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Yang L, Zhou W, Gao Y, Wu T, Zhang H, Gan X. Development and validation of the missed intensive nursing care scale. BMC Nurs 2024; 23:165. [PMID: 38454469 PMCID: PMC10919009 DOI: 10.1186/s12912-024-01805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Missed nursing care is a pervasive issue in hospitals, nursing homes, and communities, posing a significant threat to patient safety and the quality of nursing care. It has adverse effects on patient satisfaction and the motivation of nursing staff. Understanding the causes and nature of these care omissions in clinical settings is essential for implementing effective interventions. This study aims to develop and validate a tool for assessing missed nursing care in adult intensive care units. METHODS Semi-structured interviews, expert consultations conducted via the Delphi method and item analysis were used to develop the initial scale. Our analysis involved data collected from 400 nurses and employed correlation coefficient analysis, critical ratio assessment, Cronbach's α coefficient evaluation, discrete trend analysis, and factor analysis, which were grounded in both classical test theory and item response theory, allowing us to scrutinize and refine the items in the scale. To validate the scale, we conveniently sampled 550 nurses and assessed structural validity, internal reliability, split-half reliability, and test-retest reliability to ensure the scale's robustness and accuracy. RESULTS The Missed Intensive Nursing Care Scale (MINCS) comprises three distinct components. Part A serves to collect general information about the participants. In Part B, the missed care elements are categorized into five domains, following the framework of Maslow's hierarchy of needs theory: physiology, safety, belongingness, esteem, and cognition. Part C is dedicated to detailing the reasons behind missed care, which encompass labor resources, material resources, communication factors, and managerial factors. Remarkably, the Cronbach's α coefficient for the MINCS stands at an impressive 0.951, with S-CVI values of 0.988 and 0.977 in Part B and C, respectively, underscoring the scale's exceptional reliability and validity. This demonstrates the scale's effectiveness in measuring missed nursing care while upholding rigorous standards of quality. CONCLUSIONS The MINCS emerges as a robust and dependable instrument for quantifying instances of missed care within the ICU. Its efficacy makes it a valuable resource for informing the development of strategies aimed at averting and mitigating the adverse effects associated with missed nursing care.
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Affiliation(s)
- Li Yang
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Wen Zhou
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Yan Gao
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Taiqin Wu
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Huan Zhang
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Xiuni Gan
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China.
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Papathanasiou I, Tzenetidis V, Tsaras K, Zyga S, Malliarou M. Missed Nursing Care; Prioritizing the Patient's Needs: An Umbrella Review. Healthcare (Basel) 2024; 12:224. [PMID: 38255111 PMCID: PMC10815730 DOI: 10.3390/healthcare12020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
The objective of this review of reviews was to identify the reasons for missed nursing care and to shed light on how nurses prioritize what care they miss. Missed nursing care refers to essential nursing activities or tasks that are omitted or not completed as planned during a patient's care. This omission can result from various factors, such as staffing shortages, time constraints, or communication issues, and it can potentially compromise the quality of patient care and safety. Identifying and addressing missed nursing care is crucial to ensure optimal patient outcomes and the well-being of healthcare professionals. To be included, reviews had to use the systematic review process, be available in the English language, examine missed care in hospitals and at home, and include participants who were over eighteen years old. The review intended to answer the following questions: 'Why nursing care is missed?' 'How nurses prioritize what care they missed?'. An umbrella review was developed guided by the JBI methodology and using PRISMA-ScR. A total of 995 reviews were identified. According to the inclusion criteria, only nine reviews were finally evaluated. The findings indicate that care is missed due to staffing levels, organizational problems, and the working climate. Prioritization of care depends on acute care needs as well as educational and experiential background. Missed nursing care is associated with patient safety and the quality of provided nursing care. Specifically, it has negative impacts on patients, healthcare professionals, and healthcare service units. Organizational characteristics, nursing unit features, and the level of teamwork among nursing staff affect Missed Nursing Care. Individual demographic characteristics of the staff, professional roles, work schedules, and adequate staffing may potentially contribute to the occurrence of Missed Nursing Care, which is why they are under investigation. However, further consideration is needed regarding the management of patient needs and nurse prioritization.
