Measurement tools used to assess unfinished nursing care: A systematic review of psychometric properties

Care quality and safety in long-term aged care settings: A systematic review and narrative analysis of missed care measurements

AIM

To critically evaluate missed care measurement approaches and their application in long-term aged care (LTAC) settings.

DESIGN

Systematic review using Tawfik's guideline.

DATA SOURCES

PubMed, Scopus, Web of Science, CINAHL and ProQuest were searched. Supplemental searching was from reference lists of retrieved records, first authors' ORCID homepages and Google advanced search for grey literature. Search limitations were English language, published between 1 January 2001 and 31 December 2022.

REVIEW METHOD

COVIDENCE was utilized for screening, data extraction and quality appraisal. JBI Critical Appraisal Tools and COSMIN Risk of Bias Tool were used for quality appraisal. Data were summarized and synthesized using narrative analysis.

RESULTS

Twenty-four publications across 11 regions were included, with two principal methods of missed care measurement: modified standard scales and tailored specific approaches. They were applied inconsistently and generated diverse measurement outcomes. There were challenges even with the most commonly used tool, the BERNCA-NH, including absence of high-quality verification through comparative analysis against an established 'gold standard', reliance on self-administration, incomplete assessment of constructs and inadequate exploration of psychometric properties.

CONCLUSION

Globally, there are deficiencies in the effectiveness and comprehensiveness of the instruments measuring missed care in LTAC settings. Further research on theoretical and practical perspectives is required.

IMPLICATIONS

Findings highlighted a critical need to establish a standardized, validated approach to measure missed care in LTAC settings. This review calls for collaborative efforts by researchers, clinical staff and policymakers to develop and implement evidence-based practices as a way of safeguarding the well-being of older clients living in LTAC settings.

IMPACT

Measurements of missed care in LTAC settings rely on adapting acute care tools. There is a critical gap in measuring missed care in LTAC settings. Developing a new tool could improve care quality and safety in LTAC settings globally.

REPORTING METHOD

Adhered to PRISMA guideline.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The association of teamwork and missed nursing care in acute care setting: A mixed-methods systematic review

AIM(S)

Teamwork among healthcare professionals is a key aspect of patient safety that influences the prevalence of missed nursing care. The association between teamwork and missed care in acute care hospitals is now well established in the literature. Therefore, this review aimed to synthesise the existing empirical evidence on the association between teamwork and missed care in the acute care setting.

DESIGN

A mixed-method systematic review study.

METHODS

The search was carried out in February 2023 in four scientific databases, PubMed, ProQuest, Web of Science and Scopus based on their institutional availability. The search produced 1542 studies. The method of thematic analysis was used in data synthesis.

RESULTS

A total of 18 studies were selected that revealed the relationship between teamwork and missed care. The teamwork score was weak to moderate but significantly associated with the overall score of missed care and was found to be a statistically significant predictor of missed care in an acute care setting. Additionally, teamwork represented an important reason for missed care, primarily in the context of poor communication, lack of trust and cooperation in the nursing team and lack of leadership.

CONCLUSION

The review findings contribute to a deeper understanding of the intricate dynamics between teamwork and missed care and provide valuable information to healthcare professionals and institutions looking to optimise teamwork and mitigate instances of missed care in the acute care setting.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Recognising how teamwork influences the occurrence of missed care, healthcare organisations can strategically implement targeted interventions to enhance collaboration, address communication gaps, foster trust, and provide effective leadership.

IMPACT

This review suggests that improving teamwork seems to be one of the most important strategies focused on mitigating missed care in acute care settings.

REPORTING METHOD

The reporting of this review followed the PRISMA 2020 checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Effects of the nursing practice environment, nurse staffing, patient surveillance and escalation of care on patient mortality: A multi-source quantitative study

BACKGROUND

A favourable nursing practice environment and adequate nurse staffing have been linked to reduced patient mortality. However, the contribution of nursing care processes such as patient surveillance and escalation of care, on patient mortality is not well understood.

OBJECTIVE

The aim of this study was to investigate the effect of the nursing practice environment, nurse staffing, missed care related to patient surveillance and escalation of care on 30-day inpatient mortality.

DESIGN

A multi-source quantitative study including a cross-sectional survey of nurses, and retrospective data extracted from an audit of medical and admission records.

SETTING(S)

A large tertiary teaching hospital (600 beds) in metropolitan Sydney, Australia.

