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Murray J, Hunter SC, Conroy T, Kitson AL, Splawinski Z, Block H, Lewis A. REDUCE missed oral healthcare: The outcomes of and learnings from an implementation project in an acute geriatric unit. Res Nurs Health 2024. [PMID: 38923546 DOI: 10.1002/nur.22408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 05/17/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Oral healthcare is one of the most missed aspects of fundamental care. Failure to provide reliable and effective daily oral healthcare for older patients can lead to hospital-acquired pneumonias, longer hospital stays, increased health costs, and poor patient experience. The objective of this study was to codesign, implement, and evaluate an oral healthcare intervention for older adults in a geriatric unit. This mixed methods implementation project combined the hospital's quality improvement processes with the i-PARIHS knowledge translation framework. Multilevel facilitation guided the development of multidisciplinary implementation strategies, which were co-designed, tailored, and implemented at the ward and organizational level, targeting: awareness/engagement; clinical guideline development; building workforce capacity; access to appropriate products; patient awareness and support; utilization of multidisciplinary/dental referral pathways; and systematizing oral healthcare documentation. Gaps between evidence-based and current oral healthcare practice were identified through audits of practice and interviews with patients. Interviews and surveys with staff evaluated the feasibility and acceptability of the oral healthcare intervention and the success of implementation strategies. At the conclusion of the project, awareness, attitudes, and capacity of staff had increased, however, we could not demonstrate change in multidisciplinary oral healthcare practices or improvements for individual patients. Despite mixed success, the project informed discussions about including oral healthcare as a national healthcare standard for the acute care sector in Australia. Attempts to address oral healthcare may have started locally, but its impact was through policy change, which will empower health practitioners and managers to support practice change more widely.
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Affiliation(s)
- Joanne Murray
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Sarah C Hunter
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Alison L Kitson
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Zita Splawinski
- Division of Rehabilitation, Aged Care & Palliative Care, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Heather Block
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Adrienne Lewis
- SA Dental, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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Cohen M, Drach-Zahavy A, Srulovici E. The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design. J Clin Nurs 2024. [PMID: 38923756 DOI: 10.1111/jocn.17322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
AIMS To examine a novel moderated-mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress. DESIGN Nested diary study. METHODS Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium-sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse-patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated-mediation model. RESULTS Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses. CONCLUSION The study highlights accountability's dual role-safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff. IMPACT By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes. REPORTING METHOD The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Mirit Cohen
- Department of Nursing, The University of Haifa, Haifa, Israel
- Baruch Padeh Medical Center, Poriya, Israel
| | | | - Einav Srulovici
- Department of Nursing, The University of Haifa, Haifa, Israel
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Nazari AM, Borhani F, Zare-Kaseb A, Zafarnia N. The relationship between nurses' moral competency and missed nursing care: a descriptive-correlational study. BMC Nurs 2024; 23:388. [PMID: 38844989 PMCID: PMC11155051 DOI: 10.1186/s12912-024-02058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections, increased mortality rates, and poor prognosis. Moral competence is crucial for clinical nurses as it guarantees high-quality patient care in nursing practice. Thus, this study aimed to investigate the correlation between moral competencies and MNC among nurses. METHODS This study was conducted with a descriptive-correlational design. The participants in the study were nurses who were currently enrolled at Shahid Beheshti University of Medical Sciences. In order to recruit nurses for the study, a convenience sampling method was implemented. The study tools were completed by a total of two hundred nurses. Research tools included a demographic questionnaire, the Moral Competence of Clinical Nurses Questionnaire, and the Kalisch and Williams Missed Nursing Care (MISSCARE) survey. ETHICAL CONSIDERATION This study was approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences. RESULTS The mean scores of moral competencies and MNC were 151.83 ± 12.60 and 42.71 ± 9.38, respectively. In other words, descriptive statistics showed that the moral competence score was more than 75%, and the MNC score was less than 50%. Also, there was a significant negative correlation between the total scores of moral competencies and MNC (r = -0.38, p < 0.001), indicating that more moral competence was correlated with lower levels of MNC. CONCLUSION The study revealed a negative correlation between nurses' moral competence and MNC, suggesting that enhancing moral competence could reduce MNC. To reduce MNC occurrences, hospitals, and organizations should prioritize moral competency, according to our research.
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Affiliation(s)
- Amir Mohamad Nazari
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Borhani
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Akbar Zare-Kaseb
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Niloofar Zafarnia
- Educational Development Center, Kerman University of Medical Sciences, Kerman, Iran
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Kohanová D, Bartoníčková D, Žiaková K. Missed nursing care as reported by paediatric nurses: A cross-sectional study. J Clin Nurs 2024; 33:1444-1458. [PMID: 37985425 DOI: 10.1111/jocn.16935] [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] [Received: 07/10/2023] [Revised: 10/10/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
AIMS Missed nursing care (MNC) significantly affects patient safety and quality of care. It is a widely used concept that has been studied in different settings, but research in paediatric care is quite limited. Therefore, this descriptive cross-sectional study aimed to report the prevalence, patterns, correlates, factors and predictors of MNC in paediatric care units in two central European countries. DESIGN A cross-sectional comparative study. METHODS Data collection was carried out between June and November 2021 using the MISSCARE Survey-Pediatric. The study included 441 registered nurses working in paediatric care units in the Czech Republic and Slovakia. Data were analysed using descriptive and inferential statistics in the SPSS 25.0 statistical program. RESULTS Almost all nurses, 92.7% of nurses missed at least one nursing activity during the last shift. The most missed care activity in both countries was the promotion of neuroevolutionary development, and the most prominent reasons were labour resources. MNC was weakly but significantly correlated with nurse experience in the current position and was predicted by the country, nurse education and overtime hours (p ≤ .05). Differences in prevalence of MNC and reasons for MNC were identified based on several variables (p ≤ .05). CONCLUSION The assessment of MNC in paediatric settings is often a neglected area, although the prevalence in this study was moderate. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurse staff shortages, as a global problem, have many impacts on patient outcomes in the delivery of nursing care. However, there are also many factors that can reduce the prevalence of MNC. More research should focus on a closer examination of these factors that involve hospital and nurse variables. REPORTING METHOD The study was carried out according to the STROBE checklist and the RANCARE guideline. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Dominika Kohanová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovakia
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia
| | - Daniela Bartoníčková
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czechia
| | - Katarína Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia
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Kohanová D, Kirwan M, Bartoníčková D, Gurková E, Žiaková K. Examining the Perspectives of Nurse Managers on Missed Nursing Care in Surgical Units. J Nurs Adm 2024; 54:148-153. [PMID: 38349870 DOI: 10.1097/nna.0000000000001399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To examine nurse managers' perspectives on missed nursing care (MNC) on surgical units. BACKGROUND The phenomenon of MNC is an important concern for nurse researchers. However, the reality of how it is experienced by clinical nurse managers is largely unexplored. Understanding nurse managers' experiences with MNC could help develop useful approaches to reducing levels of MNC. METHODS A descriptive qualitative study was conducted between December and June 2020, using face-to-face semistructured interviews with 10 nurse managers. RESULTS Five themes were identified: 1) awareness of MNC; 2) rationale for MNC; 3) consequences of MNC; 4) questions of reporting; and 5) management of MNC. CONCLUSIONS Nurse managers must use their positions and leadership skills to expect appropriate staffing approaches and material resources for surgical units, effective process for newly hired nurses, and the establishment of a reporting system for MNC to reduce the phenomenon in practice.
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Affiliation(s)
- Dominika Kohanová
- Author Affiliations: Faculty (Dr Kohanová), Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University, Nitra; and Faculty (Dr Kohanová), Department of Nursing, Jessenius Faculty of Medicine in Martine, Comenius University, Bratislava, Slovakia; Associate Professor (Dr Kirwan), School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin, Ireland; Lecturer (Bartoníčková), Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Olomouc, Czech Republic; and Associated Professor (Dr Gurková), Department of Nursing, Faculty of Health Care, University of Prešov; and Professor (Dr Žiaková), Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia
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Valkenet K, McRae P, Reijneveld E, Jans M, Bor P, van Delft L, Young DL, Veenhof C. Inpatient physical activity across a large university city hospital: a behavioral mapping study. Physiother Theory Pract 2024; 40:153-160. [PMID: 36036375 DOI: 10.1080/09593985.2022.2112116] [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] [Received: 08/17/2021] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Physical inactivity is common during hospitalization. Physical activity has been described in different inpatient populations but never across a hospital. PURPOSE To describe inpatient movement behavior and associated factors throughout a single university hospital. METHODS A prospective observational study was performed. Patients admitted to clinical wards were included. Behavioral mapping was undertaken for each participant between 9AM and 4PM. The location, physical activity, daily activity, and company of participants were described. Barriers to physical activity were examined using linear regression analyses. RESULTS In total, 345 participants from 19 different wards were included. The mean (SD) age was 61 (16) years and 57% of participants were male. In total, 65% of participants were able to walk independently. On average participants spent 86% of observed time in their room and 10% of their time moving. A physiotherapist or occupational therapist was present during 1% of the time, nursing staff and family were present 11% and 13%, respectively. Multivariate regression analysis showed the presence of an intravenous line (p = .039), urinary catheter (p = .031), being female (p = .034), or being dependent on others for walking (p = .016) to be positively associated with the time spent in bed. Age > 65, undergoing surgery, receiving encouragement by a nurse or physician, reporting a physical complaint or pain were not associated with the time spent in bed (P > .05). CONCLUSION As family members and nursing staff spend more time with patients than physiotherapists or occupational therapists, increasing their involvement might be an important next step in the promotion of physical activity.
