What impact does nursing care left undone have on patient outcomes? Review of the literature

Comparing nursing medication rounds before and after implementation of automated dispensing cabinets: A time and motion study

Nursing medication administration is an integral, albeit time consuming component of a nursing shift. Automated dispensing cabinets (ADCs) are a medicines management solution designed to improve both efficiency and patient safety. This study aimed to evaluate the time taken to undertake a medication round including the number of locations visited to retrieve medicines, across four different clinical specialties within one hospital. Studies to date have investigated the effect of ADCs on nursing medication rounds centred around one clinical specialty, in hospitals with varying levels of digital maturity. This study adds to the existing body of evidence by investigating multiple clinical specialties where EPMA in use throughout the study period. In this study, prior to ADC implementation nurses retrieved required medicines from shelves in the medication room, mobile medication carts, and patients' own drug (POD) lockers. Post-ADC implementation, medicines were retrieved exclusively from the ADC and POD lockers only. Nurses were observed on each ward completing medication rounds, using the data collection tool designed for this study. Pre-implementation data was collected between February and June 2023, and post-implementation data collected between July and September 2023. There was a statistically significant reduction in the time required for medicines retrieval on the surgical ward only, post- ADC implementation. The time taken to retrieve each medication went from a mean of 98.1 s to 47.2 s (p = 0.0255). When comparing all four specialties as a whole, there was a reduction in the mean time required to issue each medicine preversus post-ADC implementation, from 83.3 s to 62.6 s respectively, however this difference was not shown to be statistically significant. The mean number of locations visited to obtain all required medicines for each patient reduced significantly from 1.73 to 1.04 (p < 0.01). There is potential for improved efficiency as nurses become more familiar with new workflows. It may be of benefit to repeat this study to ascertain whether time savings have been further improved.

The effect of missed care on the nursing image perceived by patients and their trust relationships with nurses

BACKGROUND

Missed care has negative consequences for patients, directly affecting the quality of nursing care and patient safety.

AIM

This study investigated the effect of missed care on the nursing image perceived by patients and their trust relationships with nurses.

METHODS

This descriptive and correlational study was conducted in all inpatient wards of a hospital in southern Türkiye. The sample consisted of 200 patients. Data were collected using a patient information form, the MISSCARE Survey-Patient, the Nursing Image Scale (NIS), and the Trust in Nurses Scale (TNS). The data were analyzed using the Statistical Package for Social Sciences (for Windows 25.0). The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

FINDINGS

Participants had a mean MISSCARE Survey-Patient, TNS, and NIS score of 2.09 ± 0.53, 23.48 ± 5.01, and 71.52 ± 6.75, respectively. There was a moderate negative correlation between MISSCARE Survey-Patient and TNS scores. There was a weak negative correlation between MISSCARE Survey-Patient and NIS scores. Moreover, there was a strong positive correlation between NIS and TNS scores.

DISCUSSION

MISSCARE Survey-Patient total scores vary due to the imbalance in the number of nurses and the complexity of their tasks. Poor quality of care and incomplete care undermine the image of nursing and negatively affect the trust relationship between patients and nurses.

CONCLUSIONS

Nursing image and trust in nurses decreases as patient-nurse communication and basic care interventions are skipped.

IMPLICATIONS FOR NURSING POLICY

Inadequate care can have a detrimental effect on the nursing image and erode patient-nurse trust relationships. Therefore, there is a pressing need for ongoing review and enhancement of nursing education, policy, and practice to elevate the quality of care provided. Further research utilizing objective staff measures and outcome assessments, along with gathering primary data directly from patients, is essential to substantiate the assertion that missed care significantly influences patient outcomes.

Nursing Students' Operating Room Experiences: A Qualitative Metasynthesis

PURPOSE

This study was conducted to analyze the findings of qualitative studies about nursing students' experiences with operating room (OR) practices. There is a need to conduct metasynthesis studies to highlight the overarching dimensions of nursing students' experiences in the OR learning environment, identify and summarize key elements, draw attention to the professional implications of the experience, and then help define the future research agenda. This original study is the first metasynthesis of qualitative studies focusing on nursing students' OR practice experiences.

DESIGN

A qualitative metasynthesis.

METHODS

This metasynthesis study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and registered with PROSPERO (International prospective register of systematic reviews) (CRD42021252129). This metasynthesis consists of qualitative studies that included themes, were conducted with nursing students with OR experience, and were published in English between December 2000 and June 2022. Data were analyzed using the two-step metasynthesis procedures proposed by Sandelowski and Barroso.

FINDINGS

This metasynthesis study was carried out by analyzing 12 qualitative studies that met the inclusion criteria, reflected the results of a total of 244 nursing students, and were conducted in 7 different countries. As a result of the analysis of the studies, two main themes and seven subthemes were determined about the OR experiences of nursing students. The main themes of the study included (1) the OR environment and (2) professionalism and career choices.

CONCLUSIONS

The synthesis of studies in this research revealed nursing students' OR experiences and provided evidence about the association between these experiences and their professionalism and career goals. The research drew attention to the limitations and facilitators of the OR learning environment for nursing students and provided guidance for a positive interactive learning environment.

Nursing Students' Perception of Missed Perioperative Nursing Care: Hermeneutic Phenomenology

PURPOSE

Missed nursing care is a condition that is likely to be encountered frequently in the surgical care process and is generally related to the educational and emotional needs of the patients. Perception of and witnessing missed care can affect nursing images, expectations, and experiences by causing nursing students to experience professional disappointment. The purpose of the study was to explore nursing students' perception of perioperative missed nursing care (PMNC) according to "role theory" and Benner's "novice to expert" theories.

DESIGN

The study used a qualitative design based on Heidegger's hermeneutical phenomenological approach.

METHODS

Study data were collected using a semistructured interview form prepared by the researchers through face-to-face interviews lasting approximately 50 minutes. The analysis of the data was conducted using van Manen's thematic analysis. The Standards for Reporting Qualitative Research checklist was used in reporting the study.

FINDINGS

This study, which was conducted to explore awareness of PMNC, consisted of 12 students, including five males and seven females. It was understood that nursing students noticed PMNC in clinical practice, experienced internal conflict about the issue, were concerned about the image of nursing, and experienced role and professional identity confusion. The themes of the study were formed in light of these experiences of nursing students. Three themes and 11 subthemes emerged in the study. The themes of the study were (1) perceived PMNC application-behavior patterns, (2) internal reflections of PMNC-its impact on professional identity development, and (3) perceptions of professionalism in perioperative nursing.

CONCLUSIONS

This study provided important data about the awareness of PMNC in the surgical clinical practice of nursing students in Turkey and the effects of this awareness on the professional roles and professional identity process. Students were aware of the behavioral patterns of PMNC and that they experienced internal conflict, anxiety about the nursing image, role confusion, and professional identity confusion due to this awareness. Some students justified the PMNC behaviors of the nurses and others saw themselves as the power to change the PMNC behaviors.

Missed nursing care and associated factors among nurses and midwives in maternity wards of Sidama region public hospitals, Ethiopia

BACKGROUND

Missed nursing care refers to any aspect of care performed by nursing staff that is omitted or significantly delayed. Even though the potential impact of missing nursing care on maternal and fetal outcomes is significant, there is currently limited evidence regarding the extent of this issue specifically within the maternity wards. Therefore, this study aimed to assess missed nursing care and associated factors in the maternity wards of public hospitals in the Sidama region, Ethiopia 2022.

METHODS

A hospital-based cross-sectional study was conducted among 361 nurses and midwives in maternity wards of Sidama region public hospitals from March 28 to April 26, 2022. Simple random sampling was used to select participants. The data was collected using the MISSCARE survey tool and analyzed with SPSS version 26. Simple linear and multiple linear regression analyses were used to identify the factors associated with missed nursing care.

RESULTS

The overall mean missed nursing care score was 67 out of 130 (95% CI: 65.92, 68.02) and the average score for each nursing intervention was 2.58 out of 5 (95% CI: 2.54, 2.62). The intention to leave the institution (β = 3.812, 95% CI: 2.285, 5.340) and increasing weekly work hours (β = 0.203, 95% CI: 0.134, 0.272) were factors positively associated with missed nursing care. However, increased work experience (β= -0.963, 95%CI: -1.475, -0.452) and job satisfaction (β= -4.976, 95%CI: -6.431, -3.522) were negatively associated with missed nursing care.

CONCLUSION

This study found that the level of missed nursing care was significant. Factors positively associated with missed nursing care included an intention to leave the institution and an increase in weekly work hours. In contrast, an increase in work experience and higher job satisfaction were negatively associated with missed nursing care.