METHODS

Data on the nursing practice environment, nurse staffing and missed care were obtained from the nursing survey. Patient deterioration data and patient outcome data were collected from the medical and admission records respectively. Logistic regression models were used to examine the association between the nursing practice environment, patient deterioration and 30-day inpatient mortality accounting for clustering of episodes within patients using generalised estimating equations.

RESULTS

Surveys were completed by 304 nurses (84.5 % female, mean age 34.4 years, 93.4 % Registered Nurses) from 16 wards. Patient deterioration data was collected for 30,011 patient deterioration events and 63,847 admitted patient episodes of care. Each additional patient per nurse (OR = 1.22, 95 % CI = 1.04-1.43) and the presence of increased missed care for patient surveillance (OR = 1.13, 95 % CI = 1.03-1.23) were associated with higher risk of 30-day inpatient mortality. The use of a clinical emergency response system reduced the risk of mortality (OR = 0.82, 95 % CI = 0.76-0.89). A sub-group analysis excluding aged care units identified a 38 % increase in 30-day inpatient mortality for each additional patient per nurse (OR = 1.38, 95 % CI = 1.15-1.65). The nursing practice environment was also significantly associated with mortality (OR = 0.79, 95 % CI: 0.72-0.88) when aged care wards were excluded.

CONCLUSIONS

Patient mortality can be reduced by increasing nurse staffing levels and improving the nursing practice environment. Nurses play a pivotal role in patient safety and improving nursing care processes to minimise missed care related to patient surveillance and ensuring timely clinical review for deteriorating patients reduces inpatient mortality.

TWEETABLE ABSTRACT

Patient mortality can be reduced by improving the nursing practice environment & increasing the number of nurses so that nurses have more time to monitor patients. Investing in nurses results in lower mortality and better outcomes. #PatientSafety #NurseStaffing #WorkEnvironment #Mortality.

Unmet care needs in psychiatric healthcare context: A systematized literature review

WHAT IS KNOWN ON THE SUBJECT

Missed, rationed or unfinished nursing care represents a global problem that jeopardizes the provision of quality and safe care. This phenomenon is frequently observed in adult, paediatric and child healthcare facilities and various care units.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

The findings of this review contribute valuable information to inform evidence-based practices, foster organizational improvements and ultimately optimize the overall quality of care in psychiatric healthcare settings. In addition, the review illuminates the far-reaching consequences of care on both patient and nurse outcomes, emphasizing the urgent need for tailored strategies to mitigate these effects.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Based on the synthesis of the literature, a thorough and continuous assessment of patient care needs in the physical, psychological and social domains is needed, primarily utilizing standardized instruments designed for psychiatric settings to ensure a comprehensive understanding of unmet needs. Based on identified unmet needs, nurses should develop individualized care plans and tailor interventions to address them. In addition, nurse managers must adopt and implement regular monitoring mechanisms to track the prevalence of unmet care needs and at the same time establish reporting systems that capture the proportion of unmet needs, allowing timely interventions and adjustments to care delivery. Lastly, nurse managers must not only emphasize the importance of ethical care practices and dignity-focused interventions but also educate healthcare providers, especially nurses, on the potential threats to patient dignity arising from unmet care needs.

ABSTRACT

INTRODUCTION: Despite frequent observations of unmet care needs in acute care adult settings, there are a limited number of studies that focus on investigating this phenomenon in the psychiatric setting.

AIM

To synthesize the existing empirical research on unmet care needs in psychiatric healthcare settings.

METHODS

The search was carried out in August 2023 in four scientific databases, PubMed, ProQuest, Web of Science and OVID Nursing, based on their institutional availability. The search produced 1129 studies. The search and retrieval process reflected the recommendations of the Preferred Reporting Items for systematic reviews and meta-analyses.

RESULTS

This review included 14 studies investigating unmet care needs in the psychiatric healthcare setting. Unmet care needs included three domains: physical, psychological and social. The analysis of the factors revealed factors related to the characteristics of the organization, nurse and patient.

DISCUSSION

The classification of unmet needs provides a comprehensive understanding of the various challenges facing people in psychiatric healthcare settings.

IMPLICATION FOR PRACTICE

Identified factors that influence the occurrence of unmet care needs will help prevent the occurrence of unmet care needs and timely assessment. The resolution of needs helps to achieve patient and nurse outcomes, increase the quality of care provided and patient satisfaction in a psychiatric healthcare setting.

