“It's about how we do it, not if we do it”. Nurses’ experiences with implicit rationing of nursing care in acute care hospitals: A descriptive qualitative study

How Do Nurses Decide on Missed Nursing Care? A Grounded Theory Study of Grassroots Arrangement of Nursing Care

AIMS

To explore the complete decision-making process and action logic of nurses making autonomous decisions that result in missed nursing care.

BACKGROUND

The complex characteristics of patients in Intensive Care Units place higher demands on the allocation of nursing resources, as well as on the professional skills, resilience and ethics of nursing staff. Preventing missed nursing care is particularly crucial in Intensive Care Units.

DESIGN

A theory construction qualitative study using grounded theory.

METHODS

Semistructured face-to-face interviews were conducted with 20 nurses, including three head nurses and 17 bedside nurses. Head nurses provided insights into counselling and management practices.

RESULTS

The theoretical model of nurses' decision-making processes comprise four strategies: setting priorities, seeking help, delaying nursing care and omitting nursing care. The latter two constitute missed nursing care. Inadequate staffing, task urgency and negative emotions can lead to omitting nursing care.

CONCLUSIONS

This study proposes an original concept: grassroots arrangement of nursing care (GANC). Grassroots arrangement of nursing care includes the autonomous and adaptive decision-making process used by bedside nurses to optimise workflow in busy environments. It includes specific strategies and quality implications, enabling a nuanced balance between limited nursing resources, increasing patient needs and maintaining the best possible quality of care.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should consider the dual aspects of grassroots arrangement of nursing care, support nurses' grassroots autonomy and streamline decision-making processes.

REPORTING METHOD

This study follows the Consolidated Criteria for Reporting Qualitative Studies (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Presenteeism and missed nursing care: a descriptive, correlational and observational study

BACKGROUND

Missed nursing care poses a significant challenge for healthcare staff in terms of patient safety and care quality.

OBJECTIVE

To evaluate presenteeism and missed care attitudes of nurses and to determine the correlation between presenteeism and missed care.

METHODS

This descriptive, correlational, and observational study was conducted between February and August 2023. The Stanford Presenteeism Scale-Short Form and the MISSCARE Survey were used to collect the data among nurses at two public hospitals in a city in Turkey. The study was completed with 229 nurses representing 27.4% of the total number of nurses who met the inclusion criteria. The data was analyzed using a comprehensive analytical approach, including Cronbach's alpha analysis, frequency and percentage distribution, the Shapiro-Wilk test of normality, correlation coefficient analysis, Pearson correlation coefficient, and the Bonferroni test.

RESULTS

The participants' mean age was 30.22 ± 7.14 years, and 74.2% of them were female. 53.3% of the participants reported difficulty providing patient care due to material shortages, and 62.9% experienced challenges delivering care due to the intensity of paperwork in the clinic. Nurses who felt that paperwork intensity affected patient care and were not confident in their care provision had higher levels of presenteeism (p = 0.041) and a significantly higher frequency of missed care instances (p < 0.001).

CONCLUSIONS

Material shortages and high paperwork intensity are contributing factors to the difficulties experienced by nurses in their practice. These difficulties may lead to an increase in presenteeism and instances of missed nursing care. It is important to address these challenges to ensure adequate care provision and reduce the likelihood of presenteeism among nurses. The correlation between presenteeism and instances of missed nursing care highlights the impact of presenteeism behaviors on the quality of patient care.

Checking nasogastric tube safety in children cared for in the community: a re-examination of the evidence base

Nasogastric tube feeding is generally considered safe provided a nasogastric aspirate with a pH ≤5.5, which indicates that the end of tube is correctly located in the stomach, can be obtained. When this is not possible, hospital attendance or admission is usually required so that an X-ray can be undertaken to check the tube's position. This practice is based on an interpretation of the evidence that places undue importance on nasogastric aspirate pH testing before every use of a tube that is already in place, with potential negative consequences for children cared for in the community and their families. Following a re-examination of the evidence base, a revised approach is proposed in this article: when a child has a tube in place, provided its position has been confirmed as correct on initial placement using aspirate pH testing, nurses can use checks other than aspirate pH testing, alongside their clinical judgement, to determine whether it is safe and appropriate to use the tube. This proposed revised approach would reduce delayed or missed administration of fluids, feeds and medicines and enable more children to remain at home.

