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Babaei S, Amini K, Ramezani-Badr F. Unveiling missed nursing care: a comprehensive examination of neglected responsibilities and practice environment challenges. BMC Health Serv Res 2024; 24:977. [PMID: 39180086 PMCID: PMC11344376 DOI: 10.1186/s12913-024-11386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 08/01/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND The global variable of missed nursing care and practice environment are widely recognized as two crucial contextual factors that significantly impact the quality of nursing care. This study assessed the current status of missed nursing care and the characteristics of the nursing practice environment in Iran. Additionally, this study aimed to explore the relationship between these two variables. METHODS We conducted an across-sectional study from May 2021 to January 2022 in which we investigated 255 nurses. We utilized the Missed Nursing Care Survey, the Nursing Work Index-Practice Environment Scale, and a demographic questionnaire to gather the necessary information. We used the Shapiro‒Wilk test, Pearson correlation coefficient test, and multiple linear regression test in SPSS version 20 for the data analyses. RESULTS According to the present study, 41% of nurses regularly or often overlooked certain aspects of care, resulting in an average score of 32.34 ± 7.43 for missed nursing care. It is worth noting that attending patient care conferences, providing patient bathing and skin care, and assisting with toileting needs were all significant factors contributing to the score. The overall practice environment was unfavorable, with a mean score of 2.25 ± 0.51. Interestingly, 'nursing foundations for quality of care' was identified as the sole predictor of missed nursing care, with a β value of -0.22 and a p-value of 0.036. CONCLUSIONS This study identified attending patient care interdisciplinary team meetings and delivering basic care promptly as the most prevalent instances of missed nursing care. Unfortunately, the surveyed hospitals exhibited an undesirable practice environment, which correlated with a higher incidence of missed nursing care. These findings highlight the crucial impact of nurses' practice environment on care delivery. Addressing the challenges in the practice environment is essential for reducing instances of missed care, improving patient outcomes, and enhancing overall healthcare quality.
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Affiliation(s)
- Somayeh Babaei
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kourosh Amini
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Mahdavi St., Zanjan, 4515789589, Iran.
| | - Farhad Ramezani-Badr
- Department of Critical Care Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
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Andersson I, Eklund AJ, Nilsson J, Bååth C. First-line managers´ perceptions of missed nursing care in community health care for older people-A phenomenographic study. Scand J Caring Sci 2024. [PMID: 39129432 DOI: 10.1111/scs.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION First-line managers in Swedish communities have responsibility for that care to older people is provided, staffing is sufficient and the budget is balanced in their unit. It is a struggle with limited resources due to a growing population in need of care. This can lead to missed nursing care. The aim was to describe first-line managers´ perceptions of missed nursing care in community health care for older people. METHODS A qualitative design with a phenomenographic approach, interviewing 24 first-line managers. Ethics approval for the study was received from the Research Ethics Committee at Karlstad University (Dnr HNT 2020/566). RESULTS The results are shown in six descriptive categories containing 15 perceptions. The descriptive categories are 'occurrence of missed nursing care', 'becoming aware of missed nursing care', 'reasons for missed nursing care', 'missed nursing care has consequences for the older persons', 'missed nursing care has consequences for the staff' and 'taking action to decrease missed nursing care'. CONCLUSIONS It is important for first-line managers to become aware of the existence and reasons for missed nursing, as it has consequences for older people and staff. Managers need to take missed nursing care seriously in order to work with improvements for maintaining good quality of care and patient safety.
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Affiliation(s)
- Ingrid Andersson
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Anna Josse Eklund
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
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Chiappinotto S, Bayram A, Lupi T, Basaran-Acil S, Gurkovà E, İspir Demir Ö, Kohanová D, Özsaban A, Grassetti L, Palese A. Unfinished nursing care occurrence, priority order and reasons as perceived by nursing students: An international study. Nurse Educ Pract 2024; 79:104100. [PMID: 39173395 DOI: 10.1016/j.nepr.2024.104100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/05/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
AIM The study aimed to measure and compare differences (a) in the unfinished nursing care interventions overall and the order in which they are left unfinished; and (b) in the underline reasons, as perceived by Italian, Slovak and Turkish nursing students. BACKGROUND In recent years, in the nursing education context a novel line of research in the field of unfinished nursing care as those interventions required by patients, but omitted or delayed, has emerged. However, no studies have been conducted at the international level. DESIGN An international, comparative cross-sectional study was performed in 2022-2023 and reported here according to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. METHODS A multinational research network was formed with a convenient sample of 13 universities and 60 campuses (4595 students). The Unfinished Nursing Care Survey for Students (UNCS4S) was administered. A total of 1850 students participated. RESULTS According to the UNCS4S total score, Italians reported an average 50.9 out of 110 unfinished nursing care interventions (CI95 % 47.6-54.1), Slovakians 54.9 (CI95 % 53.7-56.1) and Turkish students 50.4 (CI95 % 49.2-51.5) (p<0.001). Some interventions were reported more often as unfinished across countries as supervising the task assigned to the nursing aides, going to the patient without being called, spending the required time with the patient and their caregivers and emotionally supporting patients and their caregivers. In terms of reasons, total scores were statistically different across countries (Italy: 45.92 out of 90, CI95 % 43.91-47.9; Slovakia: 62, CI95 % 61.02-62.98; Türkiye: 72.29, CI95 % 71.13-73.45; p<0.001); however, at the factor level, communication issues, lack of material resources and issues in supervision of nursing aides were reported in all countries as the most important reasons of the unfinished nursing care. CONCLUSIONS Students learn to shape and set priorities early in their nursing careers with similar order in what to leave unfinished as first, despite the different educational structures, care cultures and healthcare systems. Among the unfinished nursing care reasons perceived, the most influential were similar across countries, suggesting common areas for improvement. How to better prepare students to be resilient and capable of managing the challenges posed by unfinished nursing care episodes due to the lack of resources and communications issues should be considered as a priority by nurse educators.
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Affiliation(s)
| | - Aysun Bayram
- Karadeniz Technical University, Faculty of Health Sciences, Department of Fundamentals Nursing, Trabzon, Türkiye.
| | - Tommaso Lupi
- University of Udine, Department of Medicine, Udine 33100, Italy.
| | - Seher Basaran-Acil
- Hacettepe University Faculty of Nursing, Nursing Services Administration Department, Ankara, Türkiye.
| | - Elena Gurkovà
- Elena Gurkova, University of Prešov, Faculty of Health Care, Department of Nursing, Prešov 08001, Slovakia.
| | - Öznur İspir Demir
- Osmaniye Korkut Ata University, Faculty of Health Sciences, Department of Gerontology, Osmaniye, Türkiye
| | - Dominika Kohanová
- Constantine the Philosopher University in Nitra, Faculty of Social Sciences and Health Care, Department of Nursing, Nitra 949 01, Slovakia.
| | - Aysel Özsaban
- Karadeniz Technical University, Faculty of Health Sciences, Department of Fundamentals Nursing, Trabzon, Türkiye.
| | - Luca Grassetti
- University of Udine, Department of Economy and Statistic, Udine 33100, Italy.
| | - Alvisa Palese
- University of Udine, Department of Medicine, Udine 33100, Italy.
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Erdat Y, Kuruca-Ozdemir E, Kocoglu-Tanyer D, Duygulu S. The holistic nursing competence and transition shock of newly graduated nurses as the determinants of missed nursing care: The mediation analysis. J Clin Nurs 2024; 33:3576-3585. [PMID: 38284458 DOI: 10.1111/jocn.17030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
AIMS AND OBJECTIVE To investigate the determinants of missed nursing care and to analyse the mediating effect of holistic nursing competence on the relationship between transition shock and missed nursing care. BACKGROUND Transition shock of newly graduated nurses is associated with missed nursing care. Previous studies have shown the determinants of missed nursing care among nurses, but little is known about the relationship between missed nursing care, transition shock and holistic nursing competence. DESIGN Descriptive and correlational design. METHODS The study was conducted among newly graduated nurses (n = 201) working in acute care hospitals for 1-12 months. The MISSCARE survey, Holistic Nursing Competence Scale and Nursing Transition Shock Scale were used for data collection, in addition to a sociodemographic question form. Data were analysed using Pearson correlation, multiple regression and mediation analyses. The study was reported following the STROBE checklist. RESULTS The determinants of missed nursing care among newly graduated nurses were sex, unit type, rotating shift work, holding a certificate, holistic nursing competence and transition shock. All these variables explain 35% of the variance in missed nursing care. Holistic nursing competence directly mediated 51.7% of the relationship between transition shock and missed nursing care. CONCLUSIONS Holistic nursing competence may decrease missed nursing care by reducing the effects of transition shock on newly graduated nurses. RELEVANCE TO CLINICAL PRACTICE The study highlighted that newly graduated nurses are an important population regarding missed nursing care. The determinants of missed care should be considered in the nursing care delivery to prevent missed care by newly graduated nurses. Based on the study findings, some recommendations were made for nurse managers and faculty for the orientation program and undergraduate nursing education.
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Affiliation(s)
- Yildiz Erdat
- Faculty of Nursing, Department of Nursing Management, Hacettepe University, Ankara, Türkiye
| | - Emine Kuruca-Ozdemir
- Faculty of Nursing, Department of Nursing Management, Hacettepe University, Ankara, Türkiye
| | - Deniz Kocoglu-Tanyer
- Faculty of Nursing, Department of Public Health Nursing, Selcuk University, Konya, Türkiye
| | - Sergul Duygulu
- Faculty of Nursing, Department of Nursing Management, Hacettepe University, Ankara, Türkiye
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Abere Y, Biresaw H, Misganaw M, Netsere B, Adal O. Missed nursing care and its associated factors in public hospitals of Bahir Dar City, Northwest Ethiopia: a cross-sectional study. BMJ Open 2024; 14:e081647. [PMID: 38626963 PMCID: PMC11029394 DOI: 10.1136/bmjopen-2023-081647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
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.
