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Topal S, Çaka SY, Öztürkler S, Gürbüz Y. Burnout inpediatric nurses: Examining the relationship between moral distress and missed nursing care. J Pediatr Nurs 2024; 78:e404-e410. [PMID: 39112121 DOI: 10.1016/j.pedn.2024.08.001] [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: 02/25/2024] [Revised: 08/01/2024] [Accepted: 08/01/2024] [Indexed: 09/14/2024]
Abstract
PURPOSE This study investigates the relationship between burnout levels of moral distress and missed nursing care in pediatric nurses. DESIGN AND METHOD A cross-sectional study was conducted between November and December 2023. Pediatric nurses working in two hospitals and providing direct care to children (n = 140) completed the Moral Distress Scale-Revised Pediatric Nurses, MISSCARE Survey - Pediatric Version and Burnout Measure-Short Version questionnaire. Multivariate regression analysis modeling was applied to test the mediating effect on the relationship between burnout, moral distress, and missed nursing care. RESULTS There was a significant positive correlation between the Moral Distress Scale-Revised Pediatric Nurses and its sub-dimensions and the Burnout Measure-Short Version (p < 0.05). There was a significant positive correlation between the mean MISSCARE- Survey-Ped score of the nurses participating in the study and its sub-dimensions and Burnout Measure-Short Version (p < 0.05). Providing Benefit-Do No Harm, one of the Moral Distress Scale-Revised Pediatric Nurses sub-dimensions, and Labour Resources, one of the MISSCARE sub-dimensions, were found to be predictors of burnout. The ethical principle of Providing Benefit-Do No Harm was found to mediate between moral distress and burnout and reduce burnout associated with missed care. CONCLUSIONS Accordingly, as the nurses' moral distress and inability to meet the necessary patient care increase, their burnout levels also increase. Providing Benefit-Do No Harm is an basic ethical principle that will positively affect the burnout level of pediatric nurses. PRACTICE IMPLICATIONS This study may provide insights into ethics training, communication improvement strategies, and individual support intervention programs aimed at reducing moral distress, and burnout and improving the coping mechanisms of nurses working in pediatric wards.
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Affiliation(s)
- Sümeyra Topal
- Department of Pediatric Nursing, Faculty of Health Science, Kahramanmaraş İstiklal University, Kahramanmaraş, Turkey
| | - Sinem Yalnızoğlu Çaka
- Department of Pediatric Nursing, Faculty of Health Science, Kocaeli University, Kocaeli, Turkey.
| | - Sinem Öztürkler
- Department of Pediatric Nursing, Faculty of Health Science, Kocaeli University, Kocaeli, Turkey
| | - Yunus Gürbüz
- Wound Care Nurse, Kahramanmaras Sutcu Imam University Health Practice and Research Hospital, Kahramanmaraş, Turkey
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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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Wang X, Rihari-Thomas J, Bail K, Bala N, Traynor V. Care quality and safety in long-term aged care settings: A systematic review and narrative analysis of missed care measurements. J Adv Nurs 2024. [PMID: 39092879 DOI: 10.1111/jan.16358] [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: 02/27/2024] [Revised: 07/08/2024] [Accepted: 07/19/2024] [Indexed: 08/04/2024]
Abstract
AIM To critically evaluate missed care measurement approaches and their application in long-term aged care (LTAC) settings. DESIGN Systematic review using Tawfik's guideline. DATA SOURCES PubMed, Scopus, Web of Science, CINAHL and ProQuest were searched. Supplemental searching was from reference lists of retrieved records, first authors' ORCID homepages and Google advanced search for grey literature. Search limitations were English language, published between 1 January 2001 and 31 December 2022. REVIEW METHOD COVIDENCE was utilized for screening, data extraction and quality appraisal. JBI Critical Appraisal Tools and COSMIN Risk of Bias Tool were used for quality appraisal. Data were summarized and synthesized using narrative analysis. RESULTS Twenty-four publications across 11 regions were included, with two