Nursing students' perceptions of unfinished nursing care: A cross-sectional study.

AIM: To investigate the prevalence, patterns and reasons for unfinished nursing care as perceived by nursing students. BACKGROUND: Unfinished nursing care (UNC) is a frequently observed phenomenon in the acute care setting. To date, studies have focused primarily on the perspective of nurses or patients, but another important perspective is that of nursing students who provide nursing care in all healthcare settings. DESIGN: A descriptive cross-sectional study. METHODS: The study included 738 undergraduate nursing students from nine Slovak universities. Data were collected between September 2022 and February 2023 using the Slovak version of the Unfinished Nursing Care Survey tool (UNCS). Data were analyzed using descriptive and inferential statistics. RESULTS: The mean composite score of UNCS was 2.48 (SD=0.68). In general, 100% of nursing students reported that nurses missed at least one or more nursing care activities during their last clinical placement. The average number of missed nursing care activities was 11.2 per nurse as perceived by nursing students during their last clinical placement. Nursing students reported that the most frequently omitted nursing care activity was spending time with patients and their caregivers (3.15 ± 1.11; 92.9%). The most frequently reported reason for UNC was an inadequate number of nurses on the ward (4.31 ± 1.01; 98.1%). In the study, reported UNC could be predicted by previous experience in healthcare, previous clinical rotation, number of patients per shift, perceived staff adequacy and outcome expectations (p <0.05). CONCLUSIONS: The findings reveal that UNC is a widespread phenomenon and all nursing students report this phenomenon during their clinical placements. Spending time with patients and their caregivers emerged as the most frequently omitted nursing care activity, highlighting the importance of patient-centered care. The primary reason cited for UNC was an inadequate number of nurses, highlighting staffing issues as a significant contributing factor. These findings emphasize the need for targeted interventions to address staff shortages and improve nursing education to prepare students to address UNC in their future practice.

Examining the Perspectives of Nurse Managers on Missed Nursing Care in Surgical Units.

OBJECTIVE: To examine nurse managers' perspectives on missed nursing care (MNC) on surgical units. BACKGROUND: The phenomenon of MNC is an important concern for nurse researchers. However, the reality of how it is experienced by clinical nurse managers is largely unexplored. Understanding nurse managers' experiences with MNC could help develop useful approaches to reducing levels of MNC. METHODS: A descriptive qualitative study was conducted between December and June 2020, using face-to-face semistructured interviews with 10 nurse managers. RESULTS: Five themes were identified: 1) awareness of MNC; 2) rationale for MNC; 3) consequences of MNC; 4) questions of reporting; and 5) management of MNC. CONCLUSIONS: Nurse managers must use their positions and leadership skills to expect appropriate staffing approaches and material resources for surgical units, effective process for newly hired nurses, and the establishment of a reporting system for MNC to reduce the phenomenon in practice.

Missed nursing care as reported by paediatric nurses: A cross-sectional study.

AIMS: Missed nursing care (MNC) significantly affects patient safety and quality of care. It is a widely used concept that has been studied in different settings, but research in paediatric care is quite limited. Therefore, this descriptive cross-sectional study aimed to report the prevalence, patterns, correlates, factors and predictors of MNC in paediatric care units in two central European countries. DESIGN: A cross-sectional comparative study. METHODS: Data collection was carried out between June and November 2021 using the MISSCARE Survey-Pediatric. The study included 441 registered nurses working in paediatric care units in the Czech Republic and Slovakia. Data were analysed using descriptive and inferential statistics in the SPSS 25.0 statistical program. RESULTS: Almost all nurses, 92.7% of nurses missed at least one nursing activity during the last shift. The most missed care activity in both countries was the promotion of neuroevolutionary development, and the most prominent reasons were labour resources. MNC was weakly but significantly correlated with nurse experience in the current position and was predicted by the country, nurse education and overtime hours (p ≤ .05). Differences in prevalence of MNC and reasons for MNC were identified based on several variables (p ≤ .05). CONCLUSION: The assessment of MNC in paediatric settings is often a neglected area, although the prevalence in this study was moderate. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurse staff shortages, as a global problem, have many impacts on patient outcomes in the delivery of nursing care. However, there are also many factors that can reduce the prevalence of MNC. More research should focus on a closer examination of these factors that involve hospital and nurse variables. REPORTING METHOD: The study was carried out according to the STROBE checklist and the RANCARE guideline. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Trust in healthcare professionals of people with chronic cardiovascular disease.

