title: Clinical prioritizations and contextual constraints in nursing homes--a qualitative study.
abstract: OBJECTIVE
  The aim of the study was to describe nurses' and physicians' experiences of prioritization factors in nursing homes.
  
  
  BACKGROUND
  What are the experiences of health care personnel when prioritizing treatment and care for elderly residents in nursing homes? Little research has been done in this area, yet with the growing elderly population and limited health care budgets there can be little doubt about its relevance.
  
  
  METHODS
  The study was conducted through semi-structured interviews with 13 physicians and nurses in six nursing homes. The interviews were analysed by manifest content analysis based on first- and second-level categories describing relevant factors. The categories were developed after preliminary readings of the texts.
  
  
  RESULTS
  This study revealed that there was a complex set of contextual constraints which influenced the care provided. There were three main findings: (i) some overall challenges related to providing good care to nursing home residents; these in turn influenced (ii) prioritizing dilemmas and (iii) factors influencing prioritization decisions.
  
  
  CONCLUSIONS
  Contextual constraints and higher level prioritizations seem to play a key role in clinical prioritizations in nursing homes. The combination of implicit rationing and the factors described as most predominant in the clinical prioritizations in nursing homes may result in inadequate and unjust health care services for some of the nursing home residents. In particular, those patients who do not speak up or do have comprehensive needs are at risk of being neglected.
authors.affiliation: Oslo University College, Faculty of Nursing, Oslo, Norway. Aashild.Slettebo@su.hio.no
authors.forename: Ashild
authors.initials: A
authors.lastname: Slettebø
authors.forename: Marit
authors.initials: M
authors.lastname: Kirkevold
authors.forename: Berit
authors.initials: B
authors.lastname: Andersen
authors.forename: Reidar
authors.initials: R
authors.lastname: Pedersen
authors.forename: Kristin
authors.initials: K
authors.lastname: Halvorsen
authors.forename: Marita
authors.initials: M
authors.lastname: Nordhaug
authors.forename: Per
authors.initials: P
authors.lastname: Nortvedt
mesh_terms: D006292:Health Priorities; D007407:Interviews as Topic; D009664:Norway; D009735:Nursing Homes