Unraveling the impact of subjective and objective workload on patient experience: Mediation and moderation by missed nursing care assessments in a nested multisource diary design

BACKGROUND

Patient reporting of their care experience is crucial for evaluating healthcare quality. Negative patient reports are often associated with missed nursing care, with previous research primarily attributing this to objective workload, neglecting the role of subjective workload. Furthermore, there is a gap in understanding the combined impact of patient and nurse assessments of missed nursing care on the overall patient experience.

OBJECTIVE

This study aims to explore how the interaction of objective and subjective workload influences nurse-reported missed nursing care. Additionally, it investigates how the interaction of missed nursing care, as assessed by both patients and nurses, influences the patient's overall experience.

DESIGN

A quantitative daily diary design, employing a nested (shifts within nurses) and multi-sourced (nurses, patients, and objective data) approach, was implemented.

SETTING

The study was conducted in two medium-sized public hospitals, encompassing internal medicine and surgical wards.

PARTICIPANTS

A total of 141 registered nurses providing direct patient care and 627 patients treated by these nurses participated in the study.

METHODS

Participating nurses completed questionnaires during five morning shifts, detailing their experiences with specific patients. Concurrently, the same patients provided feedback through questionnaires. A dual moderated mediation model was analyzed using mixed-model regression analyses, suitable for the nested design.

RESULTS

The study supported the dual moderated mediation model. Subjective workload emerged as a statistically significant moderator, influencing the impact of objective workload on nurse-reported missed nursing care (β = -0.476, p = .009). Particularly, under high subjective workload, missed nursing care was higher during low compared to high objective workload. Moreover, patient-reported missed nursing care moderated the relationship between nurse-reported missed nursing care and patient experience (β = -0.411, p < .001). In instances of high patient-reported missed nursing care, positive patient experiences were observed with low compared to high nurse-reported missed nursing care.

CONCLUSIONS

This research emphasizes the need to recognize and address subjective aspects of nursing workload. Effectively managing these perceptions is vital for upholding high care standards and enhancing patient experiences. The study advocates for targeted strategies to manage workload effectively and improve patient-nurse communication, especially in high-workload healthcare settings.

TWEETABLE ABSTRACT

Exploring the link between nursing workload and patient experience: revealing the impact of patient and nurse assessments on missed nursing care. #HealthcareQuality #NursingResearch.

How Shift Nurses' Presenteeism is Related to Insomnia and Care Left Undone: A Cross-Sectional Study Using Generalised Structural Equation Modelling

AIM

To examine the association between nurses' insomnia, presenteeism and care left undone and explore the mediating effect of presenteeism on the relationship between insomnia and care left undone among nurses in acute care hospitals, applying a dynamic model of presenteeism and absenteeism.

DESIGN

A cross-sectional design.

METHODS

A secondary data analysis was conducted using online survey data collected in January 2023. Participants were 1154 registered nurses who provided direct nursing care to patients in tertiary or general hospitals (hospitals with 300 or more beds) in South Korea. Poisson regression analysis was used to examine the association between nurses' insomnia, presenteeism and care left undone. Generalised structural equation modelling was performed to examine the mediating effect of presenteeism on the relationship between insomnia and care left undone.

RESULTS

The prevalence of insomnia was 15.3%. More than half of the participants (63.7%) reported experiencing presenteeism in the past 4 weeks. All reported at least one nursing care left undone during their last shift. Insomnia and presenteeism were positively associated with care left undone, and presenteeism mediated the relationship between insomnia and care left undone among nurses in acute care hospitals.

CONCLUSION

Nurses experienced insomnia and presenteeism, related to higher rates of care left undone. Nurses' insomnia had a direct effect on care left undone and an indirect effect through presenteeism.

IMPLICATIONS FOR THE PROFESSION

Nurse managers and administrators need to make greater efforts to reduce insomnia and presenteeism among nurses, thereby reducing care left undone and improving patient safety in acute care settings.

IMPACT

Nurse managers and administrators should consider proactive interventions to address nurses' insomnia and foster a workplace with healthy systems and culture to reduce sleep disturbance and presenteeism, which can effectively decrease care left undone.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Treatment effect analysis of the Frailty Care Bundle (FCB) in a cohort of patients in acute care settings

PURPOSE

The aim of this study is to explore the feasibility of using machine learning approaches to objectively differentiate the mobilization patterns, measured via accelerometer sensors, of patients pre- and post-intervention.

METHODS

The intervention tested the implementation of a Frailty Care Bundle to improve mobilization, nutrition and cognition in older orthopedic patients. The study recruited 120 participants, a sub-group analysis was undertaken on 113 patients with accelerometer data (57 pre-intervention and 56 post-intervention), the median age was 78 years and the majority were female. Physical activity data from an ankle-worn accelerometer (StepWatch 4) was collected for each patient during their hospital stay. These data contained daily aggregated gait variables. Data preprocessing included the standardization of step counts and feature computation. Subsequently, a binary classification model was trained. A systematic hyperparameter optimization approach was applied, and feature selection was performed. Two classifier models, logistic regression and Random Forest, were investigated and Shapley values were used to explain model predictions.

RESULTS

The Random Forest classifier demonstrated an average balanced accuracy of 82.3% (± 1.7%) during training and 74.7% (± 8.2%) for the test set. In comparison, the logistic regression classifier achieved a training accuracy of 79.7% (± 1.9%) and a test accuracy of 77.6% (± 5.5%). The logistic regression model demonstrated less overfitting compared to the Random Forest model and better performance on the hold-out test set. Stride length was consistently chosen as a key feature in all iterations for both models, along with features related to stride velocity, gait speed, and Lyapunov exponent, indicating their significance in the classification.

CONCLUSION

The best performing classifier was able to distinguish between patients pre- and post-intervention with greater than 75% accuracy. The intervention showed a correlation with higher gait speed and reduced stride length. However, the question of whether these alterations are part of an adaptive process that leads to improved outcomes over time remains.

The Nursing Human Capital Value Model

Nursing's economic value is presently framed within the dominant "outcomes-over-cost" value framework. Within this context, organizations employing nurses often use nursing budget reductions as a cost-minimization strategy, with the intent of retaining high quality outcomes. However, persistent issues such as nurse understaffing, burnout, and turnover threaten healthcare systems' capacity to deliver the quality, equitable, affordable patient care that the public requires. In this paper, we propose a new conceptual model and definition of nursing's economic value. The model development is guided by the convergence of three classic economic frameworks: human capital theory, production theory, and value theory. Grounded in these theories, we envision nursing as a value-adding human capital asset and explicitly link nursing staff characteristics and allocation to the production of healthcare services and organizational financial outcomes. We redefine nursing's economic value as the return on investment (ROI) in nursing human capital reflected in the improvement of consumer, nurse, and organizational outcomes. This new conceptual model, termed the Nursing Human Capital Value Model, presents a cycle of value creation that starts with investments in growing, developing and sustaining an organization's nursing human capital. Nurses, as a human capital asset, deliver nursing care-a foundational ingredient to the production of healthcare services and consumer outcomes. Improved outcomes, subsequently, drive organizational revenue growth. Finally, the accrued revenue is reinvested in nursing, further propelling the cycle's continuation. This innovative model, which is applicable across health systems financed through both governmental and private/non-governmental payor sources, highlights that investment in nursing human capital development is essential for sustainable value generation, identifying opportunities for optimizing nurses' contributions to the value cycle. By directly incorporating economic theories of human capital, production, and value, our model paves the way for future research on the dynamic scope of nursing's economic contribution within healthcare organizations and systems and underscores its necessity for the long-term sustainability and growth of the nursing profession. Tweetable abstract: The economic value of nursing lies in the return on investment in nursing human capital. #nurses #ROI #healthcare.

Determining awareness of and readiness for standardized nursing languages in a mid-level midwestern hospital and associated school of nursing

PURPOSE

The purpose of this study was to examine knowledge, attitude, and barriers toward care planning documentation practices with standardized nursing languages (SNLs) of nurses and nursing students at a midwestern healthcare system, comparing student and nurse responses.

METHODS

Cross-sectional surveys were given over a 2-month period with nurses and nursing students at different sites in a midwestern healthcare system, using convenience sampling. The Knowledge, Attitude, and Barriers to Using Standardized Nursing Languages and Current Practices Survey was adapted for use and re-tested for validity/reliability (Content Validity Index 0.81-1.00; Cronbach alpha = 0.82-0.99) with 28 Likert scale items measuring knowledge, attitude, and barriers. Descriptive statistics, composite scores, correlations, t-tests, and multiple regression were used to analyze the concepts of the tool.