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Affiliation(s)
- Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Utrecht, Netherlands
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Elja Reijneveld
- Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Utrecht, Netherlands
| | - Marielle Jans
- Institute of Mobility Studies, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Petra Bor
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Lotte van Delft
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, NV, USA
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Utrecht, Netherlands
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Daraghmeh H, Ayed A, Salameh B, Fashafsheh I. Factors of Missed Nursing Care in Intensive Care Units: Palestinian Perspective. Crit Care Nurs Q 2024; 47:62-70. [PMID: 38031309 DOI: 10.1097/cnq.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Maintaining a high standard of nursing care is imperative for ensuring patient safety. Several factors significantly impact the provision of nursing care, including work environment resources, personnel coordination, work systems, and head nurse leadership. In addition, each nurse's clinical and academic career also plays a role in shaping the quality of care provided to patients. This article reports results of a cross-sectional study aimed to identify the different types of missed nursing care and the factors that contribute to them, as perceived by nurses, and second, to investigate how nurses' characteristics may relate to the occurrence of missed nursing care. Data for this study were obtained through a self-administered questionnaire that was distributed to participants working in an intensive care unit. The study included a final sample size of 176 participants, all of whom worked in intensive care unit hospitals located in the north region of Palestine. The study found that handwashing, setting up meals for patients who feed themselves, discharge planning, and response to a call light were the most frequently missed nursing care activities. The primary factors identified as reasons for missed nursing care were inadequate availability of labor and material resources, along with communication issues. Efforts to address these identified issues can potentially lead to improved quality of nursing care in intensive care units.
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Affiliation(s)
- Hameed Daraghmeh
- Ministry of health/Nablus-Palestine (Mr Daraghmeh); and Department of Nursing, Arab American University of Jenin, Jenin, Palestine (Drs Ayed, Salameh, and Fashafsheh)
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Zabaleta-Del-Olmo E, Santesmases-Masana R, Martín-Payo R, Romero-Collado À, Zamora-Sánchez JJ, Urpí-Fernández AM, Gonzalez-Del-Rio M, Lumillo-Gutiérrez I, Sastre-Rus M, Jodar-Fernández L, Hernández-Martínez-Esparza E. Research on missed nursing care during the COVID-19 pandemic: A scoping review. Worldviews Evid Based Nurs 2023; 20:559-573. [PMID: 37743584 DOI: 10.1111/wvn.12682] [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] [Received: 05/18/2023] [Revised: 07/18/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Missed nursing care is defined as care that is delayed, partially completed, or not completed at all. The scenario created by the COVID-19 pandemic may have influenced multifactorial determinants related to the care environment, nursing processes, internal processes, and decision-making processes, increasing missed nursing care. AIM This scoping review aimed to establish the quantity and type of research undertaken on missed nursing care during the COVID-19 pandemic. METHODS This review was conducted following the Joanna Briggs Institute methodology for scoping reviews. We searched CINAHL, MEDLINE, Scopus, two national and regional databases, two dissertations and theses databases, a gray literature database, two study registers, and a search engine from November 1, 2019, to March 23, 2023. We included quantitative, qualitative, and mixed studies carried out in all healthcare settings that examined missed nursing care during the COVID-19 pandemic. Language restrictions were not applied. Two independent reviewers conducted study selection and data extraction. Disagreements between the reviewers were resolved through discussion or with an additional reviewer. RESULTS We included 25 studies with different designs, the most common being acute care cross-sectional survey designs. Studies focused on determining the frequency and reasons for missed nursing care and its influence on nurses and organizational outcomes. LINKING EVIDENCE TO ACTION Missed nursing care studies during the COVID-19 pandemic were essentially nurses-based prevalence surveys. There is an urgent need to advance the design and development of longitudinal and intervention studies, as well as to broaden the focus of research beyond acute care. Further research is needed to determine the impact of missed nursing care on nursing-sensitive outcomes and from the patient's perspective.
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Affiliation(s)
- Edurne Zabaleta-Del-Olmo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain
- Barcelona Primary Care Directorate, Barcelona Regional Management, Institut Català de la Salut, Barcelona, Spain
| | - Rosalía Santesmases-Masana
- School of Nursing, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rubén Martín-Payo
- Faculty of Medicine and Health Sciences, Universidad de Oviedo, Oviedo, Spain
- PRECAM Research Group, ISPA-Asturias, Oviedo, Spain
| | | | - Juan-José Zamora-Sánchez
- Barcelona Primary Care Directorate, Barcelona Regional Management, Institut Català de la Salut, Barcelona, Spain
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana-María Urpí-Fernández
- Barcelona Primary Care Directorate, Barcelona Regional Management, Institut Català de la Salut, Barcelona, Spain
- School of Nursing, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marina Gonzalez-Del-Rio
- Nursing Research Unit, Hospital Univrsitari Dr. Josep Trueta, Girona, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona, Spain
- Biomedical Research Institute (IDIBGI), Girona, Spain
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr Josep Trueta Hospital and Santa Caterina Hospital, Girona-Salt, Spain
| | - Iris Lumillo-Gutiérrez
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain
- Chronic Disease Management Team, Baix Llobregat Centre Primary Care Service, Costa de Ponent Primary Care Directorate, Metropolitana Sud Regional Management, Institut Català de la Salut, Cornellà de Llobregat, Barcelona, Spain
- Nursing Care Research Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Meritxell Sastre-Rus
- Nursing Care Research Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Gimbernat School of Nursing, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lina Jodar-Fernández
- Montbaig Primary Care Centre, Delta Primary Care Service, Costa de Ponent Primary Care Directorate, Metropolitana Sud Regional Management, Institut Català de la Salut, Barcelona, Spain
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Falk AC, Boström AM, Nymark C, von Vogelsang AC. Missed nursing care in relation to registered nurses' level of education and self-reported evidence-based practice. Worldviews Evid Based Nurs 2023; 20:550-558. [PMID: 37735718 DOI: 10.1111/wvn.12681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Patient safety is one of the cornerstones of high-quality healthcare systems. Evidence-based practice is one way to improve patient safety from the nursing perspective. Another aspect of care that directly influences patient safety is missed nursing care. However, research on possible associations between evidence-based practice and missed nursing care is lacking. AIM The aim of this study was to examine associations between registered nurses' educational level, the capability beliefs and use of evidence-based practice, and missed nursing care. METHODS This study had a cross-sectional design. A total of 228 registered nurses from adult inpatient wards at a university hospital participated. Data were collected with the MISSCARE Survey-Swedish version of Evidence-Based Practice Capabilities Beliefs Scale. RESULTS Most missed nursing care was reported within the subscales Basic Care and Planning. Nurses holding a higher educational level and being low evidence-based practice users reported significantly more missed nursing care. They also scored significantly higher on the Evidence-based Practice Capabilities Beliefs Scale. The analyses showed a limited explanation of the variance of missed nursing care and revealed that being a high user of evidence-based practice indicated less reported missed nursing care, while a higher educational level meant more reported missed nursing care. LINKING EVIDENCE TO ACTION Most missed nursing care was reported within the subscales Planning and Basic Care. Thus, nursing activities are deprioritized in comparison to medical activities. Nurses holding a higher education reported more missed nursing care, indicating that higher education entails deeper knowledge of the consequences when rationing nursing care. They also reported varied use of evidence-based practice, showing that higher education is not the only factor that matters. To decrease missed nursing care in clinical practice, and thereby increase the quality of care, educational level, use of evidence-based practice, and organizational factors must be considered.
