姑息治疗环境中影响护理自我配给的因素。

Factors influencing the self-rationing of nursing care in palliative care settings.

作者信息

Włostowska Karolina, Uchmanowicz Izabella, Jędrzejczyk Maria, Czapla Michał, Guzak Beata

机构信息

Hospice of Divine Providence in Wolomin, Wolomin, 05-200, Poland.

Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, 51-618, Poland.

出版信息

BMC Nurs. 2025 Mar 31;24(1):345. doi: 10.1186/s12912-025-03029-5.

DOI:10.1186/s12912-025-03029-5

PMID:40165197

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11959988/

Abstract

BACKGROUND

The rationing of nursing care is a significant concern in palliative care settings, where resource limitations can prevent nurses from providing comprehensive patient care. This study aims to examine the factors influencing the rationing of nursing care among palliative care nurses, focusing on the impact of psychological factors and workplace characteristics.

METHODS

A cross-sectional survey was conducted using the Perceived Implicit Rationing of Nursing Care (PIRNCA) questionnaire among 104 nurses working in palliative care. Data on anxiety and depression levels were collected using the HADS scale. Multivariate regression analysis was employed to identify key predictors of care rationing, including depression, anxiety, and type of care setting.

RESULTS

The average PIRNCA score was 0.82 (SD = 0.53), indicating that care rationing occurs "rarely." The most frequently rationed tasks were emotional and psychological support, patient education, and assistance with mobility. Nurses with higher depression (p = 0.002) and anxiety levels (p = 0.0012) were more likely to ration care. Working in a home-based hospice was associated with increased care rationing (p = 0.0012), while working in a palliative care ward reduced it (p = 0.0027).

CONCLUSIONS

Psychological distress, particularly depression and anxiety, significantly contributes to nursing care rationing in palliative care. Additionally, the type of care setting plays a critical role, with home-based hospice care being more prone to rationing. Interventions to support nurses' mental health and optimize resource allocation, particularly in home-based care, are essential to ensure comprehensive patient care in palliative settings.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

背景

在姑息治疗环境中，护理资源的分配是一个重大问题，资源限制可能会使护士无法提供全面的患者护理。本研究旨在探讨影响姑息治疗护士护理资源分配的因素，重点关注心理因素和工作场所特征的影响。

方法

使用护理感知隐性配给问卷（PIRNCA）对104名从事姑息治疗的护士进行横断面调查。使用医院焦虑抑郁量表（HADS）收集焦虑和抑郁水平的数据。采用多元回归分析确定护理配给的关键预测因素，包括抑郁、焦虑和护理环境类型。

结果

PIRNCA平均得分为0.82（标准差=0.53），表明护理配给“很少”发生。最常被配给的任务是情感和心理支持、患者教育以及行动辅助。抑郁程度较高（p=0.002）和焦虑水平较高（p=0.0012）的护士更有可能进行护理配给。在居家临终关怀机构工作与护理配给增加有关（p=0.0012），而在姑息治疗病房工作则会减少护理配给（p=0.0027）。