Factors influencing the self-rationing of nursing care in palliative care settings

BACKGROUND: The rationing of nursing care is a significant concern in palliative care settings, where resource limitations can prevent nurses from providing comprehensive patient care. This study aims to examine the factors influencing the rationing of nursing care among palliative care nurses, focusing on the impact of psychological factors and workplace characteristics. METHODS: A cross-sectional survey was conducted using the Perceived Implicit Rationing of Nursing Care (PIRNCA) questionnaire among 104 nurses working in palliative care. Data on anxiety and depression levels were collected using the HADS scale. Multivariate regression analysis was employed to identify key predictors of care rationing, including depression, anxiety, and type of care setting. RESULTS: The average PIRNCA score was 0.82 (SD = 0.53), indicating that care rationing occurs "rarely." The most frequently rationed tasks were emotional and psychological support, patient education, and assistance with mobility. Nurses with higher depression (p = 0.002) and anxiety levels (p = 0.0012) were more likely to ration care. Working in a home-based hospice was associated with increased care rationing (p = 0.0012), while working in a palliative care ward reduced it (p = 0.0027). CONCLUSIONS: Psychological distress, particularly depression and anxiety, significantly contributes to nursing care rationing in palliative care. Additionally, the type of care setting plays a critical role, with home-based hospice care being more prone to rationing. Interventions to support nurses' mental health and optimize resource allocation, particularly in home-based care, are essential to ensure comprehensive patient care in palliative settings. CLINICAL TRIAL NUMBER: Not applicable.