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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. [ABSTRACT FROM AUTHOR]

Aims: To explore nurses' perceptions of factors affecting workloads and their impact on patient care. Background: Fiscal restraints and unpredictable patient illness trajectories challenge the provision of care. Cost containment affects the number of staff employed and the skill‐mix for care provision. While organisations may acknowledge explicit rationing of care, implicit rationing takes place at the point of service as nurses are forced to make decisions about what care they can provide. Method: A self‐report cross sectional study was conducted using an on‐line survey with 2,397 nurses in Queensland, Australia. Results: Twenty to forty per cent reported being unable to provide care in the time available; having insufficient staff; and an inadequate skill‐mix. The respondents reported workload and skill‐mix issues leading to implicit care rationing. Over 60% believed that the processes to address workload issues were inadequate. Conclusions: Institutional influences on staffing levels and skill‐mix are resulting in implicit care rationing. Implications for Nurse Managers: Adequate staffing should be based on patient acuity and the skill‐mix required for safe care. Managers should be more assertive about adequate clinical workloads, involve staff in decision‐making, and adopt a systematic planning approach. Failure to do so results in implicit care rationing impacting on patient safety. [ABSTRACT FROM AUTHOR]

Individual realities and perceptions are embedded in a web of dominant social and cultural views which shape the individual. Mothers of deaf children therefore cannot be understood in isolation, and neither can their experiences, perceptions, and well-being. The present research investigated the construction of deafness through the experiences of mothers raising a deaf child and considered the manner in which these constructions impacted their well-being and relationship with the child. The study explored the experiences of six Black South African hearing mothers of a deaf child between the ages of 3 and 8 years. Individual semi-structured interviews were conducted. Through an interpretive theoretical framework, this qualitative study noted seven main themes, namely, deafness is foreign and unknown, increased awareness and normalising of deafness, religious and Traditional African beliefs about disability/deafness, external pity and the mother's rejection of it, the discourse of the 'superiority' of speech and encouragement of speech and hearing, barriers to communicating with her child, and 'Why me?' attribution of cause and the emergence of blame. Extrapolation of the data suggests that there is a lack of awareness regarding the deaf individual, and this creates misinformed perceptions about deafness which impact negatively both mother and child. [ABSTRACT FROM AUTHOR]

Researchers using qualitative methods are required to be ethically mindful not to cause harm to participants. However, when emotional encounters between researchers and participants occur there are inherent ethical tensions that need to be continuously navigated. In this paper I contemplate the challenges I encountered whilst using a psychoanalytically informed research interview method (adapted from Cartwright, 2004; Kvale, 1999; Stromme, Gullestad, Stänicke & Killingmo, 2010). I interviewed women on the topic of maternal subjectivity when their children have a disability. The ethical quandaries included accessing nuanced data by engaging with participants' unconscious material; as well as the use of the transferencecountertransference situation outside of a psychotherapy setting. Literature has previously discussed the ethics of using this psychoanalytic method, particularly around the interpretation of data from a psychoanalytic lens. However, the aim in this paper is focused on the application of psychoanalytic concepts in the process of data collection and how to ethically manage these emotional engagements with participants. It will be argued that when researchers are also mindful, psychoanalytically-trained psychotherapists, who engage with their own subjectivity in personal psychoanalytic psychotherapy, this psychoanalytic inquiry method can be a very ethical way of being with participants. [ABSTRACT FROM AUTHOR]