Hospital Magnet® Designation and Missed Nursing Care in Neonatal Intensive Care Units

Qualitative evaluation of missed nursing care in neonatal intensive care units in a teaching hospital in Jordan

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.

Exploring the role of communication in missed nursing care: A systematic review

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.

Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability

AIM

To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC).

DESIGN

A qualitative descriptive design.

METHODS

Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis.

RESULTS

A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.

Predictors of Nurse-Reported Quality of Care in Neonatal Intensive Care Units in Korea

PURPOSE

This study aimed to investigate predictors of nurse-reported quality of care (NQoC) in neonatal intensive care units (NICU) in Korea.

DESIGN AND METHODS

The study participants were 217 NICU nurses working in four tertiary general hospitals and three general hospitals across South Korea. Data were collected in February 2019, when a survey was performed to measure nurse-related characteristics, intent to leave, job satisfaction, and NQoC. Collected data were analyzed using t-test, chi-square test, and hierarchical logistic regression on the SPSS WIN 26.0 program.

RESULTS

Approximately 53% of NICU nurses perceived good quality of care. NICU work experience of less than 2 years and 2 to 4 years were associated with increased odds of good NQoC in all regression models. Perceived adequacy of nurse staffing level was significantly associated with increased odds of good NQoC in model 2 (OR 4.90, 95% CI: 1.75-13.70), model 3 (OR 5.01, 95% CI: 1.73-14.50), and model 4 (OR 3.96, 95% CI: 1.29-12.12). Moreover, in model 3, intent to leave was associated with decreased odds of good NQoC (OR 0.83, 95% CI: 0.21-0.71), and job satisfaction was associated with increased odds of good NQoC (OR 5.41, 95% CI: 2.74-10.67) in model 4.

CONCLUSIONS

Nurses' NICU work experience, adequate nurse staffing level, no intent to leave, and job satisfaction were predictors of good NQoC among NICU nurses.

PRACTICE IMPLICATION

Improvement of nurse staffing levels and job satisfaction is a promising strategy to achieve good quality of care in NICUs.

Healthcare workers' structured daily reflection on patient safety, workload and work environment in intensive care. A descriptive retrospective study

OBJECTIVES

To describe the results of use of structured daily reflection assessments among healthcare workers at an intensive care unit over the course of one year.

METHODS

In this descriptive retrospective study, data were analysed both quantitatively and qualitatively. The data encompassed 1095 work shifts, evaluated by healthcare workers at an intensive care unit using a structured daily reflection instrument. The areas evaluated were patient safety, workload and work environment, and free-text comments were possible.

FINDINGS

The results showed that 36% (n = 395) of work shifts, most of them daytime shifts (44%; n = 161), were affected. Workload was the area that affected most work shifts (29%; n = 309). Missed nursing care, complex care and inaccurate communication impacted patient safety, while patient care, multitasking and working conditions affected workload. Work environment was impacted by organisational factors, environment, lack of control and moral stress.

CONCLUSION

Using daily reflection among healthcare workers in the intensive care unit illuminated areas that affect patient safety, workload, and work environment. The importance of communication and collaboration and how they can impact patient safety, workload, and the work environment were highlighted by the team.

Missed nursing care in the Malaysian context: A cross-sectional study from nurses' perspective

AIM

To determine the occurrence, factors and outcome of missed nursing care from the perspective of Malaysian nurses.

BACKGROUND

Missed nursing care is an important issue in the global health care sector. However, little is known on the extent of missed nursing care in the Malaysian context and its contributing factors.

METHODS

A cross-sectional design was adopted for data collection using the MISSCARE Survey instrument. Participants comprised 364 nurses from medical and surgical wards of a large teaching hospital. Data were analysed using descriptive, binomial logistic and hierarchical regression analyses.

RESULTS

The overall occurrence of missed nursing care was 1.88 (on a scale of 1.00-5.00), which differed across 24 nursing care elements. Basic nursing care and communication-related care were the most frequently missed elements. Types of ward and labour resources were identified as contributing factors to missed nursing care (p < .001). No significant association was found between missed nursing care and nurses' intention to leave (p > .05).

