10 January 2024 : Meta-Analysis
The Impact of Rationing Nursing Care on Patient Safety: A Systematic Review
Izabella Uchmanowicz
1ADFG, Magdalena Lisiak 12ABCEF, Marta Wleklik 12CE, Andrzej Maciej Pawlak 1BCE, Agnieszka Zborowska 1BF, Bartłomiej Stańczykiewicz 3ACEF, Catherine Ross 4EF, Michał Czapla 256EG*, Raúl Juárez-Vela 6E
DOI: 10.12659/MSM.942031
Med Sci Monit 2024; 30:e942031
Table 2 Extracted data from the articles.
| Article | Citation and year | Study design | Study population | Sample size | Aim of the study | Research instrument | Statistical tests | Intervention/exposure | Results |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Gurková et al. 2020 | A cross-sectional study | European nurses from four countries (Croatia, the Czech Republic, Poland and Slovakia) | N=1353 | Nurses’ perceptions of the safety climate in four selected central European countries; relationship between safety climate and unfinished nursing care | The Hospital Survey on Patient Safety Culture; the Perceived Implicit Rationing of Nursing Care | Descriptive statistic Pearson’s correlations and multipleregression. Cronbach’salpha coefficient. AP-value<0.05 | ‘Perceived Patient Safety’ and ‘Reporting of Incident Data’ | Significant differences were found between countries in all unit/hospital/outcome dimensions.‘Perceived Patient Safety’ and ‘Reporting of Incident Data’ were associated with aspects of ‘OrganizationalLearning’ and ‘Feedback and Communication about Error’. Higher prevalence of unfinished nursing care is associated with more negative perceptions of patient safety climate |
| 2 | Ausserhofer et al. 2013 | Multicenter-cross sectional | Registered nurses (RNs) working in 132 surgical, medical and mixed surgical-medical units within 35 Swiss acute care hospitals | N=1630 | Explore the relationship between PSC and patient outcomes in Swiss acute care hospitals | The 9 item Safety Organizing Scale | Multilevel multivariate logistic regression | Patient safety climate and patient outcomes | In none of our regression models was PS C a significant predictor for any of the seven patient outcomes |
| 3 | Dhainiet et al. 2020 | Longitudinal study | RNs | N=90 | Explore the trends and variability of rationing of care per shift between individual nurses, services over time, and its relationship with work environment factors | The Basel extent of rationing of nursing care (BERNCA) | Intraclass correlation coefficients (ICC); inear mixed models | Rationing of care per shift | Rationing of care was positively associated with nurses’ self-perceived workload in both shifts, but not with patient-to-nurse ratios |
| 4 | Papastavrou et al. 2014 | Descriptive, correlational design | Patients and nurses from ten medical and surgical units of five general hospitals | N=352 patients and 318 nurses | Explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses’perceptions of their practice environment; identify the threshold score of rationing by comparing the level of patient satisfaction factors acrossrationing levels | The BERNCA scale, the RPPE scale, the Patient Satisfaction scale to | Kendall’s correlation coefficient, multiple regression analysis | Patient satisfaction link to nurse-reported rationing of nursing care | care rationing and work environment were related to patient satisfaction, even after controlling for nurse and patient characteristic; even at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction |
| 5 | Jarosz et al. 2022 | Cross-sectional study | Nurses working in urology departments | N=130 | Assess the level of rationing care, fatigue, job satisfaction and occupational burnout | Link Burnout Questionnaire, Job Satisfaction Scale, Nursing Care Rationing Scale and Modified Fatigue Impact Scale | The basic descriptive statistics, the Kolmogorov-Smirnov distribution normality test, a series of correlation analyzes with the Pearson r coefficient, the Student’s t-test for independent samples and linear regression analysis | Level of rationing care, fatigue, job satisfaction and occupational burnout | The level of rationing nursing care in urology departments is similar to that in other departments |
| 6 | Renner et al. 2022 | Time-series cross-sectional analysis | RNs from nursing homes | N=3269 | Describe changes in levels and patterns of implicit rationing of nursing care in Swiss nursing homes over time | The Basel Extent of Rationing of Nursing Care instrument | Multiple linear mixed models | Changes in levels and patterns of implicit rationing of nursing care | Overall increases of rationing of care activities over the five-year period studied, with documentation and social activities most rationed at both measurement points |