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Affiliation(s)
- Iokasti Papathanasiou
- Department of Nursing, University of Thessaly, 41500 Larisa, Greece; (I.P.); (V.T.); (K.T.)
| | - Vasileios Tzenetidis
- Department of Nursing, University of Thessaly, 41500 Larisa, Greece; (I.P.); (V.T.); (K.T.)
| | - Konstantinos Tsaras
- Department of Nursing, University of Thessaly, 41500 Larisa, Greece; (I.P.); (V.T.); (K.T.)
| | - Sofia Zyga
- Department of Nursing, University of the Peloponnese, 22131 Tripolis, Greece;
| | - Maria Malliarou
- Department of Nursing, University of Thessaly, 41500 Larisa, Greece; (I.P.); (V.T.); (K.T.)
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Cartaxo A, Dabney BW, Mayer H, Eberl I, Gonçalves L. External influencing factors on missed care in Austrian hospitals: Testing the theoretical antecedents of missed care using structural equation modelling. J Adv Nurs 2023; 79:3569-3584. [PMID: 37170413 DOI: 10.1111/jan.15700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/15/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
PROBLEM Missed Nursing Care (MNC) is an error of omission which occurs when a necessary nursing intervention is not initiated, is not completed, or when it is delayed. The MNC model explains this problem and describes four antecedents that can lead to MNC: (1) demand for patient care, (2) available human resources, (3) material resources, and (4) and relationship and communication factors. AIMS This study aims to test the relationship between the theoretical antecedents of MNC and their impact on MNC. DESIGN A quantitative cross-sectional study. METHODS The Austrian version of the revised MISSCARE Survey was completed by nurses working in general hospital units between May and July 2021. Recruitment followed a respondent-driven sample via Austrian nursing education institutions and social media. One thousand six nurses fulfilled inclusion criteria. The structure of the theoretical constructs of the MNC model was tested using a confirmatory factor analysis approach. The relationships between the four antecedents and MNC were explored using structural equation modelling with 427 complete cases. RESULTS The results support the structural validity of the revised MISSCARE Austria concerning the defined theoretical constructs, although discriminant validity and measurement error should be further investigated. The antecedent "resource allocation: labor" had a statistically significant impact on MNC: The lack of adequate nursing staff played the most important role to explain missed care in our model. CONCLUSION In our study in Austria, MNC was mostly influenced by a lack of appropriate labor resources. Further studies exploring mediation effects and non-linear relationships may contribute to better understanding of reasons for MNC. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Ana Cartaxo
- Department of General Health Studies, Division Nursing Science with focus on Person-Centred Care Research, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
- Austrian Academy of Sciences, Doctoral Fellowship Programme, Vienna, Austria
- Vienna Doctoral School of Social Sciences, University of Vienna, Vienna, Austria
| | - Beverly W Dabney
- School of Nursing, University of Michigan-Flint, Flint, Michigan, USA
| | - Hanna Mayer
- Department of General Health Studies, Division Nursing Science with focus on Person-Centred Care Research, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Inge Eberl
- Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Luzia Gonçalves
- Global Health and Tropical Medicine, Portuguese Institute of Hygiene and Tropical Medicine, NOVA University Lisbon, Lisbon, Portugal
- Department of Statistics and Operations Research, Faculty of Sciences, Centre of Statistics and its Applications, University of Lisbon, Lisbon, Portugal
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Rahimi S, Ebadi A, Khankeh HR, Eghbali M, Sharifi A, Mohammadian B, Lotfi MS. Validation and psychometric properties of the Persian version of the MISSCARE survey. Nurs Open 2023; 10:6058-6066. [PMID: 37565382 PMCID: PMC10416002 DOI: 10.1002/nop2.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/20/2022] [Accepted: 05/07/2023] [Indexed: 08/12/2023] Open
Abstract
AIM To conduct, translate, and psychometric evaluation of the MISSCARE-Persian Survey. DESIGN A cross-sectional study was conducted in Iran in February-June 2021. METHODS The translation of the MISSCARE Survey was accomplished according to World Health Organization (WHO) guidelines. Construct validity was performed by (N = 300) exploratory factor analysis and confirmation. To assess the reliability, internal consistency was assessed using Cronbach's alpha coefficient, and relative stability was assessed using the interclass correlation coefficient (ICC). The study adhered to COSMIN guidelines. RESULTS The exploratory factor analysis, which resulted in the identification of three factors in the second part of the tool, explained 79.6% of the total variance. Confirmatory factor analysis indicated the model's good fit of information. The reliability of the first and second parts of the tool was 0.912 and 0.901, respectively. Additionally, the ICC was found to be 0.687 for the first and 0.706 for the second part of the tool.
