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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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Sist L, Chiappinotto S, Messina R, Rucci P, Palese A. The Reasons for Unfinished Nursing Care during the COVID-19 Pandemic: An Integrative Review. NURSING REPORTS 2024; 14:753-766. [PMID: 38651470 PMCID: PMC11036286 DOI: 10.3390/nursrep14020058] [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: 01/24/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Background: The concept of unfinished nursing care (UNC) describes nursing interventions required by patients and families that nurses postpone or omit. UNC reasons have been documented; however, no studies have summarised the underlying factors triggering the UNC during the pandemic. Therefore, the aim was to synthesise the available studies exploring factors affecting UNC during a pandemic. Methods: We conducted an integrative review following Whittemore and Knafl's framework according to the Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Scopus databases were searched for primary studies that collected data from 1 January 2020 to 1 May 2023. Both qualitative and quantitative studies assessing the reasons for UNC were eligible and evaluated in their quality using the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool. Results: Four studies were included-three qualitative and one cross-sectional. The reasons for UNC have been documented at the following levels: (a) system (e.g., new healthcare system priorities); (b) unit (e.g., ineffective work processes); (c) nurse management (e.g., inadequate nurse manager's leadership); (d) nurse (e.g., nurses' attitudes, competences, performances); and (e) patient (increased demand for care). Conclusion: The reasons for UNC during the COVID-19 pandemic are different to those documented in the pre-pandemic times and reflect a pre-existing frailty of the National Health Service towards nursing care.
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Affiliation(s)
- Luisa Sist
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy; (L.S.); (R.M.); (P.R.)
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy; (L.S.); (R.M.); (P.R.)
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy; (L.S.); (R.M.); (P.R.)
| | - Alvisa Palese
- Department of Medicine, University of Udine, 33100 Udine, Italy;
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Bayram A, Chiappinotto S, Palese A. Unfinished nursing care in healthcare settings during the COVID-19 pandemic: a systematic review. BMC Health Serv Res 2024; 24:352. [PMID: 38504283 PMCID: PMC10949800 DOI: 10.1186/s12913-024-10708-7] [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: 11/02/2023] [Accepted: 02/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Unfinished nursing care is becoming increasingly more of a concern in worldwide healthcare settings. Given their negative outcomes, it is crucial to continuously assess those nursing interventions that are commonly postponed or missed, as well as the underlying reasons and consequences. The worldwide COVID-19 pandemic has made it difficult for health facilities to maintain their sustainability and continuity of care, which has also influenced the unfinished nursing care phenomenon. However, no summary of the studies conducted during the COVID-19 pandemic was produced up to now. The main aim of this study was to systematically review the occurrence of, reasons for, and consequences of unfinished nursing care among patients in healthcare settings during the COVID-19 pandemic. METHODS Systematic review registered in PROSPERO (CRD42023422871). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline and the Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies were used. MEDLINE-PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from March 2020 up to May 2023, using keywords established in the field as missed care, unfinished nursing care, or implicit rationing. RESULTS Twenty-five studies conducted mainly in European and Asiatic countries were included and assessed as possessing good methodological quality. The following tools were used: the MISSCARE Survey (= 14); the Basel Extent of Rationing of Nursing Care (= 1), also in its revised form (= 2) and regarding nursing homes (= 2); the Perceived Implicit Rationing of Nursing Care (= 4); the Intensive Care Unit-Omitted Nursing Care (= 1); and the Unfinished Nursing Care Survey (= 1). The order of unfinished nursing care interventions that emerged across studies for some countries is substantially in line with pre-pandemic data (e.g., oral care, ambulation). However, some interesting variations emerged at the country and inter-country levels. Conversely, labour resources and reasons close to the emotional state and well-being of nurses were mentioned homogeneously as most affecting unfinished nursing care during the pandemic. None of the studies investigated the consequences of unfinished nursing care. CONCLUSIONS Two continents led the research in this field during the pandemic: Europe, where this research was already well established, and Asia, where this research is substantially new. While unfinished care occurrence seems to be based on pre-established patterns across Europe (e.g., regarding fundamentals needs), new patterns emerged across Asiatic countries. Among the reasons, homogeneity in the findings emerged all in line with those documented in the pre-pandemic era.
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Affiliation(s)
- Aysun Bayram
- Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | | | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy
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Labrague LJ, T Kostovich C. A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review. West J Nurs Res 2024; 46:133-142. [PMID: 38014816 DOI: 10.1177/01939459231214598] [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: 11/29/2023]
Abstract
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.
