Uwarunkowania racjonowania opieki pielęgniarskiej nad osobami starszymi
Department of Holistic Care and Nursing Management, Medical University of Lublin
Autor do korespondencji
Kinga Bandoła   

Department of Holistic Care and Nursing Management, Medical University of Lublin
Med Og Nauk Zdr. 2023;29(3):150–152
Wprowadzenie i cel pracy:
Szacuje się, że co piąty senior nie otrzymuje przysługującej mu opieki. Sugeruje się, że osoby starsze są mniej asertywne i dlatego nie są w stanie wyrazić swoich potrzeb i preferencji dotyczących opcji leczenia. Po- nadto częściej mają większe potrzeby w zakresie opieki i nie są w stanie wykonywać niektórych czynności życia codziennego oraz częściej występują u nich zaburzenia komunikacyjne, depresja czy narażenie na izolację społeczną, co może uniemożliwiać im wyrażanie swoich potrzeb. Celem pracy jest analiza piśmiennictwa dotyczącego etycznych uwarunkowań racjonowania opieki pielęgniarskiej nad osobami starszymi.

Metody przeglądu:
Zastosowano krytyczną analizę piśmien- nictwa. Materiałem analizowanym w pracy była literatura na- ukowa dostępna w bazach danych PubMed, SCOPUS, CINAHL Complete oraz Web of Science, wybierana według słów klu- czowych: „racjonowanie opieki pielęgniarskiej”, „brak opieki”, „osoby starsze”, „etyka”

Opis stanu wiedzy:
Czynnikiem przyczyniającym się do racjonowania opieki pielęgniarskiej nad osobami starszymi jest nieodpowiednie środowisko opieki. Innym jest dyskryminujące zachowanie pielęgniarek wobec słabych, starszych pacjentów, będących w fazie terminalnej.

Głównymi powodami racjonowania opieki pielęgniarskiej są czynniki organizacyjne placówki oraz uprzedzenia pielęgniarek w stosunku do seniorów. Istnieje potrzeba dokładnego zbadania procesu decyzyjnego pielęgniarek w tym zakresie oraz zasad etycznych nieodłącznie z nim związanych.

Introduction and objective:
According to estimates, one in five senior citizens is not receiving the care they are entitled to. It is suggested that older people are less assertive and therefore unable to effectively express their needs and preferences on the available treatment options. In addition, they are more likely to have higher care needs and unable to perform certain daily activities; they are also at greater risk of communication disorders, depression, or exposure to social isolation, thus preventing them from expressing their needs. The aim of this study is to analyse the literature on the ethical considerations of the rationing of nursing care for older people.

Review methods:
A critical analysis of the literature was applied. The material analysed was the scientific literature available in PubMed, SCOPUS, CINAHL Complete, and Web of Science databases, using the following key words: nursing rationing, lack of care, older people, ethics.

Brief description of the state of knowledge:
The factors contributing to the rationing of nursing care for older people is an inadequate care environment. Another factor contributing to the occurrence of nursing rationing is the discriminatory behaviour of nurses towards weak, older, adult patients in cases in which care is in the terminal phase.

Nursing rationing occurs mainly due to organisational factors in the healthcare facility and nurses’ biased approach towards seniors. There is a need for an in- depth analysis of the decision-making process undertaken by nurses, and the ethical elements inherent in such a process.