Missing nurses cause missed care: is that it? Non-trivial configurations of reasons associated with missed care in Austrian hospitals - a qualitative comparative analysis

BACKGROUND

Errors of omissions affect the quality of nursing care in hospitals. The Missed Nursing Care Model explains that the reasons for missed care are linked with 1) demand for patient care, 2) labor resource allocation, 3) material resource allocation, and 4) relationship and communication factors. Scientific evidence points to a lack of adequate nursing staffing as the most important factor triggering missed care. However, it remains unclear how the different theoretical reasons for missed care are interlinked with reports on missed care from the perspective of nurses in acute care settings. The aim of this study was to explore non-trivial configurations of reasons for missed care that are associated with missed care interventions from the perspective of nurses working in general units in Austrian hospitals.

METHODS

A cross-sectional study was conducted. Data collection was performed using the revised MISSCARE-Austria questionnaire. Our sample consisted of 401 nurses who provided complete data. Data were analyzed using qualitative comparative analysis. Configurational models of contextual factors, reasons for missed care, and missed nursing interventions were analyzed.

RESULTS

In our study contextual factors were not consistent precursors of the reasons for missed care. Missed care was consistently present when the demand for patient care was high. A lack of labor resources, in combination with the other known reasons for missed care, was consistently observed when missed care occurred. Different configurations of reasons were found to be non-trivially associated with different types and frequencies of missed care.

CONCLUSIONS

To understand the complexity of the causal mechanisms of missed care, complexity theory may be necessary. Accordingly, a theoretical framework that acknowledges that complex systems, such as missed care, are composed of multiple interacting causal components must be further developed to guide new methodical approaches to enlighten its causal mechanisms.

Exploring the nexus between the standardized nursing terminologies and the unfinished nursing care phenomenon: An empty systematic review

PURPOSE

To identify and synthesize evidence regarding the documented relationship between the standardized nursing terminologies and the unfinished nursing care phenomenon.

DATA SOURCES

A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature Complete databases were last consulted on November 27, 2023. The review included primary quantitative studies that reported an association between recognized standardized nursing terminologies and unfinished nursing care. Two researchers completedtitle and abstract and full-text screening.

DATA SYNTHESIS

Our search identified 149 citations. A full-text review of one paper was undertaken. No studies met our inclusion criteria. We report an empty review.

CONCLUSIONS

Standardized nursing terminologies and Unfinished Care are two sides of the same coin: despite their potential commonalities, no studies have documented their potential links. Digital systems, such as electronic health records and decision support systems, could foster this linkage.

IMPLICATIONS FOR NURSING PRACTICE

This review suggests that linking the conceptual frameworks can promote the diffusion of standardized nursing terminologies in clinical practice and increase accuracy in the measurement of Unfinished Care. This synergy could promote the contribution of nursing knowledge to patient care, nursing visibility, and be beneficial to clinical nurses, managers, and healthcare systems to international level.

Unfinished nursing care in healthcare settings during the COVID-19 pandemic: a systematic review

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.

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.

Missed nursing care: A cross-sectional and multi-centric study from Turkey

AIM

The aim of this study is to explore the extent of missed nursing care in Turkey and identify its predictors.

DESIGN

This was a descriptive, cross-sectional, multicentre study.

METHODS

A total of 477 nurses working in seven public hospitals participated in this study from March to July 2019. The survey included two components: a personal and professional characteristics data form and the MISSCARE survey.

RESULTS

The study revealed that emotional support, patient bathing and ambulation were the most frequently missed nursing care activities. An inadequate number of assistive personnel and staff, along with an unexpected increase in patient volume, were identified as the primary reasons for missed nursing care. Of the 21 missed nursing care activities, nine predictive models showed statistical significance (p < 0.05). Factors such as the type of unit, years of work experience, working hours, number of patients cared for in a shift and intention to leave the unit were found to be significant predictors of seven missed nursing care activities (p < 0.05).

CONCLUSION

This study found that numerous variables influence each care activity, which suggests the need to devise more targeted and specific strategies to minimize missed nursing care. Thorough investigation into the impact of these strategies on each care activity is essential.

Were the unfinished nursing care occurrence, reasons, and consequences different between COVID-19 and non-COVID-19 patients? A systematic review

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.

External influencing factors on missed care in Austrian hospitals: Testing the theoretical antecedents of missed care using structural equation modelling

PROBLEM

Missed Nursing Care (MNC) is an error of omission which occurs when a necessary nursing intervention is not initiated, is not completed, or when it is delayed. The MNC model explains this problem and describes four antecedents that can lead to MNC: (1) demand for patient care, (2) available human resources, (3) material resources, and (4) and relationship and communication factors.

