Rationing of nursing care, a deviation from holistic nursing: A systematic review

Area of Science:

• Nursing
• Healthcare Management
• Patient Safety

Background:

• Nursing care rationing, defined as the inability to provide all necessary patient care due to resource constraints, is linked to patient safety and quality of care.
• This phenomenon has been explored across various contexts and perspectives.

Purpose of the Study:

• To systematically review and synthesize existing research on nursing care rationing.
• To identify common themes, antecedents, and consequences of rationing in nursing practice.

Main Methods:

• Adherence to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.
• Comprehensive literature searches across major databases (MEDLINE, CINAHL, PsycInfo, Web of Science, EMBASE).
• Inclusion of 57 quantitative studies in the systematic review.

Main Results:

• Commonly rationed nursing activities include those addressing patients' emotional, educational, mobility, and hygiene needs.
• Antecedents identified include resource inadequacy and organizational work environment factors.
• Rationing negatively impacts patient satisfaction, increases mortality and adverse events, and reduces nurse job satisfaction, increasing turnover.

Conclusions:

• Nursing care rationing is a pervasive issue within the healthcare environment, threatening both patient safety and the nursing profession.
• Strategies involving organizational change and interprofessional collaboration are recommended to reduce rationing.
• Future research should explore diverse methodological approaches to further investigate nursing care rationing.