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

Schubert, Maria; Clarke, Sean P.; Glass, Tracy R.; Schaffert-Witvliet, Bianca; Geest, Sabina De

doi:10.1016/j.ijnurstu.2008.10.008

Cited by 111 publications

(126 citation statements)

References 21 publications

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“…Our results found multiple missed care opportunities in the 24 hours before diagnosis of pneumonia. Numerous previous studies have reported that missed fundamental hospital care is linked to poorer patient outcomes, 17,[19][20][21][22][23][24][25] a finding that is also supported by our data.…”

Section: Discussionsupporting

confidence: 91%

“…18,19 Data from some studies support that a large amount of fundamental care is being missed in U.S. acute care hospitals. 17,[19][20][21][22][23][24][25] Furthermore, missed hospital care in both U.S. and international studies has been linked to numerous harmful outcomes for patients and increased cost for hospitals. 17 Two recent systematic reviews of these therapeutic interventions to prevent pneumonia found that the use of oral care was associated with the most evidence of benefit.…”

mentioning

confidence: 99%

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Understanding factors that impact on public and patient’s risk perceptions and responses toward Clostridium difficile and other health care-associated infections: A structured literature review

Burnett

Johnston

Kearney

et al. 2013

American Journal of Infection Control

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Understanding factors that impact on public and patient’s risk perceptions and responses toward Clostridium difficile and other health care-associated infections: A structured literature review

Burnett

Johnston

Kearney

et al. 2013

American Journal of Infection Control

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“…A study in eight hospitals in Switzerland found care rationing to be associated with medication errors (OR = 1.68; p < .005); falls (OR = 2.81; p < .001); nosocomial infections (OR = 1.61; p < .04); critical incidents (OR = 1.10; p < .002); and pressure ulcers (OR = 1.15; p < .0010) (Schubert et al., 2008). A subsequent analysis of the sample from the previous study (1,338 nurses and 779 patients) sought to define a clinically meaningful rationing threshold level and found consistent reports of nosocomial infections, pressure ulcers and patient satisfaction being sensitive to rationing with negative consequences (Schubert, Clarke, Glass, Schaffert‐Witvliet, & De Geest, 2009). …”

Section: Resultsmentioning

confidence: 99%

What impact does nursing care left undone have on patient outcomes? Review of the literature

Recio‐Saucedo

Dall’Ora

Maruotti

et al. 2017

Journal of Clinical Nursing

312

304

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Aims and objectivesSystematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes.BackgroundA considerable body of evidence supports the hypothesis that lower levels of registered nurses on duty increase the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear.DesignSystematic review.MethodsWe searched Medline (via Ovid), CINAHL (EBSCOhost) and Scopus for studies examining the association of missed nursing care and at least one patient outcome. Studies regarding registered nurses, healthcare assistants/support workers/nurses’ aides were retained. Only adult settings were included. Because of the nature of the review, qualitative studies, editorials, letters and commentaries were excluded. PRISMA guidelines were followed in reporting the review.ResultsFourteen studies reported associations between missed care and patient outcomes. Some studies were secondary analyses of a large parent study. Most of the studies used nurse or patient reports to capture outcomes, with some using administrative data. Four studies found significantly decreased patient satisfaction associated with missed care. Seven studies reported associations with one or more patient outcomes including medication errors, urinary tract infections, patient falls, pressure ulcers, critical incidents, quality of care and patient readmissions. Three studies investigated whether there was a link between missed care and mortality and from these results no clear associations emerged.ConclusionsThe review shows the modest evidence base of studies exploring missed care and patient outcomes generated mostly from nurse and patient self‐reported data. To support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes as a result of missed care, more research that uses objective staffing and outcome measures is required.Relevance to clinical practiceAlthough nurses may exercise judgements in rationing care in the face of pressure, there are nonetheless adverse consequences for patients (ranging from poor experience of care to increased risk of infection, readmissions and complications due to critical incidents from undetected physiological deterioration). Hospitals should pay attention to nurses’ reports of missed care and consider routine monitoring as a quality and safety indicator.

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“…Our quantitative results, however, indicated that nurses still regularly carried out caring practices despite a generally negative perception of their work environment, which is consistent with Schubert et al's (2008) findings that most types of care were rarely rationed. Nevertheless, even infrequent rationing of care has been linked to negative patient outcomes (Schubert, Clarke, Glass, Schaffert-Witvliet, & De Geest, 2009).…”

Section: Discussionmentioning

confidence: 99%

Organizational Climate and Hospital Nurses' Caring Practices: A Mixed‐Methods Study

Roch

Dubois

Clarke

2014

Research in Nursing & Health

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Organizational climate in healthcare settings influences patient outcomes, but its effect on nursing care delivery remains poorly understood. In this mixed-methods study, nurse surveys (N = 292) were combined with a qualitative case study of 15 direct-care registered nurses (RNs), nursing personnel, and managers. Organizational climate explained 11% of the variation in RNs' reported frequency of caring practices. Qualitative data suggested that caring practices were affected by the interplay of organizational climate dimensions with patients and nurses characteristics. Workload intensity and role ambiguity led RNs to leave many caring practices to practical nurses and assistive personnel. Systemic interventions are needed to improve organizational climate and to support RNs' involvement in a full range of caring practices.

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

Cited by 111 publications

References 21 publications

Understanding factors that impact on public and patient’s risk perceptions and responses toward Clostridium difficile and other health care-associated infections: A structured literature review

Understanding factors that impact on public and patient’s risk perceptions and responses toward Clostridium difficile and other health care-associated infections: A structured literature review

What impact does nursing care left undone have on patient outcomes? Review of the literature

Organizational Climate and Hospital Nurses' Caring Practices: A Mixed‐Methods Study

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