China's No-Companion Care Model: Nursing Policy Reform and Lessons From International Practice

Abstract

Background

In many Organization for Economic Cooperation and Development (OECD) countries, hospital nursing care is comprehensively provided by professional nurses and multidisciplinary teams, with no reliance on family companions. By contrast, China has historically depended on family caregivers at the bedside, a practice shaped both by deep-rooted cultural traditions of filial piety and by persistent nursing workforce shortages. With the introduction of the Hospital No-Companion Care Service Pilot Work Plan (2025–2027), China is entering a critical reform phase aimed at transitioning from informal family-dependent caregiving toward a more institutionalized, standardized, and professionalized hospital nursing model.

Methods

This study employed a comparative policy analysis combined with a narrative literature review. The review followed PRISMA guidelines for transparent literature selection and applied Walt & Gilson's Policy Triangle Framework to examine policy context, content, processes, and actors. Sources included PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Organization for Economic Cooperation and Development (OECD), World Health Organization (WHO), and Chinese government policy documents, ensuring both international and domestic perspectives were incorporated.

Results

Findings indicate that China's model addresses demographic aging and nursing shortages through hybrid approaches combining nurses with supervised assistants. Compared with OECD systems, China faces lower nurse density (2.9 vs. 9.2 per 1,000) and lower nurse-to-bed ratios (0.6:1 vs. 1.4:1). Preliminary pilot outcomes suggest notable improvements in patient safety, fall prevention, and satisfaction levels. However, they also reveal ongoing financing challenges, regulatory gaps, and varying degrees of cultural acceptance among patients and families, reflecting the tension between traditional caregiving norms and new institutional practices.

Conclusion

China's no-companion model is both an innovative reform and a transitional stage in health system transformation. Long-term sustainability requires systematic investment in expanding nurse education, gradual integration of no-companion services into medical insurance coverage, and deliberate efforts to foster cultural adaptation through patient and family engagement strategies. China's experience offers lessons for low- and middle-income countries seeking professionalized care models under resource constraints, highlighting how institutional restructuring can respond to workforce shortages while respecting cultural contexts. This study provides policy insights into how professional nursing reform can balance workforce capacity, cultural expectations, and institutional accountability in the context of China's hospital no-companion care initiative.