FINDINGS

134/400 RNs responded (34%); 109/116 students responded (93.9%). Data analyses indicate adequate to superior levels of knowledge related to SNLs and NANDA International, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), collectively referred to as NNN (NANDA, NIC, & NOC), positive attitudes toward SNLs/NNN and for adopting SNLs/NNN into documentation practices, but moderate to great barriers for implementation in practice. Barriers included lack of financial resources for change, lack of mentors, and lack of mandates to use SNLs. Students scored significantly higher than nurses in attitude only.

CONCLUSIONS

Perceptions of nurses and student nurses for current documentation indicate awareness of inadequacy in existing systems and willingness to change existing systems for standardized languages, with perceived barriers to change/implementation of SNLs. Students were more positive about SNLs than nurses.

IMPLICATIONS FOR NURSING PRACTICE

Major implications for nursing are to reevaluate electronic documentation systems and determine how to insert and easily apply SNLs in these systems, such that nursing care documentation is standardized, interoperable, effective, time-saving, and attainable.

Quality of nursing care: Predictors of patient satisfaction in a national sample

AIM

To assess patients' satisfaction with the quality of nursing care and the relationship between patients' characteristics and their level of satisfaction.

DESIGN

A descriptive correlational cross-sectional design was used in this study.

METHODS

Convenient sampling was utilized to include 1014 inpatients from six hospitals in Jordan: three private hospitals; two governmental hospitals; and one university-affiliated hospital. The data collection process occurred from September 2022 to January 2023. The data were collected using the Arabic version of the Patients' Satisfaction with Nursing Care Quality Questionnaire. The data were analysed using Pearson correlation, t-test, one-way ANOVA and multiple hierarchal regression.

RESULTS

The study included 1014 patients with an average age of 51.3 (SD = 18.6), and 59.9% were females. More than two thirds of the sample reported having health insurance, and 62.7% were unemployed. The mean total score of patients' satisfaction with nursing care quality (NCQ) was 68.2 (SD = 12.9), indicating high satisfaction. Higher-income levels (p < 0.001), higher education levels (p = 0.003), having health insurance (p < 0.001), being admitted to private hospitals (p < 0.001), being admitted to critical care units (p = 0.002), being in a single room (p = 0.001), excellent perceived health status (p < 0.001) and willingness to recommend the hospital to family and friends (p < 0.001) were significant predictors of patients' satisfaction with NCQ.

CONCLUSIONS

Patient and hospital environment characteristics affected patients' satisfaction with NCQ. Hospital management should consider these characteristics to improve patient satisfaction and outcomes.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Policymakers and hospital management should consider improving the physical environment of their facilities to improve patients' satisfaction. Continuous professional development should emphasize nurses' communication skills to enhance their abilities to deliver information to their patients.

IMPACT

This study examined levels and predictors of patients' satisfaction with the quality of nursing care. The results indicated that improving patients' satisfaction can be achieved by focusing on areas of nurses' communication skills and explaining information to patients.

REPORTING METHOD

The study adhered to STORBE guidelines for reporting observational studies.

PATIENT OR PUBLIC CONTRIBUTION

Hospitalized patients contributed to the data of this study. Hospital administrators facilitated its implementation.

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.

Rationing of nursing care and assessment of work safety and a healthy work environment in intensive care units: A cross-sectional, correlational study

INTRODUCTION

Rationing of nursing care, whichrefers to the aspects of care not delivered by nurses in an intensive care unit (ICU), has implicationsfor patient outcomes and experiences.

OBJECTIVES

This study aimed to identify the extent to which nursing care is rationed in intensive care units, as well as asses quality of nursing care, and the level of job satisfaction and its correlation with an assessment of the climate of work safety, teamwork, and a healthy work environment.

METHODOLOGY

A cross-sectional, correlational study was conducted. The study included 226 ICU nurses. It was conducted with the use of three instruments: the Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on the rationing of nursing care, assessment of patient care quality and job satisfaction, American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) and the Safe Attitudes and Behaviours Questionnaire questionnaire in the version: Teamwork and Safety Climate (BePoZa).

SETTINGS

Intensive Care Units in Warmia and Mazury Region in Poland.

MAIN OUTCOME MEASURES

Level of Nursing Care Rationing in Intensive Care Units.

RESULTS

The majority of participants were women (89.82 %) with a mean age of 42.47 years. The average score for nursing care rationing across all groups was 0.58. The mean score for the HWEAT was 2.7 and BePoZa was 3.72. The scores from the questionnaires were negatively correlated with the nursing care rationing scores, being -0.36 for the HWEAT and -0.45 for BePoZa. All correlation coefficients were statistically significant at a p-value of less than 0.05.

CONCLUSIONS

It is important to monitor work safety, teamwork climate, and standards of a healthy work environment in ICUs to minimise the risk of rationing nursing care.

IMPLICATIONS FOR CLINICAL PRACTICE

Interventions that enhance work organisation and teamwork can elevate nursing quality and job satisfaction in ICUs, while underestimating patient care tasks; thus, highlighting the need for further research on the factors influencing nursing performance.

Rationing nursing care and organizational factors in intensive care units

INTRODUCTION

Rationing nursing care is a term that applies to various aspects of the required patient care that are omitted or their performance is delayed.

AIM

This study aimed to identify the extent of rationing of nursing care in intensive care units (ICUs) in different types of hospitals and determine the relationship between rationing of nursing care and hospital and staff characteristics.

METHODS

This quantitative, cross-sectional, multicenter study was performed. The sample comprised 226 nurses working in ICUs in a North-East part of Poland. The Polish version of the PRINCA questionnaire methods was applied. The survey was conducted between 15 January and 31 May 2023.

RESULTS

There were statistically significant differences between rationing of nursing care in university/provincial hospitals and district hospitals t = 6.92 p<0.001. In provincial and university hospitals, nursing care is often omitted, leading to a lower perceived quality of nursing care (t = -3.0 p = 0.003). This is further compounded by the fact that nursing care is more likely to be rationed in units with a larger number of beds. The level of rationing of nursing care was significantly correlated with the perceived work quality and job satisfaction in both types of hospitals. The most frequently omitted aspects of nursing care included providing emotional support (university/provincial 1.27 vs. district 0.89), patient and family education (1.11 vs. 0.74), communication with external entities (1.11 vs. 0.84), and observing safe patient-handling practices (1.01 vs. 0.99).

CONCLUSION

The type of hospital and organizational factors influence the rationing of nursing care. Improvements in working conditions can improve nursing care quality in ICUs.

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.

'Implicit rationing of nursing care processes'-Decision-making in ICU nurses' experiences: A qualitative study

BACKGROUND

Implicit rationing of nursing care is defined as the withholding of necessary nursing measures for patients because of a lack of nursing resources. However, no studies have explored the experience of decision-making about implicit rationing of nursing care in an intensive care unit (ICU).

AIM

To explore the process of ICU nurses' decisions and judgement based on the conceptual framework of implicit rationing of nursing care.

STUDY DESIGN

A qualitative study was undertaken between June 2020 and September 2020. The data collection methods were participative observation and interview. Eighteen ICU nurses participated in interviews. A thematic analysis was performed for the data analysis.

RESULTS

The following five themes emerged: assessment of the condition and nature of nursing and time taken; strategies for setting personal priorities; plan implementation under mitigation strategy; existing nursing in reality; evaluation of the implementation of implicit rationing care. Nurses choose different strategies during plan implementation.

CONCLUSIONS

In the absence of explicit guidelines on rationing nursing care, nurses often rely on intuitive and situational decision-making processes for setting priorities. Given the vulnerability of ICU patients and the absence of family caregivers, nurses bear a heightened ethical responsibility to provide care. Establishing a positive nursing culture is essential. It is both reasonable and effective to organize work by accurately quantifying workload, improving staffing levels and optimizing scheduling methods. These themes align with the decision-making process outlined in the conceptual framework and offer fresh perspectives.

RELEVANCE TO CLINICAL PRACTICE

Nurses have a greater responsibility to provide care in an ethical manner and to increase awareness of the importance of holistic nursing care for the patient, that is to raise awareness of the importance of care that is often missed. Nurses actively adopt strategies to reduce implicit rationing of nursing care, including teamwork, organized nursing, working overtime and ignoring quality. The findings highlight the importance of creating a positive nursing culture that encourages nurses to adopt positive strategies.

Working conditions, missed care and patient experience in home care nursing in Italy: An observational study

INTRODUCTION

The aging of the population requires an appropriate knowledge of the type of care that needs to be provided to inform healthcare policies. In Italy, neither home care nursing, nor the patient experiences have ever been described.