BACKGROUND: Trust is an essential phenomenon of relationship between patients and healthcare professionals and can be described as an accepted vulnerability to the power of another person over something that one cares about in virtue of goodwill toward the trustor. This characterization of interpersonal trust appears to be adequate for patients suffering from chronic illness. Trust is especially important in the context of chronic cardiovascular diseases as one of the main global health problems. RESEARCH AIM: The purpose of the qualitative study was to gain a deeper understanding of how people with chronic cardiovascular disease experience and make sense of trust in healthcare professionals. RESEARCH DESIGN: Eleven semi-structured interviews with participants analysed using interpretative phenomenological analysis to explore in detail their lived experience of trust as a relational phenomenon. PARTICIPANTS AND RESEARCH CONTEXT: Participants with chronic cardiovascular disease were purposively recruited from inpatients on the cardiology ward of the university hospital located in central Slovakia. ETHICAL CONSIDERATIONS: The study was approved by the faculty ethics committee. Participants gave their written informed consent. FINDINGS FOUR INTERRELATED GROUP EXPERIENTIAL THEMES: Sense of co-existence; Belief in competence; Will to help; Ontological security with eight subthemes were identified. The findings describe the participants' experience with trust in healthcare professionals as a phenomenon of close co-existence, which is rooted in the participants' vulnerability and dependence on the goodwill and competence of health professionals to help with the consequence of (re)establishing a sense of ontological security in the situation of chronic illness. CONCLUSION: Findings will contribute to an in-depth understanding of trust as an existential dimension of human co-existence and an ethical requirement of healthcare practice, inspire patient empowerment interventions, support adherence to treatment, and person-centred care.

Nurses' Perception of Professionalism in Practice: A Review of Qualitative Studies.

Professionalism is a fundamental concept in nursing and a central aspect of nursing care. The review aimed to synthesize evidence presented in qualitative studies related to the perception of professionalism in nursing practice. Six main analytical themes were generated from primary studies included in the literature review: everyday practice, ethical aspects of nursing care, nurses' identity, nurses' professional growth, achieving autonomy, complexity of relationships. Presented themes are considered key elements of nursing professionalism, are closely interconnected, and support the multidimensional structure of professionalism in nursing. Nursing professionalism means providing high-quality care while upholding the values of integrity, accountability, and respect.

Self-report of Nurse Professionalism and Factors Affecting It: A Cross-sectional Study.

OBJECTIVE: To evaluate the perception of professionalism by nurses and identify factors that affect the evaluation of professionalism. BACKGROUND: Professionalism is conceptualized as the set of beliefs related to the autonomy of the profession. Lack of professional respect, a disruptive work environment, and suppression of progressivism in the profession are identified as factors that lead to leaving the profession. METHODS: The study was carried out according to the CHEERIES (Checklist for Reporting Results of Internet E-Surveys) checklist and included 250 RNs. The Nurses' Professionalism Inventory (NPI) was used. RESULTS: The mean composite score of the NPI indicates a positive reflection of the professionalism of the nurse. Nurse education and job position were the most significant factors that affected perception of professionalism (P < 0.05). CONCLUSIONS: The results show the need to examine the issue of professionalism in nursing to a greater extent and implement the findings of research on innovations at all levels of nursing education.

Involvement of Proteasomal and Endoplasmic Reticulum Stress in Neurodegeneration After Global Brain Ischemia.

