Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Adv Nurs. 2024 May;80(5):1891-1901. doi: 10.1111/jan.15970. Epub 2023 Nov 20.
To explore potential areas of low-value home-based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home-based nursing care.
A quantitative, cross-sectional design.
An online survey with questions containing scaled frequencies on five-point Likert scales and open questions on possible related influencing factors of low-value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results.
A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low-value care practices reported were: (1) 'washing the client with water and soap by default', (2) 'application of zinc cream, powders or pastes when treating intertrigo', (3) 'washing the client from head to toe daily', (4) 're-use of a urinary catheter bag after removal/disconnection' and (5) 'bladder irrigation to prevent clogging of urinary tract catheter'. The top five related influencing factors reported were: (1) 'a (general) practitioner advices/prescribes it', (2) 'written in the client's care plan', (3) 'client asks for it', (4) 'wanting to offer the client something' and (5) 'it is always done like this in the team'. Higher educational levels and an age above 40 years were associated with a lower provision of low-value care.
According to registered nurses and certified nursing assistants, a number of low-value nursing practices occurred frequently in home-based nursing care and they experienced multiple factors that influence the provision of low-value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de-implementation strategy.
STROBE checklist for cross-sectional studies.
No Patient or Public Contribution.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nursing care is increasingly shifting towards the home environment. Not all nursing care that is provided is effective or efficient and this type of care can therefore be considered of low-value. Reducing low-value care and increasing appropriate care will free up time, improve quality of care, work satisfaction, patient safety and contribute to a more sustainable healthcare system.
探讨家庭护理中潜在的低价值护理实践领域、其普遍性以及影响护士和护理助理提供低价值护理的相关因素。
定量、横断面设计。
采用包含 5 点 Likert 量表评分的在线问卷和关于低价值护理相关影响因素的开放性问题进行调查。数据收集于 2022 年 2 月至 4 月进行。采用描述性统计和线性回归对结果进行总结和分析。
全国范围内有 776 名认证护理助理、注册护士和执业护师对调查做出了回应。报告的实施频率最高的前五项低价值护理实践是：（1）“默认用肥皂和水给客户洗澡”；（2）“在治疗间擦疹时使用氧化锌乳膏、粉剂或糊剂”；（3）“每天从头到脚给客户洗澡”；（4）“在移除/断开后重新使用导尿管袋”；（5）“为防止尿路导管堵塞而进行膀胱冲洗”。报告的前五个相关影响因素是：（1）“（全科）医生建议/开处方”；（2）“写入客户的护理计划”；（3）“客户要求”；（4）“想给客户提供一些东西”；（5）“团队中一直都是这样做的”。较高的教育水平和年龄在 40 岁以上与低价值护理的提供呈负相关。
根据注册护士和认证护理助理的说法，家庭护理中存在多种低价值护理实践，他们经历了多种影响低价值护理提供的因素，如缺乏临床自主性和处理客户的要求、偏好和需求。结果可以用作多方面实施策略的起点。
STROBE 横断面研究检查表。
无患者或公众贡献。
对专业和/或患者护理的影响：护理服务正越来越多地向家庭环境转移。并非所有提供的护理都是有效的或高效的，因此可以认为这种护理是低价值的。减少低价值护理并增加适当的护理将腾出时间，提高护理质量、工作满意度、患者安全性，并有助于建立更可持续的医疗保健系统。
