Department of Nursing, School of Health Sciences, Cyprus University of Technology, Vragadinos street 15, Limassol, Cyprus.
Department of Economics and Finance, School of Business, University of Nicosia, Nicosia, Cyprus.
BMC Nurs. 2014 Sep 3;13:26. doi: 10.1186/1472-6955-13-26. eCollection 2014.
Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses' perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. The aims of the study were: a) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses' perceptions of their practice environment while adjusting for patient and nurse characteristics. b) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across rationing levels.
A descriptive, correlational design was employed. Participants in this study included 352 patients and 318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were used: the BERNCA scale for rationing of care, the RPPE scale to explore nurses' perceptions of their work environment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The statistical analysis included the use of Kendall's correlation coefficient to explore a possible relationship between the variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together with organizational characteristics on patient satisfaction.
The mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0-3), the overall mean of RPPE was 2.76 (SD = 0.32, range = 1.28 - 3.69) and the two scales were significantly correlated (τ = -0.234, p < 0.001). The regression analysis showed that care rationing and work environment were related to patient satisfaction, even after controlling for nurse and patient characteristics. The results from the adjusted regression models showed that even at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction.
The results support the relationships between organizational and environmental variables, care rationing and patient satisfaction. The identification of thresholds at which rationing starts to influence patient outcomes in a negative way may allow nurse managers to introduce interventions so as to keep rationing at a level at which patient safety is not jeopardized.
护理服务的隐性配给是指由于资源短缺而故意不提供或未能实施所有必要的护理措施。有证据表明，护理服务的配给、护士对其职业环境的看法、负面的患者结果以及危及患者安全之间存在关联。本研究的目的是：a）探讨在调整患者和护士特征的情况下，患者满意度是否与护士报告的护理服务配给以及护士对其实践环境的看法有关。b）通过比较配给水平与患者满意度因素之间的关系，确定配给的阈值分数。
采用描述性、相关性设计。本研究的参与者包括来自五家综合医院十个医疗和外科病房的 352 名患者和 318 名护士。使用了三种测量工具：用于评估护理服务配给的 BERNCA 量表、用于评估护士对工作环境看法的 RPPE 量表以及用于评估患者对护理服务满意度的患者满意度量表。统计分析包括使用 Kendall 相关系数探索变量之间的可能关系，以及多元回归分析评估护理服务隐性配给以及组织特征对患者满意度的影响。
护理服务隐性配给的平均得分为 0.83（SD=0.52，范围 0-3），总体 RPPE 平均得分为 2.76（SD=0.32，范围 1.28-3.69），两个量表显著相关（τ=-0.234，p<0.001）。回归分析表明，即使在控制了护士和患者特征后，配给和工作环境与患者满意度相关。调整后的回归模型结果表明，即使在配给最低水平（即 0.5）时，患者表示满意度较低。
研究结果支持组织和环境变量、护理配给和患者满意度之间的关系。确定配给开始以负面方式影响患者结果的阈值，可以使护士管理人员引入干预措施，以确保在不危及患者安全的情况下进行配给。
