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Miyamori D, Yoshida S, Kashima S, Koike S, Ishii S, Okazaki Y, Ikeda K, Matsumoto M. How the 2018 Japan Floods Impacted Nursing Home Admissions for Older Persons: A Longitudinal Study Using the Long-Term Care Insurance Comprehensive Database. J Am Med Dir Assoc 2023; 24:368-375.e1. [PMID: 36587929 DOI: 10.1016/j.jamda.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES As disasters become more frequent because of global warming, countries across the world are seeking ways to protect vulnerable older populations. Although these conditions may increase nursing home admission (NHA) rates for older persons, we know of no studies that have directly tested this hypothesis. DESIGN This was a retrospective cohort study. SETTING AND PARTICIPANTS We analyzed data from long-term care insurance (LTCI) users in 3 Japanese prefectures that incurred heavy damage from the 2018 Japan Floods, which is the largest recorded flooding disaster in national history. Specifically, we extracted NHA data from the LTCI comprehensive database, both for disaster-affected and unaffected individuals. METHODS We employed the Cox proportional hazards model to calculate multivariate-adjusted hazard ratios (HRs) for NHAs within a 6-month period following the 2018 Japan Floods, with adjustments for potential confounding factors. RESULTS Of the 187,861 individuals who used LTCI services during the investigated period, we identified 2156 (1.1%) as disaster affected. The HR for NHA was significantly higher for disaster-affected (vs unaffected) individuals (adjusted HR 3.23: 95% CI 2.88‒3.64), and also higher than the HRs for older age (90-94 years vs 65-69 years: 2.29, CI 1.93‒2.70), cognitive impairment (severe impairment vs normal: 1.40, CI 1.25‒1.57), and physical function (bedridden vs independent: 2.27, CI 1.83‒2.70). According to our subgroup analyses, the adjusted HR for disaster-affected individuals unable to feed themselves was 6.00 (CI 3.68‒9.79), with a significant interaction between the 2 variables (P = .01). CONCLUSIONS AND IMPLICATIONS Natural disasters increase the risk of NHA for older persons, especially those who are unable to feed themselves. Health care providers and policymakers should understand and prepare for this emerging risk factor.
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Affiliation(s)
- Daisuke Miyamori
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Shuhei Yoshida
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Saori Kashima
- Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Soichi Koike
- Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Okazaki
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kotaro Ikeda
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masatoshi Matsumoto
- Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Renner A, Ausserhofer D, Zúñiga F, Simon M, Serdaly C, Favez L. Increasing implicit rationing of care in nursing homes: A time-series cross-sectional analysis. Int J Nurs Stud 2022; 134:104320. [PMID: 35868214 DOI: 10.1016/j.ijnurstu.2022.104320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/20/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022]
Abstract
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.
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Affiliation(s)
- Anja Renner
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Dietmar Ausserhofer
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Claudiana Research, College of Health Care-Professions Claudiana, Lorenz-Böhler-Strasse 13, 39100 Bozen, Italy.
| | - Franziska Zúñiga
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Christine Serdaly
- serdaly&ankers snc, 210 route de Florissant, 1231 Conches, Switzerland.
| | - Lauriane Favez
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
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Zhang H, Peng Z, Chen Q, Liu W. A cross-sectional study of implicit rationing of care in publicly funded nursing homes in Shanghai, China. J Nurs Manag 2021; 30:345-355. [PMID: 34590763 DOI: 10.1111/jonm.13479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/06/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022]
Abstract
AIMS To investigate the level of implicit care rationing and its association with training needs in nursing homes in Shanghai, China. BACKGROUND Nursing homes in Shanghai are confronted with a lack of care resources. Implicit care rationing can emerge due to inadequate training of care workers. METHODS A cross-sectional survey was conducted between 10 September and 17 November 2020. A total of 374 care workers from 16 randomly were selected nursing homes from each of the administrative districts participated the surveys. The Basel Extent of Rationing of Nursing Care-Nursing Home instrument and the training needs analysis were adopted to measure implicit care rationing and training needs, respectively. Multiple regression techniques were used to explore the factors associated with implicit care rationing. RESULTS Activities related to social care, documentation and activation/rehabilitation (mean rating = 2.8, 1.89 and 1.93 respectively) were mostly likely to be rationed. Training needs of activities of daily living (ADL), activation/rehabilitation and documentation were significantly related to their implicit rationing (β = 0.864, 0.21 and 0.166, respectively, p < .01). CONCLUSION Training needs are crucial determinants of implicit care rationing. IMPLICATIONS FOR NURSING MANAGEMENT Quality control systems are needed to ensure care comprehensiveness. The current training system should be re-designed according to results of training needs analysis.
