Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study

The Relationship Between Work Environment and Missed Nursing Care in Nurses: The Moderator Role of Profession Self-Efficacy

AIMS

This study aimed to examine the relationship between work environment and missed nursing care (MNC) in nurses and determine whether profession self-efficacy has a moderator role in this relationship.

DESIGN

A quantitative, cross-sectional, correlational study design was used to test the study model.

METHODS

The study was conducted with 433 nurses in 2 city hospitals in Istanbul, Turkey. Data were collected between November 2022 and February 2023 using the "MISSCARE Survey-Turkish," the "Work Environment Scale," and the "Nursing Profession Self-Efficacy Scale."

RESULTS

The participants had a mean Nursing Profession Self-Efficacy Scale score of 66.67 ± 14.37, a mean Work Environment Scale score of 84.96 ± 13.62, a mean elements of MNC score of 1.30 ± 0.73, and a mean reason for MNC score of 3.18 ± 0.78. Nursing profession self-efficacy was determined to be positively related to the work environment of the participants and their reasons for MNC (respectively, r = 0.276 and r = 0.114) and negatively related to elements of MNC ( r = -0.216) ( P < 0.05). There was also a negative relationship between the work environment and elements of MNC ( r = -0.249; P < 0.05). Profession self-efficacy had a significant moderator role in the relationship between the work environment and elements of MNC. Having low or moderate levels of profession self-efficacy moderated the negative effects of the work environment on elements of MNC.

CONCLUSIONS

There is a need for interventions to reduce elements of missed nursing care in nurses. Especially nurses and/or nurse managers may have difficulties in improving their work environment, considering its multifaceted structure. In such cases, administrators can reduce missed nursing care by increasing the profession self-efficacy of nurses. Therefore, profession self-efficacy should be considered in addition to interventions for the work environment to improve care.

Factors influencing the formation of balanced care teams: the organisation, performance, and perception of nursing care teams and the link with patient outcomes: a systematic scoping review

BACKGROUND

The composition of care teams is crucial for delivering patient-centered healthcare, yet assembling a well-balanced team remains a challenge. This difficulty stems from the intricate dynamics of team capacity, culture, context, and the demands of the job. The current literature offers limited guidance for decision-makers on how to effectively navigate these dynamics to compose a balanced care team.

METHODS

We conducted a systematic scoping review of literature spanning from 2009 to 2022. The aim was to identify factors that significantly influence the work environment, team performance, nursing outcomes, and patient outcomes within healthcare settings. Our review focused on extracting and synthesizing evidence to uncover these influencing factors.

RESULTS

Our analysis identified 35 factors that play a significant role in shaping the work environment and influencing team performance, nursing outcomes, and patient outcomes. These factors were categorized into nine key domains: workload, leadership, team composition, stress and demands, professional relationships, safety, logistics and ergonomics, autonomy and responsibility, and transparency and task clearness.

CONCLUSIONS

To improve patient care and nursing job satisfaction, policymakers and decision-makers can consider these influencing factors in the design and management of care teams. The findings advocate for strategic adjustments in these domains to enhance a team's balance. Furthermore, our review underscores the need for further research to fill the identified gaps in knowledge, offering a directive for future studies into optimal care team composition. This systematic approach to team composition can significantly impact patient outcomes and nurse satisfaction, providing a roadmap for creating more effective and harmonious teams.

Exploring nurse mentors' job crafting: A longitudinal study on missed nursing care across student supervision

AIM

To compare the job crafting strategies nurse mentors use when mentoring students versus during periods of respite and to assess the effectiveness of these strategies in reducing instances of missed nursing care (MNC).

BACKGROUND

Nurses who serve as mentors may have to train a group of nursing students on top of their routine nursing duties. The corresponding high workloads and limited resources may force them to decide which nursing care to delay or omit (i.e., MNC). The mentors' initiative and the actions they take to address the multiple job requirements which do not align with the organization's resources are referred to as job crafting strategies. Mentors can use these strategies to shape their role as nurses as well as their role as mentors, depending on their motives and personality.

