Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left ...undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource.
Aims
The aims of this paper are to explore the role of cross‐disciplinary knowledge exchange and integration in advancing the science of unfinished nursing care and to offer preliminary guidance for ...theory development activities for this growing international community of scholars.
Background
Unfinished nursing care, also known as missed care or rationed care is a highly prevalent problem with negative consequences for patients, nurses and healthcare organizations around the world. It presents as a ‘wicked’ sustainability problem resulting from structural obstacles to effective resource allocation that have been resistant to conventional solutions. Research activity related to this problem is on the rise internationally but is hindered by inconsistencies in conceptualizations of the problem and lack of robust theory development around the phenomenon. A unified conceptual framework is needed to focus scholarly activities and facilitate advancement of a robust science of unfinished nursing care.
Design
Discussion paper.
Data Sources
This discussion paper is based on our own experiences in international and interdisciplinary research partnerships related to unfinished nursing care. These experiences are placed in the context of both classic and current literature related to the evolution of scientific knowledge.
Implications for Nursing
The problem of unfinished nursing care crosses multiple scientific disciplines. It is imperative that the community of scholars interested in solving this wicked problem engage in meaningful cross‐disciplinary knowledge integration and move towards transdisciplinarity.
Conclusion
Metatheorizing guided by structuration theory should be considered as a strategy to promote transdiciplinarity around the problem of unfinished nursing care.
目的
本文旨在探讨跨学科知识交流和整合在推进未经护理科学中的作用,并为日益壮大的国际学者群体发展理论提供初步指导。
背景
未竟护理,又称错过护理或配给护理,是一个非常普遍的问题,对世界各地的患者、护士和医疗机构都有负面影响。这是由有效资源分配的结构性障碍造成的“有害”的可持续性问题,这些障碍一直阻碍着传统的解决方案。与该问题相关的研究活动在全球呈上升趋势,但由于对该问题存在不一致的概念以及缺乏围绕这一现象的强有力理论,该趋势受到阻碍。学术活动需要统一的概念框架,促进未竟护理科学强有力的发展。
设计
讨论文件。
数据来源
本讨论稿的产生基于我们在未竟护理相关国际和跨学科研究合作中的经验。
这些经验的背景科学知识演进的相关经典和现有文献。
对护理的启示
未竟护理问题跨越多个学科。对该问题感兴趣的学者进行有意义的跨学科知识整合并走向跨学科研究是必要的。
结论
以结构理论为指导的元理论应被作为未完成护理问题跨学科研究的促进策略。
Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to ...establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes.
The results confirm that the topic of patient safety is generally not explicitly taught, rather it remains a hidden element within the curriculum, taught across many subjects. Variation in how nursing is regulated exists across the countries also, with the professionalization of nursing remaining a challenge in some states. No guidelines exist at EU level which address how patient safety should be taught to nursing students, and as yet regulatory bodies have not put forward criteria on the subject. As a result individual HEIs determine how patient safety should be taught.
The WHO guidelines for teaching patient safety are currently underutilized in nurse education, but could offer a structure and standard which would address the deficits identified in this work.
•Approaches to regulation of nursing across European countries remains inconsistent.•Decisions around patient safety teaching to student nurses are taken at HEI level.•Patient safety content is rarely taught as an entity in itself but is integrated across subjects.•EU and national guidelines for teaching patient safety to nurses are needed.
Aims
To investigate how nursing experts and experts from other health professions understand the concept of rationing/missed/unfinished nursing care and how this is compared at a cross‐cultural ...level.
Design
The mixed methods descriptive study.
Methods
The semi‐structured questionnaires were sent to the sample of 45 scholars and practitioners from 26 countries. Data were collected from November 2017–February 2018.
Results
Assigning average cultural values to participants from each country revealed three cultural groups: high individualism‐high masculinity, high individualism‐low masculinity and low individualism‐medium masculinity. Content analysis of the findings revealed three main themes, which were identified across cultural clusters: (a) projecting blame for the phenomenon: Blaming the nurse versus blaming the system; (b) intentionality versus unintentionality; and (c) focus on nurses in comparison to focus on patients.
Conclusion
Consistent differences in the understanding of missed nursing care can be understood in line with the nation's standing on two main cultural values: individualism and masculinity.
Impact
The findings call for scholars' caution in interpreting missed nursing care from different cultures, or in comparing levels and types of missed nursing tasks across nations. The findings further indicated that mimicking interventions to limit missed nursing care from one cultural context to the other might be ineffective. Interventions to mitigate the phenomenon should be implemented thoughtfully, considering the cultural aspects.
目的
调查护理专家和其他医疗卫生专家如何理解定量护理、过失护理和未完成护理的概念以及跨文化层面是如何比较这些概念的。
设计
混合方法描述性研究。
方法
这些半结构化的问卷被发送给了实验对象——来自26个国家的45位学者和医生。搜集了从2017年十一月至2018年二月的数据。
结果
将平均文化价值观分配给各个国家的参与者,从而得到了三个文化群体:高个人主义‐高男子气概、高个人主义‐低男子气概以及低个人主义‐高男子气概。调查结果的内容分析揭示了三个跨文化群体认同的主题:(a)将这一现象归咎于谁:责备护士还是责备系统;(b)故意还是无意;以及(c)关注护理人员还是关注病人。
结论
对过失护理理解的一致差异可以理解为与国家长期的两种主要文化价值观有关:个人主义和男子气概。
影响
研究结果呼吁学者们谨慎解释不同文化背景下的过失护理或者是比较各国过失护理任务的程度和类型。研究结果进一步表明一个文化环境模仿另一个文化环境限制过失护理的干预措施可能是无效的。考虑到文化差异,应当谨慎采取干预措施来缓和这种现象。
PDF
