Trends and variability of implicit rationing of care across time and shifts in an acute care hospital : a longitudinal study

The proposed study was funded for 2 years (2018‐2020) by the Medical Practice Plan, Faculty of Medicine, American University of Beirut, Lebanon.Background Implicit rationing of nursing care is associated with work environment factors. Yet a deeper understanding of trends and variability is needed. Aims To explore the trends and variability of rationing of care per shift between individual nurses, services over time, and its relationship with work environment factors. Methods Longitudinal study including 1,329 responses from 90 nurses. Intraclass correlation coefficients (ICC) were computed to examine variability of rationing per shift between individual nurses, services, and data collection time; generalized linear mixed models were used to explore the relationship with work environment factors. Results Percentage of rationing of nursing activities exceeded 10% during day and night shifts. Significant variability in rationing items was observed between nurses, with ICCs ranging between 0.20 and 0.59 in day shifts, and between 0.35 and 0.85 in night shifts. Rationing of care was positively associated with nurses’ self‐perceived workload in both shifts, but not with patient‐to‐nurse ratios. Conclusion Most variability in rationing over time was explained by the individual.PostprintPeer reviewe

Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools

BACKGROUND: Pain is a common and major problem among nursing home residents. The prevalence of pain in elderly nursing home people is 40–80%, showing that they are at great risk of experiencing pain. Since assessment of pain is an important step towards the treatment of pain, there is a need for manageable, valid and reliable tools to assess pain in elderly people with dementia. METHODS: This systematic review identifies pain assessment scales for elderly people with severe dementia and evaluates the psychometric properties and clinical utility of these instruments. Relevant publications in English, German, French or Dutch, from 1988 to 2005, were identified by means of an extensive search strategy in Medline, Psychinfo and CINAHL, supplemented by screening citations and references. Quality judgement criteria were formulated and used to evaluate the psychometric aspects of the scales. RESULTS: Twenty-nine publications reporting on behavioural pain assessment instruments were selected for this review. Twelve observational pain assessment scales (DOLOPLUS2; ECPA; ECS; Observational Pain Behavior Tool; CNPI; PACSLAC; PAINAD; PADE; RaPID; Abbey Pain Scale; NOPPAIN; Pain assessment scale for use with cognitively impaired adults) were identified. Findings indicate that most observational scales are under development and show moderate psychometric qualities. CONCLUSION: Based on the psychometric qualities and criteria regarding sensitivity and clinical utility, we conclude that PACSLAC and DOLOPLUS2 are the most appropriate scales currently available. Further research should focus on improving these scales by further testing their validity, reliability and clinical utility

Predictors of Quality Of Life in a Sample of Lebanese Patients with Cancer

Quality of life (QoL) is a multi-dimensional phenomenon bordering on all aspects of one’s life. The aim of this study was to determine the factors that are considered predictors of QoL in a Lebanese sample of cancer patients attending a tertiary healthcare center. A cross-sectional descriptive survey was used. A total of 200 adult oncology patients over 18 years of age were interviewed over a one-year period, 2009-2010. Two widely known instruments were used; the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC QLQ-C30) and the Memorial Symptom Assessment Scale (MSAS) to evaluate the QoL and symptoms experienced in this population group. The reliability coefficients of both instruments were generally satisfactory. The results showed significant predictors of better QoL were being married (p = 0.04) and being single (p = 0.04), having breast (p = 0.01) and gastro-intestinal cancer (0.02) as primary cancer sites and emotional functioning (p = 0.00); significant predictors of poorer QoL were the MSAS total symptoms (p = 0.01) and fatigue (p = 0.00). Our findings provide insight into the predictors of QoL of cancer patients and set the path for future research in order to improve the QoL of cancer patients in Lebanon