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Affiliation(s)
- Yirgalem Abere
- Adult Health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Henok Biresaw
- Adult Health Nursing, Bahir Dar University, Bahir Dar, Ethiopia
| | | | | | - Ousman Adal
- Emergency and critical care nursing, Bahir Dar University, Bahir Dar, Ethiopia
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Peng M, Saito S, Mo W, Guan H. Why do nurses miss nursing care? A qualitative meta-synthesis. Jpn J Nurs Sci 2024; 21:e12578. [PMID: 37987226 DOI: 10.1111/jjns.12578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
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.
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Affiliation(s)
- Mengyun Peng
- School of Nursing, Soochow University, Suzhou, China
- Graduate School of Health Sciences, Okayama University, Okayama, Japan
| | - Shinya Saito
- Graduate School of Health Sciences, Okayama University, Okayama, Japan
| | - Wenping Mo
- Graduate School of Medicine, Division of Health Sciences, Osaka University, Osaka, Japan
| | - Hong Guan
- Department of Nursing, The Third Hospital of Dalian Medical University, Dalian, China
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Rivaz M, Abbasi F, Pasyar N. Structural Equation Modeling of Associations Between Nursing Practice Environment And Missed Nursing Care: A Cross-sectional Study. J Nurs Care Qual 2024; 39:E16-E22. [PMID: 37782913 DOI: 10.1097/ncq.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Missed nursing care (MNC) negatively impacts the quality of patient care. There may be a relationship between the nursing practice environment (NPE) and MNC; however, this relationship has not been examined in developing countries during the COVID-19 pandemic. PURPOSE To determine the relationship between the NPE and MNC during the COVID-19 pandemic. METHODS A cross-sectional study of 300 participants was conducted in 4 teaching hospitals in Iran. Data were collected using a demographic and clinical form, the Nursing Professional Practice Environment Questionnaire, and MISSCARE survey and analyzed using structural equation modeling. RESULTS The hypothesized model was well fit, showing that 1 unit improvement of the NPE domains of patient-centered care , effective leadership , and policy transparency decreased MNC by 0.18, 0.12, and 0.05, respectively. CONCLUSION The model confirmed the association between the dimensions of the NPE and MNC. These findings can assist health policymakers and nursing managers in improving the NPE.
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Affiliation(s)
- Mozhgan Rivaz
- Author Affiliations: Department of Nursing (Dr Rivaz) and Community Based Psychiatric Care Research Center (Dr Pasyar), School of Nursing and Midwifery (Ms Abbasi), Student Research Committee of Shiraz University of Medical Sciences, Shiraz, Iran
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Bayram A, Chiappinotto S, Palese A. Unfinished nursing care in healthcare settings during the COVID-19 pandemic: a systematic review. BMC Health Serv Res 2024; 24:352. [PMID: 38504283 PMCID: PMC10949800 DOI: 10.1186/s12913-024-10708-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Unfinished nursing care is becoming increasingly more of a concern in worldwide healthcare settings. Given their negative outcomes, it is crucial to continuously assess those nursing interventions that are commonly postponed or missed, as well as the underlying reasons and consequences. The worldwide COVID-19 pandemic has made it difficult for health facilities to maintain their sustainability and continuity of care, which has also influenced the unfinished nursing care phenomenon. However, no summary of the studies conducted during the COVID-19 pandemic was produced up to now. The main aim of this study was to systematically review the occurrence of, reasons for, and consequences of unfinished nursing care among patients in healthcare settings during the COVID-19 pandemic. METHODS Systematic review registered in PROSPERO (CRD42023422871). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline and the Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies were used. MEDLINE-PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from March 2020 up to May 2023, using keywords established in the field as missed care, unfinished nursing care, or implicit rationing. RESULTS Twenty-five studies conducted mainly in European and Asiatic countries were included and assessed as possessing good methodological quality. The following tools were used: the MISSCARE Survey (= 14); the Basel Extent of Rationing of Nursing Care (= 1), also in its revised form (= 2) and regarding nursing homes (= 2); the Perceived Implicit Rationing of Nursing Care (= 4); the Intensive Care Unit-Omitted Nursing Care (= 1); and the Unfinished Nursing Care Survey (= 1). The order of unfinished nursing care interventions that emerged across studies for some countries is substantially in line with pre-pandemic data (e.g., oral care, ambulation). However, some interesting variations emerged at the country and inter-country levels. Conversely, labour resources and reasons close to the emotional state and well-being of nurses were mentioned homogeneously as most affecting unfinished nursing care during the pandemic. None of the studies investigated the consequences of unfinished nursing care. CONCLUSIONS Two continents led the research in this field during the pandemic: Europe, where this research was already well established, and Asia, where this research is substantially new. While unfinished care occurrence seems to be based on pre-established patterns across Europe (e.g., regarding fundamentals needs), new patterns emerged across Asiatic countries. Among the reasons, homogeneity in the findings emerged all in line with those documented in the pre-pandemic era.
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Affiliation(s)
- Aysun Bayram
- Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | | | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy
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Norman RM, Sjetne IS. Associations between nursing home care environment and unfinished nursing care explored. Secondary analysis of cross-sectional data. Geriatr Nurs 2024; 56:55-63. [PMID: 38241877 DOI: 10.1016/j.gerinurse.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/30/2023] [Accepted: 12/31/2023] [Indexed: 01/21/2024]
Abstract
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.
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Affiliation(s)
- Rebecka Maria Norman
- Norwegian Institute of Public Health, PO Box 222, Skøyen NO-0213 Oslo, Norway; Lovisenberg Diaconal University College, Lovisenberggata 15b NO-0456 Oslo, Norway.
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Labrague LJ, T Kostovich C. A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review. West J Nurs Res 2024; 46:133-142. [PMID: 38014816 DOI: 10.1177/01939459231214598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has placed unparalleled pressure on many countries' healthcare systems, impacting the delivery of health and nursing care services. Despite the growing number of missed care studies during the pandemic, a broader perspective is essential when designing theory-driven strategies to improve nursing care delivery. This review aimed to synthesize evidence of missed nursing care during the COVID-19 pandemic in acute care settings through a systematic review and narrative synthesis. An electronic search of articles published since the emergence of the pandemic was conducted using 5 databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO). A total of 470 articles were identified during the initial search, and 10 articles were included in the review. The sample sizes of the studies ranged from 37 to 536 nurses. Results of the content analysis were grouped into 5 categories: (1) prevalence of missed care, (2) frequency of missed care, (3) reasons for missed care, (4) nurses' and organizational variables contributing to missed care, and (5) work environment elements contributing to missed care. The review's findings revealed a shift in the nature of missed nursing care during the pandemic, with an emphasis on nursing care tasks vital for the recovery of patients with COVID-19. Despite the unique circumstances brought about by the pandemic, an inadequate nursing workforce continued to be identified as the primary reason for missed care, consistent with the pre-pandemic period.
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Affiliation(s)
- Leodoro J Labrague
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Carol T Kostovich
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
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Bayram A, Özsaban A, Torun Kiliç Ç. Verbal violence and missed nursing care: A phenomenological study. Int Nurs Rev 2023; 70:544-551. [PMID: 37647223 DOI: 10.1111/inr.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
AIM To define the missed care experiences of nurses exposed to verbal violence from patients. BACKGROUND Verbal violence takes the first place among the types of violence that nurses face in healthcare settings. This can cause negative emotional and physical responses in nurses and issues in patient and nurse interaction. As a result, it may lead to missed nursing care, defined as skipped, postponed or incomplete care during the patient's care. METHODS This is a phenomenological study. The study sample included 16 nurses working in inpatient clinics who reported experiencing verbal violence at least once in Turkey. The study was conducted between January and February 2022 with institutional permission and ethics committee approval (09/12/2021-2021/357). A semi-structured interview method was used to collect data. The information gathered from the interviews underwent thematic analysis using an inductive approach. The 'Consolidated Criteria for Reporting Qualitative Research (COREQ)' was used to report this qualitative study based on a comprehensive protocol. RESULTS The types of verbal violence most frequently faced by nurses were determined as swearing, insulting, shouting and threats. Study findings were classified into three main themes: (i) response to verbal violence, (ii) missed nursing care experiences and (iii) suggestions to cope with verbal violence. The most felt emotions in the face of verbal violence were feeling sad, unsafe and worthless. Nurses common behaviours, in response to verbal abuse were ignoring, getting used to, and wishing to get away. The examples of missed care included using non-therapeutic communication, postponing care or withdrawing from care. CONCLUSION Verbal violence caused negative emotional and behavioural responses in nurses, which, in turn, negatively affected the nurse-patient interaction. These findings mean that verbal violence may pave the way for missed nursing care. IMPLICATIONS FOR NURSING POLICY According to these findings, an uninterrupted nursing care process needs to focus on preventive measures against verbal violence and increase the administrative and legal support offered to nurses.
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Affiliation(s)
- Aysun Bayram
- Fundamentals of Nursing Department, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Aysel Özsaban
- Fundamentals of Nursing Department, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Çiğdem Torun Kiliç
- Nursing Management Department, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
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Albsoul RA, Safadi RR, Alshyyab MA, FitzGerald G, Hughes JA, Ahmad M. Missed Nursing Care in Medical and Surgical Wards in Jordan: A Cross-Sectional Study. Policy Polit Nurs Pract 2023; 24:140-150. [PMID: 36798019 DOI: 10.1177/15271544231155845] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Missed nursing care is a multifaceted patient safety issue receiving increased attention among healthcare scholars worldwide. There is limited research on missed nursing care in the Jordanian healthcare context. The current study sought to examine the perceptions of Jordanian nurses toward the amount and types of missed nursing care in medical and surgical wards. We also examined the differences in missed care items between public, private, and university hospitals in Jordan. This was a cross-sectional study using the MISSCARE Survey tool. Data collection spanned 4 months between March and July 2021. The final study sample consisted of 672 registered nurses employed in five public, three private, and two university hospitals in Jordan. Data were analyzed using descriptive statistics, Analysis of variance, and Pearson correlation coefficent test. Of the 672 registered nurses who participated, the majority were females (n = 421; 62.6%). Most participants held a bachelor's degree in nursing (n = 577; 85.9%). The three most common missed nursing activities in the participating hospitals were: ambulation, oral care, and emotional support. Nurses working in public hospitals reported the highest missed nursing care. The age and number of patients under care significantly correlated with missed nursing care. The findings could help nursing managers develop plans to reduce missed nursing care in their healthcare institutions.