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Affiliation(s)
- Leodoro J Labrague
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Carol T Kostovich
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
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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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Chiappinotto S, Bayram A, Grassetti L, Galazzi A, Palese A. Were the unfinished nursing care occurrence, reasons, and consequences different between COVID-19 and non-COVID-19 patients? A systematic review. BMC Nurs 2023; 22:341. [PMID: 37759199 PMCID: PMC10523650 DOI: 10.1186/s12912-023-01513-4] [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: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Unfinished Nursing Care (UNC) has been documented also during the Coronavirus (COVID-19) pandemic; however, while several secondary studies were conducted before this period to summarise occurrences, reasons, and consequences of UNC and provide a global picture of the phenomenon, no synthesis of the evidence produced during the pandemic has been documented to date. Therefore, the aim of this review is to identify differences, if any, in the UNC occurrence, reasons, and consequences perceived by nurses caring for COVID-19 and non-COVID-19 patients. METHODS This study is a systematic review (PROSPERO CRD42023410602). According to the Population, Exposure, Comparator, and Outcomes framework, primary comparative cross-sectional, longitudinal, and cohort studies, randomised/non-randomised controlled trials were included from Medline, CINAHL, and Scopus, collecting perceptions of nurses with tools measuring UNC between COVID-19 and non-COVID-19 patients and published in English, Italian, or Turkish. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Johanna Briggs Quality Appraisal Tool were used, and findings were summarised narratively. RESULTS Five hospital-based cross-sectional studies using the self-administered MISSCARE and UNC Survey comparing data collected (a) before the pandemic vs. in the first wave; (b) before, in the second and in the third wave; and (c) simultaneously among COVID-19 and non-COVID-19 patients in the second wave. Three main patterns emerged suggesting a higher UNC occurrence among COVID-19 patients in the first wave, less occurrence among them compared to non-COVID-19 patients in the second wave, and contrasting findings with some in favour and others in contrast to COVID-19 patients. Similar patterns emerged regarding UNC reasons while no studies investigated the UNC consequences. CONCLUSIONS In the first wave, COVID-19 patients were likely to be at increased risk of UNC, while in later waves non-COVID-19 patients were at increased risk of UNC. Reasons also were different across waves. Findings documented during the COVID-19 pandemic may help to prevent UNC in future disasters.
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Saravanan P, Nisar T, Zhang Q, Masud F, Sasangohar F. Occupational stress and burnout among intensive care unit nurses during the pandemic: A prospective longitudinal study of nurses in COVID and non-COVID units. Front Psychiatry 2023; 14:1129268. [PMID: 36993929 PMCID: PMC10040835 DOI: 10.3389/fpsyt.2023.1129268] [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: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
Background Intensive care unit (ICU) nurses are highly prone to occupational stress and burnout, affecting their physical and mental health. The occurrence of the pandemic and related events increased nurses' workload and further exacerbated their stress and burnout. This work investigates occupational stress and burnout experienced by ICU nurses working with COVID and non-COVID patients. Method A prospective longitudinal mixed-methods study was conducted with a cohort of ICU nurses working in medical ICU (COVID unit; n = 14) and cardiovascular ICU (non-COVID unit; n = 5). Each participant was followed for six 12-h shifts. Data on occupational stress and burnout prevalence were collected using validated questionnaires. Physiological indices of stress were collected using wrist-worn wearable technologies. Participants elaborated on the causes of stress experienced each shift by completing open-ended questions. Data were analyzed using statistical and qualitative methods. Results Participants caring for COVID patients at the COVID unit were 3.71 times more likely to experience stress (p < 0.001) in comparison to non-COVID unit participants. No differences in stress levels were found when the same participants worked with COVID and non-COVID patients at different shifts (p = 0.58) at the COVID unit. The cohorts expressed similar contributors to stress, based in communication tasks, patient acuity, clinical procedures, admission processes, proning, labs, and assisting coworkers. Conclusion Nurses in COVID units, irrespective of whether they care for a COVID patient, experience occupational stress and burnout.
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Affiliation(s)
- Pratima Saravanan
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Tariq Nisar
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Qian Zhang
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Faisal Masud
- Department of Anesthesiology and Critical Care, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, United States
| | - Farzan Sasangohar
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
- Department of Industrial and Systems Engineering, Texas A&M College of Engineering, Texas A&M University, College Station, TX, United States
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One Word to Describe My Experience as a COVID-19 Survivor Six Months after Its Onset: Findings of a Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094954. [PMID: 35564348 PMCID: PMC9106002 DOI: 10.3390/ijerph19094954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/05/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic emotionally affected the lives of patients cared for in different settings. However, a comprehensive view of the whole experience as lived by survived patients, from the onset of the disease and over time, is substantially unknown to date. A descriptive qualitative design was implemented according to the Standards for Reporting Qualitative Research. Adult patients (=1067) cared for during the first wave (March/April 2020) capable of answering an interview and willing to participate were interviewed (=397) by phone with an interview guide including open- and closed-ended questions. In this context, they were asked to summarise with a metaphor their entire COVID-19 experience at six months. Then, the emotional orientation (positive, neutral, or negative) of the metaphors expressed was identified. The participants were mainly female (206; 51.9%), with an average age of 52.6 years (CI 95% 50.4–53.6), reporting a mild severity of COVID-19 disease at the onset (261; 65.7%) and the perception of being completely healed (294; 70%) at six months. The patients summarised their experiences mainly using negative-oriented (248; 62.5%) metaphors; only 54 (13.6%) reported positive-oriented metaphors and a quarter (95; 23.95) neutral-oriented metaphors. Nearly all positive-oriented metaphors were reported by patients with symptoms at the onset (53; 98.1%), a significantly higher proportion compared to those reporting negative- (219; 88.3%) and neutral–oriented (78; 82.1%) metaphors (p = 0.014). While no other clinical features of the disease were associated, among females, significantly more negative-oriented metaphors emerged. Moreover, neutral-oriented metaphors were reported by younger patients (49.5 years, CI 95% 64.11–52.92) as compared to those negative and positive that were reported by more mature patients (53.9; CI 95% 52.04–55.93 and 54.8; CI 95% 50.53–59.24, respectively) (p = 0.044). Nurses and healthcare services require data to predict the long-term needs of patients. Our findings suggest that, for many patients, the COVID-19 lived experience was negative over time.
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