DESIGN

A longitudinal study with data collected at two time points.

METHODS

One hundred nurse mentors completed validated questionnaires assessing job crafting strategies, MNC and work overload while actively mentoring students. Eighty returned for a follow-up during a non-mentoring period three months later. Data analysis included paired t-tests and hierarchical multivariable linear regressions.

RESULTS

No significant differences were found in MNC between the two points (1.83 SD 0.6 vs. 1.82 SD 0.75; p=0.942). A decrease in hindering demands was noted during active mentoring compared with respite (2.6 SD 0.97 vs. 2.84 SD 0.96; p=0.038). Enhancing structural job resources was significantly negatively correlated with MNC during active mentoring, while enhancing challenging job demands was positively correlated with MNC during these periods (β=0.48, p=0.18 and β=-0.35, p=0.014, respectively).

CONCLUSION

Nurse mentors can effectively reduce MNC by focusing on enhancing structural resources and limiting challenging demands during mentoring periods. It is essential for healthcare organizations to support nurse mentors with manageable workloads and necessary resources to maintain high-quality care.

Primary Care Organizational Support for Nurse Practitioner Practice and Emotional Health Care Delivery

OBJECTIVES

Nurse practitioners (NPs) are key to delivery of primary care services. However, poor organizational support for independent NP practice, such as lack of access to clinic resources, may lead to prioritizing patient physical health over emotional health. We investigated the relationship between organizational support for independent NP practice and emotional health care delivery.

METHODS

This was a secondary analysis of cross-sectional survey data collected from 397 NPs in 2017. We measured organizational support for independent NP practice using the independent practice and support subscale of the NP Primary Care Organizational Climate Questionnaire. Emotional health care delivery was measured by asking NPs how frequently they addressed emotional concerns of patients. We utilized multilevel mixed effects linear regression models, adjusting for NP and practice covariates.

RESULTS

Controlling for NP age, gender, marital status, race, and ethnicity, along with practice setting and size, as the independent practice and support score increased, NPs reported addressing emotional concerns of patients more frequently (beta = 0.34, 95% confidence interval = 0.02-0.66, P = 0.04). This indicates that as organizations provided more support for independent NP practice, NPs were able to more frequently address emotional concerns of patients.

CONCLUSIONS

Organizational support for independent NP practice is associated with addressing emotional concerns of patients. To support NP practice, primary care organizations should ensure that NPs manage patients independently and have access to ancillary staff and support for care management.

Emerging Nurse Billing and Reimbursement Models

OBJECTIVES

To explore and make recommendations to implement direct billing and reimbursement models for nursing care in the United States.

BACKGROUND

Nurses make up the largest group of healthcare professionals and within hospitals, nurses represent approximately a quarter of all resources and associated costs of patient care. This care is mostly hidden in daily room and board charges.

METHODS

The authors surveyed the recent and historical literature related to costing and billing for nursing care. These results were synthesized and led to the recommendation of several new models to cost, bill, and pay for nursing care provided by nurses who are not currently billing for their services.

RESULTS

Two basic billing models are proposed: the 1st is to remove nursing care out of the current daily room or facility-based charges and allocate nursing care time provided to each patient during each day of stay. The 2nd is to expand existing Current Procedural Terminology codes to bill for specific activities and interventions by nurses in all settings where nursing care is delivered.

CONCLUSIONS

It is feasible to implement the proposed methods to identify patient-level nursing intensity, cost, services, and interventions provided by individual nurses in all healthcare settings.

Unveiling missed nursing care: a comprehensive examination of neglected responsibilities and practice environment challenges

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.

Nurses' perceptions of patient handoffs and predictors of patient handoff perceptions in tertiary care hospitals in Kelantan, Malaysia: a cross-sectional study

OBJECTIVES

To study nurses' perceptions of patient handoffs in tertiary care hospitals in Kelantan, Malaysia, and to identify predictors of these perceptions.