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Affiliation(s)
- Ann-Charlotte Falk
- Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Carolin Nymark
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Zeng M, Li Y, Hu J, Peng M, Hu Y, Zhou C. Effect of various repositioning regimens on pressure wound ulcer occurrence in at-risk adult persons without existing pressure wound ulcers: A meta-analysis. Int Wound J 2023; 20:3776-3785. [PMID: 37381159 PMCID: PMC10588354 DOI: 10.1111/iwj.14277] [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] [Received: 05/19/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023] Open
Abstract
Meta-analysis research was implemented to appraise the effect of various repositioning regimens (RRs) on pressure wound ulcer (PWU) occurrence in at-risk adult persons without existing PWUs. Inclusive literature research till April 2023 was done and 1197 interconnected researches were revised. The 15 picked researches, enclosed 8510 at-risk adult persons without existing PWUs persons were in the utilised researchers' starting point, 1002 of them were utilising repositioning, 1069 were control, 3443 were utilising 2-<4 h repositioning and 2994 were utilising 4-6 h repositioning. Odds ratio (OR) and 95% confidence intervals (CIs) were utilised to appraise the consequence of various RRs on PWU occurrence in at-risk adult persons without existing PWUs by the dichotomous approach and a fixed or random model. Repositioning had significantly lower PWU (OR, 0.49; 95% CI, 0.32-0.73, p < 0.001) compared to control in at-risk adult persons without existing PWUs persons. 2-<4 h repositioning had significantly lower PWU (OR, 0.62; 95% CI, 0.42-0.90, p = 0.01) compared to 4-6 h repositioning in at-risk adult persons without existing PWUs persons. Repositioning had significantly lower PWU compared to control in at-risk adult persons without existing PWU persons. 2-<4 h repositioning had significantly lower PWU compared to 4-6 h repositioning in at-risk adult persons without existing PWUs persons. However, caution needs to be taken when interacting with its values since there was a low sample size of some of the chosen research found for the comparisons in the meta-analysis.
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Affiliation(s)
- Mei Zeng
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Yuan Li
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Juan Hu
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Miao Peng
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Yingchun Hu
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Chengli Zhou
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
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Albsoul RA, Alshyyab MA, Albayyari RY, Alselaibi DH, Flefil SA, Jardaneh LH, Dababseh SYF, Al Odat BA, Alkubaisi FA, AlKhawaldeh MH, FitzGerald G. Qualitative evaluation of missed nursing care in neonatal intensive care units in a teaching hospital in Jordan. J Pediatr Nurs 2023; 73:e277-e284. [PMID: 37788945 DOI: 10.1016/j.pedn.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Missed nursing care (MNC) is a worldwide patient safety issue. However, little is known about MNC in neonatal intensive care units (NICU). The aim of this paper is to explore the elements and factors influencing the occurrence of MNC in the NICU in a teaching hospital in Amman, Jordan. DESIGN AND METHODS The study used a qualitative descriptive design. Semi-structured interviews were conducted with NICU nurses. Purposeful sampling was used to select the participants and data collection was performed in the period August 2022 to September 2022. Data were analyzed using thematic analysis. RESULTS The participants included 15 female nurses. The majority of the participants held a bachelor's degree in nursing. Five themes emerged from the analysis of data namely: (1) Conceptualizations of MNC (2) Missed care elements in the NICU (3) Reasons behind MNC in the NICU (4) Consequences of MNC and (5) Strategies to reduce the occurrence of MNC. Feeding,changing diapers, monitoring vital signs, and medication administrationwere identified as missed care elements in the NICU. CONCLUSIONS The findings of this research may inform the development of interventions that may reduce missed care incidents in the NICU. PRACTICE IMPLICATIONS Addressing staff shortages and the provision of necessary materials and equipment appear to be the key factors that may reduce the frequency of MNC. Thus, enhancing patient safety and quality healthcare in this challenging healthcare environment.
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Affiliation(s)
- Rania Ali Albsoul
- Healthcare management, Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Muhammad Ahmed Alshyyab
- Health Services Management, Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | | | | | | | | | | | | | | | | | - Gerard FitzGerald
- Public Health, School of Public Health and Social Work, QUT, Brisbane, Victoria Park Road, Kelvin Grove, QLD 4059, Australia.
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12
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Bishop PJ, Negron SL. Enhancing safety with a hospital nursing assistant training program. Nurs Manag (Harrow) 2023; 54:46-54. [PMID: 37902376 DOI: 10.1097/nmg.0000000000000071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Pamela J Bishop
- Pamela J. Bishop is a clinical assistant professor and director of the Clinical Nurse Specialist/Educator Program at Old Dominion University (ODU) School of Nursing in Virginia Beach, Va. Shanna L. Negron is a clinical nurse leader at Hampton VA Medical Center in Hampton, Va
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13
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Campbell CM, Li P, Warshawsky N, Swiger PA, Olds D, Cramer E, Patrician PA. Modernizing Measure of the Nurse Work Environment. West J Nurs Res 2023; 45:932-941. [PMID: 37599466 DOI: 10.1177/01939459231194132] [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: 08/22/2023]
Abstract
BACKGROUND Research has established a relationship between favorable nurse work environments and better nurse, patient, and organizational outcomes. However, the instrument most frequently used to measure the nurse work environment, the Practice Environment Scale of the Nursing Work Index (PES-NWI), has not had its items significantly re-evaluated since the 1980s. OBJECTIVE We sought to examine the psychometric properties of an updated PES-NWI and create an instrument suitable for further testing and refinement to measure the present-day nurse work environment. Specifically, we sought to establish construct, structural, discriminative, and concurrent validity. For reliability, we desired to establish interrater reliability and internal consistency reliability. METHODS We administered a modified PES-NWI to a national sample of direct-care hospital nurses (n = 818) in the United States. We then assessed the psychometric properties of the instrument. RESULTS While the modified PES-NWI displayed adequate validity and reliability properties, further testing and refinement of the instrument is necessary. CONCLUSIONS With this updated measure of the nurse work environment, researchers and hospital leaders can identify modifiable opportunities for improvement in contemporary hospital nurse work environments which may enhance nurse and patient outcomes.
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Affiliation(s)
| | - Peng Li
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Danielle Olds
- Saint Luke's Hospital, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Emily Cramer
- Health Outcomes and Health Services Research, Children's Mercy Kansas City, Kansas City, MO, USA
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14
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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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15
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Dillner P, Eggenschwiler LC, Rutjes AWS, Berg L, Musy SN, Simon M, Moffa G, Förberg U, Unbeck M. Incidence and characteristics of adverse events in paediatric inpatient care: a systematic review and meta-analysis. BMJ Qual Saf 2023; 32:133-149. [PMID: 36572528 PMCID: PMC9985739 DOI: 10.1136/bmjqs-2022-015298] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/08/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Adverse events (AEs) cause suffering for hospitalised children, a fragile patient group where the delivery of adequate timely care is of great importance. OBJECTIVE To report the incidence and characteristics of AEs, in paediatric inpatient care, as detected with the Global Trigger Tool (GTT), the Trigger Tool (TT) or the Harvard Medical Practice Study (HMPS) method. METHOD MEDLINE, Embase, Web of Science and Google Scholar were searched from inception to June 2021, without language restrictions. Studies using manual record review were included if paediatric data were reported separately. We excluded studies reporting: AEs for a specific disease/diagnosis/treatment/procedure, or deceased patients; study protocols with no AE outcomes; conference abstracts, editorials and systematic reviews; clinical incident reports as the primary data source; and studies focusing on specific AEs only. Methodological risk of bias was assessed using a tool based on the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Primary outcome was the percentage of admissions with ≥1 AEs. All statistical analyses were stratified by record review methodology (GTT/TT or HMPS) and by type of population. Meta-analyses, applying random-effects models, were carried out. The variability of the pooled estimates was characterised by 95% prediction intervals (PIs). RESULTS We included 32 studies from 44 publications, conducted in 15 countries totalling 33 873 paediatric admissions. The total number of AEs identified was 8577. The most common types of AEs were nosocomial infections (range, 6.8%-59.6%) for the general care population and pulmonary-related (10.5%-36.7%) for intensive care. The reported incidence rates were highly heterogeneous. The PIs for the primary outcome were 3.8%-53.8% and 6.9%-91.6% for GTT/TT studies (general and intensive care population). The equivalent PI was 0.3%-33.7% for HMPS studies (general care). The PIs for preventable AEs were 7.4%-96.2% and 4.5%-98.9% for GTT/TT studies (general and intensive care population) and 10.4%-91.8% for HMPS studies (general care). The quality assessment indicated several methodological concerns regarding the included studies. CONCLUSION The reported incidence of AEs is highly variable in paediatric inpatient care research, and it is not possible to estimate a reliable single rate. Poor reporting standards and methodological differences hinder the comparison of study results.
