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. 2025 Feb;32(1):42-55.
doi: 10.1177/09697330241230513. Epub 2024 Feb 6.

Prioritization decision-making of care in nursing homes: A qualitative study

Pauliina Hackman  1 , Arja Häggman-Laitila  1 , Marja Hult  1   2
Affiliations

Prioritization decision-making of care in nursing homes: A qualitative study

Pauliina Hackman et al. Nurs Ethics. 2025 Feb.

Abstract

Background: Prioritization decision-making arises when nurses encounter intricate situations that demand ethically challenging judgments about care. This phenomenon has rarely been studied in nursing homes. Prioritization decision-making may lead to instances where individuals in social and healthcare may not receive all services they need. Making prioritization decisions and awareness of their consequences can increase nurses' workload.

Aim: To describe prioritization decision-making regarding unfinished nursing care in nursing homes.

Research design: A qualitative descriptive study conducted through individual theme interviews. Participants were recruited through social media. The data was analyzed using inductive content analysis.

Participants and research context: Nurses (n = 23) working in nursing homes for the elderly people in Finland. Data were collected between June 2022 and February 2023.

Ethical considerations: Finnish legislation does not mandate an ethical review or research permits, as the participants took part as private individuals. [ask authors to make reference here to informed consent process and anonymity].

Findings: Nurses stated that the need for prioritization decision-making arises from challenges associated with nurses' engagement with person-centered care, the culture of the work community, the burden due to workload and challenges associated with the leadership. Prioritization decision-making was based on the interests of residents, striving for an efficient workflow and nurse's personal interests. Nurses did not receive support for decision-making regarding unfinished care, and protocols for prioritization had not been established in their work communities. Prioritization decision-making and unfinished care were concealed and left unspoken.

Conclusion: Nursing leaders should address this hidden phenomenon, making it visible through discussions with nurses and by involving them in the development of protocols. The findings can be utilized for developing new approaches to support nurses and reduce their workload and for enhancing the quality and person-centeredness of nursing care in nursing homes.

Keywords: Aged care; decision-making; nursing home; prioritization; unfinished nursing care.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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