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Affiliation(s)
- Huimin Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
| | - Zixuan Peng
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Qianqian Chen
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
| | - Wenwei Liu
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,College of Philosophy, Law and Political Science, Shanghai Normal University, Shanghai, China
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Ludlow K, Churruca K, Mumford V, Ellis LA, Testa L, Long JC, Braithwaite J. Unfinished Care in Residential Aged Care Facilities: An Integrative Review. THE GERONTOLOGIST 2021; 61:e61-e74. [PMID: 31773131 DOI: 10.1093/geront/gnz145] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES When workload demands are greater than available time and resources, staff members must prioritize care by degree of importance and urgency. Care tasks assigned a lower priority may be missed, rationed, or delayed; collectively referred to as "unfinished care." Residential aged care facilities (RACFs) are susceptible to unfinished care due to consumers' complex needs, workforce composition, and constraints placed on resource availability. The objectives of this integrative review were to investigate the current state of knowledge of unfinished care in RACFs and to identify knowledge gaps. RESEARCH DESIGN AND METHODS We conducted a search of academic databases and included English-language, peer-reviewed, empirical journal articles that discussed unfinished care in RACFs. Data were synthesized using mind mapping techniques and frequency counts, resulting in two categorization frameworks. RESULTS We identified 17 core studies and 27 informing studies (n = 44). Across core studies, 32 types of unfinished care were organized under five categories: personal care, mobility, person-centeredness, medical and health care, and general care processes. We classified 50 factors associated with unfinished care under seven categories: staff member characteristics, staff member well-being, resident characteristics, interactions, resources, the work environment, and delivery of care activities. DISCUSSION AND IMPLICATIONS This review signifies that unfinished care in RACFs is a diverse concept in terms of types of unfinished care, associated factors, and terminology. Our findings suggest that policymakers and providers could reduce unfinished care by focusing on modifiable factors such as staffing levels. Four key knowledge gaps were identified to direct future research.
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Affiliation(s)
- Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Rey S, Savoie C, Voyer P, Ahossi EC, Bouchard S, Dallaire C, Hardy MS, Ducraux D, Ortoleva Bucher C, Cohen C. Fondamentaux des soins : un cadre et un processus pratique pour répondre aux besoins physiques, psychosociaux et relationnels des personnes soignées. Rech Soins Infirm 2020:7-30. [PMID: 33319719 DOI: 10.3917/rsi.142.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Since 2008, an international group has been helping to promote a better response to the fundamental needs of individuals receiving care. This group provides a framework on the fundamentals of care that focuses on the relationship between the nurse, the individual being cared for, and his or her relatives, as well as on the response to the patient’s physical, psychosocial, and relational needs. A practice process supports the concrete application of this framework. The purpose of this discursive article is to present the French translation of the Fundamentals of Care Framework and its Practice Process. To begin with, the translation process will be briefly explained. Next, the Fundamentals of Care Framework and the stages in its Practice Process will be presented. To help the reader better understand the proposal, a clinical illustration will be used to present the situation of Mr. Perron, who is living with Alzheimer’s disease, and his spouse, who is his family caregiver. Finally, the article discusses the usefulness of the Fundamentals of Care Framework and its Practice Process in terms of the four main areas of the discipline of nursing : practice, management, training, and research. This article paves the way for the development of knowledge on the fundamentals of care in the French-speaking world.