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Affiliation(s)
- Rania Ali Albsoul
- Department of Family and Community Medicine, School of Medicine, 54658The University of Jordan, Irbid, Jordan
| | - Reema Rafiq Safadi
- Department of Maternal and Child Health Nursing, School of Nursing, 54658The University of Jordan, Amman, Jordan
| | - Muhammad Ahmed Alshyyab
- Department of Public Health and Community Medicine, Faculty of Medicine, 37251Jordan University of Science and Technology, Amman, Jordan
| | - Gerard FitzGerald
- School of Public Health and Social Work, 1969Queensland University of Technology, Brisbane, Australia
| | - James A Hughes
- School of Nursing, 1969Queensland University of Technology, Brisbane, Australia
| | - Muayyad Ahmad
- Department of Clinical Nursing, School of Nursing, 54658The University of Jordan, Amman, Jordan
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Blackman I, Mudd A. An empirical analysis of the constructs of Fundamentals of Care Framework using structural equation modelling. J Adv Nurs 2023; 79:1139-1151. [PMID: 35867342 DOI: 10.1111/jan.15369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 05/19/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
Abstract
AIM First, to identify which aspects of missed care accurately define the integration of care and context of care dimensions of the Fundamentals of Care Framework. Second, to test the Framework for validity and reliability and lastly, to explore how leadership influences care integration. DESIGN A non-experimental research design using self-audit data collected information about variations in nursing care as exemplars for dimensions of the Framework. METHODS A multi-variate approach using path analysis was used to apply the consensus scores of 3079 Australian residential care nurses and carers to define the dimensions of the Framework. RESULTS/FINDINGS In the Australian residential care setting, the factors that define both the contexts of care and the integration of care dimensions constructs are now empirically established. The most direct predictor for the integration of care dimension arises from both the leadership and resource allocation variables, while the remaining context of care factors have indirect but significant effects. The integration of psychosocial care in the residential care sector is not influenced by any of the Framework's context-based factors. CONCLUSION The component variables of the Framework show both good reliability and convergent validity. These findings confirm a predictive relationship exists between the elements of the context of care and the different types of nursing activities that form the integration of the care dimension, including organizational leadership.
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Affiliation(s)
- Ian Blackman
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alexandra Mudd
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Allari RS, Hamdan K. Caring Behavior and Hourly Rounding: Nurses’ Perception. Open Nurs J 2023. [DOI: 10.2174/18744346-v17-e230210-2022-118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background:
Caring behavior impacts care quality and improves patients’ satisfaction. Hourly rounding aims at preventing missed care and improving hospital patient satisfaction.
Objectives:
This study aimed to examine the Jordanian nurses’ perception of caring behavior and hourly rounding and assess the correlation between perception of caring behavior and hourly rounding.
Methods:
A cross-sectional descriptive correlational design was used to conduct this study. A convenience sample of 1378 nurses completed the online Hourly Rounding Questionnaire (HRQ) and the Caring Dimension Inventory (CDI-25).
Results:
Nurses’ lowest agreement about hourly rounding was on the documentation. In comparison, the highest agreement was making patients safer by preventing falls. The mean of caring behavior was 105.39, indicating a high level of care. This study revealed significant differences in nurses’ perceptions of hourly rounding concerning hospital type, shifts, working units, and gender. Moreover, a strong positive correlation was found between nurses’ perceptions of hourly rounding and their perception of caring.
Implications for Nursing:
Nurses should take the psychosocial aspect of the patients as an essential priority when providing care. The nurse leaders are responsible for supervising, supporting, and evaluating that hourly rounding according to policy and protocols.
Conclusion:
This study demonstrated the importance of hourly rounding and caring behavior and their correlation.
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Senek M, Robertson S, Taylor B, Wood E, King R, Ryan T. Consequences of understaffing on type of missed community care- a cross-sectional study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100075. [PMID: 38745608 PMCID: PMC11080403 DOI: 10.1016/j.ijnsa.2022.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/30/2021] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Resource cuts to primary and community care in combination with a decline of those working in community settings is compromising quality of care and patient safety in the UK. It is reported that the negative consequences of understaffing and underfunding have worsened due to the COVID-19 pandemic. OBJECTIVE This is a cross-sectional study that aimed to examine short and long-term District and Community nursing working conditions. The objectives were to assess the prevalence of understaffing and missed care and the relationship between individual and organisational factors and their association with missed care outcome. We further explored the relationship between additional caseload, staffing levels and missed care. METHODS We developed a questionnaire based on the validated MISSCARE survey. Outcome measures were, number of vacancies per team, staffing levels, reported incidence of missed care, type of missed care, length of shift and overtime. RESULTS Only 23% of teams reported having no vacancies. The mean staffing ratio was reported at 60%, including agency/bank staff (0.59±1.5). Prevalence of missed care was relatively high (60%≈). The distribution of types of missed care was spread evenly across all types of nursing care. A backward stepwise regression analysis showed that the Proportion of Permanent staff capacity OR=7.9 (95% CI 0.09-0.65), Active Caseload Size OR= 5.5 (95% CI: 1.0 - 1.003), Number of RNs on the team (OR 4.8 (95% CI:1.003-1.058) and Amount of Overtime worked (OR= 3.9 (95% CI:0.98-1.0) variable are statistically significant predictors of missed care. The analysis showed an increase in additional allocated cases per RN as the permanent staff proportion decreased to 70%, at which point the likelihood of reported Missed Care outcome peaks. CONCLUSION The compromised quality of care related to human resources and organisational aspects of the nursing process. Where RNs worked longer hours to make up for the backlog of cases, the prevalence of missed care was more likely. Longer working hours in the community increased the risk of compromised care and sub-optimal patient care. The aspects of the nursing process identified as 'missed' related to The World Health Organisation's three main pillars of community nursing (health promotion, patient education and screening). As such, significant components of the two first pillars are, according to these data, being undermined.
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Affiliation(s)
- Michaela Senek
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
| | - Steven Robertson
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
| | - Bethany Taylor
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
| | - Emily Wood
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
| | - Rachel King
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
| | - Tony Ryan
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
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16
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Mazzetti G, Sciolino L, Guglielmi D, Mongardi M, Nielsen K, Dawson J. Organizational citizenship behaviour as a protective factor against the occurrence of adverse nursing-sensitive outcomes: A multilevel investigation. J Nurs Manag 2022; 30:4294-4303. [PMID: 36190738 PMCID: PMC10092892 DOI: 10.1111/jonm.13827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 12/30/2022]
Abstract
AIMS This study aimed to investigate the association between organizational citizenship behaviour enacted by nurses and the occurrence of adverse nursing-sensitive patient outcomes. BACKGROUND Managing psychosocial factors (i.e., aspects concerning the work environment) is key to ensure patient safety, to prevent exacerbation of case complexity and to cope with critical shortages in human and financial resources. METHODS Self-report measures of nurses' organizational citizenship behaviour were combined with objective data on the incidence of adverse nursing-sensitive outcomes (i.e., pressure ulcers and restraint use) collected through patients' medical records. Participants were 11,345 patients and 1346 nurses across 52 teams working in 14 Italian hospitals. Data were analysed using multilevel binary logistic regression models. RESULTS A negative relationship between nurses' organizational citizenship behaviour and restraint use was identified, with an odds ratio of 0.11. Thus, for a one-unit higher organizational citizenship behaviour score, the odds of using restraints shrink to about one eighth of the previous level. CONCLUSIONS Intervention strategies to foster the implementation of organizational citizenship behaviour among nurses may inhibit the occurrence of critical outcomes affecting patients' health and well-being (i.e., using restraint devices). IMPLICATIONS FOR NURSING MANAGEMENT In health care organizations, shaping a psychosocial environment encouraging organizational citizenship behaviour can mitigate the occurrence of adverse nursing-sensitive outcomes such as restraint use on patients.
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Affiliation(s)
- Greta Mazzetti
- Department of Education Studies, University of Bologna, Bologna, Italy
| | - Lorenzo Sciolino
- Hospital Care Service, General Direction for People Care, Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Dina Guglielmi
- Department of Education Studies, University of Bologna, Bologna, Italy
| | - Maria Mongardi
- Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, Verona, Italy
| | - Karina Nielsen
- Sheffield University Management School, The University of Sheffield, Sheffield, UK
| | - Jeremy Dawson
- Sheffield University Management School, The University of Sheffield, Sheffield, UK.,School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
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Alfuqaha OA, Alhalaiqa FN, Alqurneh MK, Ayed A. Missed nursing care before and during the COVID-19 pandemic: A comparative cross-sectional study. Int Nurs Rev 2022; 70:100-110. [PMID: 35947610 PMCID: PMC9538371 DOI: 10.1111/inr.12795] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/22/2022] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to compare perception of nurses about missed care for the patients before and during the coronavirus disease 2019 (COVID-19) in Jordan. It also examined how nurses differed in terms of the type of missed care and the factors that contributed to it before and during the COVID-19 pandemic. Additionally, socio-demographic factors, including gender, educational level, length of clinical experience, work position, age, and type of shift, were examined to evaluate their association with missed nursing care. BACKGROUND Missed nursing care refers to omission of any aspect of required patient care. Missed care lowers patient satisfaction and also leads to adverse hospital outcomes. METHODS We adopted a cross-sectional design among 260 nurses working in medical/surgical wards and intensive care units. Views of 130 nurses before COVID-19 were compared with views of 130 nurses during the COVID-19 pandemic. We used the Arabic version of the MISSCARE survey. Data were collected between November 2019 and May 2020. RESULTS During COVID-19, nurses had significantly higher satisfaction levels and lower levels of absence and intention to leave than nurses before the COVID-19 pandemic. Differences were observed between nurses' perceptions of missed care before and during the COVID-19 pandemic. It was observed that missed nursing care increased during COVID-19. The inadequate number of staff nurses was the main reason for missed care activities among both groups. Additionally, age and shift type were significantly associated with an increased reason for missed nursing care among both groups. CONCLUSION AND IMPLICATIONS FOR NURSING Nurses reported higher satisfaction levels and fewer absences and planned departures during this period. Nurse managers should pay attention by maintaining high satisfaction levels and formulating appropriate policies to reduce missed care levels and thus improve patient care quality.