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Affiliation(s)
- Pernilla Dillner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden .,Division of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Luisa C Eggenschwiler
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne W S Rutjes
- Department of Medical and Surgical Sciences SMECHIMAI, University of Modena and Reggio Emilia, Modena, Italy.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Lena Berg
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sarah N Musy
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Giusi Moffa
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Ulrika Förberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Valkenet K, Bor P, Reijneveld E, Veenhof C, Dronkers J. Physical activity monitoring during hospital stay: a validation study. Disabil Rehabil 2023; 45:449-454. [PMID: 35175168 DOI: 10.1080/09638288.2022.2034995] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The primary aim of this study was to investigate the concurrent validity of the PAM AM400 accelerometer for measuring physical activity in usual care in hospitalized patients by comparing it with the ActiGraph wGT3X-BT accelerometer. MATERIALS AND METHODS This was a prospective single centre observational study performed at the University Medical Centre Utrecht in The Netherlands. Patients admitted to different clinical wards were included. Intraclass Correlation Coefficients (ICCs) were computed using a two-way mixed model with random subjects. Additionally, Bland-Altman plots were made to visualize the level of agreement of the PAM with the ActiGraph. To test for proportional bias, a regression analysis was performed. RESULTS In total 17 patients from different clinical wards were included in the analyses. The level of agreement between the PAM and ActiGraph was found strong with an ICC of 0.955. The Bland-Altman analyses showed a mean difference of 1.12 min between the two accelerometers and no proportional bias (p = 0.511). CONCLUSIONS The PAM is a suitable movement sensor to validly measure the active minutes of hospitalized patients. Implementation of this device in daily care might be helpful to change the immobility culture in hospitals.IMPLICATIONS FOR REHABILITATIONPhysical inactivity is common during hospital admission and the main cause of loss of muscle mass and physical fitness.The PAM AM400 is a suitable movement sensor to validly measure the active minutes of hospitalized patients.Implementation of this device in daily care might be helpful to change the immobility culture in hospitals.
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Affiliation(s)
- Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, The Netherlands
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
| | - Petra Bor
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Elja Reijneveld
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, The Netherlands
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
| | - Jaap Dronkers
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
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Zárate-Grajales RA, Benítez-Chavira LA, Hernández-Corral S, Serván-Mori E, Nigenda G, Amaya-Aguilar JA, Interial-Gúzman MG, Fabián-Victoriano R, López-Cruz EA, Ortíz-López G, Moreno-Monsiváis MG. Nursing practice environment and missed care at highly specialised hospitals in Mexico: A cross-sectional observational study. Int J Health Plann Manage 2022; 38:628-642. [PMID: 36540043 DOI: 10.1002/hpm.3606] [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: 08/14/2022] [Revised: 11/26/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The influence of the work environment on missed care and service quality has been well documented. However, available evidence concerning this relationship comes mostly from developed countries. Few studies have been conducted in low- or middle-income countries. We assessed the relationship between the work environment and missed nursing care in highly specialised hospitals in Mexico. METHODS We conducted an observational cross-sectional study with data collected from January 2019 to February 2020 in 11 highly specialised hospitals (n = 510 nurses). We estimated missed nursing care utilising the MISSCARE questionnaire and used the Practice Environment Scale-Nursing Work Index instrument to assess the work environment. After describing the main attributes of the study sample according to the type of work environment, we constructed five adjusted fractional regression models, the first concerning the overall index of missed care, and the others pertaining to its various dimensions. RESULTS The sample analysed was balanced as regards adjustment variables according to the type of work environment. The adjusted estimates confirmed an inverse relationship between the missed care index and enjoying an enhanced, or favourable, work environment. Overall, the difference was 9 percentage points (pp); however, by dimension of missed care, the major differences between enhanced and attenuated, or unfavourable, work environments were registered for basic care, followed by patient education and discharge planning (4pp) and individual needs (8pp). CONCLUSIONS The work environment determines the frequency of missed nursing care, both overall and by dimension. Nursing managers need to create short- and mid-term strategies favouring positive work environments in order to improve working conditions for nursing professionals.
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Affiliation(s)
- Rosa A Zárate-Grajales
- National School of Nursing and Obstetrics (ENEO), National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Luis A Benítez-Chavira
- National School of Nursing and Obstetrics (ENEO), National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Sandra Hernández-Corral
- National School of Nursing and Obstetrics (ENEO), National Autonomous University of Mexico (UNAM), Mexico City, Mexico.,National Institute of Rehabilitation, Mexico City, Mexico
| | | | - Gustavo Nigenda
- National School of Nursing and Obstetrics (ENEO), National Autonomous University of Mexico (UNAM), Mexico City, Mexico
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Khrais H, Alsadi M, Oweidat I, Ahmad M. Determinants of missed nursing care in Jordanian hospitals during COVID-19 pandemic. Nurs Open 2022; 10:1565-1573. [PMID: 36250917 PMCID: PMC9874651 DOI: 10.1002/nop2.1407] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/26/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
AIM The aim of the study was to examine the effect of perceived organizational support, accountability and nurses' characteristics on missed nursing care under the impact of COVID-19. DESIGN A cross-sectional design was used to describe and predict nurses' characteristics. METHODS A sample of 536 Registered Nurses participated in the study from eight hospitals in different health sectors in Jordan (three public hospitals, three private hospitals and two teaching hospitals). RESULTS Communication problems had the highest impact on missed nursing care, compared with labour resources and material resources reasons. Higher patient: nurse ratio aggravated by COVID-19 pandemic, years of experience, satisfaction with the income, perception of accountability and organizational support were among the factors associated with the levels of missed nursing care.
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Affiliation(s)
| | | | | | - Muayyad Ahmad
- Clinical Nursing Department, School of NursingUniversity of JordanAmmanJordan
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19
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He M, Zhu X, Dong Y, Zhang S, Fang S, Wang W, Zhang M, Sun J. Exploring the role of communication in missed nursing care: A systematic review. J Adv Nurs 2022; 78:4019-4033. [PMID: 36097637 DOI: 10.1111/jan.15444] [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: 05/24/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
AIMS To systematically review the literature on relationships between communication issues and missed nursing care. DESIGN Systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement. DATA SOURCES EMBASE, Web of Science, CINAHL, PubMed and Cochrane databases were comprehensively searched from inception to December 2021. REVIEW METHODS Screening, data extraction and initial quality assessment were conducted independently by two reviewers. The JBI quality assessment tool was used for study appraisal and the certainty of evidence was assessed using the five Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Discrepancies were settled by consulting a third researcher. RESULTS A total of 18 articles were included. Missed nursing care was common and the status of communication was not optimistic in clinical. Nurses' sociodemographic characteristics and work environment both influenced missed nursing care and communication. Intrateam communication included three parts: doctors-nurses communication, nurses-nurses communication and nurses-patients communication, poor intrateam communication could contribute to missed nursing care. There was an interaction between missed nursing care and communication. CONCLUSION Promoting efficient intrateam communication, to acknowledge the importance of communication factors in reducing the incidence of missed nursing care in clinics is required. Future research can explore the impact of the internal dimension of communication on missed nursing care and consider interventions aimed at nurses' effective communication. IMPACT What problem did the study address? This study offers new evidence that the impact of intrateam communication on missed nursing care. What were the main findings? Effective intrateam communication can reduce the incidence of missed nursing care, there is mutual influence between communication and missed nursing care. Where and on whom will the research have an impact? Policymakers can provide positive interventions on communication problems in different populations (e.g. nurses-patients, nurses-nurses and doctors-nurses) to provide high-quality patient care.
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Affiliation(s)
- Meng He
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Xiangning Zhu
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Yueyang Dong
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Shuang Zhang
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Shuyan Fang
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Wenxia Wang
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Mengting Zhang
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, People's Republic of China
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20
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Chiappinotto S, Palese A. Unfinished nursing care reasons as perceived by nurses at different levels of Nursing Services: findings of a qualitative study. J Nurs Manag 2022; 30:3393-3405. [PMID: 36073552 PMCID: PMC10087865 DOI: 10.1111/jonm.13800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/05/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
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21
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Examining the reasons for missed nursing care from the viewpoints of nurses in public, private, and university hospitals in Jordan: A cross-sectional research. Collegian 2022. [DOI: 10.1016/j.colegn.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Standards for Professional Registered Nurse Staffing for Perinatal Units. Nurs Womens Health 2022; 26:e1-e94. [PMID: 35750618 DOI: 10.1016/j.nwh.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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23
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Rahmah NM, Hariyati RTS, Sekarsari R, Pakasi T. The Factor Associated with Missed Nursing Care in Hospital: A Systematic Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Patient safety is a major concern in the healthcare industry worldwide. Increasing patient safety is critical for avoiding negative outcomes in nursing care and achieving goals at the desired level of quality. One of the indicators of this quality care given to patient is known as missed care.
Aim: Aims of this study to explore the factors influencing missed care in order to improve the quality of nursing care.
Methods: This study is a systematic review that explores the factors influencing missed nursing care in hospitals. Meanwhile, the literature search was carried out in the CINAHL Pubmed, Ebsco, Science Direct, Proquest, Willey, Sage from 2017 to 2021.
Results: The results from six databases (n=3702) were sorted into 22 collected articles which include 18 quantitative, 2 qualitative, and 2 mixed methods. These findings highlighted three factors that influence missed nursing care: a lack of staffing, nurse competency, and the working environment.
Conclusion: The factors that contribute with missed nursing care in hospitals include lack of nurse staff, competency, and work environment. As a result, the nursing manager's critical role is to create adequate nursing staff, improve their competency, and foster a positive work environment.