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Ludlow K, Churruca K, Mumford V, Ellis LA, Braithwaite J. Staff members' prioritisation of care in residential aged care facilities: a Q methodology study. BMC Health Serv Res 2020; 20:423. [PMID: 32410685 PMCID: PMC7222492 DOI: 10.1186/s12913-020-05127-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When healthcare professionals' workloads are greater than available resources, care activities can be missed, omitted or delayed, potentially leading to adverse patient outcomes. Prioritisation, a precursor to missed care, involves decision-making about the order of care task completion based on perceived importance or urgency. Research on prioritisation and missed care has predominantly focused on acute care settings, which differ from residential aged care facilities in terms of funding, structure, staffing levels, skill mix, and approaches to care. The objective of this study was to investigate how care staff prioritise the care provided to residents living in residential aged care. METHODS Thirty-one staff members from five Australian residential aged care facilities engaged in a Q sorting activity by ranking 34 cards representing different care activities on a pre-defined grid from 'Least important' (- 4) to 'Most important' (+ 4). Concurrently, they participated in a think-aloud task, verbalising their decision-making processes. Following sorting, participants completed post-sorting interviews, a demographics questionnaire and semi-structured interviews. Q sort data were analysed using centroid factor analysis and varimax rotation in PQMethod. Factor arrays and data from the think-aloud task, field notes and interviews facilitated interpretation of the resulting factors. RESULTS A four-factor solution, representing 22 participants and 62% of study variance, satisfied the selection criteria. The four distinct viewpoints represented by the solution were: 1. Prioritisation of clinical care, 2. Prioritisation of activities of daily living, 3. Humanistic approach to the prioritisation of care, and 4. Holistic approach to the prioritisation of care. Participants' prioritisation decisions were largely influenced by their occupations and perceived role responsibilities. Across the four viewpoints, residents having choices about their care ranked as a lower priority. CONCLUSIONS This study has implications for missed care, as it demonstrates how care tasks deemed outside the scope of staff members' defined roles are often considered a lower priority. Our research also shows that, despite policy regulations mandating person-centred care and the respect of residents' preferences, staff members in residential aged care facilities tend to prioritise more task-oriented aspects of care over person-centredness.
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Affiliation(s)
- Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, 2109, Australia.
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, 2109, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, 2109, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, 2109, Australia
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Kalánková D, Kirwan M, Bartoníčková D, Cubelo F, Žiaková K, Kurucová R. Missed, rationed or unfinished nursing care: A scoping review of patient outcomes. J Nurs Manag 2020; 28:1783-1797. [DOI: 10.1111/jonm.12978] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dominika Kalánková
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
| | - Marcia Kirwan
- School of Nursing and Human Sciences Dublin City University in Dublin Glasnevin, Dublin Ireland
| | - Daniela Bartoníčková
- Department of Nursing 2nd Faculty of Medicine Charles University in Prague Prague Czech Republic
| | - Floro Cubelo
- School of Health and Social Studies Jyväskylä University of Applied Sciences Jyväskylä Finland
| | - Katarína Žiaková
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
| | - Radka Kurucová
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
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Mandal L, Seethalakshmi A, Rajendrababu A. Rationing of nursing care, a deviation from holistic nursing: A systematic review. Nurs Philos 2019; 21:e12257. [DOI: 10.1111/nup.12257] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Lata Mandal
- Faculty of Nursing Sri Ramachandra Institute of Higher Education and Research Chennai India
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Evripidou M, Merkouris A, Charalambous A, Papastavrou E. Implementation of a training program to increase knowledge, improve attitudes and reduce nursing care omissions towards patients with dementia in hospital settings: a mixed-method study protocol. BMJ Open 2019; 9:e030459. [PMID: 31326938 PMCID: PMC6661557 DOI: 10.1136/bmjopen-2019-030459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/16/2019] [Accepted: 06/28/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION There is an evidence showing that when nurses have to allocate their time because of a lack of resources, older patients and especially those with dementia have a secondary care priority. The purpose of this study is to advance the level of knowledge, promote positive attitudes of nurses and reduce care deficits towards people with dementia through the implementation of a training programme. The programme will be enriched by an observational study of the care of patients with dementia to identify areas of missed care. METHOD AND ANALYSIS This study will follow a mixed methodology consisting of three stages: (1) evaluation of the level of nurses' knowledge and attitudes towards dementia care through the use of structured questionnaires, (2) observational study to evaluate nursing care in hospital settings, in order to detect any missed care and (3) quasi-experimental study, with a before-and-after design, through the implementation of the training programme in order to increase nurses' knowledge, improve attitudes and consequently to promote care for patients with dementia. The data will be analysed with descriptive and inferential statistics with the use of the SPSS V.24.0 and with content analysis as regard to the observational data. ETHICS AND DISSEMINATION The protocol was approved by the National Bioethics committee and other local committees (ΕΕΒΚ: 2018.01.02). The participants will give their informed consent and the anonymity and confidentiality. Also, the protection of data will be respected. The results of the study will be disseminated in peer-reviewed international journals and conferences. If the intervention is successful, the training package will be given to the continuous education unit of the National Professional Association in order to be used on a regular basis.
