6.11 ± 1.41 | 7.03 ± 1.83 |
≥ Three, n (%), M ± SD | 14 (9.33%) | 0.64 ± 0.66 | 6.43 ± 1.87 | 8.14 ± 1.46 |
No answer | 1 (0.67%) | |||
Work system, p-Value 2 | p 0.197 | p 0.606 | p 0.443 | |
Single shift work, n (%), M ± SD | 15 (10.00%) | 0.74 ± 0.92 | 5.8 ± 1.9 | 6.73 ± 1.83 |
Shift work in 8-hour system, n (%), M ± SD | 8 (5.33%) | 1.13 ± 0.4 | 6.5 ± 1.07 | 6.75 ± 1.28 |
Shift work in 12-hour system, n (%), M ± SD | 127 (84.67%) | 0.79 ± 0.67 | 6.05 ± 1.68 | 7.2 ± 1.74 |
MFIS Feature | Participations (n = 150) | Princa | ||
---|---|---|---|---|
Rationing Care | Quality of Patient Care | Job Satisfaction | ||
Total MFIS result, M ± SD | 30.9 ± 15.68 | |||
Physical functions, M ± SD | 13.4 ± 7.04 | |||
Cognitive functions, M ± SD | 13.99 ± 7.46 | |||
Psycho-social functions, M ± SD | 3.5 ± 2.12 | |||
Fatigue, p-Value 1 | r = 0.469 p <0.001 * | r = −0.06 p 0.469 | r = −0.195 p 0.017 * | |
Physical fatigue, p-Value 1 | r = 0.455 p <0.001 * | r = −0.041 p 0.622 | r = −0.195 p 0.017 * | |
Cognitive fatigue, p-Value 1 | r = 0.43 p <0.001 * | r = −0.065 p 0.432 | r = 0.203 p 0.013 * | |
Psycho-social fatigue, p-Value 1 | r = 0.477 p <0.001 * | r = −0.039 p 0.639 | r = −0.105 p 0.201 |
Feature | Parameter | 95%CI | p-Value 1 | ||
---|---|---|---|---|---|
Total MFIS result | 0.021 | 0.014 | 0.028 | <0.001 * | |
Sex | |||||
Females | Ref. | ||||
Males | 0.082 | −0.386 | 0.549 | 0.732 | |
Age | [Years] | −0.001 | −0.051 | 0.049 | 0.966 |
Marital status | |||||
Married | Ref. | ||||
Single | −0.035 | −0.3 | 0.23 | 0.797 | |
Place of residence | |||||
City | Ref. | ||||
Countryside | −0.121 | −0.550 | 0.317 | 0.588 | |
Education | |||||
Medium | Ref. | ||||
Bachelor’s degree | 0.085 | −0.349 | 0.519 | 0.702 | |
Master’s degree | −0.068 | −0.505 | 0.368 | 0.759 | |
Qualification courses | |||||
No | Ref. | ||||
Yes | −0.166 | −0.424 | 0.092 | 0.21 | |
Specialist courses | |||||
No | Ref. | ||||
Yes | 0.041 | −0.188 | 0.27 | 0.726 | |
Specialization | |||||
No | Ref. | ||||
Yes | 0.018 | −0.237 | 0.272 | 0.892 | |
Postgraduate education | |||||
No | Ref. | ||||
Yes | −0.135 | −0.581 | 0.311 | 0.555 | |
Seniority as a nurse | |||||
[Years] | −0.005 | −0.053 | 0.043 | 0.851 | |
Seniority in the intensive care unit | |||||
[Years] | 0.002 | −0.02 | 0.025 | 0.837 | |
Do you have more than one workplace? | |||||
No | Ref. | ||||
2 places of work | 0.189 | −0.046 | 0.423 | 0.118 | |
≥3 places of work | 0.13 | −0.343 | 0.604 | 0.591 | |
Works system | |||||
Single shift work | Ref. | ||||
8-hour shift work | 0.198 | −0.507 | 0.902 | 0.583 | |
12-hour shift work | 0.059 | −0.405 | 0.523 | 0.804 |
Feature | Parameter | 95%CI | p-Value 1 | ||
---|---|---|---|---|---|
Total MFIS result | −0.013 | −0.032 | 0.006 | 0.187 | |
Sex | |||||
Females | Ref. | ||||
Males | −0.285 | −1.566 | 0.996 | 0.663 | |
Age | [Years] | −0.065 | −0.19 | 0.06 | 0.312 |
Marital status | |||||
Married | Ref. | ||||
Single | −0.117 | −0.839 | 0.605 | 0.752 | |
Place of residence | |||||
City | Ref. | ||||
Countryside | −0.088 | −1.278 | 1.103 | 0.885 | |
Education | |||||
Medium | Ref. | ||||
