Impacts of Rationing and Missed Nursing Care: Challenges and Solutions

Description

This book reveals how economic restrictions and limited healthcare resources, combined with growing care demands due to advanced technology and more care options, have to a great extent contributed to increased workloads for healthcare professionals and put them under pressure to prioritize their work. This has led to the rationing of care, i.e., to decision-making processes on the allocation of scarce resources, especially human resources, and on which care activities take priority over others; in turn, these processes have led to unfinished or missed care, which has serious implications for quality of care and patient safety. Concerns related to nursing shortages and lean staffing practices have increased the awareness of the problem, as patient outcomes are affected by the quality and quantity of care that they receive and led to intensified scientific inquiry into this phenomenon. This book is written by the members of the Rancare Cost Action group, whose aim is to facilitate discussion about rationing of nursing care based on a cross-national comparative approach with implications for practice and professional development. Four working groups investigated four areas for four years: a) the conceptualization of care rationing and methodological inquiries concerning the investigation of the phenomenon, b) exploration of possible solutions and intervention studies, c) the ethical perspective of care rationing and missed care including patients’ rights and possible discrimination, and d) the educational implications, based on an exploration of the level of patient safety training and care rationing, as well as preparing guidelines for managers. The book will be a valuable resource for nurses, allied healthcare professionals, managers, policymakers, researchers, ethical committees, and educators whose goal is to provide better and safer care. Preface Acknowledgments Contents 1: Introduction 1.1 Introduction References 2: Understanding Missed Care: Definitions, Measures, Conceptualizations, Evidence, Prevalence, and Challenges 2.1 Introduction 2.2 Methods 2.3 Conceptual Development and Intersubjectivity 2.3.1 Conceptual Terms for an Emotionally Charged Phenomenon 2.3.2 Terminology Trends, Translation, Interpretation, and Preference 2.3.3 Drawing a Common Conceptual Picture 2.3.4 Looking to Other Disciplines 2.3.5 Divergent Perspectives Revealed 2.4 Prevalence of Missed Care 2.4.1 Prevalence of Missed Care in Acute Care 2.4.2 Prevalence of Missed Care Reported in Long Care Facilities for the Aged Population 2.4.3 Prevalence of Missed Care in the Community 2.4.4 Prevalence of Missed Care Reported by Patients and Non-Focal Nurses 2.4.5 Prevalence Complexities 2.5 Understanding Missed Care: Useful Theoretical Perspectives 2.5.1 Microsystem Perspectives on Missed Care 2.5.2 Nurse Characteristics 2.5.3 Fundamentals of Care 2.5.4 Immediate Nurse Work Environment 2.5.5 Macrosystem Perspectives of Missed Care 2.5.6 Economics and Time Scarcity 2.5.7 Integrated System Perspectives of Missed Care 2.6 Outcomes of Missed Care 2.6.1 Impact of Missed Care on Patient Outcomes in Hospitals 2.6.2 Impact of Missed Care on Resident Outcomes in Nursing Home Settings 2.6.3 Impact of Missed Care on Client Outcomes in Primary and Community Care 2.6.4 Impact of Missed Care from a Patients’ Perspective 2.6.5 Impact of Missed Care on Job Outcomes in Hospitals 2.7 Summary and Conclusions Appendix. Translation and Preferences of Missed Care Terms References 3: Does Rationing of Nursing Care Presuppose an Acceptance of Missed Care? Philosophical and Legal Aspects 3.1 Introduction 3.2 The Concept of Omission 3.2.1 The Philosophical Distinction 3.2.2 The Legal Distinction 3.2.3 Omissions by Nurses 3.3 Allocation and Rationing of Resources 3.3.1 The Concept of Rationing in Medical and Nursing Contexts 3.4 Missed Nursing Tasks and Their Consequences 3.4.1 Nurses’ Assessment of Their Tasks’ Importance 3.4.2 Harm Associated with Missed Nursing Actions 3.4.3 Does Missed Care Count as a Nursing Error? 