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Affiliation(s)
- Melina Evripidou
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Anastasios Merkouris
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andreas Charalambous
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
- Nursing, Turun Yliopisto, Turku, Finland
| | - Evridiki Papastavrou
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Chaplin T, McLuskey J. What influences nurses' decision to mobilise the critically ill patient? Nurs Crit Care 2019; 25:353-359. [PMID: 31318134 DOI: 10.1111/nicc.12464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/09/2019] [Accepted: 06/20/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the known benefits of mobilising critically ill patients, bed rest is still a common practice in intensive care units. The reasons for this are not fully understood. Early mobilisation can reduce the length of stay in the intensive care unit and in hospitals as well. However, the decision to mobilise a patient can be delayed while health professionals decide whose role it is to implement it. AIM AND OBJECTIVES The aim of this study was to explore the ways in which nurses make decisions to mobilise critically ill patients and what factors influence the decision-making process. STUDY DESIGN AND METHOD This was a qualitative study involving semi-structured interviews with 12 critical care nurses at a large urban district hospital. Interpretative phenomenological analysis was used to analyse verbatim transcripts of the interviews. RESULTS The findings demonstrated inconsistencies in the nurses' knowledge of the benefits to mobilising patients and that mobilisation was deemed to be a low priority. Decision-making was influenced by time constraints, staffing levels, and unit demands. A lack of communication and collaborative working was identified, along with uncertainty and role ambiguity, with regard to who decides to mobilise a patient. Mobilisation was found to be complicated by existing cultural influences and by previous experiences of complex mobilisation. CONCLUSION Re-education strategies are needed to re-enforce the benefits of mobilisation, along with multidisciplinary training sessions to clarify roles and overcome collaborative working issues. RELEVANCE TO CLINICAL PRACTICE This study has provided a greater understanding of the influencing factors on nurses' decision-making with regard to mobilising critical ill patients.
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Affiliation(s)
- Tara Chaplin
- Critical Care Unit, Kings Mill Hospital, Nottingham, UK
| | - John McLuskey
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Gibbon B, Crane J. The impact of 'missed care' on the professional socialisation of nursing students: A qualitative research study. NURSE EDUCATION TODAY 2018; 66:19-24. [PMID: 29655017 DOI: 10.1016/j.nedt.2018.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/22/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Missed care is a recently described concept that is subject to an increasing amount of international nursing research. The impact of missed care is associated with poorer patient outcomes (mortality and morbidity) and poorer levels of patient satisfaction with the services provided by the hospital. Missed care has also been linked to decreased staff satisfaction and increased intention to leave. Overall disaffection amongst registered nurses has also been reported. Professional socialisation refers to the acquisition of behaviours within cultural norms, and it has been suggested that students enter a period of professional socialisation during their programme. Whilst it has been proposed that students may absorb the characteristics of those around them, to date, no empirical studies have reported the impact of missed care on student nurses. METHODS The aim of this project is to explore the impact of missed care on the professional socialisation of student nurses. A qualitative study was undertaken in one higher education institute in UK with final year pre-registration nursing degree (adult field) students. Focus group interviews, utilizing a broad topic guide, were used to collect data which was analysed using thematic analysis. FINDINGS Student nurses were aware that some planned care is missed and these findings resonated with those identified in the literature. In addition to illuminating aspects of professional socialisation, analysis yielded five themes with regards to missed care: awareness, rationale, impact, strategies to avoid and influence of missed care on career aspiration. Student nurses exposed to missed care appear to accept this as part of their professional socialisation. CONCLUSION With regards to professional socialisation, student nurses developed a pragmatic acceptance that care would be missed and that this could happen in any environment. As such they did not see missed care as influencing their career aspirations.
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Affiliation(s)
- Bernard Gibbon
- Institute of Clinical Sciences, Thompson Yates Building, University of Liverpool, Liverpool, L69 3GB, UK; School of Health Sciences, Whelan Building, University of Liverpool, L69 3GB, UK.
| | - Julie Crane
- Institute of Clinical Sciences, Thompson Yates Building, University of Liverpool, Liverpool, L69 3GB, UK; School of Health Sciences, Whelan Building, University of Liverpool, L69 3GB, UK.