Keywords: missed nursing care, lack of staffing, nurse competency, working environment
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Hernández-Corral S, Serván-Mori E, Benítez-Chavira LA, Nigenda G, Zárate-Grajales RA. Missed nursing care in highly specialized hospitals: A Mexican case study. Int J Health Plann Manage 2022; 37:2997-3005. [PMID: 35723665 DOI: 10.1002/hpm.3501] [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: 12/29/2021] [Revised: 04/16/2022] [Accepted: 05/03/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To assess the status of missed nursing care and the reasons for its occurrence in a highly specialised public hospital in Mexico. MATERIALS AND METHODS An observational cross-sectional analysis with data collected from January to June 2019 at the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra in Mexico City. We assessed missed care and its causes by conducting the MISSCARE survey among 116 nursing professionals selected from a population of 162 nurses. This work presents the estimated rates of missed care-overall and broken down into its four dimensions-as well as the reasons for its occurrence, namely limited labour resources, inadequate material resources and communication problems among work teams. RESULTS The overall score for missed care was 16% (95% CI: 11.84%-20.15%), with the following rates by dimension: 19.48% for basic care, 14.66% for individual needs, 6.47% for patient education and discharge planning, and 4.31% for continuous patient assessment. The main reason cited for missed care was inadequate material resources, followed by limited labour resources and communication problems among work teams. CONCLUSION Basic care and individual needs interventions were the most frequently omitted services, primarily because of inadequate material resources, limited labour resources and communication problems among work teams. An increase in the frequency of missed care can be expected in light of the high demand for health services, particularly as regards labour and material resources, imposed by the SARS-CoV-2 pandemic.
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Affiliation(s)
| | - Edson Serván-Mori
- Center for Health Systems and Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Luis A Benítez-Chavira
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosa A Zárate-Grajales
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
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Standards for Professional Registered Nurse Staffing for Perinatal Units. J Obstet Gynecol Neonatal Nurs 2022; 51:e5-e98. [PMID: 35738987 DOI: 10.1016/j.jogn.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Toulabi T, Mohammadipour F. Effects of HIS-based intervention on patient education process and patient satisfaction with nurses' education. BMC Res Notes 2022; 15:198. [PMID: 35659724 PMCID: PMC9166321 DOI: 10.1186/s13104-022-06046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This quasi-experimental study (before and after intervention) was designed to determine the impact of hospital information system-based intervention on the patient education process and patient satisfaction in cardiac and cardiac intensive care units. RESULTS Each nurse was observed at the time of patient education on average on eight shifts (total of 256 shifts), and at last 1350 computerized reports before and after the intervention were analyzed and 150 patient satisfaction with nurses' education questionnaires were completed before and after the intervention. After the intervention, the patient education scores were significantly improved (p < 0.001). In addition, the results of a survey of patients about the level of satisfaction with the quality of patient education showed a significant increase compared to before the intervention (p < 0.001). The ability to easily, completely, and quickly edit and record the provided education, eased the process of patient education and documentation.
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Affiliation(s)
- Tahereh Toulabi
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Mohammadipour
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
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Effect of specific training course for competency in professional oral hygiene care in the intensive care unit: a quasi-experimental study for developing a standardized learning curve. BMC Anesthesiol 2022; 22:171. [PMID: 35650528 PMCID: PMC9158265 DOI: 10.1186/s12871-022-01709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background The development of evidence-based training standards can help improve the quality of educational programs for novice intensive care unit (ICU) nurses. This study was conducted to assess the application of a training course on competency development of nurses in relation to oral hygiene care in ICU patients and to develop a checklist for evaluating the competence performance. In addition, to achieve a certain level of oral hygiene competence, as well as to assess the relative importance of predicting factors and learning competency patterns in oral hygiene care, we used standard learning curve. Methods This quasi-experimental study with time series design was conducted on newly registered ICU nurses of a teaching hospital affiliated with Tehran University of Medical Sciences, Iran, between 2016 and 2018. In the first phase of this study, we designed a checklist to assess nurses' professional competence in oral hygiene care in three stages: before, during, and after care. Then, in the second phase, the level of competence of nurses in repeated times of oral hygiene care was determined based on checklist items and recorded in the learning curve. Results The greatest increase of oral hygiene care competency due to repetition was observed in the first and fourth times of repetition in comparison to the subsequent and previous steps. In the linear regression model, demographic variables predicted 12–19% of changes related to skill scores in repetitions. Conclusion According to the learning curve, newly registered ICU nurses can reach an acceptable competency after 6 repetitions of oral hygiene care.
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Joseph B, Plummer V, Cross W. Mental health nurses perceptions of missed nursing care in acute inpatient units: A multi-method approach. Int J Ment Health Nurs 2022; 31:697-707. [PMID: 35294094 PMCID: PMC9314997 DOI: 10.1111/inm.12990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Nurses have key roles in caring for hospitalized patients. Missed nursing care can lead to adverse outcomes, from minor discomfort to patient death. Mental health nurses have a significant role in advancing knowledge and practice due to missed, delayed, or unfinished nursing care. They are identifying, escalating, and managing warning signs of mental and physical health deterioration where the risk to patients is high in terms of compromised care quality and neglect and the evidence is scant. This study aimed to examine mental health nurses' perceptions of missed nursing care in acute mental health inpatient units in an Australian regional health service. A cross-sectional survey was undertaken using a modified Kalisch Phelan MISSCARE questionnaire and a qualitative content analysis was undertaken for narrative responses. Of 70 participants, the majority were aged 30-44 years, with >5 years of experience. The results indicated that care planning, safety audits, communication, and assessment of oral intake were perceived as care most frequently missed. Factors contributing to missed care need urgent exploration to ensure timely reduction of patient risk and enhancements to safe quality care.
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Affiliation(s)
- Bindu Joseph
- School of Health, Federation University, Berwick, Victoria, Australia
| | - Virginia Plummer
- School of Health, Federation University, Berwick, Victoria, Australia
| | - Wendy Cross
- School of Health, Federation University, Berwick, Victoria, Australia
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Lewis DM. Errors of commission or omission: The net risk safety analysis conversation we should be having around automated insulin delivery systems. Diabet Med 2022; 39:e14687. [PMID: 34510544 DOI: 10.1111/dme.14687] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/02/2021] [Accepted: 08/07/2021] [Indexed: 12/18/2022]
Abstract
The question of safety often arises when discussing automated insulin delivery systems, but discussion of safety is often anchored on a comparison to the risk to a person without diabetes, overlooking the risks of living with insulin-requiring diabetes. We should use a net risk safety perspective for evaluating diabetes technology that takes into account the ongoing risks of insulin management for people living with diabetes.
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Santy-Tomlinson J. Missed nursing care: Out in the open. Int J Orthop Trauma Nurs 2022; 45:100942. [PMID: 35461806 DOI: 10.1016/j.ijotn.2022.100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Janatolmakan M, Khatony A. Explaining the consequences of missed nursing care from the perspective of nurses: a qualitative descriptive study in Iran. BMC Nurs 2022; 21:59. [PMID: 35287687 PMCID: PMC8918588 DOI: 10.1186/s12912-022-00839-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Missed nursing care is a global challenge that can have many consequences. Knowing the experiences of clinical nurses can be helpful. Therefore, this study was conducted to explain the experiences of Iranian nurses regarding the consequences of missed nursing care. Methods This qualitative descriptive study was conducted with a content analysis approach. Sampling was done by the purposeful sampling method and continued until data saturation. Data were collected by in-depth semi-structured interviews. Data were analyzed using qualitative content analysis and Graneheim and Lundman’s method. MAXQDA version 10 software was used for data management. Results The participants included 14 nurses with a mean age of 38.7 ± 7.7 years. The data were classified into three categories: patient-related outcomes, nurse-related outcomes, and organization-related outcomes. These categories included nine subcategories entitled "moral distress", "job dissatisfaction", " decreased quality of nursing care "," patient dissatisfaction ","adverse events"," absenteeism ","intention to leave and subsequent turnover", "decreased hospital credit", and "increased hospital costs". Conclusion Missed nursing care can have adverse consequences for the patients, nurses, and organizations. Therefore, it is necessary to adopt management strategies such as providing sufficient manpower and increasing nurses' job satisfaction to reduce the amount of missed nursing care. Further studies are needed to explain the predictors of the missed nursing care consequences.
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Affiliation(s)
- Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Scannapieco FA, Giuliano KK, Baker D. Oral health status and the etiology and prevention of nonventilator hospital-associated pneumonia. Periodontol 2000 2022; 89:51-58. [PMID: 35244952 DOI: 10.1111/prd.12423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nonventilator hospital-associated pneumonia has recently emerged as an important preventable hospital-associated infection, and is a leading cause of healthcare-associated infection. Substantial accumulated evidence links poor oral health with an increased risk of pneumonia, which can be caused by bacterial, viral, or fungal pathogens, each with their own distinct mechanisms of transmission and host susceptibility. These infections are frequently polymicrobial, and often include microbes from biofilms in the oral cavity. Evidence documenting the importance of oral care to prevent nonventilator hospital-associated pneumonia is continuing to emerge. Reduction of oral biofilm in these populations will reduce the numbers of potential respiratory pathogens in the oral secretions that can be aspirated, which in turn can reduce the risk for pneumonia. This review summarizes up-to-date information on the role of oral care in the prevention of nonventilator hospital-associated pneumonia.