3.5 Conclusions References 4: Studying Missed Care: Designs, Instruments, and Reporting Guidelines 4.1 Introduction 4.2 Designs to Study Missed Care 4.3 Instruments Measuring Missed Care 4.3.1 Validation Studies Available 4.3.1.1 MISSCARE Survey 4.3.1.2 The Basel Extent of Rationing of Nursing Care 4.3.1.3 Task Undone Tool 4.3.2 The New Frontiers 4.3.2.1 The Unfinished Nursing Care Survey 4.3.2.2 The Single Global-Item 4.3.3 Issues Regarding Missed Care Tools 4.4 The RANCARE Guideline—Strengthening tRansparent Reporting of reseArch on uNfinished Nursing CARE 4.4.1 The Development of the RANCARE Guidelines 4.4.2 The RANCARE Guideline Implications 4.5 Summary References 5: An Ethical Perspective of Nursing Care Rationing and Missed Care 5.1 Introduction 5.2 The Nursing Workforce and Access to the Resource of Nursing Care 5.3 Nursing Care Rationing and Missed Care from a Societal and Organisational Perspective 5.3.1 Nursing Care as a Reflection of Society’s Values 5.3.2 The Organisational Basis for Nursing Care Resource Allocation and Rationing 5.4 Empirical Descriptive Ethics Perspective 5.4.1 Priorities in Society Meet Nursing 5.4.2 Priorities in the Delivery of Nursing Care 5.4.3 Professional Ethics—Professional Roles, Responsibilities, and Role Conflicts 5.5 Missed Nursing Care from the Patient Perspective 5.6 Conclusions References 6: Research Ethical Reflections in Researching Missed Nursing Care 6.1 Introduction 6.2 Research Ethics—Regulations and Principles 6.2.1 Research Ethical Principles 6.3 Discussion 6.3.1 Research Ethical Principles at Risk 6.3.2 Research Ethical Responsibilities and Implications 6.4 Summary References 7: Interventions to Reduce and Limit Rationed and Missed Nursing Care: State of the Art and Future Perspectives 7.1 Introduction 7.2 Teamwork and Staffing: Two Major Matters in Nursing 7.2.1 Teamwork 7.2.2 Staffing 7.3 Improving the Quality of Nursing Care Processes and Care Reminders 7.4 Technological Solutions for a Human Problem 7.4.1 Telehealth and Telemonitoring 7.4.2 Wearable Devices 7.4.3 Unobtrusive Sensing for Patient Monitoring 7.4.4 Robots 7.5 Tackling Methodological Challenges—Implementation Science 7.5.1 Developing Complex Interventions 7.5.2 Implementing Interventions 7.5.3 Evaluating Interventions 7.6 Conclusion References 8: Patient Safety in Nurse Education 8.1 Introduction 8.2 Evolution of Patient Safety as an Important Discipline in Healthcare 8.3 Missed Nursing Care as a Patient Safety Issue 8.4 Nurses Role in Patient Safety 8.5 Recommendations for Patient Safety Content in Nurse Education 8.6 Evidence from the Literature Regarding Patient Safety Content in Nurse Curriculum 8.7 Patient Safety Skills for Nurses 8.8 Voicing Concerns 8.9 Clinical Training for Patient Safety 8.10 The Role of Nurse Educators 8.11 Curriculum Regulation 8.12 Recognised Frameworks for Teaching Patient Safety to Nurses 8.13 Conclusion References 9: Good Management and Clinical Leadership: Supporting Quality Patient Care 9.1 Concepts of Leadership and Management 9.2 Clinical Governance and its Accountability in Nursing 9.3 Leading Through Caring for the Nursing Workforce 9.4 Managing the Circumstances Resulting from Rationed Care 9.5 Building a Good Practice Guide for Nurse Managers, Regarding the Promotion of Patient Safety Through Minimizing Missed Nursing Care 9.5.1 Information Informing the Guide 9.5.2 The Guide’s Structure 9.5.3 Process of Guide Development 9.6 Conclusion References 10: Synergies During the RANCARE Project: Opportunities for Networking and Establishment of Collaborations 10.1 Introduction 10.2 Short-Term Scientific Missions (STSM) 10.2.1 Research Methodological Approaches on Understanding the Conceptual Dimensions of Missed Nursing Care 10.2.2 Managerial Approaches—Leadership Interventions 10.2.3 Education 10.2.4 Ethical Aspects of Missed Nursing Care 10.3 Research Collaborations/Studies on Missed Nursing Care 10.4 Other Projects/Visits 10.5 Conclusions References Conclusions and the Way Forward