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Affiliation(s)
- Shoeleh Rahimi
- University of Social Welfare and Rehabilitation Sciences (USWR)TehranIran
- Educational Supervisor of Faghihi Hospital in ShirazShiraz University of Medical SciencesFarsIran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life style institute, Nursing FacultyBaqiyatallah University of Medical SciencesTehranIran
| | - Hamid Reza Khankeh
- Health in Emergency and Disaster research centerUniversity of Social Welfare and Rehabilitation SciencesTehranIran
- Department of Clinical Science and EducationKarolinska InstituteStockholmSweden
| | - Mohammad Eghbali
- Department of Nursing, school of Nursing and MidwiferyTorbat Heydariyeh University of Medical SciencesTorbat HeydariyehIran
| | - Azam Sharifi
- Nahavand School of Allied Medical SciencesHamadan University of Medical SciencesHamadanIran
| | - Batol Mohammadian
- Department of Operating Room, School of Allied Medical SciencesGonabad University of Medical SciencesGonabadIran
| | - Mohammad Sajjad Lotfi
- Trauma Nursing Research Centre, Faculty of Nursing and MidwiferyKashan University of Medical SciencesKashanIran
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Albsoul RA, Safadi RR, Alshyyab MA, FitzGerald G, Hughes JA, Ahmad M. Missed Nursing Care in Medical and Surgical Wards in Jordan: A Cross-Sectional Study. Policy Polit Nurs Pract 2023; 24:140-150. [PMID: 36798019 DOI: 10.1177/15271544231155845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Missed nursing care is a multifaceted patient safety issue receiving increased attention among healthcare scholars worldwide. There is limited research on missed nursing care in the Jordanian healthcare context. The current study sought to examine the perceptions of Jordanian nurses toward the amount and types of missed nursing care in medical and surgical wards. We also examined the differences in missed care items between public, private, and university hospitals in Jordan. This was a cross-sectional study using the MISSCARE Survey tool. Data collection spanned 4 months between March and July 2021. The final study sample consisted of 672 registered nurses employed in five public, three private, and two university hospitals in Jordan. Data were analyzed using descriptive statistics, Analysis of variance, and Pearson correlation coefficent test. Of the 672 registered nurses who participated, the majority were females (n = 421; 62.6%). Most participants held a bachelor's degree in nursing (n = 577; 85.9%). The three most common missed nursing activities in the participating hospitals were: ambulation, oral care, and emotional support. Nurses working in public hospitals reported the highest missed nursing care. The age and number of patients under care significantly correlated with missed nursing care. The findings could help nursing managers develop plans to reduce missed nursing care in their healthcare institutions.
