The globalization of missed nursing care terminology

The Relationship Between Work Environment and Missed Nursing Care in Nurses: The Moderator Role of Profession Self-Efficacy

AIMS

This study aimed to examine the relationship between work environment and missed nursing care (MNC) in nurses and determine whether profession self-efficacy has a moderator role in this relationship.

DESIGN

A quantitative, cross-sectional, correlational study design was used to test the study model.

METHODS

The study was conducted with 433 nurses in 2 city hospitals in Istanbul, Turkey. Data were collected between November 2022 and February 2023 using the "MISSCARE Survey-Turkish," the "Work Environment Scale," and the "Nursing Profession Self-Efficacy Scale."

RESULTS

The participants had a mean Nursing Profession Self-Efficacy Scale score of 66.67 ± 14.37, a mean Work Environment Scale score of 84.96 ± 13.62, a mean elements of MNC score of 1.30 ± 0.73, and a mean reason for MNC score of 3.18 ± 0.78. Nursing profession self-efficacy was determined to be positively related to the work environment of the participants and their reasons for MNC (respectively, r = 0.276 and r = 0.114) and negatively related to elements of MNC ( r = -0.216) ( P < 0.05). There was also a negative relationship between the work environment and elements of MNC ( r = -0.249; P < 0.05). Profession self-efficacy had a significant moderator role in the relationship between the work environment and elements of MNC. Having low or moderate levels of profession self-efficacy moderated the negative effects of the work environment on elements of MNC.

CONCLUSIONS

There is a need for interventions to reduce elements of missed nursing care in nurses. Especially nurses and/or nurse managers may have difficulties in improving their work environment, considering its multifaceted structure. In such cases, administrators can reduce missed nursing care by increasing the profession self-efficacy of nurses. Therefore, profession self-efficacy should be considered in addition to interventions for the work environment to improve care.

Exploring nurse mentors' job crafting: A longitudinal study on missed nursing care across student supervision

AIM

To compare the job crafting strategies nurse mentors use when mentoring students versus during periods of respite and to assess the effectiveness of these strategies in reducing instances of missed nursing care (MNC).

BACKGROUND

Nurses who serve as mentors may have to train a group of nursing students on top of their routine nursing duties. The corresponding high workloads and limited resources may force them to decide which nursing care to delay or omit (i.e., MNC). The mentors' initiative and the actions they take to address the multiple job requirements which do not align with the organization's resources are referred to as job crafting strategies. Mentors can use these strategies to shape their role as nurses as well as their role as mentors, depending on their motives and personality.

DESIGN

A longitudinal study with data collected at two time points.

METHODS

One hundred nurse mentors completed validated questionnaires assessing job crafting strategies, MNC and work overload while actively mentoring students. Eighty returned for a follow-up during a non-mentoring period three months later. Data analysis included paired t-tests and hierarchical multivariable linear regressions.

RESULTS

No significant differences were found in MNC between the two points (1.83 SD 0.6 vs. 1.82 SD 0.75; p=0.942). A decrease in hindering demands was noted during active mentoring compared with respite (2.6 SD 0.97 vs. 2.84 SD 0.96; p=0.038). Enhancing structural job resources was significantly negatively correlated with MNC during active mentoring, while enhancing challenging job demands was positively correlated with MNC during these periods (β=0.48, p=0.18 and β=-0.35, p=0.014, respectively).

CONCLUSION

Nurse mentors can effectively reduce MNC by focusing on enhancing structural resources and limiting challenging demands during mentoring periods. It is essential for healthcare organizations to support nurse mentors with manageable workloads and necessary resources to maintain high-quality care.