| 7 | Schubert et al. 2013 | Cross sectional multi-center study | RNs from 35 acute care hospitals | N=1633 | Describe the levels and association of implicit rationing of nursing care in Swiss acute care hospitals | Basel Extent of Rationing of Nursing Care (BERNCA) instrument. | three level regression models | Associations between nine selected potential rationing predictors and implicit rationing of nursing care | better unit level staff resource adequacy and a more favorable hospital level safety climate were both consistently significantly associated with lower rationing levels |
| 8 | Gil et al. 2022 | Observational, analytical, descriptive, concurrent and quantitative study | Nursing professionals from eight Inpatient Units | N=104 | Relate nursing workloads to professional job satisfaction | The Overall Job Satisfaction scale | the Mann-Whitney U test, the Kruskal-Wallis K test, Cohen’s d | Nursing workloads to professional job satisfaction | Higher levels of satisfaction in the variables “relationship with immediate boss” and “relationship with fellow workers”, and lower levels in “relationship with senior management” and “organizational system of the unit” |
| 9 | Młynarska et al. 2020 | Ccross-sectional survey | Anaesthesiological nurses | N=150 | Assess the rationing level of nursing care among staff in the intensive care units | The PIRNCA, The Modified Fatigue Impact Scale (MFIS) | The Mann-Whitney test; Kruskal-Wallis test; the Spearman correlation coefficient, the regression model | The rationing level of nursing care | The higher the level of fatigue, the greater the rationing of care and the less satisfaction from work |
| 10 | Gehriet et al. 2021 | Multicenter observational study | Psychiatric hospital RNs | N=1300 | Describe health care quality by exploring hospital structures such as nurse staffing and the work environment | The nurse survey consisted of 164 items covering three dimensions-work environment, patient safety climate, and the rationing of care. The unit-level questionnaire included 57 items, including the number of beds, number of nurses, and nurses’ education levels | Multilevel regression linear mixed models and generalized linear mixed models | Nurse staffing and the work environment | Study will contribute to improvement strategies for nurses’ work environments and patient experiences in Swiss psychiatric hospitals |
| 11 | Witczak et al. 2021 | Cross-sectional study | RNs | N=245 | Determine the extent of nursing care rationing and its relationship with patient safety | Hospital Survey on Patient Safety Culture (HSOPSC) and the Perceived Implicit Rationing of Nursing Care (PIRNCA) | Hierarchical multiple regression analysis | Nursing care rationing and its relationship with patient safety | The PIRNCA scores were negatively correlated with the HSOPSC subscales;the PIRNCA scores among the internal unit were significantly higher than in the intensive care and surgical units |
| 12 | Zhu et al. 2019 | Cross-sectional research | RNs and Patients | N=nurse (n=7802) and Patient (n=5430) | Test the mediation effect of rationing of nursing care (RONC) and the relationship this has between nurse staffing and patient outcomes | The China Nurse Survey | Logistic regression analyses; Structural equation modeling (SEM) | Mediation effect of rationing of nursing care | A lack of nurse staffing leads to RONC, which leads to poorer patient outcomes |
| 13 | Rochefort et al. 2016 | Cross-sectional survey | RNs working in one of 7 NICUs in the province of Quebec | N=285 | Assess these relationships | The Neonatal Extent of Work Rationing Instrument (NEWRI) | Multivariable linear regression | Rationing of nursing interventions | The rationing of nursing interventions appears to influence parent and infant readiness for discharge, as well as pain control in NICUs |
| 14 | Uchmanowicz et al. 2021 | Cross-sectional survey | RNs | N=547 | Assess the effects of nurses’ life satisfaction and life orientation on the level of nursing care rationing | The Basel Extent of Rationing of Nursing Care-R (BERCA-R), the Satisfaction with Life Scale (SWLS) and the Life Orientation Test (LOT-R) | Bivariate analyses | Life satisfaction and life orientation on the level of nursing care rationing | More pessimistic nurses with low and moderate levels of life satisfaction, and those with a neutral life orientation, presented with significantly higher BERCA-R scores |
| 15 | Duffy et al. 2018 | Cross-sectional correlational study | RNs | N=138 | Describe and evaluate the factors associated with missed nursing care in an acute care community hospital | The MISSCARE survey; the Practice Environment Scale Nursing Work Index (PES-NWI) | Regression mode | Factors associated with missed nursing care | The extent of missed nursing care is consistent with other studies, was greater on medical-surgical and telemetry units compared with specialty units, and was negatively associated with staffing/resources, satisfaction with current position |