AIMS

This study aims to test the relationship between the theoretical antecedents of MNC and their impact on MNC.

DESIGN

A quantitative cross-sectional study.

METHODS

The Austrian version of the revised MISSCARE Survey was completed by nurses working in general hospital units between May and July 2021. Recruitment followed a respondent-driven sample via Austrian nursing education institutions and social media. One thousand six nurses fulfilled inclusion criteria. The structure of the theoretical constructs of the MNC model was tested using a confirmatory factor analysis approach. The relationships between the four antecedents and MNC were explored using structural equation modelling with 427 complete cases.

RESULTS

The results support the structural validity of the revised MISSCARE Austria concerning the defined theoretical constructs, although discriminant validity and measurement error should be further investigated. The antecedent "resource allocation: labor" had a statistically significant impact on MNC: The lack of adequate nursing staff played the most important role to explain missed care in our model.

CONCLUSION

In our study in Austria, MNC was mostly influenced by a lack of appropriate labor resources. Further studies exploring mediation effects and non-linear relationships may contribute to better understanding of reasons for MNC.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Validation and psychometric properties of the Persian version of the MISSCARE survey

AIM

To conduct, translate, and psychometric evaluation of the MISSCARE-Persian Survey.

DESIGN

A cross-sectional study was conducted in Iran in February-June 2021.

METHODS

The translation of the MISSCARE Survey was accomplished according to World Health Organization (WHO) guidelines. Construct validity was performed by (N = 300) exploratory factor analysis and confirmation. To assess the reliability, internal consistency was assessed using Cronbach's alpha coefficient, and relative stability was assessed using the interclass correlation coefficient (ICC). The study adhered to COSMIN guidelines.

RESULTS

The exploratory factor analysis, which resulted in the identification of three factors in the second part of the tool, explained 79.6% of the total variance. Confirmatory factor analysis indicated the model's good fit of information. The reliability of the first and second parts of the tool was 0.912 and 0.901, respectively. Additionally, the ICC was found to be 0.687 for the first and 0.706 for the second part of the tool.

Missed Nursing Care in Medical and Surgical Wards in Jordan: A Cross-Sectional Study

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.

A Danish version of the MISSCARE survey: Translation and validation

BACKGROUND

Measuring missed nursing care in clinical settings may serve as an important indicator for improving patient safety and nursing staff retention. Internationally, several tools exist, with the MISSCARE Survey being the most frequently used and validated; however, no tools are available in the Danish language.

AIM

This study aimed at translating the MISSCARE Survey from US English to Danish and evaluate its psychometric properties.

METHODS

The translation followed the recommended method, that is forward-and-backward translation, involving clinical experts and a professional, native English-speaking translator. The final version was approved by the survey's original developer. Face validity was tested among 10 nurses and 1 practical nurse. Nursing staff from 34 selected departments at Aarhus University Hospital's (n = 1241) were invited to participate in a pilot test in November 2020. The survey consisted of a demographic section, a section of 'nursing elements' (Part A) and section of 'reasons' (Part B). Acceptability was assessed on Part A and B. Reliability was tested by Cronbach's alpha, and psychometric properties were investigated using Confirmatory Factor Analysis (Part B).

RESULTS

The face-validity test resulted in minor contextual changes and the addition of a 'not applicable' response option in Part A. The pilot test had a 42.6% response rate (n = 529). Acceptability was good, with 1-10 missing responses per item in Part A and 0-20 missing responses in Part B. The numbers of 'not applicable' responses ranged from 0 to 81. The overall Cronbach's alpha was 0.81. Factor-loading ranges were 0.62-0.48 for 'communication', 0.79-0.39 for 'materials and resources', and 0.50-0.35 for 'labour', suggesting an acceptable fit with the theoretical model.

CONCLUSION

The MISSCARE Survey was successfully translated into Danish. The psychometric properties confirmed the questionnaire as a valid and reliable tool for measuring missed nursing care in Danish hospital settings.

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.

Clinical nurses' patient safety competency, systems thinking and missed nursing care: A cross-sectional survey

AIM

The aim of this study was to examine the relationships among patient safety competency, systems thinking and missed nursing care.

BACKGROUND

Patient safety competency and systems thinking are important nurse attributes that promote patient safety. Missed nursing care is known to negatively impact patient safety. However, how nurses' patient safety competency and systems thinking relate to missed nursing care is unknown.

