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Background: In clinical settings where missed nursing care prevails, nursing students' instructions, supervision and the joint reflection on clinical practice with mentors are also affected and nursing students become involved in dealing with missed nursing care. AIM: To explore the experience of missed nursing care in clinical placements, its meaning for nursing students, and actions they considered or took. METHODS: Qualitative study based on a content analysis of nursing students' written reports. Nursing students in three universities in Germany with experience of at least one clinical practice placement were invited to participate. Online, they answered three open questions concerning missed nursing care focusing on: (1) experiences of the phenomenon, (2) its meaning and (3) actions that had been considered or taken when dealing with missed nursing care. A content analysis was performed. RESULTS: The recruitment criteria were met by 69 nursing students. Four main themes and 20 sub-themes were identified. The reports covered all forms of missed nursing care. Becoming involved led to intrapersonal conflicts and, feelings of powerlessness but also to learning opportunities. It challenged professional and ethical standards. Students identified a broad spectrum of actions to answer the challenge. CONCLUSION: Dealing with missed nursing care creates opportunities and challenges for nursing students. To build up a well-trained and sustainable nursing workforce, learning environments for nursing students must reflect the challenges and counteract deficits.

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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.

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BACKGROUND: Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses' professional and moral values. OBJECTIVE: To explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses. DESIGN, DATA SOURCES AND METHODS: A scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis. RESULTS: Nurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients' daily care needs, prioritising work by essential tasks and participating in priority setting for patients' access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient's situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses' moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise. CONCLUSIONS: Analysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.

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BACKGROUND: In the context of demographic ageing, municipalities are tasked with ensuring cross-sectoral care services for the elderly close to residential environments so that elderly people can remain in their own domestic environment as long as possible. A particular challenge is the inclusion of the migrant population, which is often still inadequate. OBJECTIVES: Indicators for the municipal monitoring of integration have been developed on the basis of surveys of experts . The interviews dealt with (a) the knowledge of available data and the data necessary for monitoring the integration of elderly with a migrant background and (b) the use of integration monitoring as an instrument in the planning of elderly care and, if available, the indicators used. MATERIAL AND METHODS: Guideline-based interviews with 76 members from community elder care and integration work in 16 German municipalities were conducted, transcribed and analysed. The results were discussed in two focus groups, each with nine experts. RESULTS: (a) Data deficits prevent the migrant-sensitive orientation of planning and control in elder care; (b) only the beginnings of community integration monitoring in elderly care are established in a few communities; (c) 18 indicators for integration monitoring of migrant sensitive elder care have been developed. CONCLUSIONS: Deficits in the integration of migrants into community care structures can be addressed by integration monitoring of elder care. The selection and use of some or all of the indicators developed requires that consent be sought in municipalities with the inclusion especially of migrant organisations.

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Preventig errors and implementing risk management systems in health and nursing care requires knowledge about nurses' perceptions of errors, such as their handling and their reporting of errors. Whistleblowing is a way of reporting serious deficits by leaving predetermined pathways and addressing persons, institutions or media outside the organisation. In eighteen semi-structured interviews nurses were asked if they could imagine acting as a whistleblower, or if they even had ever blown the whistle before. The scope of their appraisal ranged from strictly disapproving such behaviour (what was done by most of the interviewees) to approving only hesitantly because of personal risks. Central themes were allegiance to the organisation, to the team and to colleagues, responsibility for the patients, and the consideration of personal risks. This corresponds to the results of other studies on whistleblowing, as described in the discussion. Nurses have to be encouraged to accept professional responsibilities as well as organisational ways of error reporting have to be found and to be discussed, e. g. in terms of best practice examples. Whistleblowing should be regarded as an act by which patient advocacy is expressed.

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Knowledge on errors is important to design safe nursing practice and its framework. This article presents results of a survey on this topic, including data of a representative sample of 724 nurses from 30 German hospitals. Participants predominantly remembered medication errors. Structural and organizational factors were rated as most important causes of errors. Reporting rates were considered low; this was explained by organizational barriers. Nurses in large part expressed having suffered from mental problems after error events. Nurses' perception focussing on medication errors seems to be influenced by current discussions which are mainly medication-related. This priority should be revised. Hospitals' risk management should concentrate on organizational deficits and positive error cultures. Decision makers are requested to tackle structural problems such as staff shortage.

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