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Affiliation(s)
- Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Karen K Giuliano
- Elaine Marieb Center for Nursing and Engineering Innovation, Institute for Applied Life Sciences and College of Nursing, Nursing and Engineering Center for Innovation, University of Massachusetts, Amherst, Massachusetts, USA
| | - Dian Baker
- School of Nursing, California State University, Sacramento, California, USA
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Affiliation(s)
- Kathleen Rice Simpson
- Dr. Kathleen Rice Simpson is a Perinatal Clinical Nurse Specialist in St. Louis, MO, and the Editor-in-Chief of MCN . Dr. Simpson can be reached via email at
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Hope J, Schoonhoven L, Griffiths P, Gould L, Bridges J. 'I'll put up with things for a long time before I need to call anybody': Face work, the Total Institution and the perpetuation of care inequalities. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:469-487. [PMID: 35076086 PMCID: PMC9306934 DOI: 10.1111/1467-9566.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/01/2022] [Accepted: 01/05/2022] [Indexed: 06/01/2023]
Abstract
Failures in fundamental care (e.g. nutrition or pain-relief) for hospitalised patients can have serious consequences, including avoidable deaths. Policy rhetoric of 'shared decision-making' fails to consider how structural constraints and power dynamics limit patient agency in nursing staff-patient interactions. Goffman's concepts of face work, the presentation of self and the Total Institution shaped our analysis of interview and focus group data from hospital patients. Patients avoided threatening 'good' patient and staff face by only requesting missed care when staff face was convincing as 'caring' and 'available' ('engaged'). Patients did not request care from 'distracted' staff ('caring' but not 'available'), whilst patient requests were ignored in Total Institution-like 'dismissive' interactions. This meant patients experienced missed care with both 'distracted' and 'dismissive' staff. Patients with higher support needs were less able to carry out their own missed care to protect staff face, so experienced more serious care omissions. These findings show that many elements of the Total Institution survive in modern healthcare settings despite attempts to support individualised care. Unless nursing staff can maintain face as 'engaged' (despite organisational constraints that can reduce their capacity to do so) patient participation in care decisions will remain at the level of rhetoric.
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Affiliation(s)
- Jo Hope
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Lisette Schoonhoven
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Peter Griffiths
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Lisa Gould
- Department of Surgery and CancerFaculty of MedicineInstitute of Global Health InnovationImperial College LondonLondonUK
| | - Jackie Bridges
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
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Bor P, van Delft L, Valkenet K, Veenhof C. Perceived Factors of Influence on the Implementation of a Multidimensional Project to Improve Patients' Movement Behavior During Hospitalization: A Qualitative Study. Phys Ther 2022; 102:6423599. [PMID: 34751782 DOI: 10.1093/ptj/pzab260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/29/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to explore perceived factors of influence on the implementation of Hospital in Motion, a multidimensional and multidisciplinary implementation project to improve inpatients' movement behavior. METHODS This qualitative study was conducted on 4 wards. Per ward, a tailored action plan was implemented consisting of multiple tools and interventions to stimulate the integration of inpatient physical activity in usual care processes. After implementation, semi-structured interviews were performed with health care professionals and patients to explore perceived factors of influence on the implementation of the Hospital in Motion project. A content analysis was performed using the framework of the Medical Research Council for complex interventions as guidance for the identification of categories and themes. RESULTS In total, 16 interviews were conducted with health care professionals and 12 with patients. The results were categorized into the 3 key components of the Medical Research Council framework: implementation, mechanisms of impact, and context. An important factor of influence within the theme "implementation" was the iterative and multidisciplinary approach. Within the theme "mechanisms of impact," continuous attention and the interaction of multiple interventions, tailored to the target group and targeting multiple dimensions (individual, inter-professional, community and society), were perceived as important. Within the theme "context," the intrinsic motivation and inter-professional, community and societal culture towards physical activity was perceived to be of influence. CONCLUSION Impact can be achieved and maintained by creating continuous attention to inpatient physical activity and by the interaction between different interventions and dimensions during implementation. To maintain enough focus, the amount of activities at one time should be limited. IMPACT To improve inpatients' movement behavior, implementation project teams should be multidisciplinary and should implement a small set of tailored interventions that target multiple dimensions. Intermediate evaluation of the implementation process, strategies, and interventions is recommended.
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Affiliation(s)
- Petra Bor
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lotte van Delft
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Expertise Center Healthy Urban Living, Utrecht, the Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Expertise Center Healthy Urban Living, Utrecht, the Netherlands
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Psychometric properties of the perinatal missed care survey and missed care during labor and birth. Appl Nurs Res 2022; 63:151516. [PMID: 35034697 PMCID: PMC9733661 DOI: 10.1016/j.apnr.2021.151516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/22/2021] [Accepted: 10/17/2021] [Indexed: 02/03/2023]
Abstract
Aim: To evaluate the psychometric characteristics of the Perinatal Missed Care Survey and assess the prevalence of nurse-reported missed care during labor and birth. Background: Nursing care during labor and birth differs from other nursing care. Empirical evidence is scant regarding nursing quality and missed nursing care during labor and birth, which are important aspects of quality in maternity care. Methods: We conducted exploratory and confirmatory factor analysis on a previously developed perinatal missed nursing care instrument using data from 3,466 registered nurses. Measures included missed nursing care, reasons for missed nursing care, and demographic characteristics. All birth hospitals in each of 37 states were invited to distribute surveys electronically via email to their labor and delivery RN staff. The overall response rate from 277 hospitals that facilitated the survey was 35%. Results: Some missed care was reported for each of 25 missed care items. Labor support, intake and output, patient teaching, timely documentation, timely medication administration, and thorough review of prenatal records were missed at least occasionally by >50% respondents. Labor resources (83%), material resources (77%), and communication (60%) were reported reasons for missed nursing care. Exploratory factor analysis aligned with previous testing. Confirmatory factor analysis demonstrated good model fit. Conclusions: The Perinatal Missed Care Survey demonstrates good validity and reliability as a measure of missed nursing care during labor and birth. Our findings suggest missed nursing care during labor and birth is prevalent and occurs in aspects of care that could contribute to patient harm when missed.
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Srulovici E, Yanovich O. Missed nursing care: Testing the moderation-mediation energetic and motivational pathways via a nested design. J Adv Nurs 2022; 78:2339-2348. [PMID: 34989434 DOI: 10.1111/jan.15144] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/01/2021] [Accepted: 12/18/2021] [Indexed: 11/27/2022]
Abstract
AIMS To examine: (1) a motivational pathway where head nurse proactive leadership and nurse vigour are linked, which in turn correlates to missed nursing care, and might be moderated by workload; and (2) an energetic pathway where workload and nurse exhaustion are linked, which in turn correlates to missed nursing care, and might be moderated by head nurse proactive leadership. DESIGN A cross-sectional design, with nurses nested in wards. METHODS During 2018, 196 nurses from 37 wards completed questionnaires that included the 22-item MISSCARE survey; the 6-item Work Demand subscale; the 10-item Proactivity Personality scale; the 5-item Exhaustion subscale of the Maslach Burnout Inventory; the 5-item Vigour subscale of the Work Engagement scale; and nurse's and head nurse's sociodemographic characteristics. Moderation-mediation models were performed using mixed-linear model analyses. RESULTS A moderation-mediation motivational pathway was supported. Specifically, nurse vigour was higher under low workload when head nurse proactive leadership was high (β = -.09, p = .050), which in turn was associated with lower missed nursing care (β = -.10, p = .045). Yet, a moderation-mediation energetic pathway was not supported. Specifically, nurse exhaustion was lower under low workload when head nurse proactive leadership was high (β = .14, p = .032), but no association was found between exhaustion and missed nursing care. CONCLUSIONS This study shows that there is a significant role for nurse agency and nurse ability to cope with scarce resources. IMPACT To date, research has focused mainly on the assumption that missed nursing care is a result of scarce resources. Findings indicate that even under scarce resources, nurses can be motivated to reduce missed nursing care. Emphasis should be placed on promoting and maximizing nurse motivation. This can be achieved by developing and implementing interventions of proactive leadership of head nurses.