[Registered nurses' experience of necessary performed and missed nursing care: a qualitative study]

Registered nurses' experience of necessary performed and missed nursing care: a qualitative study Abstract: Background: Providing high quality care based on their caring attitude is essential for nurses. Missed Care can cause feelings of guilt and dissatisfaction among them. Studies on their experiential transition between fully performed and missed care are lacking. They may contribute to a more comprehensive understanding of influencing factors and the impact on nurses' experience. Aim: The aim was to explore how nurses at a centre hospital in German-speaking Switzerland describe performance of nursing interventions in terms of the different expressions between performed and missed care. Methods: Between September 2020 and March 2021 the first author conducted eleven qualitative guide-based individual interviews with registered nurses which were analysed using Mayring's qualitative content analysis and knowledge maps. Results: The analysis resulted in five main categories: Optimal care, satisfaction in mediocrity, a huge lack, patients' reactions and influencing factors. Nurses described, in addition to personal experience and expertise, different coping strategies to prevent missed care and maintain patients' and their own satisfaction. Conclusions: In addition to interventions that can prevent missed care, nurses' experience of performed care should be explored further. This can deepen the understanding of its relationship with professional caring attitudes as well as with patient-related and professional satisfaction.

'Implicit rationing of nursing care processes'-Decision-making in ICU nurses' experiences: A qualitative study

BACKGROUND

Implicit rationing of nursing care is defined as the withholding of necessary nursing measures for patients because of a lack of nursing resources. However, no studies have explored the experience of decision-making about implicit rationing of nursing care in an intensive care unit (ICU).

AIM

To explore the process of ICU nurses' decisions and judgement based on the conceptual framework of implicit rationing of nursing care.

STUDY DESIGN

A qualitative study was undertaken between June 2020 and September 2020. The data collection methods were participative observation and interview. Eighteen ICU nurses participated in interviews. A thematic analysis was performed for the data analysis.

RESULTS

The following five themes emerged: assessment of the condition and nature of nursing and time taken; strategies for setting personal priorities; plan implementation under mitigation strategy; existing nursing in reality; evaluation of the implementation of implicit rationing care. Nurses choose different strategies during plan implementation.

CONCLUSIONS

In the absence of explicit guidelines on rationing nursing care, nurses often rely on intuitive and situational decision-making processes for setting priorities. Given the vulnerability of ICU patients and the absence of family caregivers, nurses bear a heightened ethical responsibility to provide care. Establishing a positive nursing culture is essential. It is both reasonable and effective to organize work by accurately quantifying workload, improving staffing levels and optimizing scheduling methods. These themes align with the decision-making process outlined in the conceptual framework and offer fresh perspectives.

RELEVANCE TO CLINICAL PRACTICE

Nurses have a greater responsibility to provide care in an ethical manner and to increase awareness of the importance of holistic nursing care for the patient, that is to raise awareness of the importance of care that is often missed. Nurses actively adopt strategies to reduce implicit rationing of nursing care, including teamwork, organized nursing, working overtime and ignoring quality. The findings highlight the importance of creating a positive nursing culture that encourages nurses to adopt positive strategies.

The relevance of the contribution of psychoneuroendocrinoimmunology and psychology of reasoning and decision making to nursing science: A discursive paper

AIM

Patients' death or adverse events appear to be associated with poor healthcare decision-making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem-related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision-making (PRDM) to support a new nursing theoretical frame.

DESIGN

Discursive paper.

METHOD

This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections.

CONCLUSION

Nursing recognizes the patient-nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections.

IMPACT ON NURSING PRACTICE

A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement in the design or writing of this discursive article.

Delegating care as a double-edged sword for quality of nursing care: a qualitative study

BACKGROUND

Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care.

METHODS

This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985).

RESULTS

In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword".

CONCLUSIONS

The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.

Nurses' experiences and perceptions of unfinished nursing care: a qualitative systematic review protocol

OBJECTIVE

The aim of this review is to synthesize the findings of qualitative studies about the experiences and perceptions of nurses regarding unfinished nursing care.