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Affiliation(s)
- Rania Ali Albsoul
- Department of Family and Community Medicine, School of Medicine, 54658The University of Jordan, Irbid, Jordan
| | - Reema Rafiq Safadi
- Department of Maternal and Child Health Nursing, School of Nursing, 54658The University of Jordan, Amman, Jordan
| | - Muhammad Ahmed Alshyyab
- Department of Public Health and Community Medicine, Faculty of Medicine, 37251Jordan University of Science and Technology, Amman, Jordan
| | - Gerard FitzGerald
- School of Public Health and Social Work, 1969Queensland University of Technology, Brisbane, Australia
| | - James A Hughes
- School of Nursing, 1969Queensland University of Technology, Brisbane, Australia
| | - Muayyad Ahmad
- Department of Clinical Nursing, School of Nursing, 54658The University of Jordan, Amman, Jordan
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Chiappinotto S, Papastavrou E, Efstathiou G, Andreou P, Stemmer R, Ströhm C, Schubert M, de Wolf-Linder S, Longhini J, Palese A. Antecedents of unfinished nursing care: a systematic review of the literature. BMC Nurs 2022; 21:137. [PMID: 35698217 PMCID: PMC9195215 DOI: 10.1186/s12912-022-00890-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach. RESULTS Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability). CONCLUSIONS At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.
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Affiliation(s)
| | - Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Georgios Efstathiou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.,Nursing Services, Ministry of Health, Nicosia, Cyprus
| | | | | | | | - Maria Schubert
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Susanne de Wolf-Linder
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy.
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Factors Contributing to Rationed Nursing Care in the Slovak Republic-A Secondary Analysis of Quantitative Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020702. [PMID: 35055524 PMCID: PMC8775605 DOI: 10.3390/ijerph19020702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/01/2022] [Accepted: 01/07/2022] [Indexed: 02/04/2023]
Abstract
Rationed nursing care is a significant problem in healthcare facilities worldwide. Awareness of contributing factors to rationed care might support the development and implementation of strategies for reducing this phenomenon from clinical practice. The study examined the association between selected hospital, unit, and staff variables and the prevalence of rationed nursing care. Secondary analysis of cross-sectional data collected between December 2017 and July 2018 from 895 registered nurses in seven acute care hospitals in the Slovak Republic was performed. Data were collected using the questionnaire Perceived Implicit Rationing of Nursing and analyzed by descriptive and inferential statistics in the statistical program SPSS 25.0. Statistically significant associations were found between rationed nursing care and unit type, education, shift type, nurses' experience in the current unit, overtime hours, missed shifts, intention to leave the position, perceived staff adequacy, quality of patient care, and job satisfaction. Differences in rating rationed nursing care, quality of patient care, and job satisfaction were identified based on hospital type. Together with top hospital management, nurse managers should develop targeted interventions focusing on mitigating rationed nursing care from the clinical practice with a focus placed on university hospitals. Quality and safe care might be ensured through constant monitoring of the quality of patient care and job satisfaction of nurses as these factors significantly predicted the estimates of rationed nursing care.
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Pan SP, Lin CF. The relationship between organizational communication and missed nursing care in oncology wards in Taiwan. Nurs Open 2021; 9:2750-2760. [PMID: 34170634 PMCID: PMC9584478 DOI: 10.1002/nop2.976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 11/15/2022] Open
Abstract
Aim Unfavourable communication increases missed nursing care. Oncology wards have more communication complexity than general wards; therefore, creating a positive communication environment is important for ensuring quality care. This study aimed to understand the relationship between organizational communication satisfaction and missed nursing care in Taiwan. Design This cross‐sectional study was performed to measure organizational communication satisfaction and missed nursing care in six oncology wards at a stand‐alone cancer centre hospital in Taipei, Taiwan in December, 2018. Methods The study collected data using the Communication Satisfaction Questionnaire and the MISSCARE survey. The data were analysed using descriptive statistics, t test, analysis of variance and Pearson product–moment correlation analysis in December 16, 2018. Results A total of 111 questionnaires were collected, and the response rate was 92.5%. The study showed that nurses tended to miss nursing care when they were dissatisfied with the unit's manpower status organizational communication environment, horizontal and diagonal communication and informal communication.