principal methods of missed care measurement: modified standard scales and tailored specific approaches. They were applied inconsistently and generated diverse measurement outcomes. There were challenges even with the most commonly used tool, the BERNCA-NH, including absence of high-quality verification through comparative analysis against an established 'gold standard', reliance on self-administration, incomplete assessment of constructs and inadequate exploration of psychometric properties. CONCLUSION Globally, there are deficiencies in the effectiveness and comprehensiveness of the instruments measuring missed care in LTAC settings. Further research on theoretical and practical perspectives is required. IMPLICATIONS Findings highlighted a critical need to establish a standardized, validated approach to measure missed care in LTAC settings. This review calls for collaborative efforts by researchers, clinical staff and policymakers to develop and implement evidence-based practices as a way of safeguarding the well-being of older clients living in LTAC settings. IMPACT Measurements of missed care in LTAC settings rely on adapting acute care tools. There is a critical gap in measuring missed care in LTAC settings. Developing a new tool could improve care quality and safety in LTAC settings globally. REPORTING METHOD Adhered to PRISMA guideline. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Xinxia Wang
- School of Nursing, Faculty of Health, Medicine and Health, University of Wollongong, Wollongong, Australian Capital Territory, Australia
| | - John Rihari-Thomas
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kasia Bail
- Centre for Ageing Research and Translation, University of Canberra and Synergy Nursing and Midwifery Research Centre ACT Health Directorate, Canberra, Australian Capital Territory, Australia
| | - Nina Bala
- School of Nursing, Faculty of Health, Medicine and Health, University of Wollongong, Wollongong, Australian Capital Territory, Australia
| | - Victoria Traynor
- School of Nursing, Faculty of Health, Medicine and Health, University of Wollongong, Wollongong, Australian Capital Territory, Australia
- Aged and Dementia Health Education and Research (ADHERe) Centre, Wollongong, Australian Capital Territory, Australia
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Lisiecka D, Kearns Á, Evans W, Farrell D. Aspiration pneumonia in nursing literature-a mapping review. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1393368. [PMID: 39113687 PMCID: PMC11304538 DOI: 10.3389/fresc.2024.1393368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/03/2024] [Indexed: 08/10/2024]
Abstract
Introduction Aspiration pneumonia (AP) is an infection of the lungs caused by inhalation of material. The reported incidences vary across literature and clinical populations and is associated with high morbidity and mortality. Management of AP is best carried out by a multidisciplinary team. Methods This aim of this review was to collate and describe the available evidence on AP to develop a greater understanding of the concept of AP as it is represented in the nursing literature. As a collaborative team, we undertook the six stages of a systematic mapping review. We searched for the term aspiration pneumonia in 200 peer reviewed nursing journals across 10 databases, over a ten-year period (2013-2023). Results In this review, 293 papers were coded. Dysphagia, oral health and tube feeding emerged as the most frequent risk factors for AP, and the most reported factors for preventing this condition. Mortality was the most commonly described consequence of AP, followed by hospitalisations and morbidity. Multiple management approaches were reported including dysphagia assessment, risk evaluation, oral care and texture modification of food and fluids. The role of nurses and interprofessional collaborations were described. Discussion Despite limited evidence related to the topic of AP in the nursing literature, the complexity of the causes, prevention, management and consequences of AP emerged. Certain factors, such as dysphagia, oral health, and tube feeding, were described under prevention, cause and management of AP. The importance of multidisciplinary approach in the management and prevention of AP was presented.
