Nurses' Perception of Patient Safety Culture in Primary Care During the COVID-19 Pandemic: A Preliminary Results.

Investigation of nurses' perceptions of patient safety culture (PSC) might be beneficial in identifying safety areas that need improvement, especially during the COVID-19 pandemic. The study reports on the PSC in primary care from the nurses' perspective during the pandemic. Nurses (n = 117) evaluated teamwork (87.3%) and staff training (80.9%) positively but work pressure and pace (26.1%) and patient care tracking (45.3%) concerning PSC dimensions negatively. Limited care coordination and continuity lead to patient hospitalizations and care fragmentation. However, regular assessment of PSC can lead to adopting the necessary strategies to reinforce weaknesses and thus improve patient safety in primary care.

Factors Contributing to Rationed Nursing Care in the Slovak Republic-A Secondary Analysis of Quantitative Data.

Rationed nursing care is a significant problem in healthcare facilities worldwide. Awareness of contributing factors to rationed care might support the development and implementation of strategies for reducing this phenomenon from clinical practice. The study examined the association between selected hospital, unit, and staff variables and the prevalence of rationed nursing care. Secondary analysis of cross-sectional data collected between December 2017 and July 2018 from 895 registered nurses in seven acute care hospitals in the Slovak Republic was performed. Data were collected using the questionnaire Perceived Implicit Rationing of Nursing and analyzed by descriptive and inferential statistics in the statistical program SPSS 25.0. Statistically significant associations were found between rationed nursing care and unit type, education, shift type, nurses' experience in the current unit, overtime hours, missed shifts, intention to leave the position, perceived staff adequacy, quality of patient care, and job satisfaction. Differences in rating rationed nursing care, quality of patient care, and job satisfaction were identified based on hospital type. Together with top hospital management, nurse managers should develop targeted interventions focusing on mitigating rationed nursing care from the clinical practice with a focus placed on university hospitals. Quality and safe care might be ensured through constant monitoring of the quality of patient care and job satisfaction of nurses as these factors significantly predicted the estimates of rationed nursing care.

Undergraduate nursing students' experiences of rationed nursing care - A qualitative study.

BACKGROUND: Nursing students are required to spend a significant portion of their educational preparation in clinical practice. Because of the prevalence of missed or rationed care, it seems irrefutable that students are exposed to rationed care during their practice placement, or that they contribute to its prevalence either actively or passively. OBJECTIVES: The study aimed to discover how nursing students interpret the concept of rationed care, and their experiences of rationing in practice. DESIGN: A descriptive qualitative study. PARTICIPANTS: Eighteen final year nursing students from three universities within the Slovak Republic. METHODS: Semistructured face-to-face interviews were conducted (n = 18). Data were analyzed using thematic analysis which resulted in the development of themes and subthemes. RESULTS: We identified three meaningful themes focused on the phenomenon of rationed care from the perspective of nursing students, namely Incomplete care is normalized; Provision of impersonal patient care; and the Existence of a hidden curriculum for practice placements. CONCLUSIONS: Student nurses were quite demanding about the learning experience during their clinical training. They are often frustrated by inconsistencies between their theoretical preparation and the realities of practice. They recognise difficulties for registered nurses in providing safe, high quality care in constrained circumstances, and although they are critical of this, they acknowledge their own acceptance of the situation. Based on this, students must establish an understanding of the theory behind, and reasons for rationed care before commencing clinical placement. A greater understanding would enable students to develop strategies for coping with inconsistencies and voicing concerns.

Unmet care needs of older people: A scoping review.

The aim was to synthesize the findings of empirical research about the unmet nursing care needs of older people, mainly from their point of view, from all settings, focusing on (1) methodological approaches, (2) relevant concepts and terminology and (3) type, nature and ethical issues raised in the investigations. A scoping review after Arksey and O'Malley. Two electronic databases, MEDLINE/PubMed and CINAHL (from earliest to December 2019) were used. Systematic search protocol was developed using several terms for unmet care needs and missed care. Using a three-step retrieval process, peer-reviewed, empirical studies concerning the unmet care needs of older people in care settings, published in English were included. An inductive content analysis was used to analyse the results of the included studies (n = 53). The most frequently used investigation method was the questionnaire survey seeking the opinions of older people, informal caregivers or healthcare professionals. The unmet care needs identified using the World Health Organization classification were categorized as physical, psychosocial and spiritual, and mostly described individuals' experiences, though some discussed unmet care needs at an organizational level. The ethical issues raised related to the clinical prioritization of tasks associated with failing to carry out nursing care activities needed. The unmet care needs highlighted in this review are related to poor patient outcomes. The needs of institutionalized older patients remain under-diagnosed and thus, untreated. Negative care outcomes generate a range of serious practical issues for older people in care institutions, which, in turn, raises ethical issues that need to be addressed. Unmet care needs may lead to marginalization, discrimination and inequality in care and service delivery. Further studies are required about patients' expectations when they are admitted to hospital settings, or training of nurses in terms of understanding the complex needs of older persons.