DESIGN

Cross-sectional study.

SETTING

Three tertiary care hospitals in Kelantan, Malaysia, February-March 2023.

PARTICIPANTS

The study's inclusion criteria were nurses who were Malaysian citizens, working in shifts and possessing a minimum of 6 months of work experience. Nurses holding administrative positions and those unavailable during the study period were excluded from participation. A stratified proportionate random sampling method was employed, and a 100% response rate was achieved, with all 418 selected nurses participating in the study.

OUTCOME MEASURES

Nurses' perceptions of patient handoffs were assessed using the validated Hospital Patient Handoff Questionnaire. Predictors of these perceptions were identified through multiple linear regression analysis.

RESULTS

The study revealed an overall positive perception of handoffs, with a mean score of 3.5 on a 1-5 scale. Receiving formal in-service training on handoff practices (regression coefficient 0.089, 95% CI: 0.016 to 0.161) and expressing satisfaction with the handoff process (regression coefficient 0.330, 95% CI: 0.234 to 0.425) were positively associated with nurses' perceptions. Working in the paediatric department was associated with a lower perception of handoffs (regression coefficient -0.124, 95% CI: -0.195 to -0.053).

CONCLUSIONS

Formal in-service training, satisfaction and working in the paediatric department were significantly associated with nurses' perceptions of patient handoffs in Kelantan. These findings suggest the need for tailored interventions to improve handoff processes and enhance patient safety. Further research could explore the effectiveness of specific training programmes targeting these identified predictors.

Nurses' perceptions of reasons for missed nursing care in hospitals: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to identify and synthesize the best available evidence on nurses' perceptions of the reasons for missed nursing care in hospitals.

INTRODUCTION

Missed nursing care in hospitals is a complex and global problem affecting patients, nurses, and the health care system. An in-depth understanding of reasons for missed nursing care is essential to prevent it from happening in hospitals. Nurses' perceptions of reasons for missed nursing care in hospitals are related to the care environment, such as staff levels, nurses' workload, levels of experience and competencies, incomplete communication, and poor teamwork. The reasons are multifaceted, and there is a need to synthesize qualitative evidence on nurses' perceptions of the reasons for missed nursing care in hospitals.

INCLUSION CRITERIA

The phenomenon of interest is nurses' perceptions of reasons for missed nursing care, which is defined as care that is either delayed or partially or entirely missed. Studies of nurses with any level of experience, training, or education will be eligible for inclusion. This systematic review will consider qualitative studies that include the perceptions of nurses working in hospital settings, either inpatient or outpatient settings.

METHODS

Following an initial search in PubMed, a full search strategy will be conducted in CINAHL (EBSCOhost), PubMed, Embase, Scopus, Google Scholar, and GreyNet International. The JBI approach will inform study selection, critical appraisal, data extraction, and meta-aggregation. Confidence in the findings will be assessed in accordance with the ConQual approach.

REVIEW REGISTRATION

PROSPERO CRD42023438198.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

SETTING(S)

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TWEETABLE ABSTRACT

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

"We do others' Jobs": a qualitative study of non-nursing task challenges and proposed solutions

INTRODUCTION

Non-nursing tasks (NNTs) have become a prevalent issue among healthcare professionals, affecting nurses globally. This study delves into the experiences of Jordanian nurses regarding NNTs, aiming to uncover challenges and propose solutions within the Jordanian healthcare context.

OBJECTIVE

Explore the impact of NNTs on Jordanian nurses' roles, workload, and satisfaction. Additionally, the study aims to identify various types of NNTs performed by nurses, understand their impact, and propose solutions to mitigate challenges associated with these tasks.

METHODS

A qualitative-exploratory research design was employed for this study. Semi-structured interviews were conducted with Jordanian nurses using a purposeful sampling approach to ensure a diverse representation of experiences and perspectives. Thematic analysis was used to identify recurring themes and patterns related to NNTs, their challenges, and potential solutions. Ethical guidelines were strictly followed to maintain participant confidentiality and ensure the integrity of the data collected.