INTRODUCTION

The issue of unfinished nursing care is a widespread challenge globally, causing detrimental effects to both patients and health care practitioners. Despite its prevalence, there is a dearth of qualitative evidence synthesis summarizing the reasons for unfinished nursing care, as well as the experiences of nurses.

INCLUSION CRITERIA

This review will include studies exploring registered nurses' and nurse managers' experiences and perceptions of unfinished nursing care, utilizing qualitative methods. Our approach to qualitative methodology will be unrestricted, allowing for various designs, such as phenomenology, ethnography, grounded theory, action research, and feminist research. Only articles published in English or Chinese from 2001 onward will be included.

METHODS

Our search will encompass the following electronic databases for published and unpublished literature: MEDLINE (PubMed), PsycINFO (APA PsycNET), CINAHL (EBSCOhost), Web of Science, Embase, ScienceDirect, ProQuest Dissertations and Theses, GreyNet International, Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Biomedicine Literature Database (CBM). To ensure thoroughness, manual searches of reference lists and citations of included studies will also be conducted. Two reviewers will extract relevant information, and quality validation will be conducted using the JBI critical appraisal checklist for qualitative research. Similar findings will be categorized through meta-aggregation to establish synthesized findings. Finally, each synthesized finding will be graded according to the JBI ConQual approach.

REVIEW REGISTRATION

PROSPERO CRD42022368041.

Challenges to the delivery and utilisation of child healthcare services: a qualitative study of the experiences of nurses and caregivers in a rural district in Ghana

BACKGROUND

Sub-Saharan Africa has one of the poorest child health outcomes in the world. Children born in this region face significant health challenges that jeopardise their proper growth and development. Even though the utilisation of child healthcare services safeguards the health of children, the challenges encountered by nurses in the delivery of services, and caregivers in the utilisation of these services, especially in rural areas, have contributed to poor child health outcomes in this region.

AIM

This study explored the experiences of nurses and caregivers in respect of the nursing human resource challenges to the delivery and utilisation of child healthcare services in a rural district in Ghana.

METHODS

Individual qualitative interviews were conducted with ten nurses, who rendered child healthcare services; nine caregivers, who regularly utilised the available child healthcare services; and seven caregivers, who were not regular users of these services. These participants were purposively selected for the study. Data were collected using individual semi-structured interview guides and analysed qualitatively using content analysis. Themes and sub-themes were generated during the data analysis. The Ghana Health Service Research Ethics Review Committee and the Nelson Mandela University's Research Ethics Committee approved the study protocol prior to data collection.

RESULTS

Three main themes emerged from the data analysis. Theme One focused on the shortage of nurses, which affected the quality and availability of child healthcare services. Theme Two focused on inexperienced nurses, who struggled to cope with the demands related to the delivery of child healthcare services. Theme Three focused on the undesirable attitude displayed by nurses, which discouraged caregivers from utilising child healthcare services.

CONCLUSION

Nurses contribute significantly to the delivery of child healthcare services; hence, the inadequacies amongst nurses, in terms of staff numbers and nursing expertise, affect the quality and availability of child healthcare services. Also, caregivers' perceptions of the quality of child healthcare services are based on the treatment they receive at the hands of nurses and other healthcare workers. In this respect, the bad attitude of nurses may disincentivise caregivers in terms of their utilisation of these services, as and when needed. There is an urgent need to comprehensively address these challenges to improve child healthcare outcomes in rural areas in Ghana. Relevant authorities should decentralise training workshops for nurses in rural areas to update their skills. Additionally, health facilities should institute proper orientation and mentoring systems to assist newly recruited nurses to acquire the requisite competences for the delivery of quality family-centred care child healthcare services.

Exploring the complex realities of nursing work in Kenya and how this shapes role enactment and practice-A qualitative study

AIM

We explore how nurses navigate competing work demands in resource-constrained settings and how this shapes the enactment of nursing roles.

DESIGN

An exploratory-descriptive qualitative study.

METHODS

Using individual in-depth interviews and small group interviews, we interviewed 47 purposively selected nurses and nurse managers. We also conducted 57 hours of non-participant structured observations of nursing work in three public hospitals.