Assessment of patient safety climate by nurses in Slovak Public and private hospitals.

AIM: To examine variations in the safety climate reported by nurses in Slovak hospitals and to analyse the association between dimensions of the patient safety climate and demographic and organisational factors. BACKGROUND: A deeper understanding of how safety climate varies across hospitals can be useful in determining areas with a potential for improvement. Staffing and non-punitive response to errors were identified in recent research syntheses as the weakest dimensions of safety climate that require strengthening. METHODS: The sample consisted of 1,429 nurses working in public and private hospitals in Slovakia. The Hospital Survey on Patient Safety Culture questionnaire was used for data collection, and descriptive analysis was carried out to examine relationships between variables. RESULTS: Nurses working in general private hospitals with a bed capacity of less than 500 beds were more positive about their hospital safety climate than other nurses working in differently organised hospitals. The lowest number of positive responses was scored in the domain of 'Non-Punitive Response to Error'. This result came from a blame-free error-reporting atmosphere. CONCLUSIONS: Nurses perceived a higher level of patient safety when they had experienced better sharing of information on event reporting and had better learning opportunities. IMPLICATIONS FOR NURSING MANAGEMENT: The results revealed strengths and weaknesses of the patient safety climate in the network of Slovak hospitals from the perspective of nurses working in these hospitals. This knowledge can enable nurse managers to instigate supportive strategies for just reporting, and learning from events, within an enhanced safety culture.

Psychometric testing of perceived implicit rationing of nursing care (PIRNCA).

AIMS: To 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. DESIGN: A cross-sectional study. METHODS: The 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. RESULTS: The 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. CONCLUSION: Rationed 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. IMPACT: Rationed 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.

Missed, rationed or unfinished nursing care: A scoping review of patient outcomes.

AIMS: To collate evidence about patient outcomes resulting from the phenomenon of incomplete nursing care described in the literature variously as missed, rationed, or unfinished nursing care. BACKGROUND: Nursing care which is not completed is known to have a negative impact on patients. However, to date, there has been no thorough exploration of the extent and potential seriousness of patient outcomes. METHODS: The search was performed in four scientific databases; 44 studies were included in the final content analysis. RESULTS: Missed, rationed and unfinished care negatively influence the patient outcomes in the context of patient safety and quality of nursing care. Despite the differences among concepts, the negative association with patient outcomes was significant and common for all concepts. CONCLUSION: Awareness of potential harm of the phenomena to patient outcomes may help the management to develop preventive strategies to reduce or eliminate its actual occurrence. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital management should consider the phenomenon as an indicator of the quality of nursing care as well as establish the routine monitoring of the phenomena in the assessment of patient safety in healthcare facilities.

Factor analysis, validity of the perceived implicit rationing of nursing care instrument and prevalence and patterns of unfinished nursing care in Slovakia.

AIM: The aim of the study was to adapt and validate the perceived implicit rationing of nursing care instrument in the Slovak nurse work environment and to evaluate the prevalence of unfinished nursing care in acute care hospitals. BACKGROUND: The measurement of unfinished nursing care could be assumed as a proxy indicator of nurse staffing adequacy or higher risk of adverse events. METHODS: A cross-sectional survey design was used. The sample of 1,429 registered nurses from 21 hospitals in Slovakia was recruited. Exploratory factor analysis, confirmatory factor analysis and internal reliability were performed. RESULTS: The instrument is essentially rather an inventory than scale per se. Concurrent validity of the Slovak version was supported by the significant associations between unfinished nursing care and clinically relevant variables. CONCLUSIONS: The prevalence of unfinished nursing care based the percentage of positive responses was higher than prevalence based on composite mean scores. Findings from the study raise questions about a unidimensional structure of nursing tasks reflected in most commonly used survey instruments of unfinished nursing care internationally. IMPLICATIONS FOR NURSING MANAGEMENT: The periodical measurement of unfinished nursing care based on the percentage of positive responses should be assumed as a key strategy to increase patient safety and quality of nursing care.