OBJECTIVES

To describe the characteristics of nurses and care recipients involved in home care.

METHODS

A descriptive cross-sectional study conducted in 18 Italian Regions. Between April and October 2023, data from nurses and patients involved in home care were collected through two surveys. Psychosocial conditions in workplaces, missed care, and care experiences were assessed using validated tools. Descriptive statistics and Pearson's correlations were performed.

RESULTS

A total of 46 local healthcare units were included in this study, with a total of 2549 nurses and 4709 care recipients. Nurses (mean age 46.60; 79.48% female; 44.68% regional nursing diploma as the highest qualification) reported good working conditions (42.37; SD = 12.25; range = 0-100) and a high mean number of missed care activities (5.11; SD = 3.19; range 0-9). Most nurses (83.41%) reported high levels of job satisfaction, while 20.28% intended to leave their job. Patients (mean age 75.18; 57.57% female; 36.95% primary school), on the other hand, rated positively the care they had received (8.23; range = 0-10).

CONCLUSIONS

Despite the perception of critical issues at work and some missed care, satisfaction in nurses and patients was high. These data constitute a preliminary snapshot of the studied phenomena, which will be investigated through more in-depth analyses.

Evaluation of nurse-reported missed care in a post-anesthesia care unit: A mixed-methods study

BACKGROUND

Nurse-reported missed care (NRMC) is considered as any significant delay or omission in provision of nursing care.

AIM

(i) Evaluate the frequency, types, and reasons for NRMC in the Post-anesthesia Care Unit (PACU). (ii) Evaluate associations between nurse demographic and workload factors with NRMC. (iii) Explore nurses' perception of NRMC in the PACU.

METHODS

A cross-sectional study was conducted in the PACU in a tertiary acute care hospital over 3 months. Full-time PACU nurses were conveniently sampled to complete an anonymous survey after their daily shift over different shifts. It contained three sections: (i) nurse demographics; (ii) elements of NRMC; and (iii) reasons for NRMC. Qualitative interviews employed a semi-structured guide to explore perceptions and experiences of NRMC. Descriptive, inferential statistics, and thematic analyses were applied.

RESULTS

Sixty-six survey responses were collected. 48.5% of respondents indicated at least one NRMC activity. Activities more clinically sensitive were less missed. Eight nurses were interviewed. Four main themes were identified: (i) communication with patients; (ii) communication and teamwork with colleagues; (iii) dual role of documentation; and (iv) staffing inadequacy. Language barriers made communication challenging. Staff shortage exacerbates workload but effective teamwork and documentation facilitates nursing care.

CONCLUSION

Communication and staffing concerns aggravate NRMC. Teamwork and personal contentment were satisfactory. Nurses' turnover intention may worsen staffing.

CLINICAL RELEVANCE

Timeliness and quality of nursing care is impacted by elements such as manpower, allocation of resources, work processes, and workplace environmental or interpersonal factors such as culture and language fit. Re-evaluation of nursing resources and work processes may assist post-anesthesia care unit nurses in fulfilling their role, decreasing the prevalence of nurse-reported missed care.

Quality and Safety in Nursing: Recommendations From a Systematic Review

ABSTRACT

As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care. However, a comprehensive review of evidence-based recommendations to guide nursing interventions that enhance the Q&S of patient care is lacking. Therefore, the purpose of our systematic review was to create evidence-based recommendations for the Q&S component of a nursing professional practice model for military hospitals. To accomplish this, a triservice military nursing team used Covidence software to conduct a systematic review of the literature across five databases. Two hundred forty-nine articles met inclusion criteria. From these articles, we created 94 recommendations for practice and identified eight focus areas from the literature: (1) communication; (2) adverse events; (3) leadership; (4) patient experience; (5) quality improvement; (6) safety culture/committees; (7) staffing/workload/work environment; and (8) technology/electronic health record. These findings provide suggestions for implementing Q&S practices that could be adapted to many healthcare delivery systems.

The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design

AIMS

To examine a novel moderated-mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress.

DESIGN

Nested diary study.

METHODS

Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium-sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse-patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated-mediation model.

RESULTS

Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses.

CONCLUSION

The study highlights accountability's dual role-safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff.

IMPACT

By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes.

REPORTING METHOD

The study has adhered to STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Use of Lean Management Methodology to Reduce the Rate of Unfinished Nursing Care in the Emergency Observation Room: A Quality Improvement Project

BACKGROUND AND OBJECTIVES

The integration of lean management in optimizing nursing workflow necessitates the careful examination of several factors, including nurses' work efficiency, patient experience, and health outcomes. To evaluate the extent of unfinished nursing care and patient satisfaction, we have incorporated the lean management approach into our quality improvement efforts. This proactive measure aims to address potential adverse outcomes, such as subpar inpatient experiences, escalated occurrence of adverse events, and decreased job satisfaction among nursing staff.

METHODS

We utilized the lean management methodology of value stream mapping in a specific facility between February and August 2021, aiming to pinpoint the crucial areas for enhancing nurses' workflow. By employing fishbone diagrams, we thoroughly analyzed the underlying causes, and subsequently employed the Plan-Do-Study-Act model to execute interventions devised based on these identified causes. Interventions included: (1) specifying the time of doctors' conventional rounds; (2) changing unreasonable scheduling; (3) employing 5S management to manage nursing supplies; and (4) eliminating duplicate papers and electronic reports.

RESULTS

After implementing these interventions, the rate of unfinished nursing reduced from 73.4% to 39.6%, and that of finished nursing care during the shift increased from 38.6% to 71.4%. Overtime was reduced from 37.2 ± 22.4 minutes to 14.1 ± 3.6 minutes. The total patient satisfaction score for the Patient Satisfaction Questionnaire short-form increased (P < .05).

CONCLUSIONS

The lean management of quality improvement methodologies provides effective enhancement to the work efficiency of nurses.

Nurses' experiences and perceptions of unfinished nursing care: a qualitative systematic review protocol

OBJECTIVE

The aim of this review is to synthesize the findings of qualitative studies about the experiences and perceptions of nurses regarding unfinished nursing care.

INTRODUCTION

The issue of unfinished nursing care is a widespread challenge globally, causing detrimental effects to both patients and health care practitioners. Despite its prevalence, there is a dearth of qualitative evidence synthesis summarizing the reasons for unfinished nursing care, as well as the experiences of nurses.

INCLUSION CRITERIA

This review will include studies exploring registered nurses' and nurse managers' experiences and perceptions of unfinished nursing care, utilizing qualitative methods. Our approach to qualitative methodology will be unrestricted, allowing for various designs, such as phenomenology, ethnography, grounded theory, action research, and feminist research. Only articles published in English or Chinese from 2001 onward will be included.

METHODS

Our search will encompass the following electronic databases for published and unpublished literature: MEDLINE (PubMed), PsycINFO (APA PsycNET), CINAHL (EBSCOhost), Web of Science, Embase, ScienceDirect, ProQuest Dissertations and Theses, GreyNet International, Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Biomedicine Literature Database (CBM). To ensure thoroughness, manual searches of reference lists and citations of included studies will also be conducted. Two reviewers will extract relevant information, and quality validation will be conducted using the JBI critical appraisal checklist for qualitative research. Similar findings will be categorized through meta-aggregation to establish synthesized findings. Finally, each synthesized finding will be graded according to the JBI ConQual approach.

REVIEW REGISTRATION

PROSPERO CRD42022368041.

Missed nursing care and its associated factors in public hospitals of Bahir Dar City, Northwest Ethiopia: a cross-sectional study

OBJECTIVES

The aim of this study was to investigate the prevalence of missed nursing care and its associated factors among public hospitals in Bahir Dar City, Northwest Ethiopia.

DESIGN

An institution-based cross-sectional study was conducted among 369 randomly selected nurses.

SETTING

The study was conducted in primary and secondary-level public hospitals in Bahir Dar City.

PARTICIPANTS

Nurses who had worked in hospitals in Bahir Dar City were included.

INTERVENTION

No intervention was needed in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

A binary logistic regression model was used for statistical analysis. Statistical significance of the association between outcome variables and independent variables was declared at a p value of <0.05 with a 95% CI.