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Abstract
Purpose
The purpose of this paper is to explore how nurses make decisions to ration care or leave it undone within a clinical environment that is controlled by systems level cost containment. The authors wanted to find out what professional, personal and organisational factors contribute to that decision-making process. This work follows previous international research that explored missed nursing care using Kalisch and Williams’ MISSCARE survey.
Design/methodology/approach
The authors drew on the care elements used by Kalisch and Williams, asking nurses to tell us how they decided what care to leave out, the conduits for which could include delaying care during a shift, delegating care to another health professional on the same shift, handing care over to staff on the next shift or leaving care undone.
Findings
The findings suggest that nurses do not readily consider their accountability when deciding what care to leave or delay, instead their priorities focus on the patient and the organisation, the outcomes for which are frequently achieved by completing work after a shift.
Originality/value
The actions of nurses implicitly rationing care is largely hidden from view, the consequences for which potentially have far reaching effects to the nurses and the patients. This paper raised awareness to hidden issues facing nurses within a cycle of implicitly rationing care, caught between wanting to provide care to their patients, meeting the organisation’s directives and ensuring professional safety. Rethinking how care is measured to reflect its unpredictable nature is essential.
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Abstract
BACKGROUND Rationing of various needed services, for example, nursing care, is inevitable due to unlimited needs and limited resources. Rationing of nursing care is considered an ethical issue since it requires judgment about potential conflicts between personal and professional values. OBJECTIVES The present research sought to explore aspects of rationing nursing care in Iran. RESEARCH DESIGN This study applied qualitative content analysis, a method to explore people's perceptions of everyday life phenomena and interpret the subjective content of text data. Data collection was performed through in-depth, unstructured, face-to-face interviews with open-ended questions. Participants and research context: The study population included Iranian nurses of all nursing positions, from clinical nurses to nurse managers. Purposive sampling was employed to select 15 female and 3 male nurses (11 clinical nurses, 3 supervisors, 1 matron, 1 nurse, and 2 members of the Nursing Council) working in hospitals of three cities in Iran. Ethical considerations: The study protocol was approved by Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all participants. FINDINGS According to the participants, rationing of nursing care consisted of two categories, that is, causes of rationing and consequences of rationing. The first category comprised three subcategories, namely, patient needs and demands, routinism, and VIP patients. The three subcategories forming the second category were missed nursing care, patient dissatisfaction, and nurses' feeling of guilt. CONCLUSION Levels at which healthcare practices are rationed and clarity of the rationing are important structural considerations in the development of an equal, appropriate, and ethical healthcare system. Moreover, the procedure of rationing is critical as it not only influences people's lives but also reflects the values that dominate in the society. Therefore, in order to minimize the negative consequences of rationing of nursing care, further studies on the ethical dimensions of this phenomenon are warranted.
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Voutilainen P, Backman K, Isola A, Laukkala H. Family Members' Perceptions of the Quality of Long-Term Care. Clin Nurs Res 2016; 15:135-49. [PMID: 16638831 DOI: 10.1177/1054773805285697] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the study is to assess family members' perceptions of the quality of nursing care of older people and its relationships between demographic factors and family involvement. Data were gathered from family members of four residential homes ( N= 474) using structured questionnaires. Data were analyzed using descriptive statistics, correlation, and predictive analyses. The results imply that family members' perceptions of quality were fairly positive. Age, educational background, and the frequency of visits on the ward were related with the quality perception. The association between quality perceptions and family involvement in care proved to be strong. The information and support from the staff and possibilities to participate in decision making were associated with high-quality ratings. The results demonstrate the need for formulating ward policies and training the nursing staff to allow increased family involvement and to support it in an appropriate way.