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Affiliation(s)
- Dominika Lisiecka
- Department of Nursing and Healthcare Sciences, Munster Technological University—Kerry Campus, Tralee, Ireland
- Kerry Speech & Language Therapy Clinic, Tralee, Ireland
| | - Áine Kearns
- Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland
| | - William Evans
- Department of Nursing and Healthcare Sciences, Munster Technological University—Kerry Campus, Tralee, Ireland
| | - Dawn Farrell
- Department of Nursing and Healthcare Sciences, Munster Technological University—Kerry Campus, Tralee, Ireland
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Cartaxo A, Mayer H, Eberl I, Bergmann JM. Missing nurses cause missed care: is that it? Non-trivial configurations of reasons associated with missed care in Austrian hospitals - a qualitative comparative analysis. BMC Nurs 2024; 23:282. [PMID: 38671443 PMCID: PMC11055368 DOI: 10.1186/s12912-024-01923-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Errors of omissions affect the quality of nursing care in hospitals. The Missed Nursing Care Model explains that the reasons for missed care are linked with 1) demand for patient care, 2) labor resource allocation, 3) material resource allocation, and 4) relationship and communication factors. Scientific evidence points to a lack of adequate nursing staffing as the most important factor triggering missed care. However, it remains unclear how the different theoretical reasons for missed care are interlinked with reports on missed care from the perspective of nurses in acute care settings. The aim of this study was to explore non-trivial configurations of reasons for missed care that are associated with missed care interventions from the perspective of nurses working in general units in Austrian hospitals. METHODS A cross-sectional study was conducted. Data collection was performed using the revised MISSCARE-Austria questionnaire. Our sample consisted of 401 nurses who provided complete data. Data were analyzed using qualitative comparative analysis. Configurational models of contextual factors, reasons for missed care, and missed nursing interventions were analyzed. RESULTS In our study contextual factors were not consistent precursors of the reasons for missed care. Missed care was consistently present when the demand for patient care was high. A lack of labor resources, in combination with the other known reasons for missed care, was consistently observed when missed care occurred. Different configurations of reasons were found to be non-trivially associated with different types and frequencies of missed care. CONCLUSIONS To understand the complexity of the causal mechanisms of missed care, complexity theory may be necessary. Accordingly, a theoretical framework that acknowledges that complex systems, such as missed care, are composed of multiple interacting causal components must be further developed to guide new methodical approaches to enlighten its causal mechanisms.
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Affiliation(s)
- Ana Cartaxo
- Vienna Doctoral School of Social Sciences, University of Vienna, Universitätsstraße 7, Vienna, Austria.
- Austrian National Public Health Institute (Gesundheit Österreich GmbH, GÖG), Stubenring 6, Vienna, Austria.
| | - Hanna Mayer
- Division Nursing Science With Focus On Person-Centred Care Research, Department of General Health Studies, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems, Austria
| | - Inge Eberl
- Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Ostenstraße 26, Eichstätt, Germany
| | - Johannes M Bergmann
- Münster Department of Health, FH Münster University of Applied Sciences, Johann-Krane-Weg 21, Münster, 48149, Germany
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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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Cartaxo A, Dabney BW, Mayer H, Eberl I, Gonçalves L. External influencing factors on missed care in Austrian hospitals: Testing the theoretical antecedents of missed care using structural equation modelling. J Adv Nurs 2023; 79:3569-3584. [PMID: 37170413 DOI: 10.1111/jan.15700] [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: 10/26/2022] [Revised: 03/15/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
PROBLEM Missed Nursing Care (MNC) is an error of omission which occurs when a necessary nursing intervention is not initiated, is not completed, or when it is delayed. The MNC model explains this problem and describes four antecedents that can lead to MNC: (1) demand for patient care, (2) available human resources, (3) material resources, and (4) and relationship and communication factors. AIMS This study aims to test the relationship between the theoretical antecedents of MNC and their impact on MNC. DESIGN A quantitative cross-sectional study. METHODS The Austrian version of the revised MISSCARE Survey was completed by nurses working in general hospital units between May and July 2021. Recruitment followed a respondent-driven sample via Austrian nursing education institutions and social media. One thousand six nurses fulfilled inclusion criteria. The structure of the theoretical constructs of the MNC model was tested using a confirmatory factor analysis approach. The relationships between the four antecedents and MNC were explored using structural equation modelling with 427 complete cases. RESULTS The results support the structural validity of the revised MISSCARE Austria concerning the defined theoretical constructs, although discriminant validity and measurement error should be further investigated. The antecedent "resource allocation: labor" had a statistically significant impact on MNC: The lack of adequate nursing staff played the most important role to explain missed care in our model. CONCLUSION In our study in Austria, MNC was mostly influenced by a lack of appropriate labor resources. Further studies exploring mediation effects and non-linear relationships may contribute to better understanding of reasons for MNC. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Ana Cartaxo