RESULTS

Analysis of the interviews revealed four major themes: challenges of NNTs, types of NNTs, impact of NNTs, and proposed solutions. Nurses faced significant difficulties due to task ambiguity, role confusion, and increased workload from NNTs, which included administrative duties, clerical work, and tasks typically performed by other healthcare professionals. These NNTs negatively impacted nurses' effectiveness, productivity, and job satisfaction by diverting time and energy from primary nursing responsibilities, causing professional strain. To address these issues, participants suggested clearer job descriptions, stricter task assignment protocols, and systemic changes to tackle the root causes of NNTs.

CONCLUSION

This study sheds light on the pervasive challenges posed by NNTs among Jordanian nurses and emphasizes the importance of addressing these issues to enhance nursing care quality and nurse well-being. By proposing actionable solutions tailored to the Jordanian context, this research contributes to the global discourse on NNTs and underscores the need for organizational support and advocacy to optimize nurses' roles and improve patient care outcomes.

InCHARGE: Co-creating, implementing and evaluating interventions to utilize nurses' competence and achieve person-centred fundamental care-A research protocol describing an action research approach

AIM AND OBJECTIVES

This research protocol presents an action research project with the aim to demonstrate the value of person-centred fundamental care to nurses and nurse managers in surgical care units to encourage a far-reaching change in this direction. The objectives are to describe this process and to evaluate the effects on missed nursing care and person-centred fundamental care.

METHODS

In a novel collaboration between nursing science and medical humanities the action research design will be used to interact with nursing staff and leaders in three surgical care units and design interventions with the purpose to affect the direction of nursing. Initially, the care units will be presented with interactive workshops including evidence-based education on person-centered fundamental care, person-centredness, nurse role responsibility and leadership. This will be followed by cocreation of interventions to stimulate person-centered fundamental care. The Fundamentals of Care framework will be used as the overarching theoretical framework. Data on missed nursing care, person-centred climate and person-centered fundamental care will be collected repeatedly from patient- and nursing stakeholders through interviews and validated questionnaires. Additionally, data from written reflections following clinical observations and focus group interviews will be included. The duration of the study will be approximately five years from ethical approval.

DISCUSSION

It has been previously reported that the current working environments of registered nurses are forcing them to ration their caring responsibilities, leading to a lack of fulfillment of patients' fundamental care needs, with possible severe consequences for patients. The action research design helps researchers gain an understanding of the contextual factors important for forthcoming interventions, enabling reflective processes and cocreation of interventions with stakeholders. This may lead to feasible interventions and strengthen nursing leadership in the involved units.

Nursing categories' perceptions of the practice environment and quality of care in North West Province: a cross-sectional survey design

BACKGROUND

There is a substantial amount of literature on the perception of the practice environment and quality of care as perceived by registered nurses and community services nurses in South Africa and worldwide, but there is little to no research that could be found regarding other categories of nurses, and how these perceptions differ between the different categories. Therefore, the aim of this study is to describe the different nursing categories' perceptions of the practice environment and quality of care and the association between the variables.

METHODS

This study applied a cross-sectional survey design. Data were collected in April 2021 in the public sector of the North West Province. Multiphase sampling was applied to all categories of nurses who worked in an in-patient unit in the selected hospital for at least 3 months (n = 236).

RESULTS

All nursing categories perceived the practice environment as negative, regarding nurse participation in hospital affairs; nurse manager ability, leadership, and support of nurses and staffing and resource adequacy. Perceived quality of care and patient safety items were perceived as neutral and good. However, in all instances, the perceptions of community service nurses and registered nurses were most negative, and enrolled nurse assistants most positive. Adverse events towards patients and nurses were perceived to only occur a few times a year. Overall, nurse perceptions of quality of care and patient safety were most correlated with the subscale of nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses. Adverse events towards patients were most correlated with the collegial nurse-physician relationship subscale, while adverse events towards nurses were correlated with the foundations of quality of care subscale.