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Affiliation(s)
- Othman A. Alfuqaha
- Department of NursingJordan University HospitalThe University of JordanAmman11942Jordan
| | | | - Mohammad K. Alqurneh
- Department of NursingJordan University HospitalThe University of JordanAmman11942Jordan
| | - Ahmad Ayed
- Faculty of NursingArab American UniversityJeninPalestine
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18
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Albsoul RA, FitzGerald G, Alshyyab MA. Missed nursing care: a snapshot case study in a medical ward in Australia. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:710-716. [PMID: 35797073 DOI: 10.12968/bjon.2022.31.13.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Missed nursing care is a global issue in acute healthcare settings. It is a complex phenomenon that refers to nursing care that is required by patients but left undone or significantly delayed. AIM To investigate the nature of missed nursing care and influencing factors in a general medical ward in an acute care hospital in Brisbane, Australia. METHOD This is a descriptive case study. The study was carried out in a 29-bed inpatient general medical/cardiology/telemetry ward in an acute care tertiary hospital. RESULTS The study ward has been identified as a high complexity unit. The survey data found that the most frequent nursing care elements missed, as reported by the patients, were oral care, response to machine beep, and response to call light. The most frequent nurse-reported missed care items were ambulation, monitoring fluid intake/output and attendance at interdisciplinary conferences. CONCLUSION Despite mandating nurse-to-patient ratios in the study ward, inadequate staffing was still perceived as being problematic and one of the most frequent reasons leading to missed nursing care. This possible disconnect between mandated staffing ratios and the persistence of perceived missed care suggests a more complex relationship than can be managed by macro (large-scale) resourcing formulas alone.
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Affiliation(s)
- Rania Ali Albsoul
- Assistant Professor in Healthcare Management, Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Gerard FitzGerald
- Professor in Public Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Muhammad Ahmed Alshyyab
- Assistant Professor in Health Services Management, Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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19
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Chiappinotto S, Papastavrou E, Efstathiou G, Andreou P, Stemmer R, Ströhm C, Schubert M, de Wolf-Linder S, Longhini J, Palese A. Antecedents of unfinished nursing care: a systematic review of the literature. BMC Nurs 2022; 21:137. [PMID: 35698217 PMCID: PMC9195215 DOI: 10.1186/s12912-022-00890-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach. RESULTS Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability). CONCLUSIONS At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.
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Affiliation(s)
| | - Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Georgios Efstathiou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.,Nursing Services, Ministry of Health, Nicosia, Cyprus
| | | | | | | | - Maria Schubert
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Susanne de Wolf-Linder
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy.
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20
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Kim S, Chae SM. Missed nursing care and its influencing factors among neonatal intensive care unit nurses in South Korea: a descriptive study. CHILD HEALTH NURSING RESEARCH 2022; 28:142-153. [PMID: 35538726 PMCID: PMC9091770 DOI: 10.4094/chnr.2022.28.2.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Preventing missed care is important in neonatal intensive care units (NICUs) due to neonates’ vulnerabilities. This study examined missed care and its influencing factors among NICU nurses. Methods Missed care among 120 Korean NICU nurses was measured using a cross-culturally adapted online questionnaire. The frequency of missed care for 32 nursing activities and the significance of 23 reasons for missed care were collected. Results All participants had missed at least 1 activity, missing on average 19.35 activities during a typical work-day. The most common missed item was “provide developmental care for the baby”. The most common reason for missed care was “emergency within the unit or deterioration of one of the assigned patients”. The final regression model explained 9.6% of variance in missed care. The average daily number of assigned patients receiving inotropes or sedation over the last month influenced the total number of missed care items. Conclusion Missed care was affected by nurses’ workload related to the number of patients taking medication. Frequently missed activities, especially those related to developmental care, require patience and time, conflicting with safety prioritization and inadequate working conditions. NICU nurses’ working conditions should be improved to ensure adequate time for nursing activities.
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Affiliation(s)
- Soohyun Kim
- Registered Nurse, Seoul National University Hospital, Seoul, Korea
| | - Sun-Mi Chae
- Professor, College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
- Corresponding author Sun-Mi Chae College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea TEL: +82-2-740-8816 FAX: +82-2-766-1852 E-MAIL:
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21
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Prevalence, type, and reasons for missed nursing care in municipality health care in Sweden – A cross sectional study. BMC Nurs 2022; 21:95. [PMID: 35462537 PMCID: PMC9035238 DOI: 10.1186/s12912-022-00874-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background With an ageing population, there is an increasing need for care, both as home care and in nursing homes. However, some needed care is not carried out for different reasons, which can affect patient safety. The aim of the study was to describe prevalence, type, and reasons for missed nursing care in home care and nursing homes, from nurses’ perspective. Methods A cross sectional design with quantitative and qualitative approach. A Swedish version of Basel Extent of Rationing of Nursing Care for nursing homes and 15 study specific questions were answered by 624 registered nurses, enrolled nurses, or nurse assistants. Both descriptive and analytical, independent-samples t-test, analyses were used. Qualitative content analysis was used for the open-ended question. Results The care activity most often missed in home care was: ‘set up or update care plans’ (41.8%), and in nursing homes: ‘scheduled group activity’ (22.8%). Reasons for missed nursing care were lack of preparedness for unexpected situations, obstacles in a deficient work environment, unsatisfactory planning in the organisation, and/or shortcomings related to the individual. Conclusion Not all care activities needed are performed, due to reasons such as lack of time or organisational issues. Missed nursing care can lead to adverse events and affect patient safety. It is important to be aware of missed nursing care and the reasons for it, which gives a possibility to initiate quality improvement work to ensure patient safety.
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22
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Taskiran Eskici G, Baykal U. Frequency, reasons, correlates and predictors of missed nursing care in Turkey: A multi-hospital cross-sectional study. Int J Nurs Pract 2022; 28:e13050. [PMID: 35294994 DOI: 10.1111/ijn.13050] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/20/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
AIM We aimed to examine the frequency, reasons, correlates and predictors of missed nursing care in Turkey. METHODS This descriptive and cross-sectional study sample consisted of 1310 nurses working in inpatient units of 10 public, university and private hospitals in Istanbul. Data were collected using the Nursing Teamwork Survey-Turkish and the MISSCARE Survey-Turkish between February and June 2019. Descriptive analysis, parametric comparative analysis, correlational analysis and regression analysis were used to analyse the data. RESULTS The total occurrence of missed nursing care was 2.93 (on a scale of 1.00-4.00), which differed across 21 nursing care elements. The most frequently missed care was turning patients every 2 hours. Multiple regression analysis determined that nurses' tenure in the profession, patient-nurse ratio, days absent in the last 3 months and nursing teamwork significantly affected missed nursing care. Nursing teamwork alone accounted for 23.6% of the variance in missed nursing care. CONCLUSIONS The level of missed nursing care was found to be high, and labour resources issues were the most important reason. Nurse professionals should apply interventions to improve nurses' work environment factors such as patient-nurse ratio and nursing teamwork to reduce the incidence of missed nursing care.
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Affiliation(s)
- Gulcan Taskiran Eskici
- Department of Nursing Administration, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey
| | - Ulku Baykal
- Department of Nursing Administration, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Danielis M, Fantini M, Sbrugnera S, Colaetta T, Maestra MR, Mesaglio M, Palese A. Missed nursing care in a long-term rehabilitation setting: findings from a cross-sectional study. Contemp Nurse 2022; 57:407-421. [PMID: 35023449 DOI: 10.1080/10376178.2022.2029515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: There is a growing amount of literature that links missed nursing care (MNC) to negative patient outcomes, reduced patient safety, and poor quality of care. However, only few studies have investigated this phenomenon in long-term rehabilitation settings.Aim: To explore MNC occurrence, type, reasons, and predictors in three rehabilitation units.Design: A cross-sectional study was performed between August and September 2017.Method: 95 registered nurses and nursing assistants completed section A (interventions missed) and section B (perceived reasons for MNC) of the MISSCARE Survey tool. Descriptive, bivariate, and linear regression analyses were performed.Findings: The top missed elements were patient ambulation (score 2.4 out of 5, Standard Deviation [SD] 0.8), mouth care (2.3, SD 0.8), and participation to multidisciplinary meetings (2.3, SD 1.1). Lack of personnel was the most frequent reason reported for MNC with a score of 2.9 out of 4 (SD 0.9). At the linear regression analysis, advanced nursing education (β = 3.58, CI 95% 1.32-5.84) and inadequate handovers (β = 3.64, CI 95% 0.37-6.91) both increased the perception of MNC occurrence.Conclusion: MNC occurrence in rehabilitation settings appears to be lower than in other contexts; however, the most commonly missed elements are similar to those reported in other settings. As good strategies to detect the difference between expected nursing care and the one delivered to patients, advanced education and good quality handovers seem beneficial. Further research is needed to establish more evidence on predictors by developing longitudinal study designs.
