Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing ...consequential conflicting expectations, challenges nurses’ professional and moral values.
To explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses.
A scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis.
Nurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients’ daily care needs, prioritising work by essential tasks and participating in priority setting for patients’ access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient’s situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses’ moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise.
Analysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.
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.
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