A brief period of transient global brain ischemia leads to selective ischemic neurodegeneration associated with death of hippocampal CA1 pyramidal neurons days after reperfusion. The mechanism of such selective and delayed neurodegeneration is still uncertain. Our work aimed to study the involvement of proteasomal and endoplasmic reticulum (ER) stress in ischemic neurodegeneration. We have performed laser scanning confocal microscopy analysis of brain slices from control and experimental animals that underwent global brain ischemia for 15 min and varying times of reperfusion. We have focused on ubiquitin, PUMA, a proapoptotic protein of the Bcl-2 family overexpressed in response to both proteasomal and ER stress, and p53, which controls expression of PUMA. We have also examined the expression of HRD1, an E3 ubiquitin ligase that was shown to be overexpressed after ER stress. We have also examined potential crosstalk between proteasomal and ER stress using cellular models of both proteasomal and ER stress. We demonstrate that global brain ischemia is associated with an appearance of distinct immunoreactivity of ubiquitin, PUMA and p53 in pyramidal neurons of the CA1 layer of the hippocampus 72 h after ischemic insults. Such changes correlate with a delay and selectivity of ischemic neurodegeneration. Immunoreactivity of HRD1 observed in all investigated regions of rat brain was transiently absent in both CA1 and CA3 pyramidal neurones 24 h after ischemia in the hippocampus, which does not correlate with a delay and selectivity of ischemic neurodegeneration. We do not document significant crosstalk between proteasomal and ER stress. Our results favour dysfunction of the ubiquitin proteasome system and consequent p53-induced expression of PUMA as the main mechanisms responsible for selective and delayed degeneration of pyramidal neurons of the hippocampal CA1 layer in response to global brain ischemia.

Face Validity, Content Validity, and Psychometric Testing of the Hospital Survey on Patient Safety Culture Among Undergraduate Nursing Students.

Background and Purpose: Nursing students have an essential role in patient safety. The purpose of this study was to evaluate the face validity, content validity, and psychometric properties of the Hospital Survey on Patient Safety Culture for Nursing Students (HSOPS-NS). Methods: The cross-sectional study was carried out between January and October 2021. The participants were undergraduate nursing students (N = 482) from 16 Czech nursing faculties. Results: Exploratory factor analysis revealed an eight-factor structure, which was verified by confirmatory factor analysis using the optimization process that results in adequate goodness-of-fit indices (root mean squared error approximation = .037; standardized root mean squared residuals = .056; comparative fit index = .935; Tucker-Lewis index = .926; incremental fit index = .936). The internal consistency of a new model was excellent (α = .914). Conclusion: The results indicate that the HSOPS-NS shows evidence of reliability and validity and is a valuable measure of safety culture as perceived by nursing students.

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.

Sleep-disrupting effects of nocturnal nursing interventions in intensive care unit patients: A systematic review.

Patients staying in the intensive care unit (ICU) require constant monitoring and numerous nursing interventions performed as needed, irrespective of daytime or night-time. The disturbing effect of nocturnal nursing interventions and their contribution to sleep disruptions are unclear. The review analysed nocturnal nursing interventions, and their character, frequency and effects on sleep quality. The databases CINAHL, PubMed and Scopus were searched to identify and subsequently evaluate 19 studies (1,531 patients) meeting the algorithm used. Although nocturnal nursing interventions provided to ICU patients were frequent and varied, they were responsible for only a minority of observed sleep disruptions. The most frequent nocturnal intervention was Vital signs monitoring (Nursing Interventions Classification, 6,680). Implementation of sleep protocols, of which an integral part is clustering and planning of nocturnal interventions, appears to be effective. The review suggests that nursing interventions are not the main cause of sleep disruptions in the ICU. In an effort to improve the quality of sleep in ICU patients, other factors causing disturbance need to be addressed as well. The current trend is more careful planning of nursing care, clustering of interventions and minimizing nocturnal disruptions to allow patients at least one uninterrupted sleep cycle (90 min).

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.

Exploring the meaning of night shift placement in nursing education: A European multicentre qualitative study.

