Background

Implicit rationing of nursing care is a socio-ecological problem where care workers, due to lack of resources, have to leave necessary nursing care activities undone. Cross-sectional studies on implicit rationing of nursing home care revealed associations with organizational and work environment characteristics. However, little is known on how implicit rationing of nursing care varies over time in nursing homes.

Objective

This study's purpose was to describe changes in levels and patterns of implicit rationing of nursing care in Swiss nursing homes over time, while accounting for key explanatory factors related to organizational, work environment, and individual characteristics.

Design

Time-series cross-sectional analysis.

Setting

Nursing homes in Switzerland.

Participants

A convenience sample of 47 nursing homes and 3269 care workers from all educational levels participating in two multicenter cross-sectional studies (the Swiss Nursing Home Human Resources Project) conducted in 2013 and 2018.

Methods

To quantify implicit rationing of nursing care, care workers' data were collected via the nursing home version of the Basel Extent of Rationing of Nursing Care instrument. To control for leadership ability, staffing and resource adequacy, we used the Nursing Work Index–Practice Environment Scale. Objective measures including turnover, staffing and skill mix levels were aggregated at the nursing home level. Our analyses included multiple linear mixed models, using time as a fixed effect and nursing home as a random effect.

Results

We found overall increases of rationing of care activities over the five-year period studied, with documentation and social activities most rationed at both measurement points (overall coefficients varied between 0.11 and 0.23, as well as the 95%-confidence intervals between 0.05 and 0.30). Moreover, a considerable increase in rationing of activities of daily living (coefficient of 0.47 in 2013 and 0.63 in 2018) was observed.

Conclusions

Alongside long-term deterioration of staff resources, increases in rationing of nursing care are a worrying development, particularly given their potential negative impacts both on residents and on care workers. To assess nursing home care quality and to determine adequate staffing levels and skill mixes, policy makers and nursing home managers should consider regular monitoring of rationing of nursing care.

Tweetable abstract

Time-series cross-sectional analysis reveals increasing rationing of nursing care activities in Swiss nursing homes from 2013 to 2018.

中文翻译：

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增加疗养院护理的隐性配给：时间序列横断面分析

背景

护理的隐性配给是一个社会生态问题，护理人员由于缺乏资源而不得不放弃必要的护理活动。关于疗养院护理内隐配给的横断面研究揭示了与组织和工作环境特征的关联。然而，关于养老院的隐性配给护理如何随着时间的推移而变化，我们知之甚少。

客观的

本研究的目的是描述瑞士疗养院内隐性配给护理水平和模式随时间的变化，同时考虑与组织、工作环境和个人特征相关的关键解释因素。

设计

时间序列横截面分析。

环境

瑞士的疗养院。

参与者

参与 2013 年和 2018 年进行的两项多中心横断面研究（瑞士疗养院人力资源项目）的 47 家疗养院和 3269 名护理人员的便利样本。

方法

为了量化护理的隐性配给，护理人员的数据是通过巴塞尔护理配给范围工具的疗养院版本收集的。为了控制领导能力、人员配备和资源充足性，我们使用了护理工作指数-实践环境量表。在疗养院层面汇总了包括人员流动、人员配备和技能组合水平在内的客观指标。我们的分析包括多个线性混合模型，使用时间作为固定效应，疗养院作为随机效应。

结果

我们发现在所研究的五年期间，护理活动的配给量总体增加，在两个测量点上，文件和社会活动的配给量最大（总体系数在 0.11 和 0.23 之间变化，95% 的置信区间在 0.05 和 0.30 之间） ）。此外，观察到日常生活活动配给的显着增加（2013 年系数为 0.47，2018 年为 0.63）。

结论

除了人力资源的长期恶化之外，护理配给的增加也是一个令人担忧的发展，特别是考虑到它们对居民和护理人员的潜在负面影响。为了评估疗养院护理质量并确定足够的人员配备水平和技能组合，政策制定者和疗养院管理人员应考虑定期监测护理配给。

可推文摘要

时间序列横断面分析显示，从 2013 年到 2018 年，瑞士疗养院的护理活动配给量增加。