CONCLUSION

Improving the practice environment, especially regarding the subscale nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses, is associated with improved quality of care. Nurses with higher qualifications, registered nurses and community service nurses rated quality of care lower than other categories of nurses, contributing to literature that higher qualified staff are more competent to assess the practice environment and quality of care.

Missed nursing care among nursing students: A scoping review

BACKGROUND

Nursing students report facing inconsistencies between theoretical knowledge and actualities of clinical practice, and research indicates they witness missed nursing care during clinical practice. Understanding nursing students' experiences can inform improved clinical learning environments and enhance patient care quality. Recently, research has focused on students' views regarding missed care, yet comprehensive understandings of this phenomenon are lacking.

OBJECTIVE

This review explored what is known about missed nursing care from perspectives of nursing students.

DESIGN

A scoping review according to Arksey and O'Malley's framework and Joanna Briggs Institute methodology was undertaken.

DATA SOURCES

Key databases were searched, including Medline, Embase, CINAHL, Scopus, ProQuest, PsycINFO and Web of Science in August 2023.

REVIEW METHODS

The review included qualitative, quantitative, and structured literature reviews published in English between 2006 and 2023. Inclusion and exclusion criteria and keywords guided the search. Data screening and extraction were independently performed by two reviewers. Included studies were analysed using descriptive statistics and narrative synthesis. Findings are reported in accordance with the PRISMA-ScR.

RESULTS

Of the 5873 articles identified, nine were included in the review. Studies were conducted in seven countries. Themes in students' perceptions included negligence of patients' rights and dignity, living in limbo, and pragmatic acceptance. Reasons for missed care included ineffective teamwork, lack of interest in caring, and inefficient leadership. Missed nursing care adversely affected patient health, hindered student learning and professional growth. Strategies for improvement included enhancing teamwork, enforcing ethical issues, increasing supervision, and creating commitment to work.

CONCLUSION

Missed nursing care affects patient safety and education of nursing students. Incorporating practical training modules into curricula, establishing preceptorship programs, and incorporating ethics education into clinical practice are crucial to address missed nursing care. Further research in diverse settings is warranted.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Structural Equation Modeling of Associations Between Nursing Practice Environment And Missed Nursing Care: A Cross-sectional Study

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.

Missed nursing care and stoma care: an Italian survey

BACKGROUND

In Italy, nursing research has paid special attention to 'missed nursing care'. The studies carried out, varying in tools and settings, describe considerable percentages of missed care. In the field of stoma care, the phenomenon has not been investigated to date.

AIM

To investigate the prevalence of missed nursing care (MNC) in the Italian ostomy patient population and the most relevant causes suggested for this by stoma care nurses.

DESIGN

Cross-sectional study.

METHOD

The Italian version of the MISSCARE survey was used with some questions related to the stoma care pathway. The survey was targeted at hospitals in the country with dedicated services and/or pathways for ostomy patients, between February and April 2023.

FINDINGS

A total of 461 questionnaires were sent out, 214 (53.3%) were analysed. The majority of the participants were female (160, 76.2%), median age of 50 years (35.0-53.8). The most common qualification was a Bachelor's degree (n=117; 54.9%) and work experience in stoma care was more than 10 years in 95 cases (50.3%). Prominent instances of MNC were identified, with hand washing (score 4.6 out of 5), compilation of nursing documentation and hygiene/skin care (score 4.5 out of 5) and patient/family education (score 4.4 out of 5) emerging as the most prevalent. The most notable omissions in the stoma care process encompassed educational facets, clinical monitoring, a comprehensive discharge plan, and diligent follow-up. Among the most frequent reasons were staff shortages (score 3.1 out of 4), unsuitable nurse-patient ratios (score of 3 out of 4) and insufficient numbers of experienced stoma care personnel (score of 3 out of 4).