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Affiliation(s)
- Päivi Voutilainen
- National Research and Development Centre for Welfare and Health (Stakes), Helsinki, Finland
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15
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Zúñiga F, Schubert M, Hamers JPH, Simon M, Schwendimann R, Engberg S, Ausserhofer D. Evidence on the validity and reliability of the German, French and Italian nursing home version of the Basel Extent of Rationing of Nursing Care instrument. J Adv Nurs 2016; 72:1948-63. [PMID: 27062508 DOI: 10.1111/jan.12975] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 11/30/2022]
Abstract
AIM To develop and test psychometrically the Basel Extent of Rationing of Nursing Care for Nursing Homes instrument, providing initial evidence on the validity and reliability of the German, French and Italian-language versions. BACKGROUND In the hospital setting, implicit rationing of nursing care is defined as the withholding of nursing activities due to lack of resources, such as staffing or time. No instrument existed to measure this concept in nursing homes. DESIGN Cross-sectional study. METHODS We developed the instrument in three phases: (1) adaption and translation; (2) content validity testing; and (3) initial validity and reliability testing. For phase 3, we analysed survey data from 4748 care workers collected between May 2012-April 2013 from a randomly selected sample of 162 nursing homes in the German-, French- and Italian-speaking regions of Switzerland to provide evidence from response processes (e.g. missing), internal structure (exploratory factor analysis), inter-item inconsistencies (e.g. Cronbach's alpha) and interscorer differences (e.g. within-group agreement). RESULTS Exploratory factor analysis revealed a four-factor structure with good fit statistics. Rationing of nursing care was structured in four domains: (1) activities of daily living; (2) caring, rehabilitation and monitoring; (3) documentation; and (4) social care. Items of the social care subscale showed lower content validity and more missing values than items of other subscales. CONCLUSION First evidence indicates that the new instrument can be recommended for research and practice to measure implicit rationing of nursing care in nursing homes. Further refinements of single items are needed.
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Affiliation(s)
| | - Maria Schubert
- Institute of Nursing Science, University of Basel, Switzerland.,University Hospital Insel, Bern, Switzerland
| | - Jan P H Hamers
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, the Netherlands
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Switzerland.,Inselspital Bern University Hospital, Nursing & Midwifery Research Unit, Switzerland
| | | | - Sandra Engberg
- Institute of Nursing Science, University of Basel, Switzerland.,Department of Health Promotion & Development, School of Nursing, University of Pittsburgh, Pennsylvania, USA
| | - Dietmar Ausserhofer
- Institute of Nursing Science, University of Basel, Switzerland.,College for Health-Care Professionals Claudiana, Research Department, Bozen, Italy
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To what extent are patients' needs met on oncology units? The phenomenon of care rationing. Eur J Oncol Nurs 2016; 21:48-56. [DOI: 10.1016/j.ejon.2016.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/26/2015] [Accepted: 01/10/2016] [Indexed: 11/20/2022]
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17
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Zúñiga F, Ausserhofer D, Hamers JP, Engberg S, Simon M, Schwendimann R. The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes – A cross-sectional study. Int J Nurs Stud 2015; 52:1463-74. [DOI: 10.1016/j.ijnurstu.2015.05.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/16/2015] [Accepted: 05/12/2015] [Indexed: 01/25/2023]
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Vryonides S, Papastavrou E, Charalambous A, Andreou P, Merkouris A. The ethical dimension of nursing care rationing: A thematic synthesis of qualitative studies. Nurs Ethics 2014; 22:881-900. [PMID: 25367000 DOI: 10.1177/0969733014551377] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the face of scarcity, nurses may inevitably delay or omit some nursing interventions and give priority to others. This increases the risk of adverse patient outcomes and threatens safety, quality, and dignity in care. However, it is not clear if there is an ethical element in nursing care rationing and how nurses experience the phenomenon in its ethical perspective. OBJECTIVES The purpose was to synthesize studies that relate care rationing with the ethical perspectives of nursing, and find the deeper, moral meaning of this phenomenon. RESEARCH DESIGN A systematic review and thematic synthesis of qualitative studies was used. Searching was based on guidelines suggested by Joana Brigs Institute, while the synthesis has drawn from the methodology described. Primary studies were sought from nine electronic databases and manual searches. The explicitness of reporting was assed using consolidated criteria for reporting qualitative research. Nine studies involving 167 nurse participants were included. Synthesis resulted in 35 preliminary themes, 14 descriptive themes, and four analytical themes (professional challenges and moral dilemmas, dominating considerations, perception of a moral role, and experiences of the ethical effects of rationing). Discussion of relationships between themes revealed a new thematic framework. ETHICAL CONSIDERATION Every effort has been taken, for the thoroughness in searching and retrieving the primary studies of this synthesis, and in order for them to be treated accurately, fairly and honestly and without intentional misinterpretations of their findings. DISCUSSION Within limitations of scarcity, nurses face moral challenges and their decisions may jeopardize professional values, leading to role conflict, feelings of guilt, distress and difficulty in fulfilling a morally acceptable role. However, more research is needed to support certain relationships. CONCLUSIONS Related literature is limited. The few studies found highlighted the essence of justice, equality in care and in values when prioritizing care-with little support to the ethical effects of rationing on nurses. Further research on ethical dimension of care rationing may illuminate other important aspects of this phenomenon.