METHODS

A cross-sectional survey design was used to collect data from nurses practicing in two general hospitals in South Korea. Data were collected between 3 March and 17 April 2020. Questionnaires were distributed to nurses providing direct care in general and specialty units. Patient safety competency, systems thinking and missed nursing care were measured using reliable and valid instruments. A total of 432 complete sets of data were used in final analysis.

RESULTS

Higher patient safety competency of nurses was associated with lower missed nursing care. Systems thinking partially mediated the relationship between knowledge of patient safety competency and missed nursing care, and attitudes of patient safety competency and missed nursing care.

CONCLUSIONS

The knowledge, skills and attitudes sub-scales of patient safety competency showed somewhat different effects in the relationship between missed nursing care and systems thinking, suggesting that each attribute may tap into a separate aspect of patient safety.

Occurrence and reasons for unfinished nursing care between COVID-19 and non-COVID-19 patients

AIM

To compare the occurrence and the reasons for unfinished care among coronavirus disease (COVID-19) and non-COVID-19 patients as perceived by nurses.

BACKGROUND

The recent pandemic has imposed tremendous changes in hospitals in all countries.

INTRODUCTION

Investigating the occurrence of and the reasons for unfinished care as perceived by nurses working in COVID-19 and non-COVID-19 units might help to gain insights and to address future pandemics.

METHODS

A comparative cross-sectional study based on the STROBE guideline has been conducted during November 2020-January 2021. The Unfinished Nursing Care Survey, comprising part A (elements) and part B (reasons), was administered online to all 479 nurses working in medical and surgical units converted progressively into COVID-19 and non-COVID-19 units. A total of 90 and 200 nurses participated, respectively.

RESULTS

No differences in the unfinished care occurrence have emerged at the overall level between nurses caring for COVID (2.10 out of 5; 95% confidence interval [CI], 1.94-2.27) and non-COVID-19 patients (2.16; 95% CI, 2.06-2.26). Reasons for unfinished care reported significant higher averages among nurses caring for COVID (2.21; 95% CI, 2.10-2.31) as compared with those caring for non-COVID-19 patients (2.07; 95% CI, 2.01-2.14; p = 0.030).

DISCUSSION

The overall occurrence of unfinished care was slightly higher compared with pre-pandemic data in all patients.

CONCLUSIONS

Reasons triggering unfinished care were slightly different and were due to priority setting and human resources issues, which were perceived at higher significance among nurses working in COVID-19 compared with non-COVID-19 units.

IMPLICATION FOR NURSING AND HEALTH POLICIES

A clear map of action has emerged that might be valid in the post-COVID-19 era as well as in the case of future pandemics.

Unfinished Nursing Care Survey for Students (UNCS4S): A multicentric validation study

BACKGROUND

Unfinished Nursing Care (UNC) indicates required interventions that are delayed or omitted. Nursing students are also exposed to UNC during their clinical rotations. However, no tools have been validated to date to collect UNC as perceived by them.

OBJECTIVES

To validate a tool measuring UNC as perceived by nursing students.

DESIGN

A validation study in 2018 by following the COnsensus-based Standards for the selection of health Measurement INstruments guideline.

SETTING

Three nursing programmes in Northern Italy.

PARTICIPANTS

All 1190 students who were attending their clinical rotation in hospital or community settings, were eligible. To assess the criterion validity, 30 clinical nurse supervisors in a random sample of units were involved.

METHODS

Content and face validity of the Unfinished Nursing Care Survey tool (UNCS) were assessed; then the tool, divided into part A (unfinished interventions) and B (reasons) was administered via Google and paper-pencil. Acceptability, construct validity (Mokken Scale Analysis, Exploratory and Confirmatory Factor Analyses), hypothesis testing, and criterion validity were assessed.

RESULTS

737 students (61.9%) and 30 (100%) clinical nurse supervisors participated. On the Mokken Scale, with regard to part A, nursing interventions were ordered in higher and lower priority, reflecting different degrees of difficulty in terms of leaving the interventions unfinished. In the Confirmatory Factor Analyses, reasons for UNC were categorised into 'Communication', 'Priority setting', 'Nurses' aides' supervision', 'Material resources', 'Human resources', and 'Workload unpredictability'. Students in the second year perceived higher UNC occurrence; only some individual and nursing programme variables were significantly correlated with the UNC. No statistical differences emerged between the UNC perceptions of students and that of their clinical supervisors.

CONCLUSION

The Unfinished Nursing Care Survey for Students is composed of part A (22 items) and part B (18 items) seems to be valid in terms of acceptability, construct validity, hypothesis testing, and criterion validity.