CONCLUSION

A substantial number of basic and clinically relevant nursing interventions were perceived to be missed, and this may lead to an increase in negative outcomes for ostomy patients.

Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation

Background

Falls are the most common safety incident reported by acute hospitals. The National Institute of Health and Care Excellence recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable.

Aim

To determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute National Health Service hospitals in England.

Design

Realist review and multisite case study. (1) Systematic searches to identify stakeholders' theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (n = 50), patient and carer interviews (n = 31) and record review (n = 60).

Setting

Three Trusts, one orthopaedic and one older person ward in each.

Results

Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored. (1) Leadership: wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared responsibility: a key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient participation: nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling.

Limitations

Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted.

Conclusions

(1) Leadership: There should be a clear distinction between senior nurses' roles and falls link practitioners in relation to falls prevention; (2) shared responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) patient participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling.

Future work

(1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) mixed method and economic evaluations of patient supervision; (3) evaluation of engagement support workers, volunteers and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English.

Study registration

This study is registered as PROSPERO CRD42020184458.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129488) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.

The Effects of Organizational Characteristics, Individual Nurse Characteristics, and Occupational Fatigue on Missed Care at Night

BACKGROUND

Missed care is defined as the omission or delay of necessary patient care and is internationally reported by nurses as a significant safety risk. Nurses working at night also report high levels of occupational fatigue that, coupled with inadequate staffing and practice environment support, may impede a nurse's ability to carry out the nursing process and lead to more missed care.

OBJECTIVE

The study's objective was to examine the interrelationships among organizational and nurse characteristics, occupational fatigue, and missed care among nurses working at night.

METHODS

A cross-sectional design was used. Participants included registered nurses (RNs) who worked at night in New Jersey acute care hospitals. Multiple linear regression and simple moderation analyses were performed to examine the associations.

RESULTS

Nurses reported missing necessary care at night. Unsupportive practice environments, high RN workloads, high patient-RN ratios, high chronic fatigue levels, and low intershift recovery were individually associated with missed care at night. High patient-to-RN ratios and chronic fatigue were independently associated with missed care. However, patient-to-registered-staffing levels had the most considerable effect on missed care at night. Nurses' years of experience and the number of hours of sleep between shifts were significant moderators of the relationship between occupational fatigue states and missed care.

DISCUSSION

This study is the first to examine the interrelationship between occupational fatigue levels, organizational and nurse characteristics, and missed care at night. There is an urgent need to implement strategies in hospital organizations that foster work schedules and adequate staffing patterns that lessen nurses' occupational fatigue levels to ensure our workforce's and patients' safety.

The challenges of nursing care for patients with lumbar discectomy: A qualitative study

AIM

Patients with lumbar disc surgery experience many different problems during their hospital stay. Nurses also face different challenges in providing care to them. Nonetheless, no study has yet specifically addressed these challenges to the best of our knowledge. This study aimed at exploring the challenges of nursing care for patients with lumbar discectomy.

DESIGN

This qualitative study was conducted in 2022 using content analysis.

METHODS

Eight nurses, three patients with lumbar discectomy, and one physician were purposively selected from the neurosurgery wards of the hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Semi-structured interviews were conducted for data analysis and the content analysis method recommended by Elo and Kyngas was used for data analysis. The main phases of this method are open coding, grouping, categorization, and abstraction. The MAXQDA 10 software was employed to facilitate data management. Data collection continued to reach data saturation.

RESULTS

The challenges of nursing care for patients with lumbar discectomy were categorized into eleven subcategories and three main categories, namely dominant routine-based practice in the healthcare system, futile attempt for team-based care, and shortages as a major barrier to quality care. There are different personal, professional, financial, structural, and organizational challenges in nursing care for patients with lumbar discectomy which can negatively affect postoperative patient recovery.