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Dubuc N, Bonin L, Tourigny A, Mathieu L, Couturier Y, Tousignant M, Corbin C, Delli-Colli N, Raîche M. Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people. Int J Integr Care 2013; 13:e017. [PMID: 23882166 PMCID: PMC3718273 DOI: 10.5334/ijic.976] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 03/14/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The home care and services provided to older adults with the same needs are often inadequate and highly varied. Integrated care pathways (ICPs) can resolve these issues. The aim of this study was to develop the content of ICPs to follow-up frail and disabled community-dwelling older people. THEORY AND METHOD A RIGOROUS PROCESS WAS APPLIED ACCORDING TO A SERIES OF STEPS: identification of desirable characteristics and a theoretical framework; review of evidence-based practices and current practices; and determination of ICPs by an interdisciplinary task team. RESULTS ICPs are intended to prevent specific problems, maximize independence, and promote successful aging. They are organized according to a dynamic process: (1) needs assessment and assessment of risk/protection factors; (2) data-collection summary and goals identification; (3) planning of interventions from a client-centered view; (4) coordination, delivery, and follow-up; and (5) identification of variances, as well as review and adjustment of plans. CONCLUSION Once computerized, these ICPs will facilitate the exchange of information as well as the clinical decision-making process with a perspective to adequately matching the needs of an individual person with resources that delay or slow the progression of frailty and disability. Once aggregated, the data will also support managers in organizing teamwork and follow-up for clients.
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Affiliation(s)
- Nicole Dubuc
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, and Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Nurses' perceptions of their relationships with informal carers in institutional respite care for older people. Nurs Res Pract 2013; 2013:967084. [PMID: 23577247 PMCID: PMC3610367 DOI: 10.1155/2013/967084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/08/2013] [Accepted: 02/12/2013] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to describe nurses' experiences of their collaboration and relationships with family members in institutional respite care for the elderly. The family has a particularly important role in respite care, which is an extension of care provided at home. However no published studies were found on this subject. The data were collected through qualitative interviews (N = 22). Content analysis of the nurses' descriptions of their collaboration with family members yielded four main categories as follows: (1) conscious ignoring, (2) attempting to understand the family's situation, (3) hinting at private family matters, and (4) being a friend. The results lend support to earlier findings which emphasize the complexity of relationships between nurses and family carers. A novel finding here is that these relationships may also develop into friendships. Greater emphasis must be placed on primary nursing so that the nurse and informal carer can build up a genuine relationship of trust. If periods of respite care are to help older people and their families to manage independently, it is imperative that nurses have the opportunity to visit their patients at home.
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21
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Voyer P, McCusker J, Cole MG, Monette J, Champoux N, Ciampi A, Belzile E, Vu M, Richard S. Nursing Documentation in Long-Term Care Settings. Clin Nurs Res 2013; 23:442-61. [DOI: 10.1177/1054773813475809] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study on nursing documentation in long-term care facilities, a set of 9 delirium symptoms was used to evaluate the agreement between symptoms reported by nurses during monthly interviews and those documented in the nursing notes for the same 7-day observation period. Residents aged 65 and above ( N = 280) were assessed monthly over a 6-month period for the presence of delirium and its symptoms using the Confusion Assessment Method. The proportion of symptoms documented in the nursing notes ranged from 1.9% to 53.5%. A trend toward a lower proportion of documented symptoms for higher resident−nurse ratios was observed, although the difference was not statistically significant. Efforts should be made to improve the situation by revisiting the content of academic and clinical training given to nurses in addition to exploring innovative ways to make nursing documentation more efficient and less time-consuming within the current context of nurses’ work overload.