Development and Validation Process of the Intensive Care Unit Omitted Nursing Care (ICU-ONC) Instrument Among French Canadian Nurses

Background and Purpose: The purpose of this article is to document the development and validation process of an instrument adapted for French-speaking nurses and to measure the occurrence of omitted nursing care (ONC) in the intensive care unit (ICU). Methods: An electronic Delphi panel, involving ICU nursing experts from the province of Quebec (Canada), was used to develop the intensive care unit omitted nursing care (ICU-ONC) instrument. For the validation process, an electronic cross-sectional survey was conducted. Results: A total of 564 nurses participated in the validation study. Exploratory factor analysis performed on 478 complete observations supports the presence of a single-factor structure for the 22-item ICU-ONC instrument. Coefficient alpha for the scale was .93, 95% confidence interval (CI) was [0.92, 0.94], item-partial total correlations ranged from .49 and .68, and the mean/median interitem correlations were .38 and .37, respectively. Moderate negative correlations were found between the ICU-ONC instrument overall score and two related constructs: nurses' perception of the quality as well as the safety of care. Conclusions: Our current understanding of ONC in the ICU is based on the results drawn from the administration of generic instruments to ICU nurses. The novel 22-item ICU-ONC instrument can help better estimate the occurrence of the phenomena in the ICU.

Development and validation of the missed intensive nursing care scale

BACKGROUND

Missed nursing care is a pervasive issue in hospitals, nursing homes, and communities, posing a significant threat to patient safety and the quality of nursing care. It has adverse effects on patient satisfaction and the motivation of nursing staff. Understanding the causes and nature of these care omissions in clinical settings is essential for implementing effective interventions. This study aims to develop and validate a tool for assessing missed nursing care in adult intensive care units.

METHODS

Semi-structured interviews, expert consultations conducted via the Delphi method and item analysis were used to develop the initial scale. Our analysis involved data collected from 400 nurses and employed correlation coefficient analysis, critical ratio assessment, Cronbach's α coefficient evaluation, discrete trend analysis, and factor analysis, which were grounded in both classical test theory and item response theory, allowing us to scrutinize and refine the items in the scale. To validate the scale, we conveniently sampled 550 nurses and assessed structural validity, internal reliability, split-half reliability, and test-retest reliability to ensure the scale's robustness and accuracy.

RESULTS

The Missed Intensive Nursing Care Scale (MINCS) comprises three distinct components. Part A serves to collect general information about the participants. In Part B, the missed care elements are categorized into five domains, following the framework of Maslow's hierarchy of needs theory: physiology, safety, belongingness, esteem, and cognition. Part C is dedicated to detailing the reasons behind missed care, which encompass labor resources, material resources, communication factors, and managerial factors. Remarkably, the Cronbach's α coefficient for the MINCS stands at an impressive 0.951, with S-CVI values of 0.988 and 0.977 in Part B and C, respectively, underscoring the scale's exceptional reliability and validity. This demonstrates the scale's effectiveness in measuring missed nursing care while upholding rigorous standards of quality.

CONCLUSIONS

The MINCS emerges as a robust and dependable instrument for quantifying instances of missed care within the ICU. Its efficacy makes it a valuable resource for informing the development of strategies aimed at averting and mitigating the adverse effects associated with missed nursing care.

A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review

The coronavirus disease 2019 (COVID-19) pandemic has placed unparalleled pressure on many countries' healthcare systems, impacting the delivery of health and nursing care services. Despite the growing number of missed care studies during the pandemic, a broader perspective is essential when designing theory-driven strategies to improve nursing care delivery. This review aimed to synthesize evidence of missed nursing care during the COVID-19 pandemic in acute care settings through a systematic review and narrative synthesis. An electronic search of articles published since the emergence of the pandemic was conducted using 5 databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO). A total of 470 articles were identified during the initial search, and 10 articles were included in the review. The sample sizes of the studies ranged from 37 to 536 nurses. Results of the content analysis were grouped into 5 categories: (1) prevalence of missed care, (2) frequency of missed care, (3) reasons for missed care, (4) nurses' and organizational variables contributing to missed care, and (5) work environment elements contributing to missed care. The review's findings revealed a shift in the nature of missed nursing care during the pandemic, with an emphasis on nursing care tasks vital for the recovery of patients with COVID-19. Despite the unique circumstances brought about by the pandemic, an inadequate nursing workforce continued to be identified as the primary reason for missed care, consistent with the pre-pandemic period.