RESULTS

The prevalence of missed nursing care in this study was 46.3% (95% CI: 41.7% to 50.9%). The activities most frequently missed were physical examination (56.4%), patient discharge planning and teaching (50.9%), providing emotional support to the patient and family (50.8%), monitoring input and output (50.2%), assisting with patient ambulation (48.5%) and documentation (48%). Factors associated with missed nursing care include: male professionals (adjusted OR (AOR): 2.9, 95% CI: 1.8 to 4.8), those who had not received on-the-job training (AOR: 2.2, 95% CI: 1.4 to 3.6), those who worked full 24-hour shifts (AOR: 3.7, 95% CI: 2.0 to 6.5), those who were dissatisfied with the level of teamwork (AOR: 4.6, 95% CI: 2.8 to 7.6) and those who had an intention to leave the nursing profession (AOR: 1.8, 95% CI: 1.1 to 2.9). These factors were statistically associated with missed nursing care.

CONCLUSION

A significant proportion of nurses missed essential nursing care activities. Efforts should be made to enhance training, improve teamwork among nurses, provide stability and adjust work shifts to mitigate this issue.

Exploring Early, Middle, and Late Loss in Basic Activities of Daily Living among Nursing Home Residents: A Multicenter Observational Study

Nursing home (NH) residents commonly face limitations in basic activities of daily living (BADLs), following a hierarchical decline. Understanding this hierarchy is crucial for personalized care. This study explores factors associated with early, middle, and late loss in BADLs among NH residents. A multicenter cross-sectional study was conducted in 30 NHs in Catalonia, Spain. Dependent variables were related to limitations in BADLs: early loss (self-care-related BADLs: personal hygiene, dressing, or bathing), middle loss (mobility-related BADLs: walking or wheelchair handling, toileting, and transferring), and late loss (eating). Independent variables were based on a comprehensive geriatric assessment and institutional factors. Logistic regression was used for the multivariate analyses. The study included 671 older adults. Early loss in BADLs was significantly associated with urinary incontinence, cognitive impairment, and falls. Middle loss in BADLs was linked to fecal incontinence, urinary incontinence, ulcers, and cognitive impairment. Late loss in BADLs was associated with fecal incontinence, the NH not owning a kitchen, neurological disease, cognitive impairment, dysphagia, polypharmacy, and weight loss. These findings highlight the need to address geriatric syndromes, especially cognitive impairment and bladder/bowel incontinence. Monitoring these syndromes could effectively anticipate care dependency. The presence of kitchens in NHs may help to address limitations to eating, allowing for potential personalized meal adaptation.

Why do nurses miss nursing care? A qualitative meta-synthesis

AIM

The aim of this qualitative meta-synthesis was to discover the factors impacting on missed nursing care of nurses through systematic thinking.

BACKGROUND

Although nurses are responsible for high-quality care, missed nursing care is common, endangering patient safety. Understanding of the causes related to missed nursing care could help nursing managers improve the quality of nursing care.

DESIGN

A qualitative meta-synthesis guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).

METHODS

As a method designed to contribute to knowledge development, meta-synthesis allows for integration of qualitative study findings using thematic synthesis. Six databases were searched up to October 2021; nine studies met the inclusion and quality assessment criteria and meta-synthesis were conducted.

RESULTS

Three themes related to the causes why nurses missed nursing care were found. The themes included intrinsic resources (professional and ethical values, ambiguous nurse role, prioritization, education system, and knowledge), system structure (staff and resources shortage, heavy workload but limited time, and organizational management failure), and social environment (communication, working relationship and skill mix, and inappropriate ward layout).

CONCLUSION

The phenomenon of missed nursing care is a global tissue, with variations in its elements but also notable similarities. Meta-synthesis provides evidence of intrinsic and extrinsic factors that contribute to missed nursing care.

RELEVANCE TO CLINICAL PRACTICE

Recognizing and understanding the causes of missed nursing care is essential for nursing managers to ensure patient safety and the provision of high-quality care.

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 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.

The transition issue among new nurses in China: A mediation model analysis

AIM

To explore the impact and interrelated pathway of work environment, career adaptability, and social support on the transition process and outcomes among new nurses.

BACKGROUND

The transition issue affecting new nurses has been discussed for many decades. However, the exact interplay of various factors influencing the transition process and outcomes needs further exploration.

METHODS

A cross-sectional, descriptive survey design was employed, and a convenient sample of 1628 new nurses from 22 tertiary hospitals in China was surveyed between November 2018 and October 2019. Mediation model analysis was used to analyze the data, and the STROBE checklist was used to report the study.

FINDINGS

The transition status mediated the effects of work environment, career adaptability and social support, and had a significantly positive influence on their intention to remain and job satisfaction. Among the influencing factors, the work environment had the most significant positive impact on both the intention to remain and job satisfaction.

CONCLUSION

Work environment was found to be the most significant factor affecting both the transition status and outcomes of new nurses. The transition status played an important mediating role between the influencing factors and the transition outcomes, whereas career adaptability was found to mediate the impact of social support and work environment in the transition process.

IMPLICATIONS FOR NURSING AND NURSING POLICIES

The results underscore the critical role of the work environment and demonstrate the mediating effects of transition status and career adaptability in the transition process of new nurses. Therefore, dynamic evaluation of the transition status should serve as the foundation for developing targeted supportive interventions. Such interventions should also focus on enhancing career adaptability and fostering a supportive work environment to facilitate the transition of new nurses.

Nursing students' perceptions of unfinished nursing care: A cross-sectional study

AIM

To investigate the prevalence, patterns and reasons for unfinished nursing care as perceived by nursing students.

BACKGROUND

Unfinished nursing care (UNC) is a frequently observed phenomenon in the acute care setting. To date, studies have focused primarily on the perspective of nurses or patients, but another important perspective is that of nursing students who provide nursing care in all healthcare settings.

DESIGN

A descriptive cross-sectional study.

METHODS

The study included 738 undergraduate nursing students from nine Slovak universities. Data were collected between September 2022 and February 2023 using the Slovak version of the Unfinished Nursing Care Survey tool (UNCS). Data were analyzed using descriptive and inferential statistics.

RESULTS

The mean composite score of UNCS was 2.48 (SD=0.68). In general, 100% of nursing students reported that nurses missed at least one or more nursing care activities during their last clinical placement. The average number of missed nursing care activities was 11.2 per nurse as perceived by nursing students during their last clinical placement. Nursing students reported that the most frequently omitted nursing care activity was spending time with patients and their caregivers (3.15 ± 1.11; 92.9%). The most frequently reported reason for UNC was an inadequate number of nurses on the ward (4.31 ± 1.01; 98.1%). In the study, reported UNC could be predicted by previous experience in healthcare, previous clinical rotation, number of patients per shift, perceived staff adequacy and outcome expectations (p <0.05).

CONCLUSIONS

The findings reveal that UNC is a widespread phenomenon and all nursing students report this phenomenon during their clinical placements. Spending time with patients and their caregivers emerged as the most frequently omitted nursing care activity, highlighting the importance of patient-centered care. The primary reason cited for UNC was an inadequate number of nurses, highlighting staffing issues as a significant contributing factor. These findings emphasize the need for targeted interventions to address staff shortages and improve nursing education to prepare students to address UNC in their future practice.

Associations between nursing home care environment and unfinished nursing care explored. Secondary analysis of cross-sectional data

Understanding unfinished nursing care and its relationship with modifiable care environment factors is crucial for the service delivery to long-term frail patients. This secondary analysis aimed to explore the associations between characteristics of the care environment and unfinished nursing care, as reported by nursing care workers in Norwegian nursing homes. Of 931 respondents (37% response rate) from 66 nursing homes, six care environment characteristics correlated with at least two types of unfinished nursing care. Resources and Multidisciplinary collaboration showed a positive association with all four unfinished care categories. Input and acknowledgement, Professional, or Interpersonal leadership were not associated to unfinished care. In summary, our findings suggest that nursing care workers reporting positive care environment descriptions also reported lower frequencies of unfinished nursing care. This study offers insights crucial for human resource management which ultimately can be used to improve patient outcomes in nursing homes.

Safer and more efficient vital signs monitoring protocols to identify the deteriorating patients in the general hospital ward: an observational study

Background

The frequency at which patients should have their vital signs (e.g. blood pressure, pulse, oxygen saturation) measured on hospital wards is currently unknown. Current National Health Service monitoring protocols are based on expert opinion but supported by little empirical evidence. The challenge is finding the balance between insufficient monitoring (risking missing early signs of deterioration and delays in treatment) and over-observation of stable patients (wasting resources needed in other aspects of care).

Objective

Provide an evidence-based approach to creating monitoring protocols based on a patient's risk of deterioration and link these to nursing workload and economic impact.

Design

Our study consisted of two parts: (1) an observational study of nursing staff to ascertain the time to perform vital sign observations; and (2) a retrospective study of historic data on patient admissions exploring the relationships between National Early Warning Score and risk of outcome over time. These were underpinned by opinions and experiences from stakeholders.

