Missed nursing care, staffing levels, job satisfaction, and intent to leave among Jordanian nurses

A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review

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.

A Cross-sectional Study Evaluating the Association Between the Nursing Practice Environment and Missed Nursing Care in Medical and Surgical Wards in Jordan

BACKGROUND

Missed nursing care can jeopardize the safety of patients. The practice environment contains various elements that may impact nursing staff's capability to provide appropriate care.

PURPOSE

To examine the association between the practice environment and missed nursing care in Jordanian hospitals.

METHODS

A cross-sectional design, including the MISSCARE survey and the Practice Environment Scale of the Nursing Work Index, was used for this study.

RESULTS

Data were gathered from 672 nurses working in 10 hospitals between March and July 2021. Findings revealed significant negative correlations between nurses' participation in hospital affairs ( r = -0.077, P = .046), nursing foundations for quality of care ( r = -0.139, P < .001), and missed nursing care.

CONCLUSION

Information from this study can help nursing leaders modify practice environment elements that impact missed nursing care occurrences, which will help improve the quality of care provided to patients.

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

Missed nursing care is a multifaceted patient safety issue receiving increased attention among healthcare scholars worldwide. There is limited research on missed nursing care in the Jordanian healthcare context. The current study sought to examine the perceptions of Jordanian nurses toward the amount and types of missed nursing care in medical and surgical wards. We also examined the differences in missed care items between public, private, and university hospitals in Jordan. This was a cross-sectional study using the MISSCARE Survey tool. Data collection spanned 4 months between March and July 2021. The final study sample consisted of 672 registered nurses employed in five public, three private, and two university hospitals in Jordan. Data were analyzed using descriptive statistics, Analysis of variance, and Pearson correlation coefficent test. Of the 672 registered nurses who participated, the majority were females (n = 421; 62.6%). Most participants held a bachelor's degree in nursing (n = 577; 85.9%). The three most common missed nursing activities in the participating hospitals were: ambulation, oral care, and emotional support. Nurses working in public hospitals reported the highest missed nursing care. The age and number of patients under care significantly correlated with missed nursing care. The findings could help nursing managers develop plans to reduce missed nursing care in their healthcare institutions.

Implicit rationing of nursing care reported by nurses from different types of hospitals and hospital units

AIMS AND OBJECTIVES

The study aimed to investigate differences in assessing implicit rationing of nursing care by Czech nurses with respect to the type of unit and type of hospital.

BACKGROUND

Implicit rationing of nursing care may differ across different types of hospitals and hospital units.

DESIGN

This study used a multicentre cross-sectional study design.

METHODS

The STROBE checklist for observational cross-sectional studies was followed for reporting of the research study. The sample included 8209 nurses providing direct care to medical and surgical patients in 14 acute care Czech hospitals. The main outcome was implicit rationing of nursing care as measured with a Czech version of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument. Data were collected from September 2019 to October 2020.

RESULTS

The most frequently rationed nursing care activity was timely response to patient or family request/need, followed by emotional or psychological support and adequate supervision of delegated tasks. More implicitly rationed nursing care was reported in medical units. Statistical differences were found in rating 25 items and the PIRNCA total score. Nurses from middle-sized hospitals reported implicitly rationed care more frequently than those from large hospitals.

CONCLUSION

More rationed care was reported by nurses from medical units and nurses from middle-sized hospitals. Organisational variables (the type of unit and type of hospital) influence the implicit rationing of nursing care in our study.

RELEVANCE TO CLINICAL PRACTICE

The findings call for nursing managers to pay attention to organisational variables which may affect the implicit rationing of nursing care.

Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review

BACKGROUND

Missed nursing care undermines nursing standards of care and minimising this phenomenon is crucial to maintaining adequate patient safety and the quality of patient care. The concept is a neglected aspect of human resource for health thinking, and it remains understudied in low-income and middle-income country (LMIC) settings which have 90% of the global nursing workforce shortages. Our objective in this review was to document the prevalence of missed nursing care in LMIC, identify the categories of nursing care that are most missed and summarise the reasons for this.

METHODS

We conducted a systematic review searching Medline, Embase, Global Health, WHO Global index medicus and CINAHL from their inception up until August 2021. Publications were included if they were conducted in an LMIC and reported on any combination of categories, reasons and factors associated with missed nursing care within in-patient settings. We assessed the quality of studies using the Newcastle Ottawa Scale.