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Affiliation(s)
- Matteo Danielis
- Nurse Educator, Department of Medical Sciences, Udine University, Italy
| | - Michela Fantini
- Nurse Coordinator, Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Sonia Sbrugnera
- Nurse Coordinator, Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Tiziana Colaetta
- Nurse Coordinator, Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Maria Rosa Maestra
- Nurse Coordinator, Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Maura Mesaglio
- Chief Nursing Officer, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Alvisa Palese
- Associate Professor, Department of Medical Sciences, Udine University, Italy
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Factors Contributing to Rationed Nursing Care in the Slovak Republic-A Secondary Analysis of Quantitative Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020702. [PMID: 35055524 PMCID: PMC8775605 DOI: 10.3390/ijerph19020702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/01/2022] [Accepted: 01/07/2022] [Indexed: 02/04/2023]
Abstract
Rationed nursing care is a significant problem in healthcare facilities worldwide. Awareness of contributing factors to rationed care might support the development and implementation of strategies for reducing this phenomenon from clinical practice. The study examined the association between selected hospital, unit, and staff variables and the prevalence of rationed nursing care. Secondary analysis of cross-sectional data collected between December 2017 and July 2018 from 895 registered nurses in seven acute care hospitals in the Slovak Republic was performed. Data were collected using the questionnaire Perceived Implicit Rationing of Nursing and analyzed by descriptive and inferential statistics in the statistical program SPSS 25.0. Statistically significant associations were found between rationed nursing care and unit type, education, shift type, nurses' experience in the current unit, overtime hours, missed shifts, intention to leave the position, perceived staff adequacy, quality of patient care, and job satisfaction. Differences in rating rationed nursing care, quality of patient care, and job satisfaction were identified based on hospital type. Together with top hospital management, nurse managers should develop targeted interventions focusing on mitigating rationed nursing care from the clinical practice with a focus placed on university hospitals. Quality and safe care might be ensured through constant monitoring of the quality of patient care and job satisfaction of nurses as these factors significantly predicted the estimates of rationed nursing care.
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Oliveira MCN, Leite HDCS, Lopes VCA, Cruz JVOM, Vasconcelos CDA, Nogueira LT. Razões correlacionadas a omissão de cuidados de enfermagem. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0171pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RESUMO Objetivo: Avaliar as razões correlacionadas à omissão de cuidados de enfermagem em um hospital universitário. Método: Delineamento transversal analítico, desenvolvido em um hospital universitário do Nordeste do Brasil, nos meses de janeiro a fevereiro de 2020. A população do estudo compreendeu enfermeiros e técnicos de enfermagem que atuavam na assistência direta ao paciente. Aplicou-se a versão brasileira do Missed Nursing Care Survey em uma amostra por conveniência composta por 227 participantes (79 enfermeiros e 148 técnicos de enfermagem). Foram calculadas estatísticas uni e bivariadas no software Statistical Package for social Science, versão 26.0. Resultados: O cuidado de enfermagem mais omitido foi deambulação três vezes por dia ou conforme prescrito (70,9%). A razão mais prevalente foi aumento inesperado do volume e/ou gravidade dos pacientes da unidade (93,0%). Foram verificadas correlações positivas, embora fracas, entre a omissão de cuidados geral, bem como por nível de prioridade, e razões de omissão atribuídas pelos enfermeiros e técnicos de enfermagem (p < 0,05). Conclusão O estudo evidenciou que a omissão de cuidados de enfermagem abrangeu todas as cinco dimensões do instrumento correlacionados principalmente aos recursos laborais e materiais.
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Oliveira MCN, Leite HDCS, Lopes VCA, Cruz JVOM, Vasconcelos CDA, Nogueira LT. Reasons correlated with omission of nursing care. Rev Esc Enferm USP 2022; 56:e20220171. [PMID: 36444980 PMCID: PMC10116878 DOI: 10.1590/1980-220x-reeusp-2022-0171en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/30/2022] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT Objective: To evaluate the reasons correlated with the omission of nursing care in a university hospital. Method: Analytical cross-sectional design, developed in a university hospital in Northeast Brazil, from January to February 2020. The study population consisted of nurses and nursing technicians who worked in direct patient care. The Brazilian version of the Missed Nursing Care Survey was applied in a convenience sample consisting of 227 participants (79 nurses and 148 nursing technicians). Univariate and bivariate statistics were calculated in the software Statistical Package for Social Science, version 26.0. Results: The most omitted nursing care was walking three times a day or as prescribed (70.9%). The most prevalent reason was an unexpected increase in the volume and/or severity of patients in the unit (93.0%). Positive, albeit weak, correlations were found between overall care omission, as well as omissions by priority level, and reasons for omission given by nurses and nursing technicians (p < 0.05). Conclusion: The study showed that the omission of nursing care covered all five dimensions of the instrument, mainly correlated with labor and material resources.
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Magnitude of missed nursing care and associated factors in case of North Shewa Zone public Hospitals, Amhara regional state, Ethiopia. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Albsoul RA, FitzGerald G, Hughes JA, Ahmed Alshyyab M. Missed nursing care and complexity theory: a conceptual paper. J Res Nurs 2021; 26:809-823. [DOI: 10.1177/17449871211013073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Missed nursing care is a complex healthcare problem. Extant literature in this area identifies several interventions that can be used in acute hospital settings to minimise the impact of missed nursing care. However, controversy still exists as to the effectiveness of these interventions on reducing the occurrence of missed nursing care. Aim This theoretical paper aimed to provide a conceptual understanding of missed nursing care using complexity theory. Methods The method utilised for this paper is based on a literature review on missed care and complexity theory in healthcare. Results We found that the key virtues of complexity theory relevant to the missed nursing care phenomenon were adaptation and self-organisation, non-linear interactions and history. It is suggested that the complex adaptive systems approach may be more useful for nurse managers to inform and prepare nurses to meet uncertain encounters in their everyday clinical practice and therefore reduce instances of missed care. Conclusions This paper envisions that it is time that methods used to explore missed care changed. Strategies proposed in this paper may have an important impact on the ability of nursing staff to provide quality and innovative healthcare in the modern healthcare system.
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Affiliation(s)
- Rania Ali Albsoul
- Assistant Professor in Healthcare Management, Department of Family and Community Medicine, Jordan University, Jordan
| | - Gerard FitzGerald
- Professor in Public Health, School of Public Health and Social Work, Queensland University of Technology, Australia
| | - James A Hughes
- Nurse Researcher, Emergency and Trauma Centre, Royal Brisbane and Women's Hospital and Conjoint Senior Research Fellow, School of Nursing, Queensland University of Technology, Australia
| | - Muhammad Ahmed Alshyyab
- Assistant Professor in Health Services Management, Department of Public Health and Community Medicine, Jordan University of Science and Technology, Jordan
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Labrague LJ, de Los Santos JAA, Fronda DC. Factors associated with missed nursing care and nurse-assessed quality of care during the COVID-19 pandemic. J Nurs Manag 2021; 30:62-70. [PMID: 34590383 PMCID: PMC8646803 DOI: 10.1111/jonm.13483] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/01/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022]
Abstract
Background The coronavirus outbreak has brought unprecedented pressures to many health care systems worldwide, potentially compromising nursing care delivery and overall health care services. Aims This study identified factors that contributed to missed nursing care and nurse‐assessed quality of care during the coronavirus pandemic. Methods This study employed a cross‐sectional research design using an online survey. Survey respondents were 295 frontline nurses from the Central Region of the Philippines. Results Missed care occurred at a low level, with “adequate patient surveillance” as the most often missed nursing care activity. Hospital facility size, nurse staffing levels, and patient safety culture predicted missed nursing care. Personal protective equipment adequacy, nurse staffing levels, and patient safety culture were identified as predictors of quality of care. Conclusion Frontline nurses tended to miss clinical aspects of nursing care during the pandemic. Modifying elements of the work environment, including nurse staffing levels, safety culture, and adequacy of protective equipment, may reduce care compromise and improve the quality of nursing care. Implications for Nursing Management By addressing the identified predictors, nurse managers could effectively develop appropriate interventions to support the professional role of nurses and ensure the delivery of complete, safe, and quality nursing care during the pandemic.
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Affiliation(s)
| | | | - Dennis C Fronda
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
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Gurková E, Bartoníčková D, Mikšová Z. Nursing work environment and unfinished nursing care in hospital settings - a scoping review. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2021.12.0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Arslan GG, Özden D, Göktuna G, Ertuğrul B. Missed nursing care and its relationship with perceived ethical leadership. Nurs Ethics 2021; 29:35-48. [PMID: 34396804 DOI: 10.1177/09697330211006823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Determination of the factors affecting missed nursing care and the impact of ethical leadership is important in improving the quality of care. AIM This study aims to determine the missed nursing care and its relationship with perceived ethical leadership. RESEARCH DESIGN A cross-sectional study. PARTICIPANTS AND RESEARCH CONTEXT The sample consisted of 233 nurses, of whom 92.7% were staff nurses and 7.3% were charge nurses, who work in three different hospitals in Turkey. The study data were collected using a personal and professional characteristics data form, the Missed Nursing Care Survey, and the Ethical Leadership Scale. ETHICAL CONSIDERATIONS The study was approved by the non-interventional ethics committee of Dokuz Eylül University Ethics Committee for Noninvasive Clinical Studies. All participants' written and verbal consents were obtained. FINDINGS The most missed nursing care practices were ambulation, attending interdisciplinary care conferences, and discharge planning. According to the logistic regression analysis, sex, the number of patients that the nurse is in charge of giving care, the number of patients discharged in the last shift, and satisfaction with the team were determined as factors affecting missed care. No significant relationship was found between ethical leadership and missed nursing care (p > 0.05), and a weak but significant relationship was found between the clarification of duties/roles subscale and missed nursing care (r = -0.136, p < 0.05). DISCUSSION Ethical leaders should collaborate with policy-makers at an institutional level to particularly achieve teamwork that is effective in the provision of care, to control missed basic nursing care, and to organize working hours and at the country level to determine roles and to increase the workforce. CONCLUSION The results of this study contribute to the international literature on the most common type of missed nursing care, its reasons, and the relationship between the missed care and ethical leadership in a different cultural context.