Setting and participants

Observational study: observed nursing staff on 16 randomly selected adult general wards at four acute National Health Service hospitals. Retrospective study: extracted, linked and analysed routinely collected data from two large National Health Service acute trusts; data from over 400,000 patient admissions and 9,000,000 vital sign observations.

Results

Observational study found a variety of practices, with two hospitals having registered nurses take the majority of vital sign observations and two favouring healthcare assistants or student nurses. However, whoever took the observations spent roughly the same length of time. The average was 5:01 minutes per observation over a 'round', including time to locate and prepare the equipment and travel to the patient area. Retrospective study created survival models predicting the risk of outcomes over time since the patient was last observed. For low-risk patients, there was little difference in risk between 4 hours and 24 hours post observation.

Conclusions

We explored several different scenarios with our stakeholders (clinicians and patients), based on how 'risk' could be managed in different ways. Vital sign observations are often done more frequently than necessary from a bald assessment of the patient's risk, and we show that a maximum threshold of risk could theoretically be achieved with less resource. Existing resources could therefore be redeployed within a changed protocol to achieve better outcomes for some patients without compromising the safety of the rest. Our work supports the approach of the current monitoring protocol, whereby patients' National Early Warning Score 2 guides observation frequency. Existing practice is to observe higher-risk patients more frequently and our findings have shown that this is objectively justified. It is worth noting that important nurse-patient interactions take place during vital sign monitoring and should not be eliminated under new monitoring processes. Our study contributes to the existing evidence on how vital sign observations should be scheduled. However, ultimately, it is for the relevant professionals to decide how our work should be used.

Study registration

This study is registered as ISRCTN10863045.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/03) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 6. See the NIHR Funding and Awards website for further award information.

The ILC Maine statement: Time for the fundamental care [r]evolution

AIM

The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice.

DESIGN

Position paper.

METHODS

This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice.

RESULTS

The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action-oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non-nursing tasks: reclaim and protect time to provide high-value fundamental care. Accentuate the positive: change from deficit-based to affirmative language when describing fundamental care. Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research. Advocate for interprofessional collaboration: support high-quality, transdisciplinary fundamental care delivery via strong nursing leadership.

CONCLUSION

The ILC Maine Statement calls for ongoing action - [r]evolution - from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

We outline four action-oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered. Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems.

IMPACT

Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability. This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally.

PATIENT OR PUBLIC CONTRIBUTION

Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers. By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey.

Influence of the work environment of nurses on the 30-day mortality of patients hospitalized in Polish hospitals. cross-sectional studies

BACKGROUND

An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates.

AIM

To understand the relationships between the work environment as perceived by nurses on the 30-day mortality of patients treated in Polish hospitals.

BACKGROUND

An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates.

MATERIAL AND METHODS

The analysis used discharge data from 108,284 patients hospitalized in internal medicine and surgery departments in 21 hospitals (with 24/7 operations) in Poland. Administrative data included coded data to estimate 30-day mortality. A Nurses' satisfaction questionnaire, including the PES-NWI scale and the SAQ questionnaire, was used to assess the work environment of nurses (n = 1,929). Correlations between variables were assessed using the Pearson coefficient. The analysis used a Poisson regression model, which belongs to the class of generalized linear models.

RESULTS

A lower 30-day mortality rate amongst patients was found among those treated in hospitals where the personnel feel that they may question the decisions or actions of their superiors regarding the care provided (r = - 0.50); nurses are informed about changes introduced on the basis of reports about negligence and mistakes (r = - 0.50); the ward nurse is a good manager (r = - 0.41); nurses receive timely information from the head of the department that may have an impact on their work (r = - 0.41).

CONCLUSIONS

Factors related to care during hospital stay such as the organization of care at the ward level, analysis of care errors, the number of staff providing direct patient care, informing nurses about mistakes without punishment, and the possibility of nurses challenging the decisions or actions of superiors, which concerns care providing, affect the 30-day mortality of patients after the end of hospitalization in Polish hospitals.

Surveillance and patient safety in nursing research: A bibliometric analysis from 1993 to 2023

AIMS

To identify and characterize the thematic foci, structure and evolution of nursing research on surveillance and patient safety.

DESIGN

Bibliometric analysis.

METHODS

Bibliometric methods were employed to analyse 1145 articles, using Bibliometrix and VOSviewer software.

DATA SOURCE

The Scopus bibliographic database was searched on April 7, 2023.

RESULTS

A keyword co-occurrence analysis found the most frequently occurring keywords to be: patient safety, nursing, nurses, adverse events, monitoring, critical care, quality improvement, vital signs, safety, alarm fatigue, education, nursing care, surveillance, clinical alarms, failure to rescue, evidence-based practice, acute care, clinical deterioration, communication, intensive care. Network mapping, clustering and time-tracking of the keywords revealed the focal themes, structure and evolution of the research field.

CONCLUSION

By assessing critical areas of the nursing research field, this study extends and enriches the current discourse on surveillance and patient safety for nursing researchers and practitioners. Critical challenges still have to be met by nurses, however, including the failure to rescue deteriorating patients. Further knowledge and understanding of surveillance and patient safety must be successfully translated from research to practice.

IMPLICATIONS FOR THE PROFESSION

This study highlights the gaps in nursing knowledge with regard to surveillance and patient safety and encourages nursing professionals to turn to evidence-based surveillance practices.

IMPACT

In addressing the problem of surveillance and its effect on patient safety, this study found that, in most clinical care settings, preventing failures to rescue and adverse patient outcomes still remains a challenge for the nursing profession. This study should have an impact on nursing academics' future research themes and on nursing professionals' future clinical practices.

REPORTING METHOD

Relevant EQUATOR guidelines have been adhered to by employing recognized bibliometric reporting methods.

Evidence Synthesis for the Development of National Nursing-Sensitive Indicators in Malaysia: A Literature Review and Stakeholder Engagement Approach

Introduction

Nursing-sensitive indicators measure and evaluate nursing care quality and its contribution to patient care. The identification of indicators that demonstrate nursing care contribution and the quality of care delivered locally is of paramount importance, and national indicators that demonstrate this are essential. This paper aims to provide an evidence base of nursing-sensitive indicators that can facilitate the conceptualization of local nursing national indicators.

Method

A multifaceted and iterative approach incorporating literature review, and stakeholder engagements was utilized in evidence synthesis. A review of indicators present internationally complemented by the inclusion of context-specific local NSIs through stakeholder engagements was performed. Secondary data analysis of documents from an environmental scan was also included to highlight areas of concern for nursing-sensitive indicator prioritization from the viewpoint of nurses.

Results

A total of 64 articles were reviewed and indicators were coded according to the Nursing Care Performance Framework subsystems, dimensions, and variables. All papers reviewed had documented outcome indicators. From our secondary data analysis, nurses identified areas of concern such as nursing staff supply, staff maintenance, nursing processes and risk outcomes, and safety to be prioritized for developing quality indicators.

Conclusion

This paper provides a list of NSIs coded systematically with definitions to aid stakeholders in prioritizing indicators for national indicator development. The inclusion of areas of concern provides insight into NSIs that nurse practitioners find relevant to the local context. To our knowledge, this is the first paper that includes evidence available in the literature and incorporates stakeholders' perspectives in synthesizing evidence needed to guide the development of national nursing indicators. This iterative approach is crucial because it enhances the likelihood of knowledge translation.

Translation and psychometric testing of the Chinese version of the Perinatal Missed Care Survey

Objective

This study aimed to translate and evaluate the psychometric properties of the Perinatal Missed Care Survey in China.

Methods

The Perinatal Missed Care Survey was translated according to the guidelines of the cross-cultural debugging scale recommended by the American Academy of Orthopaedic Surgeons Evidence-Based Medicine Committee, including forward translation, back translation, cultural adaption, and content validation, and its Chinese version was used in a cross-sectional study conducted from February to April in 2023. A total of 491 midwives from 14 different level hospitals in southwest China were recruited through a convenience sampling method. The discrimination ability of the items was tested through item analysis, and construct validity was assessed through exploratory factory and confirmatory factor analyses. The content validity index and Cronbach's α coefficients evaluated content validity and reliability, respectively.

Results

The Chinese version's item-total correlation coefficients ranged from 0.641 to 0.866 in part A and from 0.644 to 0.819 in part B (P < 0.001). Parts A and B's scale-level content validity indexes were 0.95, and the item-level content validity indexes were from 0.86 to 1.00. The three common factors of part A (necessary care, basic care, and postnatal care) and part B (communication, labor resources, and material resources) were extracted, accounting for 70.186% and 71.984% of the total variance, respectively. Confirmatory factor analysis indicated that the good fit of the three-factor models was acceptable. The Cronbach's α coefficients were 0.968 (part A) and 0.940 (part B).