BACKGROUND: An appropriate clinical learning environment has been identified as pivotal in nursing undergraduate education and should be planned responsibly. Specifically, night shifts placements have been documented as an important opportunity for developing a full understanding of the nursing profession and the whole process of nursing care. However, night shifts during placement have been reported to be stressful and anxiety-provoking, so their usefulness for nursing students is still debated. OBJECTIVES: To elicit nursing students' perceptions of night shift placement through metaphors, with the aim of discussing the pedagogical and ethical implications. DESIGN: A descriptive qualitative study was performed based on metaphors collected in an international cross-sectional study in 2016. SETTINGS: A network comprising five Bachelor of Nursing Science degrees located in the Czech Republic, Italy, Poland, Portugal, and Slovakia was established. METHODS: A total of 907 out of 1347 eligible nursing students from the five European countries described their learning experience on night shifts using a metaphor. RESULTS: Overall, 288/907 (31.7%) metaphors emerged as being negative-oriented and 137/907 (15.1%) as positive, while the remaining students (482; 53.2%) did not report any metaphors. In all five countries, negative metaphors prevailed: 'Wasting time' (37/288), 'Useless' (32/288) and 'Handyman' (22/288) were the most negative reported metaphors on working a night shift. However, doing a night shift is also perceived as a 'Learning opportunity' (22/137), a 'New experience' (20/137) and an 'Opportunity to socialize with the profession' (14/137) as underlined by the positive metaphors. CONCLUSIONS: Students perceive night shift placements mainly as a negative experience, which has little to do with education. While planning night shift placements, nursing educators should responsibly consider the whole process of education, analysing not only the learning outcomes that should be achieved but also the position of students and their experience as a person. Clinical mentoring can be a key resource in supporting students in transforming their night shift placements' experiences into a more meaningful or worthwhile experience. Moreover, night shifts should be offered to more experienced students, independent in their self-learning processes and capable of managing the limited possibility of interacting with other team members and patients.

Night shifts as a learning experience among nursing students across Europe: Findings from a cross-sectional survey.

BACKGROUND: Organising clinical placements during nights has been reported as an additional opportunity to introduce students to the whole picture of their future responsibilities. However, studies in this field are still lacking. OBJECTIVES: To describe and compare (a) the night shift experience of nursing students across Europe, (b) the patient-related problems that they face during night shifts, (c) the night care activities nursing students are called to perform, and (d) the perceived effects of night shift work on learning outcomes. DESIGN: A cross-sectional study, 2016. SETTINGS: Five European countries: Czech Republic, Italy, Poland, Portugal, and Slovakia. PARTICIPANTS: Nursing students from nine Bachelor of Nursing Science degree programmes attending night shifts during their study period and who were willing to participate were included. A total of 907 out of 1347 (67.3%) eligible students participated. METHODS: Questionnaire based on the available literature, translated into five languages. RESULTS: The duration of the night shift was from an average of 9.8 (CI 95% 9.6-10.0) in Italy to 11.9 (CI 95% 11.7-12.0) in the Czech Republic. Students faced mainly patients' pain without statistical differences across countries (at the overall level, 717 out of 907; 79%; p = .318). However, significant differences in the tasks performed during nights emerged: Polish students reported being more involved in performing basic nursing care (72; 93.5%) as compared to other countries (e.g., Portuguese students 337; 84.9%), (p = .02). Overall, an average of 28.9% of the night shift time was reported to be free of commitments, with higher values among Polish (38%, CI 95% 33.6-42.3) and Slovakian students (33.4%, CI 95% 30.6-36.3) and lower values among Czech Republic students (20.4%, CI 95% 17.6-23.2) (p .001). Boredom and satisfaction were reported as the main feelings during night shifts, with significant differences (p .001) across countries. Students reported significant different effects (p .001) of night shifts on their understanding of a nurse's role (from 5.2 out of 10 in Poland to 6.5 in the Czech Republic), on the understanding of the continuity of nursing care (from 5.2 in Poland to 6.7 in Italy), and on having a relationship with the clinical mentors (from 2.7 and 4.2 in Poland and the Czech Republic, respectively, to 6.9 in Italy). CONCLUSIONS: Night shifts can be both a valuable and a non-valuable learning experience, suggesting the need to carefully plan and assess their effectiveness at the unit level.