Research on missed nursing care during the COVID-19 pandemic: A scoping review

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.

Nurse-led speech therapist referral initiative for older adult patients at risk of dysphagia: a best practice implementation project

INTRODUCTION AND OBJECTIVES

Dysphagia is common among older patients, affecting their nutritional status, hospital readmission, length of hospital stay, and hospitalization costs. Nurses can play a key role in early identification of dysphagia through systematic screening. This project sought to (i) achieve 80% compliance among nurses in using the 4-point questionnaire test (4QT) swallow screening test on patients and (ii) ensure all patients screening positive for dysphagia were referred to a speech therapist within 1 day.

METHODS

A short swallow screening tool was adapted from an evidence-based screening tool, the 4QT, by a team of speech therapists, a geriatrician, and a geriatric trained nurse. Ward nurses were then trained on using the tool to screen older patients upon admission or transfer to another ward. The project used the JBI Evidence Implementation Framework, which involved pre and post audits and feedback to evaluate compliance with best practice.

RESULTS

Compliance increased in the use of the short swallow screening tool, rising from 64% ( n  = 25) in the baseline audit to 71% ( n  = 34) in the follow-up audit. However, there was a decrease in the referral of patients who screened positive for dysphagia to speech therapists, with the rate dropping from 92% ( n  = 12) to 86% ( n  = 12). All patients ( n  = 12) from both baseline and follow-up audits were referred to a speech therapist within 1 day of admission/transfer post-implementation compared with 70% ( n  = 7) at pre-implementation.

CONCLUSIONS

This project applied evidence-based recommendations to clinical practice and improved patient outcomes. The nurses facilitated timely referrals to speech therapists for further assessment and intervention, which was useful in the clinical context. The nurses continue to use the screening tool routinely to prevent dysphagia complications among geriatric patients.

Nurse managers' support of fundamental care in the hospital setting. An interpretive description of nurse managers' experiences across Australia, Denmark, and New Zealand

AIMS

To explore the role of ward-based nurse managers in supporting nurses to undertake high-quality fundamental care.

DESIGN

A qualitative study guided by the principles of interpretive description. Reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ).

METHODS

Nurse managers in three urban, publicly funded hospitals in Australia, Denmark and New Zealand, were invited to participate in group interviews to discuss how they support fundamental care in their clinical areas. Six group interviews were conducted between February 2017 and March 2020 involving 31 participants.

RESULTS

Six interrelated themes were identified: Difficulty expressing how to support the nurse-patient relationship; Establishing expectations for care delivery without clear strategies for how this can be achieved; Role modelling desired behaviours; Significance of being present to support care quality; The importance of engaging and supporting staff in their work; and Recognizing the challenges of prioritizing care needs.

CONCLUSION

This study indicates that nurse managers are not universally clear in explaining how they support their staff to provide fundamental care. If fundamental care is not clearly understood and communicated in the nursing team, then there are risks that fundamental care will not be prioritized, with potential negative consequences for patient care. Nurse managers may benefit from additional resources and guidance to help them to support fundamental care delivery in their clinical areas.

IMPACT

Previous research exploring fundamental care and missed care highlights the importance of the role of the nurse manager in influencing nursing care. This study demonstrates that though nurse managers have a passion for supporting their staff to deliver fundamental care, clear strategies to achieve this are not always evident. This study suggests that scholarship around leadership to promote and facilitate fundamental care is crucial to improving nursing practice and patient outcomes.

Validation of the Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care, a Swedish version

AIM

The aim of the study was to translate, adapt and validate the instrument Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care for use in the Swedish community health care context.

DESIGN

A cross-sectional study. Data were collected from October 2019 to January 2020, and the questionnaire was sent to Registered Nurses, Enrolled Nurses and assistant nurses.