RESULTS

Thirty-one studies met our inclusion criteria. These studies were mainly cross-sectional, from upper middle-income settings and mostly relied on nurses' self-report of missed nursing care. The measurement tools used, and their reporting were inconsistent across the literature. Nursing care most frequently missed were non-clinical nursing activities including those of comfort and communication. Inadequate personnel numbers were the most important reasons given for missed care.

CONCLUSIONS

Missed nursing care is reported for all key nursing task areas threatening care quality and safety. Data suggest nurses prioritise technical activities with more non-clinical activities missed, this undermines holistic nursing care. Improving staffing levels seems a key intervention potentially including sharing of less skilled activities. More research on missed nursing care and interventions to tackle it to improve quality and safety is needed in LMIC. PROSPERO registration number: CRD42021286897.

Determinants of missed nursing care in Jordanian hospitals during COVID-19 pandemic

AIM

The aim of the study was to examine the effect of perceived organizational support, accountability and nurses' characteristics on missed nursing care under the impact of COVID-19.

DESIGN

A cross-sectional design was used to describe and predict nurses' characteristics.

METHODS

A sample of 536 Registered Nurses participated in the study from eight hospitals in different health sectors in Jordan (three public hospitals, three private hospitals and two teaching hospitals).

RESULTS

Communication problems had the highest impact on missed nursing care, compared with labour resources and material resources reasons. Higher patient: nurse ratio aggravated by COVID-19 pandemic, years of experience, satisfaction with the income, perception of accountability and organizational support were among the factors associated with the levels of missed nursing care.

The Factor Associated with Missed Nursing Care in Hospital: A Systematic Review

Background:  Patient safety is a major concern in the healthcare industry worldwide. Increasing patient safety is critical for avoiding negative outcomes in nursing care and achieving goals at the desired level of quality. One of the indicators of this quality care given to patient is known as missed care. Aim: Aims of this study to explore the factors influencing missed care in order to improve the quality of nursing care. Methods: This study is a systematic review that explores the factors influencing missed nursing care in hospitals. Meanwhile, the literature search was carried out in the CINAHL Pubmed, Ebsco, Science Direct, Proquest, Willey, Sage from 2017 to 2021. Results: The results from six databases (n=3702) were sorted into 22 collected articles which include 18 quantitative, 2 qualitative, and 2 mixed methods. These findings highlighted three factors that influence missed nursing care: a lack of staffing, nurse competency, and the working environment. Conclusion: The factors that  contribute with missed nursing care in hospitals include lack of nurse staff, competency, and work environment. As a result, the nursing manager's critical role is to create adequate nursing staff, improve their competency, and foster a positive work environment. Keywords: missed nursing care, lack of staffing, nurse competency,  working environment

Relationship between interprofessional teamwork and nurses' intent to leave work: The mediating role of job satisfaction and burnout

BACKGROUND

Reducing nurse turnover is a top priority for nursing management globally. While evidence has demonstrated that working in a favorable environment with greater interprofessional teamwork is essential in increasing nurse retention, few studies have explored the mechanism underlying this relationship.

AIM

To examine the direct and indirect effects of interprofessional teamwork on nurses' intentions to leave their jobs via the intermediary roles of job satisfaction and burnout.

METHODS

A cross-sectional study was conducted to collect data from 2113 nurses working in 21 hospitals in Oman. Data were collected using a survey questionnaire measuring teamwork, job satisfaction, burnout, and intention to leave. Logistic regression was used to investigate the direct effect of teamwork on intent to leave. A sequential mediation model was conducted to examine the mediating role of job satisfaction and burnout.

RESULTS

Interprofessional teamwork was directly associated with nurses' intentions to leave. The influence of teamwork on intention to leave was indirectly mediated by both job satisfaction and job burnout.

CONCLUSION

Findings illustrate the potential benefits of enhancing interprofessional teamwork in reducing nurses' intentions to leave. Interventions intended to foster teamwork could create satisfying workplaces, reduce perceived burnout, and ultimately contribute to organizational strategy for reducing nursing shortages.

Arabic version of the Missed Nursing Care Survey: Validity and reliability

AIM

To explore the validity and reliability of the Missed Nursing Care Survey after translating it into the Arabic language.

METHODS

We employed a cross-sectional design. We recruited 260 Jordanian nurses, and data were collected between May and July 2020. Translation, acceptability, construct, convergent, discriminant validity and reliability were investigated.

RESULTS

The factor analysis showed an adequate fit (three subscales) between the proposed missing care survey model and the observed data. This model reflected the survey's construct, convergent and discriminant validity, explaining 58.88% of the variance collectively. Confirmatory factor analyses showed adequate goodness-of-fit results (goodness of fit index = 0.91, comparative fit index = 0.94, increment fit index = 0.94, Tucker Lewis index = 0.92 and root mean square error of approximation = 0.06). The total Cronbach alpha and composite reliability achieved the criterion for all constructs in this survey.