RESULTS

Three major themes arose: (i) Rationalization of prioritization decisions, where nurses described prioritizing technical nursing tasks over routine bedside care, coming up with their own 'working standards' of care and nurses informally delegating tasks to cope with work demands. (ii) Bundling of tasks describes how nurses were sometimes engaged in tasks seen to be out of their scope of work or sometimes being used to fill for other professional shortages. (iii) Pursuit of professional ideals describes how the reality of how nursing was practised was seen to be in contrast with nurses' quest for professionalism.

The experience of nurses to reduce implicit rationing of nursing care: a phenomenological study

BACKGROUND

Implicit rationing of nursing care can adversely affect patient safety and the quality of care, and increase nurses' burnout and turnover tendency. Implicit rationing care occurs at the nurse-to-patient level (micro-level), and nurses are direct participants. Therefore, the strategies based on experience of nurses to reduce implicit rationing care have more reference value and promotion significance. The aim of the study is to explore the experience of nurses to reduce implicit rationing care, thereby to provide references for conducting randomized controlled trials to reduce implicit rationing care.

METHODS

This is a descriptive phenomenological study. Purpose sampling was conducted nationwide. There are 17 nurses were selected and semi-structured in-depth interviews were conducted. The interviews were recorded, transcribed verbatim and analyzed via thematic analysis.

RESULTS

Our study found that nurses' reported experience of coping with implicit rationing of nursing care contained three aspects: personal, resource, and managerial. Three themes were extracted from the results of the study: (1) improving personal literacy; (2) supplying and optimizing resources and (3) standardizing management mode. The improvement of nurses' own qualities are the prerequisites, the supply and optimization of resources is an effective strategy, and clear scope of work has attracted the attention of nurses.

CONCLUSION

The experience of dealing with implicit nursing rationing includes many aspects. Nursing managers should be grounded in nurses' perspectives when developing strategies to reduce implicit rationing of nursing care. Promoting the improvement of nurses' skills, improving staffing level and optimizing scheduling mode are promising measures to reduce hidden nursing rationing.

Rationing of nursing care: A concept analysis

Rationing of nursing care (RONC) refers to necessary nursing tasks that nurses refuse or fail to do because of limited time, staffing level, or skill mix. As an important process factor, it affects the quality of patient care. The concept of rationing of nursing care has not yet been clearly defined and analyzed and there are different views regarding this issue. Using Walker and Avant's eight-step method, this concept analysis was conducted to analyze the meaning, attributes, dimensions, antecedents, and consequences of nursing care rationing. The literature was collected by searching in electronic databases including PubMed, ScienceDirect, Web of Science, Scopus, and Google Scholar with no date limitation. Both qualitative and quantitative studies on rationing of nursing care, which were open-access and published in English, were included in this study. Thirty-three articles were investigated in the present study. The four defining attributes of RONC included the duty of performing nursing care, dealing with problems of doing nursing care, decision-making and prioritizing, and outcome. The antecedents included nurse-related, organization-related, care-related, and patient-related antecedents. A theoretical definition and a conceptual model of RONC were developed. The attributes, antecedents, and consequences of RONC identified in this study can be used in nursing education, research, and managerial and organizational planning.

Explanation of factors forming missed nursing care during the COVID-19 pandemic: A qualitative study

Background

Providing nursing care to patients with COVID-19 has put additional pressure on nurses, making it challenging to meet several care requirements. This situation has caused parts of nursing care to be missed, potentially reducing the quality of nursing care and threatening patient safety. Therefore, the present study aimed at explaining the factors forming missed nursing care during the COVID-19 pandemic from the perspective of nurses.

Methods

This qualitative study was conducted using a conventional content analysis approach in Iran, 2020-2021. Data were collected from in-depth, semi-structured interviews with 14 nurses based on purposive sampling. Data analysis was performed simultaneously with data collection. Graneheim and Lundman's approach was used for data analysis, and MAXQDA software was used for data management. After transcribing the recorded interviews, to achieve the accuracy and validity of the study, the criteria proposed by Lincoln and Guba were considered and used.

