Objectives: The purpose of the study is to determine the level of rationing of nursing care and its relationship to nurses' perception of their practice environment.

Methods: The study employed a descriptive, cross-sectional study design. The Basel Extent of Rationing of Nursing Care (BERNCA) was administered to assess the level of care rationing while the Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to describe nurses' practice environment. A total of 147 nurses participated in the study. Multiple regression analysis was conducted to determine the effect of various respondent characteristics and nurse practice environment on care rationing.

Results: Only practice environment total score was significantly associated with rationing of care total scores (B = -0.20, p < 0.05). Results of the regression show that for every unit increase in nurse practice environment total score, indicating a better work environment, there is a 0.20 unit decrease in rationing of nursing care total score, which indicated less rationing of care. Respondent characteristics are not significantly related.

Conclusion: Nurses most frequently rationed tasks in the areas of caring/support and monitoring. The less frequently rationed tasks involved medical, technical, and therapeutic aspects of care. The identification of rationing predictors can aid in determining starting points for hospital policy reforms. Prevalence levels can indicate when care rationing exceeds identified thresholds, if any. Nursing administrators can use implicit rationing of nursing care as a crucial indicator of the impact of strategies and changes in the nurse practice environment (e.g., changes in staffing levels, skill mix, and other resources).

Key Words: Health Care Rationing, Health Facility Environment, Nursing Care

PURPOSE: The purpose of this study was to identify the relationship among cognitive style, creative action, and challenging work and then determine whether challenging work has a mediating effect between cognitive style and creative action. METHODS: Data were collected from a convenience sample of 275 clinical nurses who graduated from 3-year nursing schools and worked in hospitals in Seoul or Kyungki Province. The questionnaire included measurements of cognitive style, creative action and challenging work. Data were analyzed using descriptive statistics, correlation, T-test, ANOVA, Duncan test, and hierarchical multiple regression. RESULTS: Mean scores for cognitive style, creative style, and challenging work were 3.28+/-0.42, 3.22+/-0.57, 3.40+/-0.63, respectively. Significant correlations were found between cognitive style and challenging work, cognitive style and creative action, and challenging work and creative action. Cognitive style was significantly different according to years in clinical career, and in hospital size. Challenging work was significantly different according to age and position. Creative action was significantly different according to years in clinical career. Finally challenging work had a mediating effect between cognitive style and creative action. CONCLUSION: Findings from this study provide a comprehensive understanding of challenging work for clinical nurses and indicate related factors and importance.
Health Facility Size ; Negotiating ; Surveys and Questionnaires ; Schools, Nursing

PURPOSE: The purpose of this study was to investigate the relationships among self-efficacy, collective efficacy, job satisfaction, and organizational commitment of nurses working in general hospitals. METHODS: Data were collected from 239 nurses working in five general hospitals of a local area by self-reported questionnaires. The collected data were analyzed with descriptive statistics, t-test, ANOVA, Pearson's correlation, and hierarchial multiple regression. RESULTS: Self-efficacy, collective efficacy, job satisfaction, and organizational commitment showed significantly positive correlations. Hierarchial multiple regression analysis showed that self-efficacy was the main factor of affecting job satisfaction, which explained 14.3% of the variance for the nurses' job satisfaction together with collective efficacy and weekly working time. In addition, the primary factor of affecting organization commitment was self-efficacy, which accounted for 17.2% of the variance for the nurses' organizational commitment together with hospital size and shift work. CONCLUSION: Self-efficacy and nursing working condition such as working time or hospital size contributed to the job satisfaction and organizational commitment and collective efficacy contributed to the job satisfaction. Therefore, the strategies for improving self and collective efficacy should be considered. Further study is also needed to investigate the concept of collective efficacy and its' measurement, and the relationship between collective efficacy and organizational commitment.
Health Facility Size ; Hospitals, General ; Job Satisfaction* ; Nursing ; Surveys and Questionnaires

Based on the theories of the Government Regulation and Administrative Licensure, aiming at the current situations of medical device registration system in China, some policy suggestions for future reform and improvement were provided as follows. (1) change the concepts of medical device registration administration. (2) perfect the regulations of medical device registration administration. (3) reform the medical device review organizational system. (4) Optimize the procedure of review and approval. (5) set up and maintain a professional team of review and approval staff. (6) reinforce the post-marketing supervision of medical devices. (7) foster and bring into play of the role of non-government organizations.
China ; Device Approval ; legislation & jurisprudence ; Equipment and Supplies ; Health Facility Administration

Operations research (OR) focuses on the application of analytical methods to facilitate better decision-making. Despite its usefulness and proliferation of papers in the academic literature, there are still major issues around getting OR models widely accepted and used as part of mainstream decision-making by clinicians, health managers and policy-makers. This article aims to raise the awareness of healthcare managers with regard to practical OR applications.
Decision Making ; Health Facility Administrators ; Humans ; Models, Theoretical ; Operations Research