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Nahasaram ST, Ramoo V, Lee WL. Missed nursing care in the Malaysian context: A cross-sectional study from nurses' perspective. J Nurs Manag 2021; 29:1848-1856. [PMID: 33544403 DOI: 10.1111/jonm.13281] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/08/2021] [Accepted: 01/31/2021] [Indexed: 12/15/2022]
Abstract
AIM To determine the occurrence, factors and outcome of missed nursing care from the perspective of Malaysian nurses. BACKGROUND Missed nursing care is an important issue in the global health care sector. However, little is known on the extent of missed nursing care in the Malaysian context and its contributing factors. METHODS A cross-sectional design was adopted for data collection using the MISSCARE Survey instrument. Participants comprised 364 nurses from medical and surgical wards of a large teaching hospital. Data were analysed using descriptive, binomial logistic and hierarchical regression analyses. RESULTS The overall occurrence of missed nursing care was 1.88 (on a scale of 1.00-5.00), which differed across 24 nursing care elements. Basic nursing care and communication-related care were the most frequently missed elements. Types of ward and labour resources were identified as contributing factors to missed nursing care (p < .001). No significant association was found between missed nursing care and nurses' intention to leave (p > .05). CONCLUSION The occurrence of missed nursing care was noted to be low. IMPLICATIONS FOR NURSING MANAGEMENT Practical strategies such as an acuity-based staffing system, close monitoring of rendered care and strengthening of teamwork are recommended to minimize missed nursing care.
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Affiliation(s)
- Sri Theyshaini Nahasaram
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vimala Ramoo
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Ling Lee
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Jarošová D, Gurková E, Zeleníková R, Plevová I, Janíková E. Hospital and unit variables of missed nursing care in acute care hospitals: A cross-sectional study. J Clin Nurs 2021; 30:1099-1110. [PMID: 33434291 DOI: 10.1111/jocn.15655] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/23/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate hospital, unit and staff variables as the correlates of missed nursing care (MNC) in Czech hospitals. BACKGROUND There is a considerable variability in patterns of MNC across different hospital, unit and staff characteristics. DESIGN A cross-sectional study was conducted. The STROBE guidelines for reporting observational studies were followed for reporting of the research study. METHODS A sample of 513 nurses working in nine acute care hospitals was recruited. MNC activities were measured with the MISSCARE Survey. Data were analysed using descriptive statistics and univariate logistic regression. RESULTS Type of unit was confirmed as a significant predictor of MNC. Staff characteristics (nurses' work position, level of education and perceived adequacy of unit staff) and hospital variables did not contribute significantly to MNC. CONCLUSIONS The study replicated the patterns of MNC across different conceptual approaches. MNC was influenced by work environment characteristics rather than individual staff variables. RELEVANCE TO CLINICAL PRACTICE The results of this research showed that missed nursing care is influenced by work environment characteristics rather than individual staff variables.
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Affiliation(s)
- Darja Jarošová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Renáta Zeleníková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ilona Plevová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Eva Janíková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Kirwan M, Schubert M. Missed or rationed nursing care: Where to now for the nurse manager? J Nurs Manag 2020; 28:1767-1769. [DOI: 10.1111/jonm.13078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Marcia Kirwan
- School of Nursing, Psychotherapy and Community Health Dublin City University Dublin Ireland
| | - Maria Schubert
- School of Health Professions Institute of Nursing ZHAW Zurich University of Applied Science Winterthur Switzerland
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35
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Palese A, Longhini J, Danielis M. To what extent Unfinished Nursing Care tools coincide with the discrete elements of The Fundamentals of Care Framework? A comparative analysis based on a systematic review. J Clin Nurs 2020; 30:239-265. [PMID: 33113209 DOI: 10.1111/jocn.15543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To establish whether, and to what extent, tools measuring Unfinished Nursing Care (UNC) that have been validated to date have the ability to detect the discrete elements of the 'Integration of care' dimension of The Fundamentals of Care Framework (The Framework). BACKGROUND UNC and The Framework have been established as two separate research lines, focused on (a) omitted care and related tools, and (b) on how to improve patient care, respectively. However, no attempts have been made to date to establish whether, and to what extent, tools measuring UNC have the ability to represent the discrete elements of The Framework. DESIGN A two-step study: (a) a secondary analysis of a systematic review up to June 2018 later updated in May 2020, followed by (b) a comparative analysis. METHODS A systematic review of studies on validated tools measuring UNC was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Then, researchers independently performed a comparative analysis between the extracted (a) discrete elements of The Framework and (b) items of the UNC tools retrieved. RESULTS A total of 14 tools were analysed. The physical dimension of The Framework was the one mostly covered by UNC tools (up to 87.5% with the Perceived Implicit Rationing of Nursing Care). The Norwegian Basel Extent of Rationing of Nursing Care showed the highest level of representation (41.6%) for the psychosocial dimension. Only the Perceived Implicit Rationing of Nursing Care and the Unfinished Care tool measure the relational dimension (22.2%, respectively). By considering all elements of the 'Integration of care' dimension, the Perceived Implicit Rationing of Care had the highest percentage of convergence (41%). CONCLUSION Not all UNC tools have the same ability to represent the discrete elements of The Framework. Moreover, physical needs are more often detected in UNC tools compared to the relational and psychological ones. RELEVANCE TO CLINICAL PRACTICE Unfinished care tools validated to date can represent a body of knowledge on which to build The Framework metrics, especially for the physical dimensions.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Matteo Danielis
- Department of Medical Sciences, University of Udine, Udine, Italy
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Longhini J, Papastavrou E, Efstathiou G, Andreou P, Stemmer R, Ströhm C, Schubert M, de Wolf-Linder S, Palese A. Strategies to prevent missed nursing care: An international qualitative study based upon a positive deviance approach. J Nurs Manag 2020; 29:572-583. [PMID: 33090604 DOI: 10.1111/jonm.13176] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify the strategies to prevent missed nursing care (MNC) that can be implemented by nurse managers/directors on a daily basis. BACKGROUND Only few recommendations have been established to date aiming at supporting nurse managers/ directors in preventing MNC. However, several strategies are implemented on a daily basis, suggesting that a body of tacit, practical and wise knowledge is already in place. METHOD(S) An international qualitative descriptive study based on the positive deviance approach conducted in 2019-2020 and reported according to the Consolidated Criteria for Reporting Qualitative Research. A purposeful sample of 35 nurse managers/directors working in hospitals in Cyprus, Italy, Germany and Switzerland was involved. Codes were extracted from each country, and a thematic analysis was performed at the transnational level to identify strategies and interventions preformed to prevent MNC. RESULTS Eight strategies and 22 interventions, mainly with preventive intent and designed at the hospital level, affecting both the processes and the structural dimensions, have been reported as effective in preventing MNC. CONCLUSION Nurse leaders are involved daily in implementing strategies to minimise MNC at the nursing and at the hospital system levels, integrated with each other. IMPLICATIONS FOR NURSING MANAGEMENT Preventing MNC should be a core value of the entire hospital, and not merely a nursing issue. Therefore, complex interventions at the system level are required.
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Affiliation(s)
- Jessica Longhini
- Department of Medical Sciences, School of Nursing, University of Udine, Udine, Italy
| | - Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Georgios Efstathiou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.,Nursing Services, Ministry of Health, Nicosia, Cyprus
| | | | | | | | - Maria Schubert
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Susanne de Wolf-Linder
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Alvisa Palese
- Department of Medical Sciences, School of Nursing, University of Udine, Udine, Italy
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Schubert M, Ausserhofer D, Bragadóttir H, Rochefort CM, Bruyneel L, Stemmer R, Andreou P, Leppée M, Palese A. Interventions to prevent or reduce rationing or missed nursing care: A scoping review. J Adv Nurs 2020; 77:550-564. [PMID: 33089553 DOI: 10.1111/jan.14596] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/15/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Abstract
AIMS To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions. BACKGROUND Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes. DESIGN Scoping review. DATA SOURCES We searched for eligible studies, published between 1980-2019, in six electronic databases. REVIEW METHODS Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based. RESULTS The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care. CONCLUSIONS The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions. IMPACT Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.
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Affiliation(s)
- Maria Schubert
- School of Health Professions, ZHAW - Zurich University of Applied Science, Institute of Nursing, Winterthur, Switzerland
| | - Dietmar Ausserhofer
- Nursing Science, Faculty of Medicine, Department of Public Health, University of Basel, Basel, Switzerland.,Claudiana College of Health-Care Professions, Bolzano, Italy
| | - Helga Bragadóttir
- Faculty of Nursing, School of Health Sciences and Landspítali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Christian M Rochefort
- School of Nursing, Faculty of Medicine and Health Sciences - Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CR-CHUS), University of Sherbrooke, Longueuil, Canada
| | - Luk Bruyneel
- Department for Public Health and Primary Care, KU Leuven - University of Leuven, Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Renate Stemmer
- Faculty of Health and Nursing, Catholic University of Applied Sciences Mainz, Mainz, Germany
| | | | - Marcel Leppée
- Project Department, Institute for Healthy Ageing, Zagreb, Croatia
| | - Alvisa Palese
- Department of Medical Science, University Udine, Udine, Italy
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Deasy C, O Loughlin C, Markey K, O Donnell C, Murphy Tighe S, Doody O, Tuohy D, Hussey M, O'Brien B, Meskell P. Effective workforce planning: Understanding final-year nursing and midwifery students' intentions to migrate after graduation. J Nurs Manag 2020; 29:220-228. [PMID: 32881132 DOI: 10.1111/jonm.13143] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022]
Abstract
AIMS To examine the factors influencing final-year nursing/midwifery students' intentions to migrate following graduation. BACKGROUND With expanding global staff shortages, effective recruitment and retention strategies targeted at new nursing/midwifery graduates are necessary. Understanding factors that influence graduates' decisions to migrate or remain in the health care organisation that supported their education is essential but under-researched. METHODS A cross-sectional electronic survey was distributed to graduating nursing/midwifery students across nine higher education institutions in Ireland with a 36% (N = 407) response rate. RESULTS 85% of Irish (n = 376) nursing/midwifery graduating students reported an intention to migrate overseas and 70% intend to return within 5 years. Pay, working conditions and career were ranked as influencing intentions to migrate. Multivariable analysis illustrated that educational opportunities and friends predict migration, while family and obligation were protective factors. CONCLUSION Nursing and midwifery leaders and policymakers must reconsider recruitment and retention strategies and embrace innovative and responsive approaches to address migration intentions and trends. IMPLICATIONS FOR NURSING/MIDWIFERY MANAGEMENT Strategic leadership is required to develop effective structures that support personal, professional and career opportunities for new graduates. Targeted recruitment innovations to entice graduates back into the health service are recommended.
