Approaches to understanding the phenomenon of missed/rationed/unfinished care – a literature review

Aim: This literature review aims to describe, analyze and compare approaches to the phenomenon of missed/rationed/unfinished nursing care, in order to better our understanding of it. Design: A narrative literature review. Methods: A method of content analysis of studies published in the scientific databases PubMed, ScienceDirect, ProQuest, and Wiley Library Online was used. Studies were selected using a set of criteria and keywords for the period 2000–2018. Twenty-one studies were analyzed in the processing of the literature review. Results: We identified the four most common approaches or conceptual frameworks used to describe the phenomenon from the available literature – Missed Care, Implicit Rationing of Nursing Care, Task Undone and the theoretical proposition, Failure to Maintain, each of which explicitly describes a particular aspect of the phenomenon, and provides us with a theoretical framework and structure. Conclusion: This review contributes to the overview of particular approaches or theoretical frameworks used to understand the phenomenon. It is necessary to understand the terminology, and to use it appropriately. All approaches identified associations between the phenomenon and negative outcomes for patients as a quality-of-care indicator

Prideľovaná ošetrovateľská starostlivosť vo vybraných nemocniciach na Slovensku

Východiská: Prideľovanie ošetrovateľskej starostlivosti je definované ako nezabezpečenie všetkých nevyhnutných ošetrovateľských činností z dôvodu nedostatku zdrojov (personálnych, časových, materiálnych). Sestry sú nútené obmedzovať, minimalizovať alebo vynechať niektoré ošetrovateľské činnosti, čím zvyšujú riziko negatívnych výsledkov u pacientov. Cieľ: Zistiť úroveň prevalencie prideľovanej ošetrovateľskej starostlivosti vo vybraných zdravotníckych zariadeniach na Slovensku. Súbor a metodika: Výskumnú vzorku tvorilo 94 sestier z nemocníc v Kežmarku, v Levoči a v Poprade. Zber údajov bol realizovaný prostredníctvom dotazníka PIRNCA (Perceived Implicit Rationing of Nursing Care). Na vyhodnotenie empirickej časti bola použitá deskriptívna a induktívna štatistika. Výsledky: Najvyššie skóre v rámci jednotlivých položiek dotazníka PIRNCA dosiahli sestry v položke Nemohol/a som viesť dôležitý rozhovor s ďalším členom multidisciplinárneho tímu ohľadom starostlivosti pacienta. Naopak najnižšie skóre dosiahli v položke Nemohol/a ste vykonať bežnú starostlivosť o kožu pacientov a v položke Nemohol/la ste vykonať ošetrenie rany (vrátane preväzu) podľa predpisu lekára/štandardu oddelenia. V našej štúdii sme potvrdili štatisticky významné rozdiely medzi prideľovanou starostlivosťou a pracovným zaradením sestier a štatisticky významný vzťah medzi prideľovanou starostlivosťou a celkovou spokojnosťou sestier. Záver: Najčastejšie vyskytujúcimi sa faktormi, ktoré prispievajú ku vzniku prideľovanej ošetrovateľskej starostlivosti je nedostatok sestier a pomocného personálu, neefektívne delegovanie úloh starostlivosti a zvyšujúca sa pracovná záťaž, čím dochádza k výskytu fenoménu implicitne prideľovanej starostlivosti. Je potrebné venovať viac pozornosti tomuto fenoménu a preskúmať stav kvality a bezpečnosti poskytovanej zdravotnej starostlivosti, aby sa vyvinuli účinné opatrenia na riešenie tohto problému.Background: Rationing of nursing care is defined as failure to provide all necessary nursing activities due to lack of resources (personnel, time, material). Nurses are forced to limit, minimize or omit some nursing activities, thus increasing the risk of negative outcomes in patients. Aim: To determine the level of prevalence of allocated nursing care in selected health care facilities in Slovakia. Sample and methodology: The research sample consisted of 94 nurses from hospitals in Kežmarok, Levoča and Poprad. Data collection was performed using the PIRNCA (Perceived Implicit Rationing of Nursing Care) questionnaire. Descriptive and inductive statistics were used to evaluate the empirical part. Results: The highest scores within the individual items of the PIRNCA questionnaire were achieved by the nurses in the item I could not have an important interview with another member of the multidisciplinary team regarding patient care. In contrast, the lowest scores were achieved in the Cannot Perform Routine Patient Skin Care item and in the Could Not Perform Wound Treatment (including dressing) as prescribed by a physician / ward standard. In our study, we confirmed statistically significant differences between the care provided and the job classification of nurses and a statistically significant relationship between the care provided and the overall satisfaction of nurses. Conclusion: The most common factors that contribute to the emergence of nursing care are the lack of nurses and support staff, inefficient delegation of care tasks and increasing workload, leading to the phenomenon of implicitly assigned care. More attention needs to be paid to this phenomenon and the state of quality and safety of healthcare provided needs to be examined in order to develop effective measures to address this problem.  Východiská: Prideľovanie ošetrovateľskej starostlivosti je definované ako nezabezpečenie všetkých nevyhnutných ošetrovateľských činností z dôvodu nedostatku zdrojov (personálnych, časových, materiálnych). Sestry sú nútené obmedzovať, minimalizovať alebo vynechať niektoré ošetrovateľské činnosti, čím zvyšujú riziko negatívnych výsledkov u pacientov. Cieľ: Zistiť úroveň prevalencie prideľovanej ošetrovateľskej starostlivosti vo vybraných zdravotníckych zariadeniach na Slovensku. Súbor a metodika: Výskumnú vzorku tvorilo 94 sestier z nemocníc v Kežmarku, v Levoči a v Poprade. Zber údajov bol realizovaný prostredníctvom dotazníka PIRNCA (Perceived Implicit Rationing of Nursing Care). Na vyhodnotenie empirickej časti bola použitá deskriptívna a induktívna štatistika. Výsledky: Najvyššie skóre v rámci jednotlivých položiek dotazníka PIRNCA dosiahli sestry v položke Nemohol/a som viesť dôležitý rozhovor s ďalším členom multidisciplinárneho tímu ohľadom starostlivosti pacienta. Naopak najnižšie skóre dosiahli v položke Nemohol/a ste vykonať bežnú starostlivosť o kožu pacientov a v položke Nemohol/la ste vykonať ošetrenie rany (vrátane preväzu) podľa predpisu lekára/štandardu oddelenia. V našej štúdii sme potvrdili štatisticky významné rozdiely medzi prideľovanou starostlivosťou a pracovným zaradením sestier a štatisticky významný vzťah medzi prideľovanou starostlivosťou a celkovou spokojnosťou sestier. Záver: Najčastejšie vyskytujúcimi sa faktormi, ktoré prispievajú ku vzniku prideľovanej ošetrovateľskej starostlivosti je nedostatok sestier a pomocného personálu, neefektívne delegovanie úloh starostlivosti a zvyšujúca sa pracovná záťaž, čím dochádza k výskytu fenoménu implicitne prideľovanej starostlivosti. Je potrebné venovať viac pozornosti tomuto fenoménu a preskúmať stav kvality a bezpečnosti poskytovanej zdravotnej starostlivosti, aby sa vyvinuli účinné opatrenia na riešenie tohto problému