Bachelor’s degree | 0.119 | −0.987 | 1.224 | 0.834 | |
Master’s degree | 0.029 | −1.084 | 1.141 | 0.959 | |
Qualification courses | |||||
No | Ref. | ||||
Yes | −0.2 | −0.898 | 0.498 | 0.575 | |
Specialist courses | |||||
No | Ref. | ||||
Yes | −0.46 | −0.683 | 0.591 | 0.888 | |
Specialization | |||||
No | Ref. | ||||
Yes | 0.223 | −0.465 | 0.911 | 0.527 | |
Postgraduate education | |||||
No | Ref. | ||||
Yes | 0.868 | −0.323 | 2.059 | 0.156 | |
Seniority as a nurse | |||||
[Years] | 0.069 | −0.053 | 0.19 | 0.271 | |
Seniority in the intensive care unit | |||||
[Years] | −0.02 | −0.079 | 0.039 | 0.51 | |
Do you have more than one workplace? | |||||
No | Ref. | ||||
2 places of work | 0.249 | −0.384 | 0.882 | 0.443 | |
≥3 places of work | 0.044 | −1.195 | 1.284 | 0.945 | |
Works system | |||||
Single shift work | Ref. | ||||
8-hour shift work | 1.007 | −0.669 | 2.683 | 0.241 | |
12-hour shift work | 0.316 | −0.796 | 1.428 | 0.579 |
Feature | Parameter | 95%CI | p-Value 1 | ||
---|---|---|---|---|---|
Total MFIS result | −0.019 | −0.038 | 0 | 0.057 | |
Sex | |||||
Females | Ref. | ||||
Males | 0.335 | −0.936 | 1.606 | 0.606 | |
Age | [Years] | 0.021 | −0.103 | 0.145 | 0.736 |
Marital status | |||||
Married | Ref. | ||||
Single | 0.389 | −0.328 | 1.106 | 0.289 | |
Place of residence | |||||
City | Ref. | ||||
Countryside | 1.184 | 0.002 | 2.365 | 0.052 | |
Education | |||||
Medium | Ref. | ||||
Bachelor’s degree | −0.549 | −1.646 | 0.549 | 0.329 | |
Master’s degree | −0.534 | −1.638 | 0.57 | 0.345 | |
Qualification courses | |||||
No | Ref. | ||||
Yes | −0.19 | −0.883 | 0.502 | 0.591 | |
Specialist courses | |||||
No | Ref. | ||||
Yes | −0.098 | −0.731 | 0.534 | 0.761 | |
Specialization | |||||
No | Ref. | ||||
Yes | 0.355 | −0.328 | 1.038 | 0.31 | |
Postgraduate education | |||||
No | Ref. | ||||
Yes | −0.058 | −1.24 | 1.125 | 0.924 | |
Seniority as a nurse | |||||
[Years] | −0.037 | −0.158 | 0.084 | 0.549 | |
Seniority in the intensive care unite | |||||
[Years] | 0.019 | −0.04 | 0.078 | 0.525 | |
Do you have more than one workplace? | |||||
No | Ref. | ||||
2 places of work | −0.107 | −0.735 | 0.521 | 0.74 | |
≥3 places of work | 1.12 | −0.109 | 2.35 | 0.077 | |
Works system | |||||
Single shift work | Ref. | ||||
8-hour shift work | 0.433 | −1.231 | 2.096 | 0.611 | |
12-hour shift work | 0.69 | −0.414 | 1.793 | 0.223 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Młynarska, A.; Krawuczka, A.; Kolarczyk, E.; Uchmanowicz, I. Rationing of Nursing Care in Intensive Care Units. Int. J. Environ. Res. Public Health 2020, 17, 6944. https://doi.org/10.3390/ijerph17196944
Młynarska A, Krawuczka A, Kolarczyk E, Uchmanowicz I. Rationing of Nursing Care in Intensive Care Units. International Journal of Environmental Research and Public Health. 2020; 17(19):6944. https://doi.org/10.3390/ijerph17196944
Chicago/Turabian StyleMłynarska, Agnieszka, Anna Krawuczka, Ewelina Kolarczyk, and Izabella Uchmanowicz. 2020. "Rationing of Nursing Care in Intensive Care Units" International Journal of Environmental Research and Public Health 17, no. 19: 6944. https://doi.org/10.3390/ijerph17196944