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      The Impact of Rationing Nursing Care on Patient Safety: A Systematic Review

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          Abstract

          Background

          Rationing of nursing care (RONC) has been associated with poor patient outcomes and is a growing concern in healthcare. The aim of this systematic study was to investigate the connection between patient safety and the RONC.

          Material/Methods

          A thorough search of electronic databases was done to find research that examined the relationship between restricting nurse services and patient safety. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers (M.L. and A.P.) independently screened the titles and abstracts, and full-text articles were assessed for eligibility. Data were extracted, and a quality assessment was performed using appropriate techniques.

          Results

          A total of 15 studies met the inclusion criteria. The studies included in the review demonstrated a correlation between rationing of nursing care and patient safety. The results of these studies revealed that there is an inverse relationship between rationing of nursing care and patient safety. The review found that when nursing care is rationed, there is a higher incidence of falls, medication errors, pressure ulcers, infections, and readmissions. In addition, the review identified that the work characteristics of nurses, such as workload, staffing levels, and experience, were associated with RONC.

          Conclusions

          RONC has a negative impact on patient safety outcomes. It is essential for healthcare organizations to implement effective strategies to prevent the RONC. Improving staffing levels, workload management, and communication amo0ng healthcare providers are some of the strategies that can support this.

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          Most cited references31

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          Bias in meta-analysis detected by a simple, graphical test

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              The association between nurse staffing and omissions in nursing care: A systematic review

              Abstract Aims To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing. Background Research has established associations between nurse staffing levels and adverse patient outcomes including in‐hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy. Design Systematic review. Data Sources We searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles. Review Methods Two reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were abstracted on study design, missed care prevalence and measures of association. Synthesis was narrative. Results Eighteen studies gave subjective reports of missed care. Seventy‐five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care. Conclusions Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated.
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                Author and article information

                Journal
                Med Sci Monit
                Med Sci Monit
                Medical Science Monitor
                Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                International Scientific Literature, Inc.
                1234-1010
                1643-3750
                2024
                10 January 2024
                16 November 2023
                : 30
                : e942031-1-e942031-11
                Affiliations
                [1 ]Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
                [2 ]Institute of Heart Diseases, University Hospital, Wrocław, Poland
                [3 ]Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wrocław Medical University, Wrocław, Poland
                [4 ]The Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
                [5 ]Department of Emergency Medical Service, Wrocław Medical University, Wrocław, Poland
                [6 ]Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
                Author notes
                Corresponding Author: Michał Czapla, e-mail: michal.czapla@ 123456umw.edu.pl
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Author information
                https://orcid.org/0000-0001-5452-0210
                https://orcid.org/0000-0003-4038-7492
                https://orcid.org/0000-0001-9574-4448
                https://orcid.org/0000-0002-8042-5345
                https://orcid.org/0000-0002-1541-1422
                https://orcid.org/0000-0001-9221-3502
                https://orcid.org/0000-0001-6311-9701
                https://orcid.org/0000-0002-4245-5420
                https://orcid.org/0000-0003-3597-2048
                Article
                942031
                10.12659/MSM.942031
                10787575
                38196186
                c7ccdcdc-e07b-460f-a84d-9328b204cd72
                © Med Sci Monit, 2024

                This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

                History
                : 03 August 2023
                : 27 October 2023
                Funding
                Funded by: Ministry of Science and Higher Education of Poland under the statutory grant of the Wrocław Medical University
                Award ID: SUBZ.E250.23.020
                Categories
                Meta-Analysis

                nursing care,health care rationing,patient safety
                nursing care, health care rationing, patient safety

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