- Department of General Health Studies, Division Nursing Science with focus on Person-Centred Care Research, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
- Austrian Academy of Sciences, Doctoral Fellowship Programme, Vienna, Austria
- Vienna Doctoral School of Social Sciences, University of Vienna, Vienna, Austria
| | - Beverly W Dabney
- School of Nursing, University of Michigan-Flint, Flint, Michigan, USA
| | - Hanna Mayer
- Department of General Health Studies, Division Nursing Science with focus on Person-Centred Care Research, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Inge Eberl
- Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Luzia Gonçalves
- Global Health and Tropical Medicine, Portuguese Institute of Hygiene and Tropical Medicine, NOVA University Lisbon, Lisbon, Portugal
- Department of Statistics and Operations Research, Faculty of Sciences, Centre of Statistics and its Applications, University of Lisbon, Lisbon, Portugal
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Hackman P, Hult M, Häggman-Laitila A. Unfinished nursing care in nursing homes. Geriatr Nurs 2023; 51:33-39. [PMID: 36878129 DOI: 10.1016/j.gerinurse.2023.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023]
Abstract
This study aimed to describe unfinished nursing care activities in nursing homes. The study was conducted as a cross-sectional survey and employed the BERNCA-NH-instrument and one open-ended question. The participants were care workers (n=486) in nursing homes. The results showed that an average of 7.3 nursing care activities out of 20 were unfinished. A large share of the unfinished activities were related to residents' social care and the documentation of care. Female gender, age, and the amount of professional experience were found to increase the likelihood of unfinished nursing care. The unfinished care was the result of insufficient resources, residents' characteristics, unexpected situations, non-nursing activities, and challenges in organizing and leading care. The results indicate that all of the necessary care activities are not performed in nursing homes. Unfinished nursing activities might affect residents' quality of life and diminish the visibility of nursing care. Nursing home leaders have a significant role to play in decreasing unfinished care. Future research should address how to reduce and prevent unfinished nursing care.
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Affiliation(s)
- Pauliina Hackman
- Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1, Kuopio 70210, Finland.
| | - Marja Hult
- Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1, Kuopio 70210, Finland
| | - Arja Häggman-Laitila
- Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1, Kuopio 70210, Finland
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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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Stănescu-Yadav DN, Lillekroken D. Nurse preceptors' perceptions of the fundamentals of nursing knowledge gained by students in clinical rotations at nursing homes: A qualitative study. J Prof Nurs 2023; 44:17-25. [PMID: 36746596 DOI: 10.1016/j.profnurs.2022.11.005] [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: 06/23/2022] [Revised: 11/04/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND International evidence suggests that clinical nurses and nursing students perceive fundamental care as not being important, not complicated and even not a nurse's responsibility, thus resulting in negative patient outcomes. AIM To explore nurse preceptors' perceptions about the factors that influence nursing students' gaining of knowledge about fundamental care during their clinical practice at nursing home. METHODS A qualitative descriptive study using individual interviews was conducted from September 2020 to April 2021. Nine nurse preceptors employed at five nursing homes participated. The data were analysed by employing an inductive qualitative content analysis. FINDINGS The analysis generated one main category-'Fostering students' knowledge and understanding of fundamental care'-supported by two categories: (i) 'Nurse preceptors - enablers of nursing students' learning fundamental care' and (ii) 'Nursing home - a learning environment that facilitates students' learning about the delivery of fundamental care', which can be interpreted as the preconditions that may contribute to fostering students' knowledge and understanding of fundamental care. CONCLUSION The study reveals that nurse preceptors' attributes, an effective preceptorship and a social learning environment can create opportunities for nursing students learning the provision of fundamental care in nursing homes. Furthermore, Vygotsky's theory of sociocultural learning may be applied when teaching in clinical nursing education.
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Affiliation(s)
| | - Daniela Lillekroken
- Oslo Metropolitan University, Department of Nursing and Health Promotion, PB 4, St. Olavs plass, NO-0130 Oslo, Norway.