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.

An interpretative phenomenological analysis of dignity in people with multiple sclerosis.

BACKGROUND: Dignity is a fundamental concept in healthcare. The symptoms of multiple sclerosis have a negative effect on dignity. Understanding of lived experience of dignity in people with multiple sclerosis is crucial to support dignity in practice. RESEARCH AIM: The aim was to explore the sense of dignity experienced by people with multiple sclerosis. RESEARCH DESIGN AND PARTICIPANTS: An interpretative phenomenological analysis design was adopted, using data collected through face-to-face interviews with 14 participants. ETHICAL CONSIDERATIONS: The study was approved by the faculty Ethical Committee (No. EC 1828/2016). FINDINGS: Four interconnected superordinate themes emerged from analysis: Loss of a fully-fledged life: Violating the dignity-of-self; To accept and fight: Promoting the dignity-of-self; Contempt and rudeness: Indignity-in-relation; and Those who know and see, help: Promoting dignity-in-relation. The loss of former fully-fledged life has a dramatic impact on integrity and impaired dignity-of-self. Accepting illness and changed identity impaired by multiple sclerosis was the step that the participants considered to be important for reacquiring the sense of dignity. The participants encountered misunderstandings, prejudices, embarrassment, insensitive remarks, labelling, unwillingness and impersonal treatment as indignities. Acceptance of their condition, needed support, the feeling of being part of a group, sensitivity and the sharing of problems had a positive effect on their dignity. DISCUSSION: Continual changes in functional ability threaten an individual's identity and were experienced as violations of dignity. Based on this, participant's dignity-of-self was not a moral, but much more existential value. Acceptance of changed identity and fighting spirit were important for restoring their dignity-of-self. The misunderstandings, prejudices and unwillingness had a negative impact on their dignity-in-relation. On the other side, support from others in fighting promoted their dignity-in-relation. CONCLUSION: Dignity is manifested as a complex phenomenon of lived experience of people with multiple sclerosis and also an umbrella concept for providing good quality of person-centred care.

Sleep quality assessment in intensive care: actigraphy vs. Richards-Campbell sleep questionnaire.

INTRODUCTION: It has been repeatedly shown that sleep of intensive care unit (ICU) patients is fragmented and its architecture is impaired. As sleep disorders have numerous negative effects on the organism, there have been efforts to implement sleep-promoting strategies into practice. When comparing the effectiveness of such measures, sleep quality assessment itself is a considerable problem. OBJECTIVE: The study aimed to assess the quality and quantity of night sleep in ICU patients simultaneously with actigraphy (ACT) and the Richards-Campbell Sleep Questionnaire (RCSQ). The secondary goals were to test the performance and effectiveness of the above methods and to verify correlations between selected RCSQ items and actigraph parameters. METHODS: A single-center prospective observational study (20 patients staying in a Interdisciplinary Intensive Care Unit). The quality of sleep was assessed using a Czech version of the RCSQ and ACT. The obtained data were analyzed and their dependence or correlations were verified by selected statistical tests. RESULTS: The mean RCSQ score was 47.6 (SD 24.4). The worst results were found for sleep latency (44.4; SD 31.2); the best results were for sleep quality (50.2; SD 29.4). The mean sleep effciency measured with ACT reached 86.6% (SD 9.2); the mean number of awakenings per night was 17.1 (SD 8.5). The RCSQ total parameter with a cutoff of 50 (RCSQ total = 50 good sleep / RCSQ total < 50 poor sleep) was shown to be suitable for discrimination of subjectively perceived sleep quality in ICU patients. However, the study failed to show statistically significant relations between subjectively perceived sleep quality (RCSQ) and ACT measurements. CONCLUSION: The RCSQ appears to be a suitable instrument for assessing night sleep quality in ICU patients. On the other hand, the study showed a very low level of agreement between subjective sleep quality assessment and objective ACT measurements. The main drawback of ACT is low reliability of obtained data. Further research is needed to determine its role in sleep quality assessment in the ICU setting.

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.