PURPOSE: This study was conducted to investigate and compare the characteristics and relations of nursing practice environment, professionalism and job satisfaction among nurses in general hospitals according to hospital size. METHODS: The participants included 314 staff and charge nurses who were working in the general medical/surgical nursing units in one large hospital, three medium sized hospitals, and four small hospitals. Data collected through using self-report questionnaire were analyzed using the SPSS and SAS statistical programs. RESULTS: Nursing practice environment and job satisfaction had significant differences according to hospital size. Both of these scales were highest for medium hospitals and lowest for small hospitals. For all hospital sizes there were positive correlations between each of the variables. Multiple regression analysis showed that both nursing practice environment and job satisfaction were affected by hospital size, but professionalism was not. CONCLUSION: The results of this study indicate that nursing practice environment and job satisfaction vary with the size of the hospital. Therefore, further study is necessary to identify the work environment variables of nurses for performance management and to implement appropriate policies.
Health Facility Environment ; Health Facility Size ; Hospitals, General ; Job Satisfaction ; Nursing, Supervisory ; Phenothiazines ; Professional Competence ; Surveys and Questionnaires ; Weights and Measures

OBJECTIVES: The purpose of this study was to determine the effect of public health facilities rebuilding on the hypertension control in the rural area. METHOD: 6 health centers and 59 health subcenters in some Chung-chung province was surveyed. And 29,503 patients were finally selected who had records of prescription about hypertension at list once in those health facilities from July 1th, 2005 to June 30th, 2006. Demographic variable of patients and whether medical doctor was a medical specialist or not, and whether the facilities were recently rebuilded or not was measured. RESULTS: The Overall control rate was 53.9%. Women had higher hypertension control rate than men. And 60s and 70s years old are had higher hypertension control rate than 40s and 80s years old. Patients who had been treated from medical specialist had higher hypertension control rate than general doctor. And patient who treated in rebuilded public health facilities had higher hypertension control rate. CONCLUSIONS: Rebuilding of public health facilities were related to increasing control rate of hypertensive patients.
Facility Design and Construction ; Female ; Health Facilities ; Humans ; Hypertension ; Male ; Prescriptions ; Public Health ; Rural Health Services ; Specialization

PURPOSE: This study was done to identify determinants of registered nurse (RN) skill mix and staffing level focused on hospital characteristics. METHODS: Data were obtained from health insurance claims data and hospital reporting system in the Health Insurance Review and Assessment Service (HIRA) for the year 2010. Data from 2,998 hospitals were analysed using t-test, ANOVA, Pearson correlation, and regression analysis. RESULTS: The RN skill mix and staffing level were positively related to hospital size and the percentage of inpatients to total patients. RN skill mix and staffing level were statistically different across regions. Including nursing aides (NA), however, there was no difference in staffing levels across regions. Medically vulnerable regions, bed operation rate, and the number of patients per doctor were also related to RN skill mix and staffing level. CONCLUSION: The statically significant determinants of RN skill mix and staffing level included hospital size, region, bed operation rate, percentage of inpatients, doctor-patient ratio. Further study needs to be done to investigate factors including RN supply and wages.
Health Facility Size ; Humans ; Inpatients ; Insurance, Health ; Korea* ; Nursing ; Nursing Staff ; Salaries and Fringe Benefits

Service diversification is recognized as an important strategy against turbulent environmental change. This study is designed to find out the trend of service diversification in Korean health care organizations and also to identify factors associated with the degree of service diversification. Data were collected from 69 hospitals out of 71 hospitals with over 300 beds. Important findings are summarized below. 1. Types of diversification are closely related to hospital size. Large hospitals have a tendency to provide sophisticated service requiring specialized skills and equipment, while small hospital have concentrated their efforts on health screening programs. 2. The more competitive and bigger hospitals are, the greater number of services that provide. Also, hospitals operating rational management information systems provide more services. Contrary to the expectation, hospitals with a low performance during last 3 years showed more service diversification. 3. A trend of more diversification was observed in hospitals whose chief executive officer used a prospector strategy. 4. A multiple regression analysis revealed that bed size, competitive environment, degree of rational management, and the growth pattern were significantly associated with teh service diversification.
Delivery of Health Care ; Health Facility Size ; Hospital Bed Capacity ; Management Information Systems ; Mass Screening

Objective: This study aims to assess the presence of stigma in health facilities and health-seeking behaviors of persons living with HIV (PLHIV). Methods: This study utilized a cross-sectional design employing self-report questionnaires answered online. A total of 100 PLHIV participants were recruited using the respondent-driven sampling method. Results: Results revealed that most participants are young adult men who have been diagnosed with HIV within the last five years. Overall, participants display moderate health-seeking behavior (M = 2.94, SD = 0.54), and moderate experience of health facility-related stigma (M = 2.21, SD = 0.87). Further, there is a negative correlation between age and health-seeking behavior (r = −0.2796, p = 0.049). The type of facility is significantly correlated with HIV stigma (r = 0.4050, p = 0.036). Conclusion A sustained linkage to care is essential for a PLHIV to remain engaged on his health and well-being. Necessary strategies should be implemented to improve the health-seeking behaviors of PLHIV. Public Rural Health Units are considered to be the most stigmatizing health facility. The presence of health facility-related stigma requires immediate action of the government to reinvigorate these catchment centers as providers of stigma-free and nondiscriminatory primary health care.
Human Immunodeficiency Virus ; HIV ; Stigma ; Health facility ; Health-seeking behaviors ; Philippines