Conclusion

The Chinese version of the Perinatal Missed Care Survey is a reliable and valid instrument for assessing nursing care missed by midwives during labor and birth and the reasons it was missed. Studies with large sample sizes are needed to verify the instrument's applicability in China.

A Review of Disparities in Outcomes of Hospitalized Patients with Limited English Proficiency: The Importance of Nursing Resources

Language barriers significantly affect communication between patients and health care staff and are associated with receipt of lower-quality care. Registered nurses are well positioned members of the health care team to reduce and eliminate disparities for patients with limited English proficiency (LEP). Current evidence recommends nurses use interpreters or translation devices to overcome language barriers; however, these recommendations fail to recognize that structural system-level factors, such as unsupportive work environments and poor nurse-to-patient staffing ratios, reduce nurses' ability to implement these recommendations. The Quality Health Outcomes Model (QHOM) is a useful framework for understanding relationships between hospital systems, the delivery of care interventions, and patient outcomes. The goal of this manuscript is to use the QHOM and existing empirical evidence to present a new perspective on the long-standing clinical challenge of reducing language-related health outcome disparities by considering the context in which nurses deliver patient care.

Development of an Implementation Strategy Tailored to Deliver Evidence-Based and Person-Centred Nursing Care for Patients with Community-Acquired Pneumonia: An Intervention Mapping Approach

Community-acquired pneumonia is a serious public health problem, and more so in older patients, leading to high morbidity and mortality. However, this problem can be reduced by optimising in-hospital nursing care. Accordingly, this study describes a systematic process of designing and developing a tailored theory- and research-based implementation strategy that supports registered nurses (RNs) in delivering evidence-based and person-centred care for this patient population in a hospital setting. The implementation strategy was developed by completing the six steps of the Intervention Mapping framework: (1) developing a logic model of the problem and (2) a logic model of change by defining performance and change objectives, (3) designing implementation strategy interventions by selecting theory-based change methods, (4) planning the interventions and producing materials through a co-design approach, (5) developing a structured plan for adoption, maintenance and implementation and (6) developing an evaluation plan. This method can serve as a guide to (1) target behavioural and environmental barriers hindering the delivery of nursing care in local clinical practice, (2) support evidence uptake, (3) support RNs in the delivery of nursing care according to individual patient needs and thereby (4) optimise health-related patient outcomes.

Moral distress in nurses in developing economies: an integrative literature review

Background

Moral distress has been extensively studied in developed economies; however, not much in terms of studies has been carried out in developing economies.

Objective

To review the literature reporting the experience of moral distress in nurses in health care settings in developing economies.

Design

An integrative literataure review was used.

Method

Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online Cochrane and Psych INFO were searched to retrieve titles and abstracts of papers on the experience of moral distress in nurses in developing economies.

Results

Sixteen articles reporting the experience of moral distress in nurses in developing economies published between 1984 and March 2019 were used for the review. Analysis of the findings revealed seven themes, nurses' experience of moral distress, inadequate material and human resources, end-of-life challenges, cultural and religious beliefs as a source of moral distress, perceived inactions of medical and nursing staff, impact of moral distress on nurses in developing economies and coping strategies.

Conclusion

There is paucity of empirical studies on moral distress in nurses in developing economies. More qualitative studies are needed in various cultural settings to enhance its understanding in nurses working in developing economies.

Missed nursing care in relation to registered nurses' level of education and self-reported evidence-based practice

BACKGROUND

Patient safety is one of the cornerstones of high-quality healthcare systems. Evidence-based practice is one way to improve patient safety from the nursing perspective. Another aspect of care that directly influences patient safety is missed nursing care. However, research on possible associations between evidence-based practice and missed nursing care is lacking.

AIM

The aim of this study was to examine associations between registered nurses' educational level, the capability beliefs and use of evidence-based practice, and missed nursing care.

METHODS

This study had a cross-sectional design. A total of 228 registered nurses from adult inpatient wards at a university hospital participated. Data were collected with the MISSCARE Survey-Swedish version of Evidence-Based Practice Capabilities Beliefs Scale.

RESULTS

Most missed nursing care was reported within the subscales Basic Care and Planning. Nurses holding a higher educational level and being low evidence-based practice users reported significantly more missed nursing care. They also scored significantly higher on the Evidence-based Practice Capabilities Beliefs Scale. The analyses showed a limited explanation of the variance of missed nursing care and revealed that being a high user of evidence-based practice indicated less reported missed nursing care, while a higher educational level meant more reported missed nursing care.

LINKING EVIDENCE TO ACTION

Most missed nursing care was reported within the subscales Planning and Basic Care. Thus, nursing activities are deprioritized in comparison to medical activities. Nurses holding a higher education reported more missed nursing care, indicating that higher education entails deeper knowledge of the consequences when rationing nursing care. They also reported varied use of evidence-based practice, showing that higher education is not the only factor that matters. To decrease missed nursing care in clinical practice, and thereby increase the quality of care, educational level, use of evidence-based practice, and organizational factors must be considered.

A divided community: A descriptive qualitative study of the impact of the COVID-19 pandemic on nurses and their relationships

AIMS

To identify the personal and professional impact of the COVID-19 pandemic on clinical nurses with regard to personal and workplace safety, personal and professional relationships and perceptions of their team, organization and community, and to understand lessons learned to inform future responses to pandemics or global emergencies.

DESIGN

Qualitative, descriptive free-text surveys, informed by appreciative inquiry.

METHODS

Nurses working in adult COVID- and non-COVID cohort medical-surgical and intensive care units, outpatient cancer and general surgery centres were invited to participate. Data were collected between April and October 2021 and analysed using summative content analysis.

RESULTS

In total, 77 participants completed free-text surveys. Five themes were identified: (1) Constraints on nursing: barriers in communication and diminished patient safety and quality of care; (2) Navigating uncertainty: the emotional toll of the pandemic; (3) Team solidarity, renewed appreciation and reaffirming purpose in nursing work; (4) Enhanced trust versus feeling expendable; and (5) Increased isolation and polarization within communities. Nurses described a perceived negative impact on a number of their relationships, including with patients, employer and community. They described a huge emotional toll that included feelings of isolation and polarization. While some nurses described feeling supported by their team and employer, others described feeling expendable.

CONCLUSION

Nurses' responses provided insights into negative emotional experiences during the pandemic due to heightened uncertainty and fear, and also the importance of support received from peers, colleagues and their employer. Nurses experienced feelings of isolation and polarization within their communities. The varied responses reflect the importance of societal solidarity when faced with global emergencies, and the need for nurses to feel valued by their patients and employer.

IMPACT

Effective responses to public health emergencies require individuals and communities to work together to achieve collective goals. Efforts to retain nurses are critical during global emergencies.

PATIENT OR PUBLIC CONTRIBUTION

No patient and public involvement.

Associated factors of nurse-sensitive patient outcomes: A multicentred cross-sectional study in psychiatric inpatient hospitals

WHAT IS ALREADY KNOWN?: The nurse-patient relationship in mental health care is an important focus of mental health nursing theories and research. There is limited evidence about which factors influence nurse-sensitive patient outcomes of the nurse-patient relationship. This hinders the development, planning, delivering, and quality assurance of the nurse-patient relationship in nursing practice and nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our best knowledge, this is the first study to examine associations between nurse-sensitive patient outcomes of the nurse-patient relationship and a range of patient characteristics and relationship-contextual factors. In this study, we found that gender, age, hospital characteristics, nurse availability when needed, nurse contact, and nurse stimulation were associated with the scores on the nurse-sensitive patient outcome scale. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Having insight into the factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship can help nurses, nursing students, nursing management and also patients to enhance the nurse-patient relationship, trying to influence outcomes of nursing care. ABSTRACT: Introduction The lack of evidence on patient characteristics and relational-contextual factors influencing nurse-sensitive patient outcomes of a nurse-patient relationship is a possible threat to the quality and education of the nurse-patient relationship. Aim To measure nurse-sensitive patient outcomes of the nurse-patient relationship and to explore the associations between nurse-sensitive patient outcomes and a range of patient characteristics and relational-contextual factors. Method In a multicenter cross-sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse-Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted. Results Overall, patient-reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital. Discussion The results may help nurses to become more sensitive and responsive to factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship. Implications The nurse-sensitive results can support nurses in designing future nurse-patient relationships.

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.