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Blackman IR, Shifaza F. Causal links behind why Australian midwifery care is missed. J Nurs Manag 2022; 30:4578-4586. [PMID: 36336904 DOI: 10.1111/jonm.13879] [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] [Received: 04/28/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
AIMS The aim of this study is to reliably estimate why midwifery care is missed and to crystallize those factors that have causal links to it. BACKGROUND Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care are even less well researched. METHODS A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to measure consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modeling. RESULTS Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed, can be both explained and predicted. CONCLUSIONS Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction levels, work roster preferences and other midwife demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials had no influence on their consensus estimates as to why midwifery care was missed. IMPLICATIONS FOR NURSING MANAGEMENT While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental, as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re-dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening, as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity, are strongly thought to be significant reason for missed care.
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Affiliation(s)
- Ian R Blackman
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Fathimath Shifaza
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Nhongo D, Holt A, Flenady T, Rebar A, Bail K. Nurse staffing and adverse events in residential aged care: Retrospective multi-site analysis. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Blackman I, Shifaza F, Mc Neil L, Willis E, Verrall C, Henderson J. The presence of missed care: a staff development response. J Nurs Manag 2022; 30:3568-3577. [PMID: 35705193 DOI: 10.1111/jonm.13714] [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: 03/21/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
AIMS This study quantifies the types and frequencies of missed care identified by nurses and measures its impact on their capacity to demonstrate mandatory practice standards as future hospital staff. BACKGROUND Considerable literature exists as to the nature of missed care but there is a paucity of findings about how missed care impacts on learning firstly as a student and then as a graduate nurse employed in a hospital setting. Additionally, there is little emphasis as to how staff development for nurses exposed to missed care may be implemented METHODS: A non-experimental research design using self-audit data was selected to collect information about the types and frequencies of missed care from nurses engaging in clinical experience. A convenience sample of 471 nursing students completing their undergraduate nursing degree program. A multi-variate statistical approach was used to apply and then model the consensus scores of undergraduate nurses' beliefs about the frequency of missed care. Implications for their developing competence in critical thinking, therapeutic communication and maintaining capacity for professional practice has been considered. RESULTS Eight variables directly affect student's total scores underpinning their understanding of missed care and their ability to meet professional standards of practice, given their exposure to care omission. These factors reflect differing nurse attributes, the nature of the clinical venues and shift times, preceptor type, student satisfaction with work teams and staffing adequacy. CONCLUSIONS Modeling outcomes suggest possible changes to hospital staff development learning program content, learning processes and how it may be better delivered through to minimise episodes of missed care.
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Affiliation(s)
- Ian Blackman
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Fathimath Shifaza
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Liz Mc Neil
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Eileen Willis
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Claire Verrall
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Julie Henderson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
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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: 19] [Impact Index Per Article: 9.5] [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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15
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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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16
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Monson A, Harvey C, Baldwin A. Lost voices: Using a case study to illustrate narrative inquiry: Research brief. Appl Nurs Res 2021; 62:151489. [PMID: 34814993 DOI: 10.1016/j.apnr.2021.151489] [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: 03/29/2021] [Revised: 08/01/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In this study, we tested the feasibility of using a narrative inquiry - three-dimensional space inquiry to elicit the experiences of an adult family member who shared her journey of care and advocacy for her husband situated in a dementia care unit. BACKGROUND The voices of family members are rarely heard in relation to their experiences about being included in or making decisions about their loved one's care. Shared decision-making has been an important patient-centred approach to nursing care since the 1990s; however, it is often not a reality in aged care facilities. METHOD An interview was conducted with one adult family member using the three-dimension space that is inspired by narrative theorists to analyse the narrative. RESULTS Three themes were identified in the responses: communication between staff and family, staffing in the dementia care unit, and loss of voice and shared decision making. CONCLUSION Results of this study indicate that narrative inquiry supports the telling of personal experiences around a problem and then using that information to raise awareness of those issues that are not always heard but which are essential for change in health care policy and practice.
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Affiliation(s)
- Ainslie Monson
- School of Nursing, Midwifery and Social Sciences, Tertiary Education Division, CQUniversity, Brisbane Campus, Australia.
| | - Clare Harvey
- School of Nursing, Massey University, Wellington, New Zealand and School of Nursing, Midwifery and Social Sciences, CQUniversity, Australia.
| | - Adele Baldwin
- School of Nursing, Midwifery and Social Sciences, Tertiary Education Division, CQUniversity, Townsville Campus, Australia.