CONCLUSION

This Arabic version of the Missed Nursing Care Survey achieved the required level of validity and reliability. Measuring missed care and its reasons may help to improve quality of health services and assist nurse managers in designing appropriate interventions to reduce it. Adoption of culturally acceptable instruments by health-care policymakers may support patient safety.

Missed nursing care in acute care hospital settings in low-middle income countries: a systematic review protocol

Background:  Missed nursing care (care left undone or task incompletion) is viewed as an important early predictor of adverse patient care outcomes and is a useful indicator to determine the quality of patient care. Available systematic reviews on missed nursing care are based mainly on primary studies from developed countries, and there is limited evidence on missed nursing care from low-middle income countries (LMICs). We propose conducting a systematic review to identify the magnitude of missed nursing care and document factors and reasons associated with this phenomenon in LMIC settings. Methods and analysis:  This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). We will conduct literature searching across the Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, from inception to 2021. Two independent reviewers will conduct searches and data abstraction, and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be determined using the Newcastle-Ottawa Scale (NOS). Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals PROSPERO registration number: CRD42021286897 (27 th October 2021).

Nurse staffing, missed care, quality of care and adverse events: A cross-sectional study

AIM

This study aimed to illustrate the relationship between nurse staffing and missed care, and how missed care affects quality of care and adverse events in Thai hospitals.

BACKGROUND

Quality and safety are major priorities for health care system. Nurse staffing and missed care are associated with low quality of care and adverse events. However, examination of this relationship is limited in Thailand.

METHODS

This cross-sectional study collected data from 1188 nurses in five university hospitals across Thailand. The participants completed questionnaires that assessed the patient-to-nurse ratio, adequacy of staffing, missed care, quality of care and adverse events. Logistic regression models were used to estimate associations.

RESULTS

Higher patient-to-nurse ratio, poor staffing and lack of resource adequacy were significantly associated with higher odds of reporting missed care. Higher nurse-reported missed care was significantly associated with higher odds of adverse events and poor quality of care.

CONCLUSIONS

Poor nurse staffing was associated with missed care, and missed care was associated with adverse events and lower quality of care in Thai university hospitals.

IMPLICATIONS FOR NURSING MANAGEMENT

Improving nurse staffing and assuring adequate resources are recommended to reduce missed care and adverse events and increase quality of care.

Missed nursing care in acute care hospital settings in low-middle income countries: a systematic review protocol

Background:  Missed nursing care (care left undone or task incompletion) is viewed as an important early predictor of adverse patient care outcomes and is a useful indicator to determine the quality of patient care. Available systematic reviews on missed nursing care are based mainly on primary studies from developed countries, and there is limited evidence on missed nursing care from low-middle income countries (LMICs). We propose conducting a systematic review to identify the magnitude of missed nursing care and document factors and reasons associated with this phenomenon in LMIC settings. Methods and analysis:  This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). We will conduct literature searching across the Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, from inception to 2021. Two independent reviewers will conduct searches and data abstraction, and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be determined using the Newcastle-Ottawa Scale (NOS). Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals PROSPERO registration number: CRD42021286897 (27 th October 2021).

The relationship between paediatric nurses' quality of life and intent to leave: The moderating role of hospital type

Background

Different types of hospitals exist in Jordan, and each type has its own leadership style. This might affect the nursing workforce in terms of quality of life and intent to leave.

Aim

This study aimed at (1) assessing the relationship between paediatric nurses' quality of life and intent to leave, (2) examining the moderating effect of the hospital type on this relationship, (3) comparing the quality of life of paediatric nurses working at ministry of health and the University‐Affiliated hospitals and (4) exploring the determinants of nurses' intent to leave.

Design

A cross‐sectional, comparative and correlational design was used in this study.

Methods

A multi‐site sample was selected from two types of hospitals in Jordan; the ministry of health and the University‐Affiliated hospitals. A sample of 225 paediatric nurses responded to the brief quality of life questionnaire by the World Health Organization in addition to a group of sociodemographic and work‐related questions.

Results and conclusion

Nurses' quality of life and intent to leave were negatively correlated. This correlation was moderated by the type of hospital. Nurses' quality of life was significantly different in the two types of hospitals. Both salary and nursing care model predicted paediatric nurses' intent to leave. The managerial style and work environment of the ministry of health hospitals should be benchmarked against the University‐Affiliated hospitals.