Missed nursing care in emergency departments: a cross-sectional descriptive study

BACKGROUND

Missed care refers to the omission or delay in performing any aspect of patient's care (either a part of the care or the entire care). Currently, missed care has become a growing concern at the international level, which threatens the quality and safety of care and cases many unwanted consequences. This study aims to investigate the frequency and types of missed nursing care in the emergency departments of selected hospitals affiliated to Tehran University of Medical Sciences.

METHODS

This is a cross-sectional and descriptive- observational study that was conducted with the aim of determining the frequency and types of missed nursing care in the emergency departments of selected hospitals affiliated to Tehran University of Medical Sciences from January 2020 to June 2020. The research community included all nursing care offered in the designated areas, as well as all nurses working in the emergency departments of selected hospitals. Finally, 146 nurses were selected by census method. The information was collected by self-reporting method and the researcher's observation. Demographic information questionnaire, a researcher-made checklist were used to determine the frequency and types of missed nursing care. 384 observations were made for each item. Descriptive statistics methods were used to analyze the data.

RESULTS

The area of checking equipment and emergency trolley(mean = 81.80) had the lowest and the area of patient communication(mean = 55.72) had the highest level of missed care.

CONCLUSIONS

The level of missed nursing care in the emergency departments of selected hospitals affiliated to Tehran University of Medical Sciences was found to be high and the highest amount was related to the field of communication with the patient. Therefore, it is recommended that the details of missed nursing care in each area should be considered by nursing managers.

Factors of Missed Nursing Care in Intensive Care Units: Palestinian Perspective

Maintaining a high standard of nursing care is imperative for ensuring patient safety. Several factors significantly impact the provision of nursing care, including work environment resources, personnel coordination, work systems, and head nurse leadership. In addition, each nurse's clinical and academic career also plays a role in shaping the quality of care provided to patients. This article reports results of a cross-sectional study aimed to identify the different types of missed nursing care and the factors that contribute to them, as perceived by nurses, and second, to investigate how nurses' characteristics may relate to the occurrence of missed nursing care. Data for this study were obtained through a self-administered questionnaire that was distributed to participants working in an intensive care unit. The study included a final sample size of 176 participants, all of whom worked in intensive care unit hospitals located in the north region of Palestine. The study found that handwashing, setting up meals for patients who feed themselves, discharge planning, and response to a call light were the most frequently missed nursing care activities. The primary factors identified as reasons for missed nursing care were inadequate availability of labor and material resources, along with communication issues. Efforts to address these identified issues can potentially lead to improved quality of nursing care in intensive care units.

Improving patient activation with a tailored nursing discharge teaching intervention for multimorbid inpatients: A quasi-experimental study

OBJECTIVE

Preliminary effectiveness test of a novel structured personalized discharge teaching intervention for multimorbid inpatients.

METHODS

Using a 2-group sequential pre/post-intervention design, the sample comprised 68 pre-intervention control group and 70 post- intervention group participants. The discharge teaching intervention by trained clinical nurses used structured tools to engage patients and individualize discharge teaching. Outcomes measures included Patient Activation Measure, Readiness for Hospital Discharge Scale, Discharge Care Experiences Survey, and readmission with 10 days post-discharge.

RESULTS

The intervention had a statistically significant positive effect on improving patient activation (M=4.8; p = 0.05) from admission to post-discharge. The participation subscale of the Discharge Care Experiences Survey was higher in the intervention (M=4.1, SD=0.7) than the control group (M=3.8, SD=0.7; t (127)= -2.79, p = .01, effect size= .34). There were no significant between-group differences in Readiness for Hospital Discharge Scale and readmission.

CONCLUSIONS

Our results suggest that a structured personalized discharge teaching intervention can improve patient activation and participation in discharge care. Further refinement of the intervention is needed to evaluate and improve specific components of the intervention.

PRACTICE IMPLICATIONS

Structured personalized discharge teaching should include patient engagement strategies in the teaching-learning process.