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Affiliation(s)
- Shih-Ping Pan
- Department of Nursing, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chiou-Fen Lin
- College of Nursing, School of Gerontology Health Management, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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Willis E, Brady C. The impact of "missed nursing care" or "care not done" on adults in health care: A rapid review for the Consensus Development Project. Nurs Open 2021; 9:862-871. [PMID: 34132481 PMCID: PMC8859051 DOI: 10.1002/nop2.942] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
Aim To identify outcomes of missed nursing care for adult patients. Design A five‐stage rapid review process was conducted as follows: refining the question, retrieving relevant studies, determining the studies to be included, organizing the data and synthesizing the results. Methods Papers published between 2010–2020 that focused on the UK, Europe, the USA and Oceania were searched for keywords in the title and abstract in major databases. The articles that identified the impact of missed nursing care on adults in health care were selected. Results Seventeen articles met the criteria. Major impacts of missed care in adult settings were increases in mortality, adverse events and failure to maintain. These same studies also identified a range of causative factors linked to ward environment, inadequate staffing levels and skills mix although are inconclusive. Solutions include continuing education, ward and work re‐design, and appropriate skill level.
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Affiliation(s)
- Eileen Willis
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Catherine Brady
- Corporate Services, Flinders University, Adelaide, Australia
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Al-Faouri I, Obaidat DM, AbuAlRub RF. Missed nursing care, staffing levels, job satisfaction, and intent to leave among Jordanian nurses. Nurs Forum 2020; 56:273-283. [PMID: 33345335 DOI: 10.1111/nuf.12537] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/16/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
Patient safety is an important outcome for nurses who provide patient care within an environment that may increase the incidence of errors or impose them to omit care; these errors mostly happen because of staff shortage. The purpose of this study is to identify the types and reasons of "missed nursing care" among Jordanian nurses, and to examine the relationships between "missed nursing care", staffing, intent to leave, and job satisfaction. A cross-sectional descriptive design was used. A convenience sample of 300 nurses completed the Arabic version of MISSCARE which included items to measure types and reasons for "missed nursing care", staffing adequacy, job satisfaction, and intent to leave. The results of this study indicated that Labor resources were the most common cause of "missed nursing care". The results also showed that a low number of nurses per shift were associated with a high level of "missed nursing care". Nurse managers need to tackle staffing problems that may increase the rate of missed care and result in negative outcomes on the patients, nurses, as well as organizations. Nurse administrators could conduct evidence-based staffing plans to manage nurse to patient ratio to decrease missed care and enhance satisfaction.
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Affiliation(s)
- Ibrahim Al-Faouri
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Dana M Obaidat
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Raeda F AbuAlRub
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Palese A, Longhini J, Danielis M. To what extent Unfinished Nursing Care tools coincide with the discrete elements of The Fundamentals of Care Framework? A comparative analysis based on a systematic review. J Clin Nurs 2020; 30:239-265. [PMID: 33113209 DOI: 10.1111/jocn.15543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To establish whether, and to what extent, tools measuring Unfinished Nursing Care (UNC) that have been validated to date have the ability to detect the discrete elements of the 'Integration of care' dimension of The Fundamentals of Care Framework (The Framework). BACKGROUND UNC and The Framework have been established as two separate research lines, focused on (a) omitted care and related tools, and (b) on how to improve patient care, respectively. However, no attempts have been made to date to establish whether, and to what extent, tools measuring UNC have the ability to represent the discrete elements of The Framework. DESIGN A two-step study: (a) a secondary analysis of a systematic review up to June 2018 later updated in May 2020, followed by (b) a comparative analysis. METHODS A systematic review of studies on validated tools measuring UNC was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Then, researchers independently performed a comparative analysis between the extracted (a) discrete elements of The Framework and (b) items of the UNC tools retrieved. RESULTS A total of 14 tools were analysed. The physical dimension of The Framework was the one mostly covered by UNC tools (up to 87.5% with the Perceived Implicit Rationing of Nursing Care). The Norwegian Basel Extent of Rationing of Nursing Care showed the highest level of representation (41.6%) for the psychosocial dimension. Only the Perceived Implicit Rationing of Nursing Care and the Unfinished Care tool measure the relational dimension (22.2%, respectively). By considering all elements of the 'Integration of care' dimension, the Perceived Implicit Rationing of Care had the highest percentage of convergence (41%). CONCLUSION Not all UNC tools have the same ability to represent the discrete elements of The Framework. Moreover, physical needs are more often detected in UNC tools compared to the relational and psychological ones. RELEVANCE TO CLINICAL PRACTICE Unfinished care tools validated to date can represent a body of knowledge on which to build The Framework metrics, especially for the physical dimensions.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Matteo Danielis