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17
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Ryder M, Kitson AL, O'Brien TS, Timmins F. Advancing Nursing Practice Through Fundamental Care Delivery. J Nurs Manag 2021; 30:601-603. [PMID: 34212446 DOI: 10.1111/jonm.13402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/29/2022]
Abstract
There is growing awareness that there needs to be a reorientation of the nursing profession towards the fundamentals of care (Feo et al., 2019). These fundamentals often receive a low priority in clinical practice settings (Feo et al., 2019), and gaps in fundamental care provision are being exposed in nursing care internationally (McSherry et al., 2018). The concern is significant worldwide, and for this reason, many initiatives are developing to tackle the issue. The International Learning Collaborative (ILC) (2021), a global social learning and lobbying network, is leading the way on this. This network is committed to improving the delivery of person-centred and safe fundamental care, promoting excellence of fundamental care through the integration of clinical practice, research and education, and share the best evidence of Fundamentals of Care (FoC) (International Learning Collaborate 2021, Kitson 2018).
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Affiliation(s)
- Mary Ryder
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland.,Department of Nursing, St. Vincent's University Hospital, Dublin, Ireland
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Caring Futures Institute, Flinders, University, Adelaide, SA, Australia
| | - Toni Slotnes O'Brien
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Fiona Timmins
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
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18
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Andersson I, Bååth C, Nilsson J, Eklund AJ. A scoping review-Missed nursing care in community healthcare contexts and how it is measured. Nurs Open 2021; 9:1943-1966. [PMID: 34033697 PMCID: PMC9190696 DOI: 10.1002/nop2.945] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
Aim To examine the extent and nature of missed nursing care in elderly care in community healthcare contexts from the perspective of healthcare staff, and to identify instruments used to measure missed nursing care and the content of these instruments. Design Scoping review. Methods Searches were conducted in the CINAHL, PubMed, Scopus and Google Scholar databases in March 2020. The selection process followed the PRISMA flow diagram. Results Sixteen research papers were found from nine countries. The instruments used in the studies were Basel Extent of Rationing of Nursing Care for nursing homes (BERNCA‐NH), modified MISSCARE survey and study‐specific instruments or items. The item content differed, as did the number of items, which was between one and 44. The studies reported values for missed nursing care, as well as described reasons for and/or the relation between missed nursing care and organization, working climate and patient outcomes.
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Affiliation(s)
- Ingrid Andersson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - 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
| | - Anna Josse Eklund
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
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19
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Blackman I, Hadjigeorgiou E, McNeill L. Causal links to missed Australian midwifery care: What is the evidence? Eur J Midwifery 2020; 4:41. [PMID: 33537642 PMCID: PMC7839148 DOI: 10.18332/ejm/127769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/28/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The incidences and types of missed nursing care in the acute care and community sectors are both ubiquitous and quantifiable, however, there are few research studies relating to the type and frequency of missed maternity-based care for mothers and families. The aim of this study is to estimate the incidences and types of Australian missed midwifery care and to identify those factors that have causal links to it. METHODS A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to ascertain consensus estimates made by Australian midwives. Electronic invitations were extended to their membership using an inclusive link to the MISSCARE survey. Inclusion criteria were all ANMF members who were midwives and currently employed within the Australian public and private healthcare systems. Data analysis was undertaken using both Rasch analysis and Structural Equation Modelling. RESULTS The type and frequency of missed Australian midwifery care can be quantified and several demographic factors are significant predictor variables for overall missed midwifery care. The most prevalent aspects of missed care in the Australian midwifery setting are midwives’ hand hygiene, supportive care, perinatal education, and surveillance type midwifery practices. CONCLUSIONS As the frequencies and types of missed midwifery care in Australia have been identified, it is possible for midwives to be mindful of minimising care omissions related to hand hygiene, providing supportive care and education to mothers as well as surveillance-type midwifery practices.