ORIGINAL PAPER OCCURRENCE OF ANNOYING SYMPTOMS OF PATIENTS WITH CANCER

Abstract Aim: To determine symptoms those occur by patients with cancer. Design: A cross-sectional survey. Methods: The sample of research consisted of 100 patients with cancer. We used Memorial Symptom Assessment Scale (MSAS) to evaluate the symptoms. This Scale determines 32 symptoms in three subscales (physic, psychic symptoms, and complete distress) focused on frequency, intensity and distress of symptoms of Likert Scale 1-4. Results: The research results demonstrate that in terms of frequency, intensity and distress the patients most frequently suffer pain (4.30 ± 3.30), despite of all the pain treatment options. The other symptoms that patients encountered include nausea (3.52 ± 2.70), restless sleep (3.92 ± 3.48), anxiety (3.81 ± 3.55) and feelings of sadness (1.30 ± 0.22). In terms of disease severity, we had greater incidence of symptoms in patients with stage 3 -cancer metastatic disease (p ≤ 0.05). Our research also confirmed the correlation between the occurrence of symptoms and duration of illness. Greater incidence of symptoms has been reported in patients with longer lasting disease, in most cases, endstage disease (p ≤ 0.05). Conclusion: A key part of palliative care is minimizing of annoying physical, psychological, social and spiritual symptoms of patients. Assessment of the annoying symptoms in clinical practice allows the planning and implementation of effective interventions to promote quality of life of patients and their families in palliative care

The Attitudes of Nurses Towards Inpatient Aggression And Selected Staff Characteristics: a Cross-sectional Study