- Department of Medical Sciences, University of Udine, Udine, Italy
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Palese A, Navone E, Danielis M, Vryonides S, Sermeus W, Papastavrou E. Measurement tools used to assess unfinished nursing care: A systematic review of psychometric properties. J Adv Nurs 2020; 77:565-582. [PMID: 33074561 DOI: 10.1111/jan.14603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Different tools have been developed and validated to measure unfinished nursing care. However, no systematic review of the psychometric properties has been performed describing the quality of the methods used to estimate their validity. AIMS (a) To identify tools measuring unfinished nursing care that have undergone validation processes; (b) to evaluate critically the quality of the methods used in ascertaining their psychometric properties; and (c) to compare the estimated psychometric properties of these tools. DESIGN A systematic review of the psychometric properties also evaluating their methodological quality was performed by following the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guideline for systematic reviews. DATA SOURCES The databases Medline, the Cumulative Index to Nursing and Allied Health Literature, PubMed, Google and Google Scholar were searched up to 30 June 2018. REVIEW METHODS Data extraction was performed following the predetermined eligibility criteria. Eight properties and their methodological quality were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments criteria. RESULTS A total of 20 studies reported validation data regarding three family of tools: the Missed Care Survey (MISSCARE), the Basal Extent of Rationing of Nursing Care (BERNCA) and the Task Undone scale (TU-7). The most estimated psychometric properties across studies were internal consistency, followed by structural validity, content validity, and cross-cultural validity. The less evaluated psychometric properties were reliability, hypothesis testing and convergent and criterion validity. CONCLUSION The psychometric properties of the investigated tools showed a more than acceptable quality, as did the methodologies used to estimate these properties. IMPACT The MISSCARE survey is the most widely used tool validated across countries to date. Evaluating the concurrent reliability of the tools available is strongly recommended to assess their effectiveness in measuring the same phenomenon.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Elena Navone
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Matteo Danielis
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Stavros Vryonides
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Leuven, Belgium
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Bassi E, Tartaglini D, Valpiani G, Grassetti L, Palese A. Unfinished Nursing Care Survey: A development and validation study. J Nurs Manag 2020; 28:2061-2071. [DOI: 10.1111/jonm.13170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Erika Bassi
- Nursing Care Service S. Anna University Hospital Ferrara Italy
| | | | - Giorgia Valpiani
- Research Innovation Office S. Anna University Hospital Ferrara Italy
| | - Luca Grassetti
- Department of Statistics and Economics Udine University Udine Italy
| | - Alvisa Palese
- Department of Medical Science Udine University Udine Italy
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Lane A, Landers M, Andrews T. Nebulous Intentioning - Acute hospital nurses' struggle to deliver core nursing care. J Adv Nurs 2020; 76:3537-3547. [PMID: 32989815 DOI: 10.1111/jan.14546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/07/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022]
Abstract
AIM To explore the influences on nursing practice in acute hospital care. DESIGN A Classic Grounded Theory study. METHODS Data collection (2013-2015) was through interviews and non-participant observations. Analysis was undertaken using constant comparative data analysis and theoretical sampling. Memo writing was used as an aid to understanding and conceptualizing data during analysis. Theoretical coding served to integrate emerging concepts. RESULTS This theory explains core nursing as a nebulous intention, an idea which acute care nurses retain throughout each shift, that they will nurse their patients fully when they have the opportunity. It reveals this as the resolution of their main problem which is the constant deferral of core nursing care. This study explains its two sub-core categories, accommodating and integrity eroding. CONCLUSION The theory highlights nurses' attitudes towards their role, demonstrated by deferring it to accommodate the work of others, but offers a new perspective on the significant contribution nurses make to the safe and cohesive transition of patients through the acute healthcare system. IMPACT The theory adds a new understanding of the unique contribution nurses make to patient health and safety in acute care environments. It also provides insight into nurses' attitudes towards their own professional work. It explains the consequences of attitudes which undermine core nursing when it competes for priority with accommodating. Accommodating indicates a greater workload for nurses than has been previously understood in explaining the activities, additional to core nursing care, which nurses undertake to contribute safety and cohesion to the patient's acute care journey. These new insights suggest a role for managers in recognizing accommodating in decisions about staffing and resources and for educators in improving the profession's regard for its theoretical underpinnings and for its self-image.