CONCLUSION

The occurrence of missed nursing care was noted to be low.

IMPLICATIONS FOR NURSING MANAGEMENT

Practical strategies such as an acuity-based staffing system, close monitoring of rendered care and strengthening of teamwork are recommended to minimize missed nursing care.

Turkish Validation of the MISSCARE Survey - Pediatric Version

PURPOSE

To conduct Turkish validity and reliability study of the MISSCARE Survey-Pediatric version identifying the missed nursing care in pediatric units and its reasons.

DESIGN AND METHODS

The sample of this methodological study consisted of 222 nurses working in pediatric units. The study was conducted in three training and research hospitals and one university hospital. In the Turkish adaptation of the survey, confirmatory and explanatory factor analyses were performed within the context of language validity, content validity, and construct validity. In the reliability analyses of the survey, Cronbach's alpha for internal consistency analysis and intraclass correlation analysis for test re-test were used.

RESULTS

The language validity of the survey was conducted by expert linguists. Content validity index was calculated as 0.88 for section A and 0.90 for section B. Turkish version consisting of three factors and 16 items for section B of the survey met the construct validity. In reliability analyses it was determined that Cronbach's alpha values were between 0.82 and 0.88 in subscales of the survey and Intraclass Correlation Coefficient values were between 0.52 and 0.65 in subscales of the survey and 0.64 in overall survey.

CONCLUSION

In the Turkish version of MISSCARE Survey-Pediatric version, the section A with 29 items and the section B with 16 items were valid and reliable.

PRACTICE IMPLICATIONS

The survey is a valid and reliable tool for intercultural studies revealing the nursing care activities missed by nurses working in pediatric clinics and the reasons for such activities.

Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care

AIM(S)

To determine relationships among missed nursing care, job enjoyment and intention to leave for neonatal nurses.

BACKGROUND

Being unable to provide required nursing care to infants could contribute to poorer neonatal nurse job outcomes, which may exacerbate staffing challenges. Little evidence exists about how missed nursing care relates to neonatal nurse job outcomes.

METHOD(S)

The design was cross-sectional. Secondary data from the 2016 National Database of Nursing Quality Indicators Registered Nurse Survey were used, which included nurse ratings of job enjoyment, intention to leave and missed nursing care. American Hospital Association data from 2016 were used to describe hospitals. Linear and logistic regressions were calculated.

RESULTS

There were 5,824 neonatal nurses. Mean nurse job enjoyment was 4.26 out of 6 (SD = 0.97). On average, 15% of nurses intended to leave their position. Each one unit increase in missed nursing care was associated with a 0.26 decrease in job enjoyment and a 29% increased odds of intention to leave after controlling for nursing and hospital characteristics.

CONCLUSIONS

Missed nursing care can influence nurse job enjoyment and intention to leave in neonatal care units.

IMPLICATIONS FOR NURSING MANAGEMENT

Neonatal nurse managers should address missed nursing care to improve neonatal nurse job outcomes.

Adaptation of the MISSCARE Survey to the Maternity Care Setting

Missed nursing care is an important measure of nursing care quality that is sensitive to nurse staffing and is associated with patient outcomes in medical-surgical and pediatric inpatient settings. Missed nursing care during labor and birth has not been studied, yet childbirth represents the most common reason for hospitalization in the United States. The Missed Nursing Care (MISSCARE) Survey, a measure of medical-surgical nursing quality with substantial evidence for validity and reliability, was adapted to maternity nursing care using data from focus groups of labor nurses, physicians, and new mothers and an online survey of labor nurses. Content validity was evaluated via participant feedback, and exploratory factor analysis was performed to identify the factor structure of the instrument. The modified version, the Perinatal Missed Care Survey, appears to be a feasible and promising instrument with which to evaluate missed nursing care of women during labor and birth in hospitals.