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Affiliation(s)
- Einav Srulovici
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Ortal Yanovich
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.,HaEmek Medical Center, Afula, Israel
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Hosseini Z, Raisi L, Maghari A, Karimollahi M. Translation and psychometric properties of the MISSCARE survey-Persian version. BMC Nurs 2022; 21:3. [PMID: 34983498 PMCID: PMC8725292 DOI: 10.1186/s12912-021-00787-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Providing safe and high-quality nursing care is an essential task of nursing. Nurses may be unable to provide patients with all of the necessary care for numerous reasons, such as an increase in the number of patients and a low number of nursing staff. Moreover, they may have to omit, postpone, or incompletely perform a series of care, referred to as missed nursing care. The purpose of this study was to translate and conduct psychometric testing of the MISSCARE Survey. Method In this study, we accurately translated the MISSCARE Survey. Its acceptability, construct validity, and internal consistency were analyzed. This cross-sectional study was conducted in the summer of 2020 in educational hospitals in Ardabil, Iran. The participants were 300 nurses who worked in educational hospitals and were randomly selected. Results Participants in this study included 300 nurses from five units, including general medicine (13.3%), COVID-19 (45.0%), surgery (18.7%), critical care unit (6.3%), and intensive care unit (16.7%), who worked various shifts, of whom 84.7% were female. The total content validity in Part A was 0.944, and that in Part B was 0.969. Part A was divided into three domains (necessary care, secondary care, and supportive care), and Part B was divided into five domains (communication, labor resources, material resources, responsibility, and unpredictable situations). In both parts, the chi-square index was < 3, and the RMSEA index was < 0.08. The internal consistency measured by Cronbach’s alpha was 0.933 for Part A and 0.910 for Part B for the Persian version of the MISSCARE Survey. Conclusion Based on the outcomes of this research, it can be concluded that the Persian version of the MISSCARE Survey is valid for use in Iranian hospitals and can be used to identify missed care and the reasons behind it. Nursing managers can also use it to improve the situation and provide the highest-quality care.
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Affiliation(s)
- Zeinab Hosseini
- School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Leila Raisi
- Department of Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Science, Ardabil, Iran.,Department of Family Health, Social Determinants of Health Research Center (SDHRC), Ardabil University of Medical Science, Ardabil, Iran
| | - Amirhossein Maghari
- Department of Family Health, Social Determinants of Health Research Center (SDHRC), Ardabil University of Medical Science, Ardabil, Iran.,Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mansoureh Karimollahi
- Department of Nursing, Faculty of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
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Magnitude of missed nursing care and associated factors in case of North Shewa Zone public Hospitals, Amhara regional state, Ethiopia. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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40
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Strategies for Reducing Rationed Nursing Care: Qualitative Secondary Analysis. ACTA MEDICA MARTINIANA 2021. [DOI: 10.2478/acm-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction: Nursing students spend a meaningful part of their professional training in clinical practice. However, to a significant extent, they actively or passively contribute to the occurrence of rationed nursing care in clinical practice. Therefore, it is crucial that they actively participate in implementing targeted strategies to reduce rationed nursing care.
Aim: To explore nursing students′ experience with strategies focusing on the reduction of rationed nursing care.
Methods: We chose a qualitative secondary analysis to address unpublished data related to nursing students′ experience with strategies focusing on reducing rationed nursing care. The data included a set comprising of 148 pages with transcribed verbatim of 18 semi-structured interviews. The data were analyzed by a deductive content analysis.
Results: Based on the outcome of the secondary analysis, we identified two meaningful categories: Preventive strategies in clinical practice and Importance and meaning of preventive strategies. These two categories reflected nursing students′ experience with targeted strategies to reduce rationed nursing care in clinical practice.
Conclusion: Proposal and subsequent implementation of preventive strategies are essential for reducing rationed nursing care phenomenon from the clinical practice environment. The perspective of nursing students is vital due to their intensive perception of rationed nursing care in clinical practice. Students may identify areas that work-place staff may not explicitly focus on and consider important but jeopardize the quality of care or patient safety.
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Albsoul RA, FitzGerald G, Hughes JA, Ahmed Alshyyab M. Missed nursing care and complexity theory: a conceptual paper. J Res Nurs 2021; 26:809-823. [DOI: 10.1177/17449871211013073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Missed nursing care is a complex healthcare problem. Extant literature in this area identifies several interventions that can be used in acute hospital settings to minimise the impact of missed nursing care. However, controversy still exists as to the effectiveness of these interventions on reducing the occurrence of missed nursing care. Aim This theoretical paper aimed to provide a conceptual understanding of missed nursing care using complexity theory. Methods The method utilised for this paper is based on a literature review on missed care and complexity theory in healthcare. Results We found that the key virtues of complexity theory relevant to the missed nursing care phenomenon were adaptation and self-organisation, non-linear interactions and history. It is suggested that the complex adaptive systems approach may be more useful for nurse managers to inform and prepare nurses to meet uncertain encounters in their everyday clinical practice and therefore reduce instances of missed care. Conclusions This paper envisions that it is time that methods used to explore missed care changed. Strategies proposed in this paper may have an important impact on the ability of nursing staff to provide quality and innovative healthcare in the modern healthcare system.
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Affiliation(s)
- Rania Ali Albsoul
- Assistant Professor in Healthcare Management, Department of Family and Community Medicine, Jordan University, Jordan
| | - Gerard FitzGerald
- Professor in Public Health, School of Public Health and Social Work, Queensland University of Technology, Australia
| | - James A Hughes
- Nurse Researcher, Emergency and Trauma Centre, Royal Brisbane and Women's Hospital and Conjoint Senior Research Fellow, School of Nursing, Queensland University of Technology, Australia
| | - Muhammad Ahmed Alshyyab
- Assistant Professor in Health Services Management, Department of Public Health and Community Medicine, Jordan University of Science and Technology, Jordan
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The factors contributing to missed care and non-compliance in infection prevention and control practices of nurses: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Kołtuniuk A, Witczak I, Młynarska A, Czajor K, Uchmanowicz I. Satisfaction With Life, Satisfaction With Job, and the Level of Care Rationing Among Polish Nurses-A Cross-Sectional Study. Front Psychol 2021; 12:734789. [PMID: 34650492 PMCID: PMC8505674 DOI: 10.3389/fpsyg.2021.734789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/27/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Rationing of nursing care is a serious issue that has been widely discussed throughout recent years in many countries. The level of satisfaction with life and of satisfaction with job as the nurse-related factors may significantly affect the level of care rationing. Aim: To assess the rationing of nursing care among the Polish nurses and the impact of nurse-related variables, i.e., satisfaction with life and satisfaction with job on the level of nursing care rationing. Materials and Methods: A cross-sectional study was conducted among 529 Polish registered nurses employing in two University Hospitals. Three self-report scales in the Polish version were used in this study, namely, Basel Extent of Rationing of Nursing Care-revised version (BERNCA-R), Satisfaction with Life Scale (SWLS), and Satisfaction with Work Scale (SWWS). Results: The respondents indicated that the most frequently rationed activity is studying the situation of individual patients and care plans at the beginning of the shift. The least frequently rationed activity indicated by the respondents was adequate hand hygiene. The patient-to-nurse ratio and the level of satisfaction with job are significant independent factors affecting the level of care rationing. Conclusions: The assessment of the level of satisfaction with life and identification of factors affecting this assessment will enable reducing the occurrence of care rationing.
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Affiliation(s)
- Aleksandra Kołtuniuk
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Izabela Witczak
- Department of Health Care Economics and Quality, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Karolina Czajor
- Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Simpson KR, Roth CK, Hering SL, Landstrom GL, Lyndon A, Tinsley JM, Zimmerman J, Hill CM. AWHONN Members' Recommendations on What to Include in Updated Standards for Professional Registered Nurse Staffing for Perinatal Units. Nurs Womens Health 2021; 25:329-336. [PMID: 34602165 DOI: 10.1016/j.nwh.2021.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/10/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To solicit advice from members of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) on what to include in an update of nurse staffing standards. DESIGN Online, single-question survey with thematic analysis of responses. SETTING Electronic survey link sent via e-mail. PARTICIPANTS AWHONN members who shared their e-mail with the association and who responded to the survey (n = 1,813). MEASURES Participants were asked to answer this single question: "The AWHONN (2010) Guidelines for Professional Registered Nurse Staffing for Perinatal Units are being updated. During their initial development, feedback from nearly 900 AWHONN members was extremely helpful in providing specific details for the nurse staffing guidelines. We'd really like to hear from you again. Please give the writing team your input. What should AWHONN consider when updating the AWHONN nurse staffing guidelines?" RESULTS The e-mail was successfully delivered to 20,463 members; 8,050 opened the e-mail, and 3,050 opened the link to the survey. There were 1,892 responses. After removing duplicate and blank responses, 1,813 responses were available for analysis. They represented all hospital practice settings for maternity and newborn care and included nurses from small-volume and rural hospitals. Primary concerns of respondents centered on two aspects of patient acuity-the increasing complexity of clinical cases and the need to link nurse staffing standards to patient acuity. Other themes included maintaining current nurse-to-patient ratios, needing help with implementation in the context of economic challenges, and changing wording from "guidelines" to "standards" to promote widespread adoption. CONCLUSION In a single-question survey, AWHONN members offered rich, detailed recommendations that were used in the updating of the AWHONN nurse staffing standards.