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Affiliation(s)
- Aoife Lane
- School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Margaret Landers
- School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Tom Andrews
- School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
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Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
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16
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Zeleníková R, Gurková E, Friganovic A, Uchmanowicz I, Jarošová D, Žiaková K, Plevová I, Papastavrou E. Unfinished nursing care in four central European countries. J Nurs Manag 2019; 28:1888-1900. [PMID: 31680373 PMCID: PMC7754486 DOI: 10.1111/jonm.12896] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 12/02/2022]
Abstract
Aim The main aim of the research was to describe and compare unfinished nursing care in selected European countries. Background The high prevalence of unfinished nursing care reported in recently published studies, as well as its connection to negative effects on nurse and patient outcomes, has made unfinished care an important phenomenon and a quality indicator for nursing activities. Methods A cross‐sectional descriptive study was undertaken. Unfinished nursing care was measured using the Perceived Implicit Rationing of Nursing Care questionnaire (PIRNCA). The sample included 1,353 nurses from four European countries (Croatia, the Czech Republic, Poland and Slovakia). Results The percentage of nurses leaving one or more nursing activities unfinished ranged from 95.2% (Slovakia) to 97.8% (Czech Republic). Mean item scores on the 31 items of the PIRNCA in the total sample ranged from 1.13 to 1.92. Unfinished care was significantly associated with the type of hospital and quality of care. Conclusion The research results confirmed the prevalence of unfinished nursing care in the countries surveyed. Implications for Nursing Management The results are a useful tool for enabling nurse managers to look deeper into nurse staffing and other organizational issues that may influence patient safety and quality of care.
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Affiliation(s)
- Renáta Zeleníková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacky University in Olomouc, Olomouc, Czech Republic
| | - Adriano Friganovic
- University Hospital Zagreb, Zagreb, Croatia.,University of Applied Health Sciences, Zagreb, Croatia
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Darja Jarošová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Katarína Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ilona Plevová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Mandal L, Seethalakshmi A, Rajendrababu A. Rationing of nursing care, a deviation from holistic nursing: A systematic review. Nurs Philos 2019; 21:e12257. [DOI: 10.1111/nup.12257] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Lata Mandal
- Faculty of Nursing Sri Ramachandra Institute of Higher Education and Research Chennai India
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Evripidou M, Merkouris A, Charalambous A, Papastavrou E. Implementation of a training program to increase knowledge, improve attitudes and reduce nursing care omissions towards patients with dementia in hospital settings: a mixed-method study protocol. BMJ Open 2019; 9:e030459. [PMID: 31326938 PMCID: PMC6661557 DOI: 10.1136/bmjopen-2019-030459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/16/2019] [Accepted: 06/28/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION There is an evidence showing that when nurses have to allocate their time because of a lack of resources, older patients and especially those with dementia have a secondary care priority. The purpose of this study is to advance the level of knowledge, promote positive attitudes of nurses and reduce care deficits towards people with dementia through the implementation of a training programme. The programme will be enriched by an observational study of the care of patients with dementia to identify areas of missed care. METHOD AND ANALYSIS This study will follow a mixed methodology consisting of three stages: (1) evaluation of the level of nurses' knowledge and attitudes towards dementia care through the use of structured questionnaires, (2) observational study to evaluate nursing care in hospital settings, in order to detect any missed care and (3) quasi-experimental study, with a before-and-after design, through the implementation of the training programme in order to increase nurses' knowledge, improve attitudes and consequently to promote care for patients with dementia. The data will be analysed with descriptive and inferential statistics with the use of the SPSS V.24.0 and with content analysis as regard to the observational data. ETHICS AND DISSEMINATION The protocol was approved by the National Bioethics committee and other local committees (ΕΕΒΚ: 2018.01.02). The participants will give their informed consent and the anonymity and confidentiality. Also, the protection of data will be respected. The results of the study will be disseminated in peer-reviewed international journals and conferences. If the intervention is successful, the training package will be given to the continuous education unit of the National Professional Association in order to be used on a regular basis.