Introduction: The attitude of nurses to the patient aggression may also reflect how they interpret its function or what meaning they attribute to aggressive patient behaviour. These attitudes are subsequently manifested in the way, in which nurses behave towards aggressive patients and manage aggression. Methods: The study aimed to identify the attitudes of nurses from various clinical areas to the inpatient aggression and to reveal differences in attitudes based on selected staff characteristics. The study has a quantitative cross-sectional design. Nurses’ attitudes towards the inpatient aggression were identified by means of the Attitude Towards Aggression Scale (ATAS©) distinguishing five types of attitudes represented by five domains named as offensive, destructive, intrusive, communicative, and protective domains. The prevalence of patient aggression towards nurses was determined using the Violence and Aggression of Patients Scale (VAPS). The sample consisted of 1220 nurses from nine selected faculty or university hospitals in the Slovak Republic. Results: The highest scores were identified in the ATAS© domains representing a negative perception of patient aggression in terms of destruction, offensive, or intrusion; on the other hand, nurses were open also to a positive perception of patient aggression. Conclusion: The results of our study point to the need for a deeper investigation into the issue of nurses’ attitudes towards aggressive patients. Nurses’ negative attitudes towards patient aggression can have an adverse effect on the quality of care provided to aggressive patients, thus it is crucial to identify these attitudes and implement lifelong-learning interventions to reduce them.Introduction: The attitude of nurses to the patient aggression may also reflect how they interpret its function or what meaning they attribute to aggressive patient behaviour. These attitudes are subsequently manifested in the way, in which nurses behave towards aggressive patients and manage aggression. Methods: The study aimed to identify the attitudes of nurses from various clinical areas to the inpatient aggression and to reveal differences in attitudes based on selected staff characteristics. The study has a quantitative cross-sectional design. Nurses’ attitudes towards the inpatient aggression were identified by means of the Attitude Towards Aggression Scale (ATAS©) distinguishing five types of attitudes represented by five domains named as offensive, destructive, intrusive, communicative, and protective domains. The prevalence of patient aggression towards nurses was determined using the Violence and Aggression of Patients Scale (VAPS). The sample consisted of 1220 nurses from nine selected faculty or university hospitals in the Slovak Republic. Results: The highest scores were identified in the ATAS© domains representing a negative perception of patient aggression in terms of destruction, offensive, or intrusion; on the other hand, nurses were open also to a positive perception of patient aggression. Conclusion: The results of our study point to the need for a deeper investigation into the issue of nurses’ attitudes towards aggressive patients. Nurses’ negative attitudes towards patient aggression can have an adverse effect on the quality of care provided to aggressive patients, thus it is crucial to identify these attitudes and implement lifelong-learning interventions to reduce them.Úvod: Postoj sestier k agresii pacientov môže reflektovať aj to, ako interpretujú jej funkciu resp. aký význam pripisujú agresívnemu správaniu sa pacientov. Tieto postoje sa následne odrážajú v správaní sestier voči agresívnym pacientom a v spôsobe manažmentu agresie, pričom sú ovplyvnené viacerými faktormi, vrátane osobnej skúsenosti s agresiou pacientov. Metódy: Cieľom štúdie bolo identifikovať postoje sestier z rôznych klinických pracovísk k agresii hospitalizovaných pacientov a odhaliť rozdiely v postojoch na základe vybraných charakteristík. Štúdia má kvantitatívny prierezový dizajn. Postoj sestier k agresii hospitalizovaných pacientov bol identifikovaný prostredníctvom škály Attitude Towards Aggression Scale (ATAS©) rozlišujúcej päť typov postoja reprezentovaných piatimi doménami pomenovanými ako ofenzívna, deštruktívna, intruzívna, komunikatívna a protektívna doména. Prevalenciu agresie pacientov voči sestrám sme zisťovali prostredníctvom škály Violence and Aggression of Patients Scale (VAPS). Výskumnú vzorku tvorilo 1220 sestier z deviatich vybraných fakultných alebo univerzitných nemocníc Slovenskej republiky. Výsledky: V súbore sme identifikovali najvyššie skóre v doménach ATAS© reprezentujúcich negatívne vnímanie agresie pacienta v zmysle deštrukcie, ofenzívy alebo intrúzie; na druhej strane, sestry boli otvorené aj pozitívnemu vnímaniu agresie pacientov. Zistili sme, že postoje sestier boli signifikantne ovplyvnené klinickým pracoviskom, kde sestry aktuálne pracovali, prevádzkou pracoviska, vzdelaním sestier a osobnou skúsenosťou s agresiou pacientov v priebehu posledného roku ich praxe. Záver: Výsledky našej štúdie poukazujú na potrebu hlbšieho výskumu problematiky postojov sestier voči agresívnym pacientom. Negatívne postoje sestier voči agresii pacientov môžu mať nepriaznivý dopad na kvalitu starostlivosti poskytovanej agresívnym pacientom, nevyhnutné je preto identifikovať tieto postoje a realizovať intervencie v rámci celoživotného vzdelávania zamerané na ich redukciu

