Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study

Objectives To explore the association between implicit rationing of nursing care and selected patient outcomes in Swiss hospitals, adjusting for major organizational variables, including the quality of the nurse practice environment and the level of nurse staffing. Rationing was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Additional data were collected using an adapted version of the International Hospital Outcomes Study questionnaire. Design Multi-hospital cross-sectional surveys of patients and nurses. Setting Eight Swiss acute care hospitals Participants Nurses (1338) and patients (779) on 118 medical, surgical and gynecological units. Main outcome measures Patient satisfaction, nurse-reported medication errors, patient falls, nosocomial infections, pressure ulcers and critical incidents involving patients over the previous year. Results Generally, nurses reported rarely having omitted any of the 20 nursing tasks listed in the BERNCA over their last 7 working days. However, despite relatively low levels, implicit rationing of nursing care was a significant predictor of all six patient outcomes studied. Although the adequacy of nursing resources was a significant predictor for most of the patient outcomes in unadjusted models, it was not an independent predictor in the adjusted models. Low nursing resource adequacy ratings were a significant predictor for five of the six patient outcomes in the unadjusted models, but not in the adjusted ones. Conclusion As a system factor in acute general hospitals, implicit rationing of nursing care is an important new predictor of patient outcomes and merits further stud

Pandemie: Lebensschutz und Lebensqualitt in der Langzeitpflege

Die Coronapandemie hat die hohe Verletzlichkeit von Menschen in Pflegeeinrichtungen gezeigt. Medizinethikerinnen und Medizinethiker anerkennen die grosse Verantwortung von Behörden und Institutionen im Anordnen und Umsetzen von Schutzmassnahmen für diese Menschen. Sie heben gleichzeitig hervor, dass bei ihrer Umsetzung der Schutz des Lebens mit dem Schutz der Persönlichkeit und der Lebensqualität einhergehen muss

Confinement et maladie chronique ::Comment soutenir les insuffisants cardiaques pendant la pandémie

Mit der sich anbahnenden Covid-19-Welle wurden Mitte März alle nicht lebensnotwendigen medizinischen und pflegerischen Aktivitäten eingestellt. Die Autorinnen zeigen auf, was dies für die wissenschaftliche Begleitung von Personen mit symptomatischer chronischer Herzinsuffizienz konkret bedeutete und ordnen die Folgen ethisch ein.A la mi-mars 2020, toutes les activités médicales et infirmières considérées comme non essentielles ont été suspendues en raison du Covid-19. Cette décision est potentiellement lourde de conséquences pour les malades chroniques, telles que les personnes atteintes d’insuffisance cardiaque.Con l’incipiente ondata di Covid 19, tutte le attività mediche e infermieristiche non essenziali sono state sospese a metà marzo. Le autrici mostrano cosa ciò abbia significato in termini concreti per il monitoraggio scientifico delle persone con insufficienza cardiaca cronica sintomatica e ne classificano le conseguenze in modo etico

Prevention of post-operative delirium

Ziel einer erfolgreichen Prävention des postoperativen Delirs ist es, bei Patient*innen die Beeinträchtigung des funktionellen Status durch eine Operation so gering wie möglich zu halten. Dies kann durch allgemeine Präventionsmaßnahmen geschehen. Als zusätzlicher Ansatz eignen sich ergänzende individualisierte Maßnahmen. Geeignete Screening- und Assessment-Instrumente werden eingesetzt, um das individuelle Risikoprofil älterer Patient*innen zu erfassen und entsprechende präventive Maßnahmen einzuleiten. Postoperative delirium (POD) is an adverse but often preventable complication of surgery and surgery-related anaesthesia, and increasingly prevalent. This article provides an overview on non-pharmacological preventive measures, divided into individualized and non-individualized measures. Non-individualized measures, such as the most minimally invasive surgical procedure, avoidance of unnecessary fasting before surgery, and the most tolerable anaesthesia are used to minimize the risk of POD in all patients. Based on the results of preoperative screenings for risk factors such as frailty or cognitive impairment, individualized measures may encompass prehabilitation, treatment of specific risk factors, operation room companionship or cognitive, motor, and sensory stimulation as well as social support. This article additionally lists several examples of best practice approaches already implemented in German-speaking countries and websites for further readings

Identifying thresholds for relationships between impacts of rationing of nursing care and nurse- and patient-reported outcomes in Swiss hospitals : a correlational study

BACKGROUND: In the Rationing of Nursing Care in Switzerland Study, implicit rationing of care was the only factor consistently significantly associated with all six studied patient outcomes. These results highlight the importance of rationing as a new system factor regarding patient safety and quality of care. Since at least some rationing of care appears inevitable, it is important to identify the thresholds of its influences in order to minimize its negative effects on patient outcomes. OBJECTIVES: To describe the levels of implicit rationing of nursing care in a sample of Swiss acute care hospitals and to identify clinically meaningful thresholds of rationing. DESIGN: Descriptive cross-sectional multi-center study. SETTINGS: Five Swiss-German and three Swiss-French acute care hospitals. PARTICIPANTS: 1338 nurses and 779 patients. METHODS: Implicit rationing of nursing care was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Other variables were measured using survey items from the International Hospital Outcomes Study battery. Data were summarized using appropriate descriptive measures, and logistic regression models were used to define a clinically meaningful rationing threshold level. RESULTS: For the studied patient outcomes, identified rationing threshold levels varied from 0.5 (i.e., between 0 ('never') and 1 ('rarely') to 2 ('sometimes')). Three of the identified patient outcomes (nosocomial infections, pressure ulcers, and patient satisfaction) were particularly sensitive to rationing, showing negative consequences anywhere it was consistently reported (i.e., average BERNCA scores of 0.5 or above). In other cases, increases in negative outcomes were first observed from the level of 1 (average ratings of rarely). CONCLUSIONS: Rationing scores generated using the BERNCA instrument provide a clinically meaningful method for tracking the correlates of low resources or difficulties in resource allocation patient outcomes. Thresholds identified here provide parameters for administrators to respond to whenever rationing reports exceed the determined level of '0.5' or '1'. Since even very low levels of rationing had negative consequences on three of the six studied outcomes, it is advisable to treat consistent evidence of any rationing as a significant threat to patient safety and quality of care

Postoperative Schmerzversorgung : Schmerzscore, Zufriedenheit, pharmakologische und nicht-pharmakologische Behandlung

Pain after surgical interventions is a common issue. Less than 50 % of patients who underwent surgery report an adequate pain management. In a regional Swiss hospital the differences in pain scores, satisfaction and base medication between patients who underwent surgery electively and patients who underwent surgery in the case of an emergency were investigated. Influences on the pain scores of patients with non-pharmacological and pharmacological interventions were also investigated. 157 Patients from multiple surgical fields were surveyed for this study. No significant differences were found in the group comparisons. The mean pain score during rest on the NRS was 2.66 ± 2.22 (0-8). With 10.9 % of the participants the daily maximum dose was exceeded (Paracetamol and Metamizol-Sodium)