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Affiliation(s)
- Christine Deasy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | | | - Kathleen Markey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Claire O Donnell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Sylvia Murphy Tighe
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Dympna Tuohy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Mairead Hussey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Brid O'Brien
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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Palese A, Cracina A, Marini E, Caruzzo D, Fabris S, Mansutti I, Mattiussi E, Morandini M, Moreale R, Venturini M, Achil I, Danielis M. Missed nursing education: Findings from a qualitative study. J Adv Nurs 2020; 76:3506-3518. [PMID: 32947646 DOI: 10.1111/jan.14533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/21/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
Abstract
AIM To understand what nursing education activities are missed in the daily life of nursing programmes, by also identifying antecedents and consequences of missed educational activities. DESIGN A descriptive qualitative study according to the COnsolidated criteria for REporting Qualitative research guidelines. METHODS A purposeful sample of 32 participants with different roles (nurse educators, clinical nurses, students, and administrative personnel) and working in different settings (university, administrative, healthcare service levels) were involved in three focus groups and nine face-to-face interviews from 2019-2020. Both focus groups and face-to-face interviews were audio-recorded and transcribed verbatim. The data that emerged were thematically categorized by induction. FINDINGS Missed Nursing Education reflects those educational activities needed in the process of nursing education that are missed or delayed. Direct educational activities missed include clinical rotations, classroom teaching and students' overall learning experience. Indirect missed educational activities concern continuing professional development of nursing faculty members, nursing discipline development and the organizational processes of the nursing programme. As antecedents, missed nursing education is triggered by factors at the organizational, nursing faculty, and student levels. Consequences have been reported for students, nursing faculty, clinical nurses, and patients. CONCLUSIONS Missed Nursing Education can be considered a multifaceted, multicausal phenomenon, with multitargeted consequences. IMPACT To date, missed nursing care has only been investigated in clinical practice. However, care also permeates the relationship between nurse educators and students. Thus, at the point of 'educational care' delivery, aspects can also be omitted. Educational activities at risk of being missed or delayed affect the quality of nursing education and, in the short- and in the long- terms, also the quality of patient care. Some Missed Nursing Education antecedents can be modified by appropriate strategies that should be addressed by policy, health care and academic institutions.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, Udine University, Udine, Italy
| | - Arianna Cracina
- General Surgical Department, University Hospital of Udine, Udine, Italy
| | - Eva Marini
- Anesthesia and Intensive Care Department, University Hospital of Udine, Udine, Italy
| | - Davide Caruzzo
- Department of Medical Sciences, Udine University, Udine, Italy
| | - Stefano Fabris
- Department of Medical Sciences, Udine University, Udine, Italy
| | - Irene Mansutti
- Department of Medical Sciences, Udine University, Udine, Italy
| | - Elisa Mattiussi
- Department of Medical Sciences, Udine University, Udine, Italy
| | | | - Renzo Moreale
- Department of Medical Sciences, Udine University, Udine, Italy
| | | | - Illarj Achil
- Department of Medical Sciences, Udine University, Udine, Italy
| | - Matteo Danielis
- Department of Medical Sciences, Udine University, Udine, Italy
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Bagnasco A, Catania G, Zanini M, Dasso N, Rossi S, Aleo G, Timmins F, Sermeus W, Aiken LH, Sasso L. Are data on missed nursing care useful for nursing leaders? The RN4CAST@IT cross-sectional study. J Nurs Manag 2020; 28:2136-2145. [PMID: 32881131 DOI: 10.1111/jonm.13139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/04/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
AIM To describe nurses' reported missed nursing care activities among hospitalized adult patients medical and surgical wards and explore gaps in service provision. BACKGROUND In 2015, Italy replicated the RN4CAST study, which heralded the exposition of missed care as an international phenomenon. In Italy, nurse-patient workload is high, with high levels of burnout and dissatisfaction reported, all factors associated with missed care. METHODS A cross-sectional study (n = 3,590) was conducted using the 13-item online Task Left Undone Tool aimed at collecting data on missed nursing care. RESULTS The frequency of omission of activities ranged between 7% and 50%. There were significant differences between morning, afternoon and night shifts and the various clinical settings. Oral care was the most frequently missed care activity. CONCLUSIONS This study takes step forward in identifying and reducing missed care on medical and surgical wards, both in Italy and also internationally, which needs to take into account the specific organisational characteristics of each setting. IMPLICATIONS FOR NURSING MANAGEMENT Although more essential activities are missed less frequently, much is known about the relational deficits such as information giving, education, communication and discharge advice, which managers ought to spearhead through local initiatives to improve these practices.
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Affiliation(s)
- Annamaria Bagnasco
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Gianluca Catania
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Milko Zanini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Nicoletta Dasso
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Silvia Rossi
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Giuseppe Aleo
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Fiona Timmins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Walter Sermeus
- Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Loredana Sasso
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
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41
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Du H, Yang Y, Wang X, Zang Y. A cross-sectional observational study of missed nursing care in hospitals in China. J Nurs Manag 2020; 28:1578-1588. [PMID: 32726867 PMCID: PMC7589234 DOI: 10.1111/jonm.13112] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 01/22/2023]
Abstract
Aim To identify the risk of missed nursing care (MNC), and contributing factors, in Chinese hospitals. Background National reporting of adverse incidents diminishes errors of commission. To further improve service quality and patient safety, MNC should be reduced. Methods An online survey comprising the MISSCARE Survey and the McCloskey/Mueller Satisfaction Scale was conducted with a convenience sample of nurses (n = 6,158) in 34 Chinese hospitals. Results Participants’ mean age was 30.6 (SD = 7.014), and 2.5% were male. The most frequently missed nursing care items were basic care (12.7%–51.8%). The most frequently reported reasons were human resource issues (63.1%–88.2%). Being female, no child, better educated, a manager, permanently employed, no night shift, inadequate friend support and job dissatisfaction influenced the perception of MNC (odds ratio 1.00–4.848). Conclusions MNC often occurred in basic care involving informal caregivers or in surge status due to a sudden increase in workload. Implications for Nursing Management Nurse managers should prioritize effective measures that target delegation competency and mobilization of nurses for flexible repositioning during need.
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Affiliation(s)
- Hongxia Du
- Department of Nursing, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Yuanyuan Yang
- School of Nursing, Cheeloo College of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Xiaohong Wang
- Department of Nursing, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Yuli Zang
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
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42
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Willis E, Zelenikova R, Bail K, Papastavrou E. The globalization of missed nursing care terminology. Int J Nurs Pract 2020; 27:e12859. [PMID: 32656900 DOI: 10.1111/ijn.12859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 03/08/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Abstract
AIM To determine if there are cross-national differences in nurse understandings of the terms: missed care, rationed care and care left undone. BACKGROUND Nurse researchers from a number of countries have published studies on missed and rationed care. It is not clear if there are differences in understanding the key terms across various language groups. DESIGN A mixed method questionnaire was distributed to 26 member countries of a nursing research consortium in 2017. METHODS Forty-five responses to a qualitative questionnaire were received; 80% were nurse researchers. These responses were categorized into language groups and analysed for congruence and differences. FINDINGS There was congruence across all language groups in interpreting the three terms. Giddens' theory of globalization provides an explanation for this congruence. CONCLUSION Shared understandings are explained by the fact that the majority of participants are nurse researchers with knowledge of English and the research literature. Shared understanding within the globalized academic community does not necessarily translate for clinical or nurse managers, nor does it predetermine solutions.
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Affiliation(s)
- Eileen Willis
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Renata Zelenikova
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Kasia Bail
- Synergy Nursing and Midwifery Research Centre and Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Evridiki Papastavrou
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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43
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McCauley L, Kirwan M, Riklikiene O, Hinno S. A SCOPING REVIEW: The role of the nurse manager as represented in the missed care literature. J Nurs Manag 2020; 28:1770-1782. [DOI: 10.1111/jonm.13011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Lauren McCauley
- School of Nursing, Psychotherapy and Community Health Dublin City University Dublin Ireland
| | - Marcia Kirwan
- School of Nursing, Psychotherapy and Community Health Dublin City University Dublin Ireland
| | - Olga Riklikiene
- Faculty of Nursing Lithuanian University of Health Sciences Kaunas Lithuania
| | - Saima Hinno
- Department of Nursing and Midwifery Tartu Health Care College Tartu Estonia
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44
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Chegini Z, Jafari‐Koshki T, Kheiri M, Behforoz A, Aliyari S, Mitra U, Islam SMS. Missed nursing care and related factors in Iranian hospitals: A cross‐sectional survey. J Nurs Manag 2020; 28:2205-2215. [DOI: 10.1111/jonm.13055] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/02/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Zahra Chegini
- Social Determinants of Health Research CenterQazvin University of Medical Sciences Qazvin Iran
- National Institute for Health Research Tehran University of Medical Sciences Tehran Iran
| | - Tohid Jafari‐Koshki
- Molecular Medicine Research Center Department of Statistics and Epidemiology Faculty of Health Tabriz University of Medical Science Tabriz Iran
| | - Marzieh Kheiri
- Department of Health Education and Promotion Faculty of Health Iran University of Medical Science Tehran Iran
| | - Ali Behforoz
- Iranian Center of Excellence in Health Management School of Management and Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
| | - Saeedeh Aliyari
- National Institute for Health Research Tehran University of Medical Sciences Tehran Iran
| | - Udita Mitra
- The School of Health in Social Science University of Edinburgh Edinburgh UK
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Juvé-Udina ME, González-Samartino M, López-Jiménez MM, Planas-Canals M, Rodríguez-Fernández H, Batuecas Duelt IJ, Tapia-Pérez M, Pons Prats M, Jiménez-Martínez E, Barberà Llorca MÀ, Asensio-Flores S, Berbis-Morelló C, Zuriguel-Pérez E, Delgado-Hito P, Rey Luque Ó, Zabalegui A, Fabrellas N, Adamuz J. Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster-unit-level descriptive comparison. J Nurs Manag 2020; 28:2216-2229. [PMID: 32384199 PMCID: PMC7754324 DOI: 10.1111/jonm.13040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/20/2020] [Accepted: 05/02/2020] [Indexed: 12/23/2022]
Abstract
AIM To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters. BACKGROUND Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood. METHOD Descriptive design with data from four unit-clusters: medical, surgical, combined and step-down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse-sensitive outcomes. RESULTS Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters. CONCLUSION Patient acuity is similar among unit-clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit-clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.