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Zhang H, Peng Z, Chen Q, Liu W. A cross-sectional study of implicit rationing of care in publicly funded nursing homes in Shanghai, China. J Nurs Manag 2021; 30:345-355. [PMID: 34590763 DOI: 10.1111/jonm.13479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/06/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022]
Abstract
AIMS To investigate the level of implicit care rationing and its association with training needs in nursing homes in Shanghai, China. BACKGROUND Nursing homes in Shanghai are confronted with a lack of care resources. Implicit care rationing can emerge due to inadequate training of care workers. METHODS A cross-sectional survey was conducted between 10 September and 17 November 2020. A total of 374 care workers from 16 randomly were selected nursing homes from each of the administrative districts participated the surveys. The Basel Extent of Rationing of Nursing Care-Nursing Home instrument and the training needs analysis were adopted to measure implicit care rationing and training needs, respectively. Multiple regression techniques were used to explore the factors associated with implicit care rationing. RESULTS Activities related to social care, documentation and activation/rehabilitation (mean rating = 2.8, 1.89 and 1.93 respectively) were mostly likely to be rationed. Training needs of activities of daily living (ADL), activation/rehabilitation and documentation were significantly related to their implicit rationing (β = 0.864, 0.21 and 0.166, respectively, p < .01). CONCLUSION Training needs are crucial determinants of implicit care rationing. IMPLICATIONS FOR NURSING MANAGEMENT Quality control systems are needed to ensure care comprehensiveness. The current training system should be re-designed according to results of training needs analysis.
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Affiliation(s)
- Huimin Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
| | - Zixuan Peng
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Qianqian Chen
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
| | - Wenwei Liu
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,College of Philosophy, Law and Political Science, Shanghai Normal University, Shanghai, China
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Winter SG, Bartel AP, de Cordova PB, Needleman J, Schmitt SK, Stone PW, Phibbs CS. The effect of data aggregation on estimations of nurse staffing and patient outcomes. Health Serv Res 2021; 56:1262-1270. [PMID: 34378181 DOI: 10.1111/1475-6773.13866] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To examine how estimates of the association between nurse staffing and patient length of stay (LOS) change with data aggregation over varying time periods and settings, and statistical controls for unobserved heterogeneity. DATA SOURCES/STUDY SETTING Longitudinal secondary data from October 2002 to September 2006 for 215 intensive care units and 438 general acute care units at 143 facilities in the Veterans Affairs (VA) health care system. RESEARCH DESIGN This retrospective observational study used unit-level panel data to analyze the association between nurse staffing and LOS. This association was measured over both a month-long and a year-long period, with and without fixed effects. DATA COLLECTION We used VA administrative data to obtain patient data on the severity of illness and LOS, as well as labor hours and wages for each unit by month. PRINCIPAL FINDINGS Overall, shorter LOS was associated with higher nurse staffing hours and lower proportions of hours provided by licensed professional nurses (LPNs), unlicensed personnel, and contract staff. Estimates of the association between nurse staffing and LOS changed in magnitude when aggregating data over years instead of months, in different settings, and when controlling for unobserved heterogeneity. CONCLUSIONS Estimating the association between nurse staffing and LOS is contingent on the time period of analysis and specific methodology. In future studies, researchers should be aware of these differences when exploring nurse staffing and patient outcomes.
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Affiliation(s)
- Shira G Winter
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Stanford University School of Medicine, Stanford, California, USA
| | - Ann P Bartel
- Columbia Business School, New York, New York, USA
| | - Pamela B de Cordova
- Rutgers, The State University of New Jersey School of Nursing, Newark, New Jersey, USA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.,UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Susan K Schmitt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Ciaran S Phibbs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Jankowska-Polańska B, Czyrniańska M, Sarzyńska K, Świątoniowska-Lonc N, Chabowski M. Impact of fatigue on nursing care rationing in paediatric haematology and oncology departments - a cross-sectional study. BMC Nurs 2021; 20:139. [PMID: 34376202 PMCID: PMC8353779 DOI: 10.1186/s12912-021-00663-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rationing of nursing care is a relatively new concept. It refers to an error of omission and has a direct influence on the quality of nursing care and treatment outcomes. Nurses who experience chronic fatigue often fail to perform their duties properly, which may lead, for instance, to medical errors attributed to impaired judgment. Therefore, it is necessary to identify factors which give rise to fatigue, leading to rationing of nursing care, and develop strategies to eliminate them. The primary objective of the study was to assess the impact of fatigue on nursing care rationing in paediatric haematology and oncology departments. The secondary objective of this study was to identify the factors, which may influence the nursing care rationing. Methods The study was conducted among 95 nurses (aged between 23 and 58 years) workinginthe Department of Paediatric Oncology, Haematology and Bone Marrow Transplantation of the University Teaching Hospital in Wroclaw. Participation in the study was voluntary and anonymous. Our own sociodemographic questionnaire, the Basel Extent of Rationing of Nursing Carequestionnaire and the modified fatigue impact scale (MFIS) were used in the study. Results The level of fatigue among the nurses participating in the study, as measured by the MFIS, was high, namely 28.97 ± 16.78. It was found that the fatigue of the nurses influenced most often the psycho-social dimension of QoL (1.78 ± 1.05), and least often - cognitive (1.24 ± 0.78). A correlation analysis showed that all aspects of fatigue had a statistically significant positive impact on care rationing (p < 0.05), i.e. the greater the fatigue, the higher the level of care rationing. A regression analysis showed that a 12-h shift pattern was an independent predictor of the level of care rationing (r = 0.771, p < 0.05). Conclusions Nurses working in paediatric haematology departments report a high level of fatigue. Work pattern is an independent determinant of nursing carerationing. A high level of nursing care rationing was found for nurses working 12-h shifts. Trial registration The study was approved by the Bioethics Committee of the Wroclaw Medical University, Poland (February 8th 2019, No. 205/2019).
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Affiliation(s)
- Beata Jankowska-Polańska
- Division of Nervous System Diseases, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Bartla Street 5, 51-618, Wroclaw, Poland.
| | - Monika Czyrniańska
- Department of Paediatric Oncology, Haematology and Bone Marrow Transplantation, "Cape of Hope" Transregional Paediatric Oncology Centre, BorowskaStreet 213, 50-556, Wroclaw, Poland
| | - Kathie Sarzyńska
- Internal Medicine Nursing Student Scientific Circles, Wroclaw Medical University, Bartla Street 5, 51-618, Wroclaw, Poland
| | - Natalia Świątoniowska-Lonc
- Division of Nervous System Diseases, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Bartla Street 5, 51-618, Wroclaw, Poland
| | - Mariusz Chabowski
- Department of Surgery, 4thMilitary Teaching Hospital, Weigla Street 5, 50-981, Wroclaw, Poland.,Division of Oncology and Palliative Care, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Bartla Street 5, 51-618, Wroclaw, Poland
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Saga S, Blekken LE, Nakrem S, Sandmoe A. Relatives' experiences with abuse and neglect in Norwegian nursing homes. A qualitative study. BMC Health Serv Res 2021; 21:684. [PMID: 34247595 PMCID: PMC8272837 DOI: 10.1186/s12913-021-06713-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/29/2021] [Indexed: 12/22/2022] Open
Abstract
Background Elder abuse in nursing homes (NH) is a widespread and complex problem. Residents’ ability to share their experiences are impeded, due to a high degree of cognitive problems and frailty, and previous studies are thus mainly based on reports from staff. Therefore, we aimed to give voice to the residents by investigating their relatives’ experiences with elder abuse in NH. Methods Qualitative individual interviews were conducted with 16 relatives of residents with experience of abuse and/or neglect in NH. Content analysis was used to analyse the data. Results Relatives perceived neglect as most pervasive and staff-to-resident psychological abuse as a key problem. Physical abuse was mostly related to resident-to-resident aggression. Relatives perceived elder abuse in NH to be related to low competence among staff, low staffing, poor NH leadership, working cultures characterized by fear and loyalty to employer or co-workers, and a lack of individualized care for the residents. Furthermore, relatives themselves experienced maltreatment from NH, which caused them to suffer stress, anxiety and distrust. Relatives also expressed a need to compensate for lack of care. Conclusions Relatives of NH residents who had experienced abuse reported that neglect of basic care and individual rights was predominant and viewed organizational explanations as most important. Relatives perceive themselves as collaborators in care and are emotionally attached to their family member. Therefore, if relatives experience resident abuse or neglect, it inflicts a feeling of being mistreated themselves, particularly if they are not listened to or their notice of abuse on the part of the resident is ignored or trivialized. Including relatives in a committed partnership with NH in care practices is not only a valuable path to reduce the risk of abuse, but it also leads to a more sustainable healthcare with high standards of quality and safety.
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Affiliation(s)
- Susan Saga
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Lene Elisabeth Blekken
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Astrid Sandmoe
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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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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