13 research outputs found
Testing Cost Containment of Future Healthcare with Maintained or Improved Quality—The COSTCARES Project
Increasing healthcare costs need to be contained in order to maintain equality of access to care for all EU citizens. A cross-disciplinary consortium of experts was supported by the EU FP7 research programme, to produce a roadmap on cost containment, while maintaining or improving the quality of healthcare. The roadmap comprises two drivers: person-centred care and health promotion; five critical enablers also need to be addressed: information technology, quality measures, infrastructure, incentive systems, and contracting strategies
Testing Cost Containment of Future Health Care with Maintained or Improved Quality – The COST CARES project Running title: Cost Containment of Future Health Care
Abstract Background Increasing healthcare costs need to be contained in order to maintain equality of access to care for all EU citizens. A cross‐disciplinary consortium of experts was supported by the EU FP7 research programme, to produce a roadmap on cost containment, while maintaining or improving the quality of healthcare. The roadmap comprises two drivers: person‐centred care and health promotion; five critical enablers also need to be addressed: information technology, quality measures, infrastructure, incentive systems, and contracting strategies. Method In order to develop and test the roadmap, a COST Action project was initiated: COST−CARES, with 28 participating countries. This paper provides an overview of evidence about the effects of each of the identified enablers. Intersections between the drivers and the enablers are identified as critical for the success of future cost containment, in tandem with maintained or improved quality in healthcare. This will require further exploration through testing. Conclusion Cost containment of future healthcare, with maintained or improved quality, needs to be addressed through a concerted approach of testing key factors. We propose a framework for test lab design based on these drivers and enablers in different European countries
Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project
Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes.
The results confirm that the topic of patient safety is generally not explicitly taught, rather it remains a hidden element within the curriculum, taught across many subjects. Variation in how nursing is regulated exists across the countries also, with the professionalization of nursing remaining a challenge in some states. No guidelines exist at EU level which address how patient safety should be taught to nursing students, and as yet regulatory bodies have not put forward criteria on the subject. As a result individual HEIs determine how patient safety should be taught.
The WHO guidelines for teaching patient safety are currently underutilized in nurse education, but could offer a structure and standard which would address the deficits identified in this work
Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project
Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes
Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project
Patient safety, as a contemporary health care concern, must remain a
priority for nurse educators. This on-line consultation, carried out
within the RANCARE COST Action project, determined to establish how
patient safety teaching is incorporated into pre-registration education
of nurses across 27 countries. How nursing is regulated within countries
was examined, along with national guidelines related to nurse education.
HEIs were asked to provide details of pre-registration nurse training
and how patient safety is taught within programmes.
The results confirm that the topic of patient safety is generally not
explicitly taught, rather it remains a hidden element within the
curriculum, taught across many subjects. Variation in how nursing is
regulated exists across the countries also, with the professionalization
of nursing remaining a challenge in some states. No guidelines exist at
EU level which address how patient safety should be taught to nursing
students, and as yet regulatory bodies have not put forward criteria on
the subject. As a result individual HEIs determine how patient safety
should be taught.
The WHO guidelines for teaching patient safety are currently
underutilized in nurse education, but could offer a structure and
standard which would address the deficits identified in this work
Resource allocation and rationing in nursing care: A discussion paper
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
Understanding the concept of missed nursing care from a cross-cultural perspective
Aims: To investigate how nursing experts and experts from other health professions understand the concept of rationing/missed/unfinished nursing care and how this is compared at a cross-cultural level. Design: The mixed methods descriptive study. Methods: The semi-structured questionnaires were sent to the sample of 45 scholars and practitioners from 26 countries. Data were collected from November 2017–February 2018. Results: Assigning average cultural values to participants from each country revealed three cultural groups: high individualism-high masculinity, high individualism-low masculinity and low individualism-medium masculinity. Content analysis of the findings revealed three main themes, which were identified across cultural clusters: (a) projecting blame for the phenomenon: Blaming the nurse versus blaming the system; (b) intentionality versus unintentionality; and (c) focus on nurses in comparison to focus on patients. Conclusion: Consistent differences in the understanding of missed nursing care can be understood in line with the nation's standing on two main cultural values: individualism and masculinity. Impact: The findings call for scholars' caution in interpreting missed nursing care from different cultures, or in comparing levels and types of missed nursing tasks across nations. The findings further indicated that mimicking interventions to limit missed nursing care from one cultural context to the other might be ineffective. Interventions to mitigate the phenomenon should be implemented thoughtfully, considering the cultural aspects
Advancing the science of unfinished nursing care: Exploring the benefits of cross‐disciplinary knowledge exchange, knowledge integration and transdisciplinarity
Aims The aims of this paper are to explore the role of cross-disciplinary knowledge exchange and integration in advancing the science of unfinished nursing care and to offer preliminary guidance for theory development activities for this growing international community of scholars. Background Unfinished nursing care, also known as missed care or rationed care is a highly prevalent problem with negative consequences for patients, nurses and healthcare organizations around the world. It presents as a 'wicked' sustainability problem resulting from structural obstacles to effective resource allocation that have been resistant to conventional solutions. Research activity related to this problem is on the rise internationally but is hindered by inconsistencies in conceptualizations of the problem and lack of robust theory development around the phenomenon. A unified conceptual framework is needed to focus scholarly activities and facilitate advancement of a robust science of unfinished nursing care. Design Discussion paper. Data Sources This discussion paper is based on our own experiences in international and interdisciplinary research partnerships related to unfinished nursing care. These experiences are placed in the context of both classic and current literature related to the evolution of scientific knowledge. Implications for Nursing The problem of unfinished nursing care crosses multiple scientific disciplines. It is imperative that the community of scholars interested in solving this wicked problem engage in meaningful cross-disciplinary knowledge integration and move towards transdisciplinarity. Conclusion Metatheorizing guided by structuration theory should be considered as a strategy to promote transdiciplinarity around the problem of unfinished nursing care
Resource allocation and rationing in nursing care: A discussion paper
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
Understanding the concept of missed nursing care from a cross-cultural perspective
Aims To investigate how nursing experts and experts from other health
professions understand the concept of rationing/missed/unfinished
nursing care and how this is compared at a cross-cultural level. Design
The mixed methods descriptive study. Methods The semi-structured
questionnaires were sent to the sample of 45 scholars and practitioners
from 26 countries. Data were collected from November 2017-February 2018.
Results Assigning average cultural values to participants from each
country revealed three cultural groups: high individualism-high
masculinity, high individualism-low masculinity and low
individualism-medium masculinity. Content analysis of the findings
revealed three main themes, which were identified across cultural
clusters: (a) projecting blame for the phenomenon: Blaming the nurse
versus blaming the system; (b) intentionality versus unintentionality;
and (c) focus on nurses in comparison to focus on patients. Conclusion
Consistent differences in the understanding of missed nursing care can
be understood in line with the nation's standing on two main cultural
values: individualism and masculinity. Impact The findings call for
scholars' caution in interpreting missed nursing care from different
cultures, or in comparing levels and types of missed nursing tasks
across nations. The findings further indicated that mimicking
interventions to limit missed nursing care from one cultural context to
the other might be ineffective. Interventions to mitigate the phenomenon
should be implemented thoughtfully, considering the cultural aspects