Results

A total of 14 nurses with a mean age and standard deviation of 31.85 ± 4.95 and working in the COVID-19 wards participated in the study. The acquired data were categorized into four main categories: care-related factors, disease-related factors, patient-related factors, and organization-related factors. The category "care-related factors" comprised uncertainty in care, PPE-related limitations, attrition from care, and futile care. The category "disease-related factors" consisted of the extension of symptoms, unpredictable peaks of the disease, and restriction on the presence of patients' companions. The category "patient-related factors" included comorbidities, elderly patients, and deterioration of infected patients. Ultimately, the category "organization-related factors" consisted of restrictions on equipment supply, lack of human resources, weaknesses in teamwork, and an unsupportive work environment.

Conclusion

The results of this study showed that several reasons including factors related to care, patient, disease, and organization cause missed nursing care. By modifying the related affecting factors and considering the effective mechanisms to minimize missed nursing care, it is possible to provide better services.

Care-home Nurses' responses to the COVID-19 pandemic: Managing ethical conundrums at personal cost: A qualitative study

INTRODUCTION

The COVID-19 pandemic had an unprecedented effect on those living and working in care-homes for older people, as residents were particularly vulnerable to contracting the SARS-CoV-2 virus, associated with high morbidity and mortality. Often undervalued, care-home nurses (RNs) are leaders, managing complex care while working in isolation from their professional peers. The pandemic made this more apparent, when care and treatments for COVID-19 were initially unknown, isolation increased due to withdrawal of many professional health services, accompanied by staff shortages.

OBJECTIVE

To explore RNs' experiences of working in older people's care-homes during the COVID-19 pandemic.

DESIGN

Qualitative interview study.

SETTING

Care-homes for older people in England and Scotland, UK.

METHODS

Recruitment via direct contact with care-homes, social media, and links provided by national partners, then purposive sampling for age, gender, type of care-home, and location. Data collected through one-to-one online interviews using topic guide developed collaboratively with care-home nurses, focusing on how COVID-19 impacted on nurses' resilience and mental wellbeing. Data analyzed thematically using Tronto's ethics of care framework to guide development of interpretative themes.

RESULTS

Eighteen nurses (16 female; 16 adult, and two mental health nurses) were interviewed March-June 2021; majority aged 46-55 years; mean time registered with Nursing and Midwifery Council: 19 years; 17 had nursed residents with COVID-19. RNs' experiences resonated with Tronto's five tenets of ethical care: attentiveness, responsibility, competence, responsiveness, and solidarity. All nurses described being attentive to needs of others, but were less attentive to their own needs, which came at personal cost. RNs were aware of their professional and leadership responsibilities, being as responsive as they could be to resident needs, processing and sharing rapidly changing guidance and implementing appropriate infection control measures, but felt that relatives and regulatory bodies were not always appreciative. RNs developed enhanced clinical skills, increasing their professional standing, but reported having to compromise care, leading to moral distress. Broadly, participants reported a sense of solidarity across care-home staff and working together to cope with the crisis.

CONCLUSION

Care-home nurses felt unprepared for managing the COVID-19 pandemic, many experienced moral distress. Supporting care-home nurses to recover from the pandemic is essential to maintain a healthy, stable workforce and needs to be specific to care-home RNs, recognizing their unique pandemic experiences. Support for RNs will likely benefit other care-home workers either directly through wider roll-out, or indirectly through improved wellbeing of nurse leaders.

CLINICAL RELEVANCE

The COVID-19 pandemic, an international public health emergency, created many challenges for Registered Nurses (RNs) working in long-term care facilities for older people, as residents were particularly vulnerable to the impact of the SARS-CoV-2 virus. Care-home RNs faced challenges distinct from their hospital-based nursing peers and non-nursing social care colleagues due to their isolation, leadership roles, professional legal obligations, and ethical responsibilities, leading to psychological distress on the one hand, but also a newly found confidence in their existing and newly developed skills, and increased recognition by the wider health community of their specialisms.