Association of external interruptions with increased medication administration duration and self-interruptions: A direct observational study: Empirical research quantitative

AIMS

To examine task duration and frequency of self-interruptions among study participants during externally interrupted compared with externally uninterrupted simulated medication administration.

BACKGROUND

Interruptions are prevalent during nursing medication administration and can lead to inefficient, delayed, omitted and unsafe patient care. Interrupted nursing tasks are shown to take longer to complete compared to uninterrupted tasks; however, studies seldom indicate if the time spent in the interruption was included or excluded in the reported task duration. It is unknown if the time spent in the interruption leads to longer task completion times or if other factors, such as the time needed to re-engage in the primary task and/or self-interruptions, are involved. Little is known about associations between external interruptions and self-interruptions during nursing tasks. Self-interruptions are caused by an individual's own decision to stop an activity to attend to something else.

DESIGN

Cross-sectional within-subjects design.

METHODS

This two-site study investigated task duration and frequencies of self-interruptions during externally interrupted and externally uninterrupted simulated medication administration. Data on medication administration duration, external interruption duration and self-interruptions were collected via direct observation from November 2019-February 2020. The time spent in the external interruption was deducted from the medication administration duration.

RESULTS

Thirty-five participants were included in the study. The externally interrupted task had a significantly longer duration and significantly more frequent self-interruptions within-subjects compared to the externally uninterrupted task. Self-interruptions were most often due to forgotten supplies.

CONCLUSIONS

The findings suggest that the time needed to re-engage with an externally interrupted task and/or self-interruptions may lead to longer task completion times.

IMPACT

Researchers are encouraged to investigate mediators of interruptions that lead to longer task completion times and errors. Findings can be used to develop and implement interruption management strategies that aim to improve the safety and quality of patient care.

REPORTING METHOD

Equator guidelines were followed using the STROBE reporting method.

PATIENT/PUBLIC CONTRIBUTION

No patient or public involvement in this study.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Educators and researchers can use the study findings to guide teaching methods and direct future studies. By gaining a better understanding of the mediators of interruptions that create longer task completion times and increase the risk for errors, tailored interruption management strategies that aim to improve the safety and quality of healthcare can be developed and implemented.

Caring behaviour and its associated factors among nurses working at public hospitals in Gamo zone, southern Ethiopia: a cross-sectional study

OBJECTIVE

The purpose of this study was to assess nurses caring behaviours and its associated factors among nurses working at public hospitals in the Gamo zone of southern Ethiopia in 2022.

DESIGN

Institutional based cross-sectional study was used.

SETTING

This study was conducted in five public hospitals in Gamo zone, southern Ethiopia.

PARTICIPANTS

A total of 360 nurses of different level of qualification were included in this study using a proportional allocation method from the five hospitals and final study participants were recruited from all wards using a simple random sampling method from 20 June to 20 July 2022.

OUTCOME MEASUREMENTS

Caring behaviour was assessed using 24 standardised Caring Behaviour Inventory (CBI) scales. Data were collected using a structured questionnaire and, analysed using the logistic regression method, and those variables with a p value of <0.05 in multivariable analysis were considered statistically significant.

RESULT

The overall percentage of nurse caring behaviour in this study was 53.3%. Most of the respondents practiced technical aspects of caring behaviour rather than psychosocial aspects of caring. Being married (adjusted OR (AOR)=0.027 (0.003-0.263), having work experience of (0-5 years) (AOR=5.547 (1.42-21.64)), (6-10 years) (AOR=8.693 (2.317-32.6), being satisfied with motivation and prospect (AOR=0.473 (0.290-0.770)) and being satisfied with the nursing profession (AOR=1.716 (1.065-2.765) were significantly associated with nurses caring behaviour.

CONCLUSION

The proportion of nurses with a good caring behaviour found in this study was relatively poor. Being married, having lower work experience, being satisfied with motivation and prospects, and nursing profession were associated with nurses caring behaviour. This study recommends the need to focus on including caring behaviour courses in the nursing curriculum and training nurses focusing on those with a few experiences on the meaning and importance of caring behaviour.

Exploring Missed Nursing Care in the NICU: Perspectives of NICU Nurses in Saudi Arabia's Eastern Health Cluster

(1) Background: Missed nursing care, an omission error characterized by delayed or omitted nursing interventions, poses significant risks to patients' safety and quality of car.; (2) Methods: This is a quantitative cross-sectional study on 151 nurses who work in NICUs in three main networks in the Eastern Health Province, Saudi Arabia: Dammam (n = 84), Qatif (n = 53), and Jubail (n = 14). The study uses a self-reported questionnaire (MISSCARE) and applies the 5-point Likert Scale. Statistical analysis data were analyzed using SPSS version 23.0. (3) Results: The primary reasons for missed care were shortage of nursing staff and unbalanced patient assignments. Missed nursing care negatively affects job satisfaction and was positively correlated with nurses' intentions to quit their jobs. Inadequate equipment, supplies, and breakdowns in communication between nurses and other healthcare professionals were also significant factors contributing to missed care. (4) Conclusions: Missed nursing care is associated with overwork, nursing shortages, and lower job satisfaction, impacting the quality of care provided in the NICU. Improving working conditions, nurse staffing, and patient assignment planning should be prioritized to address this issue effectively.

The impact of safety culture, quality of care, missed care and nurse staffing on patient falls: A multisource association study

AIMS

To examine the association between nursing unit safety culture, quality of care, missed care and nurse staffing levels, and inpatient falls using two data sources: incidence of falls and nurses' perceptions of fall frequency in their units. The study explores the association between the two sources of patient falls and identifies if nurses' perceptions of patient fall frequency reflect the actual patient falls recorded in the incident management system.

BACKGROUND

Inpatient falls are associated with severe complications that result in extended hospitalisation and increased financial consequences for patients and healthcare services.

DESIGN

A multi-source cross-sectional study guided by the STROBE guidelines.

METHODS

A purposive sample of 33 nursing units (619 nurses) from five hospitals completed an online survey from August to November 2021. The survey measured safety culture, quality of care, missed care, nurse staffing levels and nurses' perceptions of patient fall frequency. In addition, secondary data on falls from participating units between 2018 and 2021 were also collected. Generalised linear models were fitted to examine the association between study variables.

RESULTS

Nursing units with strong safety climate and working conditions and lower missed care were associated with lower rates of falls using both data sources. Nurses' perceptions of the frequency of falls in their units were reflective of the actual incidence rate of falls, but the association was not statistically significant.

CONCLUSION

Nursing units with a strong safety climate and better collaborations between nurses and other professionals, including physicians and pharmacists, were associated with lower incidents of patient falls.

RELEVANCE TO CLINICAL PRACTICE

This study provided evidence for healthcare services and hospital managers to minimise patient falls.

PATIENT OR PUBLIC CONTRIBUTION

Patients who had experienced a fall, which was reported in the incident management system, from the included units in the five hospitals were part of this study.

Healthcare-associated infections in adult intensive care units: A multisource study examining nurses' safety attitudes, quality of care, missed care, and nurse staffing

OBJECTIVES

This study examined the association between safety attitudes, quality of care, missed care, nurse staffing levels, and the rate of healthcare-associated infection (HAI) in adult intensive care units (ICUs).

METHODS

A cross-sectional study was conducted in five hospitals. Nurses completed a validated survey on safety attitudes, quality of care, missed care, nurse staffing levels, and the frequency of HAIs. Secondary data were collected on the incidence of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) in participating units. Descriptive analysis and generalized linear models were performed.

RESULTS

A total of 314 nurses from eight ICUs participated in this study. The mean safety culture score was 60.85 (SD = 3.53). ICUs with strong job satisfaction had lower incidence and nurse-reported frequency of CLABSI, CAUTI, and VAP. Missed care was common, with 73.11% of nurses reporting missing at least one required care activity on their last shift. The mean patient-to-nurse ratio was 1.95. Increased missed care and higher workload were associated with higher HAIs. Nurses' perceptions of CLABSI and VAP frequency were positively associated with the actual occurrence of CLABSI and VAP in participating units.

CONCLUSION

Positive safety culture and better nurse staffing levels can lower the rates of HAIs in ICUs. Improvements to nurse staffing will reduce nursing workloads, which may reduce missed care, increase job satisfaction, and, ultimately, reduce HAIs.

IMPLICATIONS FOR CLINICAL PRACTICE

Higher levels of job satisfaction among ICU nurses, lower proportions of missed nursing care and higher nurse staffing are associated with lower rates of HAIs. Nurse-reported HAI frequency was positively associated with the incidence of HAIs; therefore, nurses provide reliable data on infection control outcomes in ICU settings.