Article
Rationing and prioritisation of nursing care in acute inpatient setting during the Covid-19 pandemic (RaPiD Care)
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Authors
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Janna Sill
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany
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Katharina Silies
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany
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Angelika Schley
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany
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Stefan Fleischer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Germany
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Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
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Katrin Balzer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany
| Published: | July 5, 2021 |
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Outline
Text
Background: The COVID-19-pandemic is still challenging healthcare systems, especially in acute inpatient setting.
Objectives: Investigation of rationing and prioritisation during the COVID-19-pandemic in acute inpatient nursing care.
Design and methods: In five acute care hospitals in Germany, qualitative semi-structured telephone interviews were conducted with nurses and nursing team leaders. A two-step content analysis was performed based on previous results [1] and frameworks for clinical practice and risk management [2], [3].
Results: Ten nursing team leaders and 16 staff members were interviewed. Six themes were developed: ‘Policies, Strategies and Legislations’, ‘Planning and Coordination’, ‘Clinical Practice’, ‘Workforce’, ‘Other Resources’ and ‘Collaboration with Health Infrastructure’.
A triage system for treatments was prepared in advance but not needed in practice. Prioritisation of care activities was described with regard to: (i) personal hygiene and basic needs, (ii) documentation, (iii) communication and (iv) care activities for patients with lower care demands. Strategies to cope with scarce resources mainly involved reorganisation of care processes and primarily aimed to reduce nurse-patient-contacts and prioritise care for COVID-19 patients. Interviewees based their decisions on individual experiences, provided plans, or priority lists. Frequent reasons for prioritisation and rationing were lack of time, staff, and material. Staffing levels varied in different phases of the pandemic. Prioritisation of nursing care was also described outside the pandemic due to staff shortage.
Conclusions: Rationing and prioritisation of nursing take place during the COVID-19 pandemic. To alleviate staff shortages, new workplace and skill mix models are needed. Decision-making should be supported by transparent monitoring and evaluation.
Conflicts of interest:
- JS declares that there are no conflicts of interests.
- KS declares that there are no conflicts of interests.
- AS declares that there are no conflicts of interests.
- SF declares that there are no conflicts of interests.
- MM declares that there are no conflicts of interests.
- KB declares that there are no conflicts of interests.
Funding: The study is funded by universities' own funds.
References
- 1.
- Silies K, Schley A, Sill J, Fleischer S, Müller M, Balzer K. Die COVID-19-Pandemie im akutstationären Setting aus Sicht von Führungspersonen und Hygienefachkräften in der Pflege - Eine qualitative Studie. Pflege. 2020;33(5):289-298. DOI: 10.1024/1012-5302/a000756
- 2.
- Victorian Government. Delivering high-quality healthcare: Victorian clinical governance framework. Melbourne: 2017.
- 3.
- World Health Organization. Health Emergency and Disaster Risk Management Framework. Geneva; 2019.