Factors Influencing the Rationing of Nursing Care in Selected Polish Hospitals

Introduction: The rationalization of nursing care can be a direct consequence of the low employment rate or unfavorable working environment of nurses. Aim: The aim of the study was to learn about the factors influencing the rationing of nursing care. Methods: The study group consisted of 209 nurses working in internal medicine departments. The study used the method of a diagnostic survey, a survey technique with the use of research tools: the BERNCA-R questionnaire and the PES-NWI questionnaire (which includes the occupational burnout questionnaire). Results: The mean total BERNCA score for rationing nursing care was 1.94 ± 0.75 on a scale from 0 to 4. A statistically significant relationship was demonstrated between the work environment and the rationing of nursing care. The results of the BERNCA-R scale correlated statistically significantly and positively (r > 0) with two (out of three) subscales of the occupational burnout questionnaire (MBI—Maslach Burnout Inventory): emotional exhaustion and depersonalization (p < 0.001), and with all types of adverse events analyzed (p < 0.05). Conclusions: The higher the frequency of care rationing, the worse the assessment of working conditions by nurses, and, therefore, more frequent care rationing determined the more frequent occurrence of adverse events. The more frequent the care rationing, the more frequent adverse events occur.

Unfinished nursing care reasons as perceived by nurses at different levels of Nursing Services: findings of a qualitative study

AIM

To investigate reasons for Unfinished Nursing Care across the whole levels of the nursing service as perceived by clinical nurses, ward managers and executive nurses.

BACKGROUND

Even though Unfinished Nursing Care has been considered an issue affected by the system, no studies to date have attempted to investigate reasons across the whole levels of the nursing service by involving clinical nurses, ward managers and executive nurses.

METHOD

A descriptive qualitative approach was performed in 2021 according to the COnsolidated criteria for REporting Qualitative research guidelines. A large public health care trust was approached, and a purposeful sample of clinical nurses, ward managers and executive nurses was invited to attend face-to-face or on-line interviews. Twenty-nine interviews were performed (nineteen clinical nurses, seven ward managers, three executive nurses) and transcribed verbatim: then, a content analysis was conducted by considering all narratives together followed by an analytic process to identify themes and subthemes at the clinical, ward manager and executive levels.

RESULTS

Reasons for Unfinished Nursing Care have emerged at five levels: System (e.g. poor support towards nursing care); Unit (e.g. ineffective models of nursing care delivery); Nurse Managers (e.g. inadequate nurse manager leadership); Nurses (e.g. weaknesses in education); and Patients (e.g. increased demand for patients' care).

CONCLUSION

The evidence available should be expanded to include also Unfinished Nursing Care reasons identified at the system and at the ward manager levels, that both can complete the perceptions of the clinical nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

The actors composing the nursing service perceive different reasons and therefore, should be involved in detecting and contrasting the Unfinished Nursing Care. The reasons applied or established at the upper level influence the bedside levels: therefore, strategies to prevent or minimize the Unfinished Nursing Care should be designed at multi-levels in a system-inclusive approach.

Missed nursing care: a snapshot case study in a medical ward in Australia

BACKGROUND

Missed nursing care is a global issue in acute healthcare settings. It is a complex phenomenon that refers to nursing care that is required by patients but left undone or significantly delayed.

AIM

To investigate the nature of missed nursing care and influencing factors in a general medical ward in an acute care hospital in Brisbane, Australia.

METHOD

This is a descriptive case study. The study was carried out in a 29-bed inpatient general medical/cardiology/telemetry ward in an acute care tertiary hospital.

RESULTS

The study ward has been identified as a high complexity unit. The survey data found that the most frequent nursing care elements missed, as reported by the patients, were oral care, response to machine beep, and response to call light. The most frequent nurse-reported missed care items were ambulation, monitoring fluid intake/output and attendance at interdisciplinary conferences.

CONCLUSION

Despite mandating nurse-to-patient ratios in the study ward, inadequate staffing was still perceived as being problematic and one of the most frequent reasons leading to missed nursing care. This possible disconnect between mandated staffing ratios and the persistence of perceived missed care suggests a more complex relationship than can be managed by macro (large-scale) resourcing formulas alone.

Increasing implicit rationing of care in nursing homes: A time-series cross-sectional analysis

BACKGROUND

Implicit rationing of nursing care is a socio-ecological problem where care workers, due to lack of resources, have to leave necessary nursing care activities undone. Cross-sectional studies on implicit rationing of nursing home care revealed associations with organizational and work environment characteristics. However, little is known on how implicit rationing of nursing care varies over time in nursing homes.