METHODS

The study was performed in four phases: (1) translation, (2) adaptation of the Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care to the Swedish context, (3) content validity testing, and (4) evaluation of psychometric properties. The collected data resulted in 611 responses. Explorative factor analysis was performed to explore the interrelationship, and Cronbach's alpha was used to evaluate the internal consistency.

RESULTS

Explorative factor analysis presented six factors/subscales: (1) fundamental care, (2) timely needed-based care, (3) dignity and support, (4) ensuring respectful treatment, (5) social activities, and (6) documentation, planning and reporting. The Cronbach's alpha for the components showed values between 0.7 and 0.9.

CONCLUSION

The analyses indicate an instrument to be usable for Enrolled Nurses and nurse assistants in community health care. Additional tests, can contribute to refining the content of the items and further test reliability and validity of the instrument.

NO PATIENT OR PUBLIC CONTRIBUTION

As this is a study of translation and validation of the instrument Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care.

Effect of role overload on missed nursing care in China: The role of work addiction and leader-member exchange

AIM

The aim was to examine the effect of role overload, work addiction and leader-member exchange on missed nursing care.

DESIGN

A cross-sectional study.

METHODS

Chinese registered nurses from five Sichuan province public hospitals were studied from March 2022-May 2022. The measurements were derived from a questionnaire on role overload, work addiction, missed nursing care, leader-member exchange and a sociodemographic datasheet. Descriptive statistics and inferential statistics were conducted (N = 403).

RESULTS

Role overload was associated with missed nursing care, and work addiction played a mediation role. Leader-member exchange negatively predicted work addiction and played a moderating role between role overload and work addiction. The effect of role overload on work addiction was attenuated when the level of leader-member exchange was higher. Promoting leader-member exchange could mitigate how role overload undermines missed nursing care.

Missed nursing care in hospital environments during the COVID-19 pandemic

BACKGROUND

Studies performed in Central European countries showed a high prevalence of missed nursing care in various clinical settings before the COVID-19 pandemic.

AIMS

The aim of the study was to investigate which domains of the work environment were significant predictors of missed nursing care activities in Czech hospitals during the COVID-19 pandemic.

METHODS

A cross-sectional study was used. The RANCARE guideline and STROBE checklist were followed for reporting in the study. The sample consisted of 371 nurses from four acute care hospitals. The MISSCARE Survey and the Practice Environment Scale of the Nursing Work Index questionnaires were used to collect data. The data were analyzed using multiple linear and logistic regression analyses.

RESULTS

Nurses reporting unfavorable environments consistently describe a higher frequency of episodes of missed care. Prevalence estimates of missed care in Czech acute care hospitals during the COVID-19 pandemic was predicted from the overtime work, the nurses' perception of the "Nursing foundations for the quality of care," and their satisfaction with their current position.

CONCLUSIONS

Missed nursing care could be mitigated by improving the nurses' work environment. Domains of the nurse work environment are known as structural modifiable factors and their refinement could be a cornerstone for interventions to reduce the prevalence of missed nursing care.

IMPLICATIONS FOR NURSING POLICY

Monitoring the conditions and aspects of the nurse work environment in hospitals and considering nurses' concerns about the work environment on an ongoing basis are important strategies for nurse supervision as well as for policymakers.

A scoping review-Missed nursing care in community healthcare contexts and how it is measured

Aim

To examine the extent and nature of missed nursing care in elderly care in community healthcare contexts from the perspective of healthcare staff, and to identify instruments used to measure missed nursing care and the content of these instruments.

Design

Scoping review.

Methods

Searches were conducted in the CINAHL, PubMed, Scopus and Google Scholar databases in March 2020. The selection process followed the PRISMA flow diagram.

Results

Sixteen research papers were found from nine countries. The instruments used in the studies were Basel Extent of Rationing of Nursing Care for nursing homes (BERNCA‐NH), modified MISSCARE survey and study‐specific instruments or items. The item content differed, as did the number of items, which was between one and 44. The studies reported values for missed nursing care, as well as described reasons for and/or the relation between missed nursing care and organization, working climate and patient outcomes.