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Affiliation(s)
- Philippe Voyer
- Faculty of Nursing Sciences, Laval University, Quebec City, QC, Canada
- Centre for Excellence in Aging-Research Unit, Quebec City, QC, Canada
| | - Jane McCusker
- St. Mary’s Research Centre, Montreal, QC, Canada
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Martin G. Cole
- Department of Psychiatry, St Mary’s Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, Jewish General Hospital, Canada
- Donald Berman Maimonides Geriatric Center, Canada
| | - Nathalie Champoux
- Institut Universitaire de Gériatrie de Montréal, Département de Médecine Familiale, Université de Montréal, QC, Canada
| | - Antonio Ciampi
- St. Mary’s Research Centre, Montreal, QC, Canada
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Eric Belzile
- St. Mary’s Research Centre, Montreal, QC, Canada
| | - Minh Vu
- Division of Geriatric Medicine, Centre Hospitalier de l’Université de Montréal and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sylvie Richard
- Centre for Excellence in Aging-Research Unit, Quebec City, QC, Canada
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Levels and correlates of implicit rationing of nursing care in Swiss acute care hospitals—A cross sectional study. Int J Nurs Stud 2013; 50:230-9. [DOI: 10.1016/j.ijnurstu.2012.09.016] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 09/11/2012] [Accepted: 09/13/2012] [Indexed: 11/21/2022]
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Papastavrou E, Andreou P, Efstathiou G. Rationing of nursing care and nurse-patient outcomes: a systematic review of quantitative studies. Int J Health Plann Manage 2013; 29:3-25. [DOI: 10.1002/hpm.2160] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 11/21/2012] [Accepted: 12/06/2012] [Indexed: 11/11/2022] Open
Affiliation(s)
- Evridiki Papastavrou
- School of Health Sciences, Department of Nursing; Cyprus University of Technology; Cyprus
| | - Panayiota Andreou
- School of Health Sciences, Department of Nursing; Cyprus University of Technology; Cyprus
| | - Georgios Efstathiou
- School of Health Sciences, Department of Nursing; Cyprus University of Technology; Cyprus
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Papastavrou E, Andreou P, Tsangari H, Schubert M, De Geest S. Rationing of Nursing Care Within Professional Environmental Constraints. Clin Nurs Res 2013; 23:314-35. [DOI: 10.1177/1054773812469543] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine rationing of nursing care and the possible relationship between nurses’ perceptions of their professional practice environment and care rationing. A total of 393 nurses from medical and surgical units participated in the study. Data were collected using the Basel Extent of Rationing of Nursing Care (BERNCA) instrument and the Revised Professional Practice Environment (RPPE) Scale. The highest level of rationing was reported for “reviewing of patient documentation” ( M = 1.15, SD = 0.94; 31.2% sometimes or often) followed by “oral and dental hygiene” ( M = 1.06, SD = 0.94; 31.5% sometimes or often) and “coping with the delayed response of physicians” ( M = 1.04, SD = 0.96; 30% sometimes or often). Regression analyses showed that teamwork, leadership and autonomy, and communication about patients accounted in total 18.4% of the variance in rationing. In regard to application, the association between the practice environment and rationing suggests improvements in certain aspects that could minimize rationing.
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Tønnessen S, Nortvedt P, Førde R. Rationing home-based nursing care: professional ethical implications. Nurs Ethics 2011; 18:386-96. [PMID: 21558114 DOI: 10.1177/0969733011398099] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to investigate nurses' decisions about priorities in home-based nursing care. Qualitative research interviews were conducted with 17 nurses in home-based care. The interviews were analyzed and interpreted according to a hermeneutic methodology. Nurses describe clinical priorities in home-based care as rationing care to mind the gap between an extensive workload and staff shortages. By organizing home-based care according to tight time schedules, the nurses' are able to provide care for as many patients as possible. Furthermore, legal norms set boundaries for clinical priority decisions, resulting in marginalized care. Hence, rationing care jeopardizes important values in the nurse-patient relationship, in particular the value of individualized and inclusive nursing care. The findings are highly relevant for clinical practice, since they have major implications for provision of nursing care. They revive debates about the protection of values and standards of care, and nurses' role and responsibility when resources are limited.
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Affiliation(s)
- Siri Tønnessen
- Department of Health and Social Sciences, Harstad University College, Harstad – N-9480, Norway.
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