OBJECTIVE

This study's purpose was to describe changes in levels and patterns of implicit rationing of nursing care in Swiss nursing homes over time, while accounting for key explanatory factors related to organizational, work environment, and individual characteristics.

DESIGN

Time-series cross-sectional analysis.

SETTING

Nursing homes in Switzerland.

PARTICIPANTS

A convenience sample of 47 nursing homes and 3269 care workers from all educational levels participating in two multicenter cross-sectional studies (the Swiss Nursing Home Human Resources Project) conducted in 2013 and 2018.

METHODS

To quantify implicit rationing of nursing care, care workers' data were collected via the nursing home version of the Basel Extent of Rationing of Nursing Care instrument. To control for leadership ability, staffing and resource adequacy, we used the Nursing Work Index-Practice Environment Scale. Objective measures including turnover, staffing and skill mix levels were aggregated at the nursing home level. Our analyses included multiple linear mixed models, using time as a fixed effect and nursing home as a random effect.

RESULTS

We found overall increases of rationing of care activities over the five-year period studied, with documentation and social activities most rationed at both measurement points (overall coefficients varied between 0.11 and 0.23, as well as the 95%-confidence intervals between 0.05 and 0.30). Moreover, a considerable increase in rationing of activities of daily living (coefficient of 0.47 in 2013 and 0.63 in 2018) was observed.

CONCLUSIONS

Alongside long-term deterioration of staff resources, increases in rationing of nursing care are a worrying development, particularly given their potential negative impacts both on residents and on care workers. To assess nursing home care quality and to determine adequate staffing levels and skill mixes, policy makers and nursing home managers should consider regular monitoring of rationing of nursing care.

TWEETABLE ABSTRACT

Time-series cross-sectional analysis reveals increasing rationing of nursing care activities in Swiss nursing homes from 2013 to 2018.

A qualitative study of medical-surgical intensive care unit nurses’ experiences in caring for critical patients

ABSTRACT Objective: To describe the meaning attributed to nurses’ clinical experience in a medical-surgical intensive care unit in Northern Cyprus. Method: The qualitative study was conducted in two medical-surgical intensive care units at a university hospital. Data were collected through in-depth interviews with 17 nurses. Giorgi’s descriptive phenomenological approach was used to analyze nurses’ experiences. The consolidated criteria for reporting a qualitative research checklist were followed in this study. Results: The data analysis led to the extraction of the 5 themes and 19 subthemes. The themes identified for the study were competence, the emotional universe, stress resources, the meaning of nursing care, and profoundly affecting events. The study results show that the nurses expressed that having gained much experience in intensive care units and working there has contributed significantly to their professional development. Conclusion: It was indicated that the nurses had meaningful, caring experiences in intensive care units, which were perceived, however, as stressful experiences as well. The study has important implications for nurses, faculty members, and administrators to gain positive care experiences in terms of intensive care units.

The role of teamwork in the implicit rationing of nursing care: A systematic mixed-methods review

AIM

To systematically evaluate the role of teamwork in implicit rationing care and how to improve teamwork.

BACKGROUND

The implicit rationing of nursing leads to adverse effects for both patients and nurses. Therefore, how to reduce it has attracted increasing research attention. How teamwork may be an important factor in reducing implicit rationing care has become a focus of research.

METHODS

Data between May 2000 and May 2020 were collected from five databases. The study was guided by the framework of a mixed studies review.

RESULTS

Seventeen studies were chosen for review regarding efficient teamwork to reduce implicit rationing care. The following seven subthemes with positive effects that improve teamwork and reduce implicit rationing care were formed: (a) improving knowledge and skills; (b) promoting effective communication; (c) building mutual trust; (d) reducing turnover intention; (e) reasonable staffing; (f) division of responsibilities; and (g) cultivating team consciousness.

CONCLUSIONS

Teamwork can decrease implicit care and is influenced by many factors, but the intervention is singular. In the future, teamwork can be further improved to reduce implicit care.

IMPLICATIONS FOR NURSING MANAGEMENT

With more intervention research in the future, leadership and team-oriented roles can be used to complete all the care needed.