Wastes in nursing practice: findings from a phenomenological study [Gli sprechi nella pratica clinica infermieristica: risultati di uno studio fenomenologico]

BACKGROUND: the International economic crisis has challenged the sustainability of health care systems imposing reforms aimed to reduce costs and increase production efficiency. At the international level, waste reduction is considered to be the basis to ensure the heath care systems sustainability. To reduce waste and increase production efficiency is required to document the types, the extent and the level were they occur. The purpose of this paper is to document the experience of waste in nurses clinical practice. METHODS: a descriptive phenomenological study was conducted. Clinical nursing operating in different care settings of the National Heath Care Service were recruited adopting a maximum variation purposeful sampling. Data saturation was considered as the finish line for the participants recruitment. RESULTS: thirty nurses participated in the study. They were mainly female (n = 28, 93.3%) and with an average age of 41.4 ± 7.3 years. For nurses waste means inadequate allocation of resources. Wastes are caused by individual and organizational choices determining improper, inefficient or ineffective use of material, human or virtual heath care resources and time as well as the incorrect application of clinical pathways, the inadequate use of electricity, food, and the improper disposal of the hospital waste. Wastes generates negative emotional impact on nurses such as frustration, anger and sense of impotence. Avoidable wastes were identified. They were mainly related to the expiration date, the use and the type of drugs and materials. Also unavoidable wastes were identified and they were related to established practices to ensure patients safety and changes in treatment choices due to the clinical instability of the patients. CONCLUSION: within the limits of the qualitative approach, in this study have been identified different types of waste present in clinical practice as perceived by nurses. National Health Service policies could focus on this evidences to improve production efficiency. To involve health care professionals in the choices and their awareness to the conscious and responsible use of public resources available, would avoid linear cuts and enhancing such operators.