To what extent are patients' needs met on oncology units? The phenomenon of care rationing

Purpose: Evidence suggests that when resources are not sufficient to provide all the care needed by their patients, nurses are forced to ration their attention between care activities. The aim of this study is to examine care omissions and their causes in oncology units.

Methods: Participants were recruited from all of the hospitals in the Republic of Cyprus with oncology in-patient units. The data were collected with the MISSCARE questionnaire consisting of demographics, part A related to the elements of missed care and part B asking the reasons why nurses omit care.

Results: One hundred and fifty seven registered nurses participated in the study (Response Rate = 91.8%). The mean value for part A of the MISSCARE survey was moderate (2.31 from 4). The elements of care described as frequently or always missed were: turning the patient every 2 h (66.9%); ambulation three times a day or as needed (49.1%); mouth care (61.1%); patient teaching (37.6%); emotional support (32.5%); and attend any interdisciplinary conferences (87.9%). Reported causes included inadequate number of staff, urgent patient situations and unexpected rise in patient volume/unit acuity. Spearman correlations showed that there is a relationship between care rationing and job satisfaction (r = 0.469, p < 0.05), with the less satisfied nurses reporting higher incidences of care omissions.

Conclusion: The results of this study may facilitate a better understanding of this phenomenon and its impact on patients and nurses, but more research is needed at an international level so as to create more robust evidence that could support nursing practice.