A recent study conducted by the Institute of Nursing Sciences at the University of Basel and published in the journal "BMJ Quality & Safety", surveyed the conditions in which registered nurses practice their profession.
The lack of time for nursing care activities in hospitals across Europe has a severely negative impact, though variability between and within surveyed countries was found. Vital aspects of nursing such as the education of patients and their families, or comforting and simply talking to the patients, are often omitted.
It appears that registered nurses frequently find themselves faced with difficult challenges that are mainly due to budget constraints. Having to make the decision as to which care activities to offer their patients and which to leave out appears to be an international phenomenon which highlighted a connection between omitted nursing care and an increase in patient mortality figures.
The Institute of Nursing Sciences at the University of Basel is the first to conduct research on prevalence and nature of omitted nursing activities on general medical/surgical wards in acute care hospitals across Europe. Responses from over 35,000 nurses in almost 490 hospitals were originally collected for the international RN4CAST study (‘Nurse forecasting in Europe’, funded within the European Union’s Seventh Framework Program) and analysed for the study. The countries selected were England, the Netherlands, Germany, Belgium, Finland, Ireland, Poland, Greece, Ireland, Norway, Switzerland and Spain.
On average, as many as four out of thirteen care activities are left undone by healthcare professionals across Europe, with the results showing a high level of variability both between and within countries. Psychoeducational care (talking with patients or the education of patients and their relatives) is more frequently left out than the documentation and planning of care, which includes the monitoring of patients, their turning or the timely administration of their medications.
Dr. René Schwendimann, head of the Swiss research group explains that although psychoeducational care activities have always constituted the core of nursing tasks this study demonstrates their neglect, mainly due to a lack of time and the limitation of resources, and subsequently, they are allocated a lower priority by nurses.
Omitting nursing care is a taboo subject among healthcare professionals as it can cause role and moral conflict, decrease job satisfaction and increase job-related burnout syndrome. Consequently, the authors of the study stress the importance of treating this topic with openness and honesty, emphasising the need for good management. As highlighted in the study findings, nursing care activities were less frequently left out in hospitals with a more favorable nurse work environments irrespective of national jurisdiction. It was the leadership skills of the nursing management, the nurses/physician teamwork quality and the frequency of non-nursing duties (e.g.cleaning) imposed on nurses, which were listed as influencing factors for the level of satisfaction in a work environment.
According to Schwendimann hospital management can help nurses avoid the omission of nursing care by optimizing the nurse work environment. Current financial constraints on healthcare in a number of countries across Europe are, however, contributing to an increase in the neglect of nursing care and by conducting regular surveys among the nurses, deficits in the care process could be identified at an earlier stage.
11 November 2013