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Affiliation(s)
- Maria-Eulàlia Juvé-Udina
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.,Catalan Institute of Health, Barcelona, Spain
| | - Maribel González-Samartino
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.,Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Magdalena López-Jiménez
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Irene Joana Batuecas Duelt
- Multidisciplinary Nursing Research Group, VHIR Vall d'Hebron Institute of Research, Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marta Tapia-Pérez
- Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Emilio Jiménez-Martínez
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Susana Asensio-Flores
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Carme Berbis-Morelló
- Joan XXIII University Hospital, Tarragona, Spain.,School of Nursing, Rovira i Virgili University, Tarragona, Spain
| | - Esperanza Zuriguel-Pérez
- Multidisciplinary Nursing Research Group, VHIR Vall d'Hebron Institute of Research, Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pilar Delgado-Hito
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain
| | - Óscar Rey Luque
- Nursing School, University of La Laguna, Tenerife, Spain.,Nuestra Señora de la Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Adelaida Zabalegui
- Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.,IDIBAPS, August Pi i Sunyer Biomedical Research Institute, Hospital Clínic, Barcelona, Spain
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.,IDIBAPS, August Pi i Sunyer Biomedical Research Institute, Hospital Clínic, Barcelona, Spain
| | - Jordi Adamuz
- Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona, Spain.,Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
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46
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Palese A, Danielis M, Cicogna C, Grassetti L. Does missed nursing care influence the use of physical restraint and its duration in acute medical patients? Secondary analysis of a longitudinal study. Nurs Health Sci 2020; 22:929-940. [PMID: 32524669 DOI: 10.1111/nhs.12747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/26/2022]
Abstract
Missed nursing care and physical restraint have been identified as indicators of patient safety, but no studies to date have explored their relation. To explore the relation between these two phenomena, a secondary analysis of a longitudinal study on 1464 in-hospital patients and 314 registered nurses was performed. The use of physical restraint was assessed at the bedside on a daily basis; missed care was assessed with the MISSCARE survey. Individual, nursing care, and hospital-level variables were measured. A total of 184 (12.6%) patients were restrained for 20.33% of their in-hospital stay. No significant differences emerged in the occurrence of missed care between restrained and unrestrained patients. However, some common antecedents of these two phenomena emerged: in units where there is a lack of personnel, both an increase in missed care and physical restraint duration should be expected. As a consequence, patients are threatened in their right to receive the required care and they are at risk of being restrained. Moreover, a higher skill mix is a preventive factor, which suggests that the increased numbers of registered nurses on the team, may prevent routine forms of physical restraint use by analyzing the physical restraint in place critically and removing them as soon as possible, thus reducing the duration of the restraints.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Science, University of Udine, Udine, Italy
| | - Matteo Danielis
- Department of Medical Science, University of Udine, Udine, Italy
| | - Chiara Cicogna
- Department of Medical Science, University of Udine, Udine, Italy
| | - Luca Grassetti
- Department of Economics and Statistics, University of Udine, Udine, Italy
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47
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Palese A, Bottega M, Cescutti A, Caruzzo D, Danielis M, Fabris S, Mattiussi E, Grassetti L. Depicting clinical nurses' priority perspectives leading to unfinished nursing care: A pilot Q methodology study. J Nurs Manag 2020; 28:2146-2156. [PMID: 32335959 DOI: 10.1111/jonm.13036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
AIMS To highlight (a) trends common to all nurses on priorities attributed to interventions, and (b) whether there are profiles of nurses working in the same context who prioritize interventions in a similar way. BACKGROUND The underlying prioritization of interventions leading to unfinished nursing care has been minimally investigated. METHODS A 2017 pilot Q methodology study. Full-time nurses, with at least 6 months of experience in a surgical unit, were involved. Eleven nurses rated the priority given in daily practice (from -3 as the lowest to +3 as the highest) to 35 Q-sample statements representing nursing care, non-nursing and organisational interventions. RESULTS Overall, the intervention receiving the lowest priority was 'Providing patient hygiene', while the highest was 'Answering phone calls'. In the by-person factor analysis (total variance = 60.79%), three profiles of nurses emerged, (a) 'Patient safety-oriented' (variance = 31.66%); (b) 'Nursing task-oriented' (=16.32%); and (c) 'Team process-oriented' (=12.81%). CONCLUSIONS Three profiles of nurses emerged in the same setting with significant differences both in the statistical order of priorities and in their practical implications. IMPLICATIONS FOR NURSING MANAGEMENT Understanding levels of prioritization, which are not only affected by the unit but also by sub-groups of nurses who rank priorities in a similar way, can support nurse managers in their role.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Science, University of Udine, Udine, Italy
| | | | - Alice Cescutti
- Department of Medical Science, University of Udine, Udine, Italy
| | - Davide Caruzzo
- School of Nursing, Department of Medical Science, University of Udine, Udine, Italy
| | - Matteo Danielis
- School of Nursing, Department of Medical Science, University of Udine, Udine, Italy
| | - Stefano Fabris
- School of Nursing, Department of Medical Science, University of Udine, Udine, Italy
| | - Elisa Mattiussi
- School of Nursing, Department of Medical Science, University of Udine, Udine, Italy
| | - Luca Grassetti
- Department of Statistics Department, University of Udine, Udine, Italy
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48
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Jaworski M, Iwanow L, Grochans E, Młynarska A, Gurowiec PJ, Uchmanowicz I, Gotlib J, Panczyk M. Optimistic thinking, satisfaction with life and job and nursing care rationing: Multicentre study in Poland. J Nurs Manag 2020; 28:1948-1959. [PMID: 32037684 DOI: 10.1111/jonm.12974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 01/07/2023]
Abstract
AIMS The aim was to examine whether the level of optimism and job and life satisfaction is a differentiating factor from the level of implicit rationing of nursing care in a sample of Polish registered nurses. BACKGROUND Satisfaction with life and job is reflected by greater effectiveness of nurses at work and creates a positive work environment, which in turn may modulate the level of implicit rationing of nursing care. METHODS A cross-sectional multicentre research design was adopted, employing a representative sample of 1,010 registered Polish nurses identified between the beginning of January and the end of June 2019. Four self-report scales were used in this study: Basel Extent of Rationing of Nursing Care, Satisfaction with Life Scale, Satisfaction with Job Scale and Life Orientation Test-Revised. The results were analysed using the k-means method, Student's t test and two-way ANOVA. RESULTS Optimistic thinking, and satisfaction with job and life exerted a significant effect on the level of implicit rationing of nursing care among Polish nurses. Nurses from the group 'pessimistic' were at higher risk of nursing care rationing than those from the group 'optimistic'. CONCLUSION Strengthening of the personal competencies, providing support and responding to all identified needs might increase job satisfaction of nurses and hence reduce the risk of nursing care rationing. IMPLICATIONS FOR NURSING MANAGEMENT Leadership modelling and training in positive thinking might be the methods to support nurses and to prevent nursing care rationing.
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Affiliation(s)
- Mariusz Jaworski
- Department of Education and Research in Health Sciences, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Lucyna Iwanow
- Department of Education and Research in Health Sciences, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Elżbieta Grochans
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | | | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Gotlib
- Department of Education and Research in Health Sciences, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
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49
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O'Donnell C, Andrews T. Care accommodation in the acute care setting: Missed care or not? J Nurs Manag 2020; 28:2128-2135. [PMID: 32255232 DOI: 10.1111/jonm.13025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 01/11/2023]
Abstract
AIM To explain how nurses care for patients with stroke in the acute setting, when working within constraints. BACKGROUND Internationally, health care environments are experiencing constraints such as reduced staffing levels, and lack of time and resources. In such circumstances, patient care is often of poorer quality or missed entirely. METHOD(S) Classic grounded theory methodology was used to explain how care is provided within the acute care setting for patients following stroke. Data were collected using unstructured interviews with 32 nurses. RESULTS Care accommodation, a typology of caring, was generated consisting of functional caring, assisted self-caring and ideal caring. Depending on the degree of constraint, nurses consciously or subconsciously prioritize care, potentially leading to missed care. CONCLUSION(S) Care accommodation elucidates what happens to care delivery with limited resources. Missed care may result from engaging with care accommodation, a factor that nurses and managers need to consider in care delivery. IMPLICATIONS FOR NURSING MANAGEMENT Care accommodation provides new insight and understanding for management of the daily challenges nurses face, thus informing nursing management that supports nurses advocating at higher levels for resources to provide necessary environments and strategies to reduce missed care.
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Affiliation(s)
- Claire O'Donnell
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Tom Andrews
- School of Nursing & Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
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50
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Pereira Lima Silva R, Gonçalves Menegueti M, Dias Castilho Siqueira L, Araújo TR, Auxiliadora‐Martins M, Mantovani Silva Andrade L, Laus AM. Omission of nursing care, professional practice environment and workload in intensive care units. J Nurs Manag 2020; 28:1986-1996. [DOI: 10.1111/jonm.13005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Renata Pereira Lima Silva
- General and Specialized Nursing Department College of Nursing at Ribeirão Preto University of São Paulo São Paulo Brazil
| | - Mayra Gonçalves Menegueti
- General and Specialized Nursing Department College of Nursing at Ribeirão Preto University of São Paulo São Paulo Brazil
| | | | - Thamiris Ricci Araújo
- General and Specialized Nursing Department College of Nursing at Ribeirão Preto University of São Paulo São Paulo Brazil
| | - Maria Auxiliadora‐Martins
- Division of Intensive Medicine of Hospital das Clínicas Department of Surgery and Anatomy of Medical School at Ribeirão Preto University of São Paulo São Paulo Brazil
| | | | - Ana Maria Laus
- General and Specialized Nursing Department College of Nursing at Ribeirão Preto University of São Paulo São Paulo Brazil
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