Rationing home-based nursing care: professional ethical implications

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.

Rationing of nursing care and nurse–patient outcomes: a systematic review of quantitative studies

“…This philosophy could be influenced by a range of factors such as education and training, working environment and the profession as a whole. Several qualitative studies offered a different explanation of nurses' choices when they have access to limited resources in health care (Halvorsen et al ., ; Nortvedt et al ., ; Tonnessen et al ., ). The results of these studies support that nurses may feel that humanistic and holistic care is not realistic within such context and may subsequently develop their own personal standards of care, which are heavily influenced by a biomedical ethos to cope with such limitations.…”

The nurse–patient relationship in the New Public Management era, in public home care: A focused ethnography

“…Tønnessen et al. () found that some nurses perceive their only responsibility is to provide services described in the decisions. Nurses in this study safeguarded needs beyond patients’ predefined decisions, expressing that they felt responsible for the patients’ overall well‐being.…”

Impact of Home Care Management on the Involvement of Informal Caregivers by Formal Caregivers

“…Similar to other professional health care organizations (Shortell & Kaluzny, 2006), over the past few decades many Dutch agencies have merged in an attempt to counter the effect of budget cuts (Postma, Oldenhof, & Putters, 2015 process has resulted in large, hierarchically managed agencies. As agencies have increased in size, so has the tendency to introduce "Tayloristic notions" in care (Da Roit, 2013;Nies et al, 2013;Postma et al, 2015): caregiving is characterized by a focus on efficiency and productivity, standardization of work processes and differentiation of tasks (Mintzberg, 1979;Tønnessen, Nortvedt, & Førde, 2011;Van der Boom, 2008), with tasks being assigned to "different care workers, depending on required professional capabilities" (Postma et al, 2015, p. 67). …”