'Implicit rationing of nursing care processes'-Decision-making in ICU nurses' experiences: A qualitative study

Area of Science:

• Nursing Science
• Healthcare Management
• Patient Safety

Background:

• Implicit rationing of nursing care involves withholding necessary nursing measures due to resource scarcity.
• Limited research exists on the decision-making processes of nurses regarding implicit rationing in intensive care units (ICUs).

Purpose of the Study:

• To explore the decision-making and judgment processes of ICU nurses concerning implicit rationing of nursing care.
• To analyze these processes within the established conceptual framework of implicit rationing.

Main Methods:

• A qualitative study employing participative observation and interviews with 18 ICU nurses.
• Data collected between June and September 2020.
• Thematic analysis was used for data interpretation.

Main Results:

• Five key themes emerged: condition assessment, priority setting strategies, mitigation during implementation, existing nursing realities, and evaluation of rationing.
• Nurses utilize diverse strategies when implementing care plans under resource constraints.
• Decision-making often involves intuitive and situational judgments in the absence of explicit guidelines.

Conclusions:

• Nurses face significant ethical responsibilities in ICUs, especially with vulnerable patients and absent family support.
• Strategies to mitigate implicit rationing include teamwork, organized care, and addressing workload.
• Establishing a positive nursing culture and optimizing staffing/scheduling are vital for effective and ethical care delivery.