Bandoła K, Dobrowolska B. Determinants of the rationing of nursing care provided to older patients. Med Og Nauk Zdr. 2023; 29(3): 150–152. doi: 10.26444/monz/171757
Jones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. IJNS 2015;52(6):1121–1137.
Piotrowska A, Lisowska A, Twardak I, et al. Determinants Affecting the Rationing of Nursing Care and Professional Burnout among Oncology Nurses. Int J Environ Res Public Health. 2022;19(12):7180.
Singer P. Setting Limits: Medical Goals in an Aging Society, by Daniel Callahan. Bioethics. 1988;2(2):151–169.
Luca CE, Cavicchioli A, Bianchi M. Nurses Who Assume the Role of Advocate for Older Hospitalized Patients: A Qualitative Study. SAGE Open Nurs. 2021;7(54):23779608211030651.
Vos J, Gerling K, Linehan C, et al. Understanding Care Navigation by Older Adults With Multimorbidity: Mixed-Methods Study Using Social Network and Framework Analyses. JMIR Aging. 2018;1(2):e11054.
Wleklik M, Uchmanowicz I, Sobański P, Pasierski T. Ethical issues concerning cardiac surgery in elderly patients—the nurse’s role as a patient advocate: A case report. Med Res J. 2020;5(2):120–125.
Dierckx de Casterlé B, Mertens E, Steenacker J, et al. Nurses’ experiences of working under time pressure in care for older persons. Nurs Ethics. 2020;27(4):979–990.
White EM, Aiken LH, McHugh MD. Registered nurse burnout, job dissatisfaction, and missed care in nursing homes. JAGS. 2019;67(10):2065–2071.
Gruber M. A dialogue with excellence. The power of certainty. Am J Nurs. 1989;89(4):502–503.
Chegini Z, Jafari-Koshki T, Kheiri M, et al. Missed nursing care and related factors in iranian hospitals: a cross sectional survey. J Nurs Manag. 2020;28(8):2205–2215.
Hegney DG, Rees CS, Osseiran-Moisson R. Perceptions of nursing workloads and contributing factors, and their impact on implicit care rationing: A Queensland, Australia study. J Nurs Manag. 2019;27(2):371– 380.
Uchmanowicz I, Karniej P, Lisiak M. The relationship between burnout, job satisfaction and the rationing of nursing care – A cross-sectional study. J Nurs Manag. 2020;28(8):2185–2195.
Griffiths P, Recio-Saucedo A, Dall'Ora C, et al. The association between nurse staffing and omissions in nursing care: A systematic review. J Adv Nurs. 2018;74(7):1474–1487.
Cordeiro R, Pires Rodrigues MJ, Calha A, et al. Good practices to reduce unfinished nursing care: An integrative review. J Nurs Manag. 2020;28(8):1798–1804.
Rezaei-Shahsavarloo Z, Atashzadeh-Shoorideh F, Ebadi A, et al. Factors affecting missed nursing care in hospitalized frail older adults in the medical wards: a qualitative study. BMC Geriatrics. 2021;21:1–12.
Lake ET, Riman KA, Sloane DM. Improved work environments and staffing lead to less missed nursing care: A panel study. J Nurs Manag. 2020;28(8):2157–2165.
Aly NAE-FM, El-Shanawany SM, Ghazala AMA. Ethico-legal aspects and ethical climate: Managing safe patient care and medical errors in nursing work. Clinical Ethics. 2020;15(3):132–140.
Levine KJ, Carmody M, Silk KJ. The influence of organizational culture, climate and commitment on speaking up about medical errors. J Nurs Manag. 2020;28(1):130–138.
Barkhordari-Sharifabad M, Mirjalili NS. Ethical leadership, nursing error and error reporting from the nurses› perspective. Nurs Ethics. 2020;27(2):609–620.
Hwang J-I, Park H-A. Nurses' perception of ethical climate, medical error experience and intent-to-leave. Nurs Ethics. 2014;21(1):28–42.
Higgins I, Der Riet PV, Slater L, et al. The negative attitudes of nurses towards older patients in the acute hospital setting: A qualitative descriptive study. Contemp Nurse. 2007;26(2):225–237.
Landry M, Van den Bergh G, Hjelle K, et al. Tuntland Betrayal of trust? The impact of the COVID-19 global pandemic on older persons. J Appl Gerontol. 2020;39(7):687–689.
Idilbi N, AboJabel N, Werner P. Examining hospital staff members› preferences for allocating a ventilator to a COVID-19 patient with and without Alzheimer›s disease. Geriatr Nurs. 2021;42(4):787–791.
DeBruin D, Leider JP. COVID-19: the shift from clinical to public health ethics. J Public Health Manag Pract. 2020;26(4):306–309.
Komrad MS. Medical ethics in the time of COVID-19. Curr Psychiatry. 2020;19(7):23–28.
Kydd A, Fleming A. Ageism and age discrimination in health care: fact or fiction? A narrative review of the literature. Maturitas. 2015;81(4):432–438.
Deasey D, Kable A, Jeong S. Emergency nurses attitudes towards older people in the emergency department: a cross-sectional study. Contemp Nurse. 2016;52(2–3):3693–80.
Levy BR, Slade MD, Chang ES, et al. Ageism amplifies cost and prevalence of health conditions. Gerontologist. 2020;60(1):174–181.
Suhonen R, Stolt M, Habermann M, et al. RANCARE Consortium COST Action – CA 15208. Ethical elements in priority setting in nursing care – a scoping review. Int J Nurs Stud. 2018;88:25–42.
Arhiri L, Gherman M-A, Holman AC. Ageism against older patients in nursing: conceptual differentiations and the role of moral sensitivity. J Elder Abuse Negl. 2022;34(3):198–221.
Lampersberger LM, Schüttengruber G, Lohrmann C, et al. Nurses' perspectives on caring for and attitudes towards adults aged eighty years and older. Scand J Caring Sci. 2023;37(2):458–471.
DeBrew JK. Can being ageist harm your older adult patients? Nursing 2020;45(10):66–67.
Blackman I, Papastavrou E, Vryonides S, et al. Predicting variations to missed nursing care: A three-nation comparison. J Nurs Manag. 2018;26(1):33–41.
Mallidou AA, Cummings GG, Schalm C, et al. Health care aides use of time in a residential long-term care unit: A time and motion study. Int J Nurs Stud. 2013;50(9):1229–1239.
Phelan A, McCarthy S, Adams E. Examining missed care in community nursing: A cross section survey design. J Adv Nurs. 2018;74(3):626–636.