Kath M. Melia

Accountingization v. Legitimation: A Comparative Study of the Use of Accounting Information in Intensive Care

Abstract This is a comparative study of management accounting in intensive care units in the UK and Finland. The management accounting problems of health care in many countries are well documented in the literature (difficulties of budgetary implementation: non-integration of health care professionals into the financial management process). This study examines these issues in the situation of intensive care, where there are difficult ethical decisions to be made by health care professionals in a climate of rapid medical advance where financial constraints may lead to rationing of health care. This paper reveals commonalities between these two countries in terms of intensive care problems, but there are differences, too, which can be attributed to contrasts in management accounting practices in the two countries.

A qualitative exploration of nurses leaving nursing practice in China

This paper reports a theoretical understanding of nurses leaving nursing practice by exploring the processes of decision‐making by registered nurses in China on exiting clinical care.

Clinical actions and financial constraints: the limits to rationing intensive care

This paper is concerned with the nature of rationing in intensive care. It reports a study of three intensive care units (ICUs) where resources were limited. We describe two conceptualisations of rationing: hard rationing, where there are absolute physical or financial constraints in place and soft rationing, in which clinicians and clinical managers, key actors in the organisation, can relax or remove apparently binding constraints. This paper demonstrates that, for the ICUs in this study, soft rationing was the norm. The existence of soft rationing was a function of three main factors: the nature of intensive care, the current state of modelling of means-end relationships in intensive care and network activity within and between ICU teams.

Providing Hospice Home Care to the Terminally Ill Elderly People With Cancer in Taiwan: Family Experiences and Needs

We explored caregivers’ experiences and needs when providing hospice home care to their terminally ill elderly patients with cancer in Taiwan for 1 year. A total of 44 caregivers were interviewed using a semistructured interview once monthly during hospice home care visits until the patients’ deaths. Content analysis of the interviews revealed 5 themes, hoping for a cure, experiencing fluctuating emotions, accepting the patient’s dying, regarding the patient’s death as a good death, and needing emotional support and information. Caregivers in hospice home care who experienced difficulties tended to seek emotional support and information throughout the entire caregiving process. With a greater understanding of caregivers’ experiences and needs, nurses can alleviate caregivers’ negative emotional reactions by actively attending to their needs during this process.