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      Resource allocation and rationing in nursing care: A discussion paper

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          Abstract

          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.

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          Most cited references 27

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          Nurse moral distress: a proposed theory and research agenda.

           Juan Corley (2002)
          As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage it.
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            Principles of justice in health care rationing.

            This paper compares and contrasts three different substantive (as opposed to procedural) principles of justice for making health care priority-setting or "rationing" decisions: need principles, maximising principles and egalitarian principles. The principles are compared by tracing out their implications for a hypothetical rationing decision involving four identified patients. This decision has been the subject of an empirical study of public opinion based on small-group discussions, which found that the public seem to support a pluralistic combination of all three kinds of rationing principle. In conclusion, it is suggested that there is room for further work by philosophers and others on the development of a coherent and pluralistic theory of health care rationing which accords with public opinions.
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              From an ethics of rationing to an ethics of waste avoidance.

               Howard Brody (2012)
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                Author and article information

                Contributors
                On behalf of : On behalf of the RANCARE Consortium COST – CA 15208
                Journal
                Nurs Ethics
                Nurs Ethics
                NEJ
                spnej
                Nursing Ethics
                SAGE Publications (Sage UK: London, England )
                0969-7330
                1477-0989
                01 April 2018
                August 2019
                : 26
                : 5
                : 1528-1539
                Affiliations
                National University of Ireland, Ireland
                Central Queensland University, Australia
                National University of Ireland, Ireland
                University of Turku, Turku University Hospital and City of Turku Welfare Division, Finland
                Hochschule Bremen, City University of Applied Sciences, Germany
                Oslo Metropolitan University, Norway
                VIA University College, Demark
                University of South Australia, Australia
                Cyprus University of Technology, Cyprus
                Author notes
                P Anne Scott, National University of Ireland, University Road, Galway H91 TK33, Ireland. Email: anne.scott@ 123456nuigalway.ie
                Article
                10.1177_0969733018759831
                10.1177/0969733018759831
                6681425
                29607703
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                Funding
                Funded by: Cordis, FundRef https://doi.org/10.13039/501100006221;
                Award ID: CA 15208
                Categories
                Original Manuscripts

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