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Affiliation(s)
- Melina Evripidou
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Anastasios Merkouris
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andreas Charalambous
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
- Nursing, Turun Yliopisto, Turku, Finland
| | - Evridiki Papastavrou
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Tolentino GS, Bettencourt ARDC, Fonseca SMD. Construction and validation of an instrument for nursing consultation in outpatient chemotherapy. Rev Bras Enferm 2019; 72:391-399. [PMID: 31017201 DOI: 10.1590/0034-7167-2018-0031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 07/17/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Construct and validate instrument content for nursing consultation in an adult chemotherapy outpatient clinic. METHOD Methodological study composed of two stages: elaboration of the instrument and validation of content. A literary review of the dimensions of customer care was carried out in the light of Theory of Basic Human Needs Theory, culminating in two instruments: one for admission consultation and other for follow-up. The content was validated by the evaluation of listed experts based on the adapted Fehring's Validation Model. RESULTS In the first round, two items of the admission instrument and three items of follow-up required reformulation. In the second round, there was an increase in agreement rate: 11% in the instrument of admission and 10% in follow-up. FINAL CONSIDERATION The instrument represents a guideline for the Nursing Process and future research, but it cannot be seen as a substitute for nurses' knowledge and clinical reasoning.
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VanFosson CA, Jones TL, Yoder LH. Monthly variation of unfinished nursing care at the US Army Burn Center. Burns 2018; 44:1910-1919. [PMID: 30314849 DOI: 10.1016/j.burns.2018.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the monthly variation in the prevalence and patterns of unfinished nursing care and to determine the relationships between the system of nursing care and unfinished nursing care at the US Army Burn Center. METHODS This was a repeated measures, descriptive study. For one week per month for six months, all nurses providing direct patient care on two inpatient burn units (intensive care and progressive care) were asked to complete an anonymous paper survey, which contained the Perceived Implicit Rationing of Nursing Care instrument, to estimate the prevalence of unfinished nursing care on their unit. Unit administrative data also were collected from the unit nursing leaders each month. Descriptive statistics and multilevel modeling were used in the analysis. RESULTS Most (80.5%) eligible nurses participated at least once; 46.6% participated three or more times. A high proportion (85.7-100%) of nurses left at least one element of care unfinished; the mean number of activities left unfinished over each 7 shift period per nurse was 16.2. Only nursing care hours provided by float staff significantly predicted nurse estimates of unfinished nursing care, β=.008, SE=.001, p<.05. CONCLUSIONS The prevalence of unfinished nursing care at the US Army Burn Center was high and generally consistent with other studies of unfinished nursing care in non-burn settings. The inability to meet the demand for nursing care, as evidenced by the presence of unfinished nursing care, may be the result of a limited surge capacity. Implications for research, policy, and practice were discussed.
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Affiliation(s)
- Christopher A VanFosson
- United States Army Institute of Surgical Research, 3698 Chambers Road, San Antonio, TX 78234, United States.
| | - Terry L Jones
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, Richmond, VA 23298, United States.
| | - Linda H Yoder
- The University of Texas at Austin School of Nursing, 1710 Red River St., Austin, TX 78712, United States.
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Bayraktar-Ekincioglu A, Kucuk E. The differences in the assessments of side effects at an oncology outpatient clinic. Int J Clin Pharm 2018; 40:386-393. [DOI: 10.1007/s11096-018-0590-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 01/05/2018] [Indexed: 02/05/2023]
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