Experience of nurses with in-patient aggression in the Slovak Republic

Aim: The aim of the study was to explore the experience of staff nurses from selected hospitals in all regions of Slovakia of inpatient aggression in their past year of practice. Design: A quantitative cross-sectional study. Methods: The sample consisted of 1042 nurses with a mean number of years of work experience of 19.23 (SD 10.96) from medical, surgical, and psychiatric wards, and emergency and intensive care units. Data collection was conducted by the self-reference instrument, the Violence and Aggression of Patients Scale (VAPS). Results: Over the past year, 97.4% of nurses have been confronted with patient aggression. 96.8% of nurses have experienced verbal aggression and 83.3% physical aggression. Nurses working in psychiatric and intensive care wards have experienced the most frequent episodes of patient aggression. A statistically significant difference was confirmed in the prevalence of patient aggression towards nurses based on their pattern of shift work. Nurses working in multiple-shift operation reported a higher frequency of patient aggression compared with those working single-shifts. The relationship between age, years of work experience, and level of education, and experience of patient aggression was not proved to be significant. Conclusion: The study highlights nurses' experience of different forms of patient aggression and provides confirmation of the current relevance of this issue. The results may become the basis for a systematic evaluation of the causative factors and the management of aggression. The implementation of preventive strategies in clinical practice is crucial

Psychometric Testing of Perceived Implicit Rationing of Nursing Care (PIRNCA)

AimsTo evaluate the psychometric properties of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument and to report the prevalence of rationed care at university and faculty hospitals.DesignA cross‐sectional study.MethodsThe study was carried out at two university and five faculty hospitals in the Slovak Republic. Participants were 895 Registered Nurses recruited by the purposive sampling method between December 2017–July 2018. Data were collected using the PIRNCA instrument. Construct validity and reliability of the instrument were tested.ResultsThe prevalence of rationed care at university and faculty hospitals was identified as being 42.1%. Furthermore, 87.6% of nurses reported rationing one or more nursing care activities. Using both statistical methods when evaluating the PIRNCA resulted in the confirmation that the tool is valid and reliable.ConclusionRationed care is a common phenomenon at university and faculty hospitals. The PIRNCA is a suitable instrument to measure the phenomenon in adult acute care units because of its high reliability and validity. We recommend using the instrument in different contexts, not only for specific conditions that were presented for this study.ImpactRationed care at university and faculty hospitals has never been reported. Psychometric properties of the instrument that measures nurses´ perception of rationed care have never been evaluated by using different approaches. The most frequently rationed nursing care activities are those that nurses are competent to initiate on the basis of their knowledge and skills – the independent ones. The PIRNCA is a valid and reliable instrument. Hospital management can use the instrument to explore the prevalence of rationed care, followed by the application of prevention strategies. Our findings represent the base for further exploration of rationed care using the PIRNCA.</p

A GP1BA Variant in a Czech Family with Monoallelic Bernard-Soulier Syndrome

Bernard-Soulier syndrome (BSS) is a rare inherited disorder characterized by unusually large platelets, low platelet count, and prolonged bleeding time. BSS is usually inherited in an autosomal recessive (AR) mode of inheritance due to a deficiency of the GPIb-IX-V complex also known as the von Willebrand factor (VWF) receptor. We investigated a family with macrothrombocytopenia, a mild bleeding tendency, slightly lowered platelet aggregation tests, and suspected autosomal dominant (AD) inheritance. We have detected a heterozygous GP1BA likely pathogenic variant, causing monoallelic BSS. A germline GP1BA gene variant (NM_000173:c.98G &gt; A:p.C33Y), segregating with the macrothrombocytopenia, was detected by whole-exome sequencing. In silico analysis of the protein structure of the novel GPIb&alpha; variant revealed a potential structural defect, which could impact proper protein folding and subsequent binding to VWF. Flow cytometry, immunoblot, and electron microscopy demonstrated further differences between p.C33Y GP1BA carriers and healthy controls. Here, we provide a detailed insight into its clinical presentation and phenotype. Moreover, the here described case first presents an mBSS patient with two previous ischemic strokes