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Affiliation(s)
- Ian Blackman
- College of Nursing and Health Sciences, Flinders University, Marion, Australia
| | - Eleni Hadjigeorgiou
- Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Liz McNeill
- College of Nursing and Health Sciences, Flinders University, Marion, Australia
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20
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Kalánková D, Stolt M, Scott PA, Papastavrou E, Suhonen R. Unmet care needs of older people: A scoping review. Nurs Ethics 2020; 28:149-178. [PMID: 33000674 DOI: 10.1177/0969733020948112] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim was to synthesize the findings of empirical research about the unmet nursing care needs of older people, mainly from their point of view, from all settings, focusing on (1) methodological approaches, (2) relevant concepts and terminology and (3) type, nature and ethical issues raised in the investigations. A scoping review after Arksey and O'Malley. Two electronic databases, MEDLINE/PubMed and CINAHL (from earliest to December 2019) were used. Systematic search protocol was developed using several terms for unmet care needs and missed care. Using a three-step retrieval process, peer-reviewed, empirical studies concerning the unmet care needs of older people in care settings, published in English were included. An inductive content analysis was used to analyse the results of the included studies (n = 53). The most frequently used investigation method was the questionnaire survey seeking the opinions of older people, informal caregivers or healthcare professionals. The unmet care needs identified using the World Health Organization classification were categorized as physical, psychosocial and spiritual, and mostly described individuals' experiences, though some discussed unmet care needs at an organizational level. The ethical issues raised related to the clinical prioritization of tasks associated with failing to carry out nursing care activities needed. The unmet care needs highlighted in this review are related to poor patient outcomes. The needs of institutionalized older patients remain under-diagnosed and thus, untreated. Negative care outcomes generate a range of serious practical issues for older people in care institutions, which, in turn, raises ethical issues that need to be addressed. Unmet care needs may lead to marginalization, discrimination and inequality in care and service delivery. Further studies are required about patients' expectations when they are admitted to hospital settings, or training of nurses in terms of understanding the complex needs of older persons.
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Affiliation(s)
| | | | - P Anne Scott
- 8799National University of Ireland Galway, Ireland
| | | | - Riitta Suhonen
- 8058University of Turku, Finland; Turku University Hospital, Finland; City of Turku Welfare Division, Finland
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21
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Bagnasco A, Zanini M, Dasso N, Rossi S, Timmins F, Galanti MC, Aleo G, Catania G, Sasso L. Dignity, privacy, respect and choice-A scoping review of measurement of these concepts within acute healthcare practice. J Clin Nurs 2020; 29:1832-1857. [PMID: 32220088 DOI: 10.1111/jocn.15245] [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: 06/04/2019] [Revised: 01/23/2020] [Accepted: 03/12/2020] [Indexed: 12/16/2022]
Abstract
AIMS AND OBJECTIVES To synthesise and review literature related to instruments that measure psychosocial aspects of fundamental care in acute hospital care settings. BACKGROUND Psychosocial aspects of care often receive less priority in terms of care provision in acute care environments. At the same time, if these elements are overlooked, there may be consequences. Despite the availability of many instruments designed to measure specific aspects of care, these concepts are often not studied within the broader context of fundamentals of care, but rather coexist as isolated explorations of specific subelements. DESIGN A scoping review was conducted, based on Arksey & O'Malley's (2005) methodological framework and following the PRISMA checklist. METHODS Using the five recommended steps-identifying the research question; identifying relevant studies; study selection; charting the data; and summarising and reporting the results-three databases were searched: MEDLINE/PubMed, CINAHL and EMBASE, in February 2019. RESULTS Following independent screening by two of the authors, 48 papers were included. From these 48 papers, 33 instruments were identified. Only five of these tools thoroughly assessed psychosocial aspects elements of care (dignity, respect, privacy and patients' choice) through dedicated items. CONCLUSIONS This review provides nurses with a synthesis of 33 instruments that assess the psychosocial aspects of care. This provides an important resource to guide measurement of dignity, respect, privacy and patients' choice. The findings also provide guidance to future research in this field. RELEVANCE TO CLINICAL PRACTICE This paper reviews and synthesises these instruments to provide a resource to nurses to inform their decisions and practice around measurement and evaluation of these key aspects of care. This provides a useful guide to measure and monitor the improvement of fundamental care delivery in practice and points to strengths and weaknesses of the instruments concerned.
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Affiliation(s)
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicoletta Dasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Silvia Rossi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Fiona Timmins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
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