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. (shrink)

The global COVID‐19 pandemic challenged the world—how it functions, how people move in the social worlds and how government/government services and people interact. Health services, operating under the principles of new public management, have undertaken rapid changes to service delivery and models of care. What has become apparent is the mechanisms within which contemporary health services operate and how services are not prioritising the person at the centre of care. Person‐centred care (PCC) is the philosophical premise upon which models of (...) health care are developed and implemented. Given the strain that COVID‐19 has placed on the health services and the people who deliver the care, it is essential to explore the tensions that exist in this space. This article suggests that before the pandemic, PCC was largely rhetoric, and rendered invisible during the pandemic. The paper presents an investigation into the role of PCC in these challenging times, adopting a Foucauldian lens, specifically governmentality and biopolitics, to examine the policies, priorities and practical implications as health services pivoted and adapted to changing and acute demands. Specifically, this paper draws on the Australian experience, including shifting nursing workforce priorities and additional challenges resulting from public health directives such as lockdowns and limitations. The findings from this exploration open a space for discussion around the rhetoric of PCC, the status of nurses and that which has been lost to the pandemic. (shrink)

This article draws on the free‐text commentaries from trans‐Tasman studies that used the MISSCARE questionnaire to explore the reasons why nurses miss care. In this paper, we examine the idea that nurses perpetuate a self‐effacing approach to care, at the expense of patient care and professional accountability, using what they describe as the art of nursing to frame their claims of both nursing care and missed nursing care. We use historical dialogue alongside a paradigmatic analysis to examine why nurses allow (...) themselves to continue working within settings that put their professional/personal selves aside in an attempt to deliver care within constraints that make completing care an impossible task. The findings suggest an ambivalence and conflict confront nurses attempting to provide care within the New Public Management environment. This can be seen in the tensions that draw a line between care as an art, and care as a financial target, juxtaposed with the inherent clash of values arising from the way nursing care is conceptualised within two contradictory paradigms. (shrink)

Health literacy is a contemporary term used in health services, often used to describe individuals requiring additional support to access, understand and implement health service information. It is used as a measure of self‐efficacy in chronic disease models of care such as the nurse navigator service. The aim of the research was to investigate the concept of health literacy in the nurse navigator service, particularly in relation to the defined role objective of person‐centred care. Fairclough's critical discourse analysis was used (...) to analyse the experiential, relational and expressive elements of texts, investigating the hidden truths which are represented in discourse. Texts from a variety of health service micro‐, meso‐ and macro‐hierarchical sources were selected for analysis using the nurse navigator evaluation data set and other associated texts. Health literacy in the nurse navigator service is a technology of government used to increase participation of individuals in their own health and well‐being. The discourse suggests that health literacy responsibilises both individuals and nurses and is discursively formed within a matrix of rational choice. In this context, health literacy contributes to structural vulnerability. (shrink)

Midwifery philosophy views childbearing as primarily normal, indicative of a woman's overall health. Midwifery practice focuses on supporting the human‐to‐human relationship between the midwife and the woman holding primacy. Despite the traditional focus on wellness, maternity care in today's risk averse world is increasingly complex. Technology has been increasingly implemented into maternity care to detect complications early and reduce harm. The Maternity Early Warning Tool is a technological innovation in this regard. Actor‐network theory (ANT) offers a framework for analysing the (...) connections between human actors (women, fetuses, and midwives) and nonhuman actors (machines, tools, and policies) within healthcare. This paper through drawing on the tenets of ANT, particularly in understanding the adoption of Maternity Early Warning Tools in midwifery practice, examines and explores the implications of integrating these tools in relation to midwifery practice. ANT also guides thoughtful considerations regarding the potential trajectory of Artificial Intelligence in midwifery, specifically regarding how these technological advancements alter midwifery practice by creating new hybrid assemblages and fluid identities. This discussion of subversive elements enhances understanding of the implications of Maternity Early Warning Tools on contemporary midwifery practice. (shrink)

The death of a resident, caused by another resident in Residential Aged Care Facilities (RACFS) is uncommon, yet under‐reported. The perpetrator of the violent act may not be legally culpable, and the act may be unintended; however, media reports suggest that this is an increasing phenomenon. This article reports an integrated review that sought to critically report homicide or an unintentional incident where one resident causes the death of another in RACFs and to explain and understand how older people are (...) supported within and external to RACFs and their under‐representation in policy. The search was registered with PROSPERO registration number CRD42023409775. The databases CINHAL ultimate, Cochrane review, Embase, Psych Info, PubMed were searched. Additionally, a grey literature search was conducted of Analysis and Policy Observatory, Google Search, and Trove. Identified themes included: exhibitor and target attributes, incident details, staff and facility experiences, incident reporting and improved resident safety related to un/intentional homicide. From the findings, we extracted two discursive elements: (1) Space and perception of a person living with dementia and unequipped environments and (2) The disregarded deaths in RACFs and other systematic problems. Within RACFs factors, such as unacceptably low staffing numbers, a lack of clinically trained nurses, poorly designed environments and a lack of skills in caring for people who have dementia or mental illness were identified. More emphasis on research into this area is essential. Several key risk factors are identified in this review on the issue of un/intentional homicides in RACFs. There is a need for governments and policy makers to consider different models of care, responsive to the needs of people who live with dementia. (shrink)