Nursing Professional Commitment as a Mediator of the Relationship Between Work Environment and Missed Nursing Care Among Nurses: A Cross-Sectional Analysis

Introduction

Nursing care plays a pivotal role in promoting patient well-being and optimizing health outcomes. The nursing profession is characterized by its commitment to delivering high-quality care to patients.

Objective

The purpose of the study was to explore the role of nursing professional commitment as a mediator between the work environment and missed nursing care.

Methods

A cross-sectional analysis study "STROBE guideline" used an online structured questionnaire to collect data. It was conducted on a sample of 813 nurses who worked at seven governmental hospitals in Egypt, in the hospital wards, operating rooms, intensive care unit (ICU) or outpatient clinics, during a 4-month period from April to August 2022. Researchers used Characteristics of nurses, Nursing Work Index-Revised, Nursing Professional Commitment Scale, and MISSCARE Questionnaire to collect the data. Structural equation modeling by AMOS was used for testing nursing professional commitment as a mediator between the work environment and missed nursing care. Nurses' professional commitment was used as a mediator between work environment and missing nursing care.

Results

The working environment has a direct impact of -0.175, an indirect impact of -0.139, and a total impact of -0.314. Furthermore, professional commitment has a direct impact of -0.421. Additionally, when the working environment increases by 1, professional commitment increases by 0.33. Similarly, when the working environment increases by 1, missed care decreases by 0.175. Moreover, when professional commitment, as a mediating factor, increases by 1, missed care decreases by 0.421.

Conclusion

In conclusion, the findings of this study highlight the significant role of professional commitment as an intermediary factor between the working environment and missed nursing care. According to these results, it is necessary to formulate and implement intervention strategies to improve nurses' professional commitment and working environment, which is the key to reducing their missed nursing care.

Nurses' Documentation Practice and Associated Factors in Eight Public Hospitals, Amhara Region, Ethiopia: A Cross-Sectional Study

Background

Nursing care documentation, which is the record of nursing care that is planned for and delivered to individual patients, can enhance patient outcomes while advancing the nursing profession. However, its practice and associated factors among Ethiopian nurses are not well investigated.

Objective

To assess the level of nursing care documentation practice and associated factors among nurses working at public hospitals in Ethiopia.

Methods

An institutional-based cross-sectional study was conducted from May 1 to 30, 2022. A total of 378 nurses and corresponding charts were randomly selected with a multistage sampling technique. Self-administered structured questionnaires and structured checklists were used to collect data about independent variables and nurses' documentation practice, respectively. Epi Data 4.6 was used for data entry and SPSS version 25 for analysis. Descriptive statistics and binary logistic regression analysis have been employed. The STROBE checklist was used to report the study.

Results

In this study, 372 nurses participated, and 30.4% (95% confidence interval [CI]: 26%-35%) of them had good nursing care documentation practice. Adequate knowledge about nursing care documentation(adjusted odds ratio [AOR] = 4.16, 95% CI: [2.36-7.33]), favorable attitude toward nursing care documentation (AOR = 3.43, 95% CI: [1.85-6.36]), adequacy of documenting sheets (AOR = 2.02, 95% CI: [1.14-3.59]), adequacy of time (AOR = 3.85, 95% CI: [2.11-7.05]), nurse-to-patient ratio (AOR = 2.78, 95% CI: [1.13-6.84]), and caring patients who had no stress, anxiety, pain, and distress (AOR = 3.56, 95% CI: [1.69-7.52]) were significantly associated with proper nursing care documentation practices.

Conclusion

Nursing documentation practice was poor in this study compared to the health sector transformation in quality standards due to the identified factors. Improving nurses' knowledge and attitude toward nursing care documentation and increasing access to documentation materials can contribute to improving documentation practice.

Nurses' experience with presenteeism and the potential consequences on patient safety: a qualitative study among nurses at out-of-hours emergency primary care facilities

OBJECTIVES

This study aimed to gain new insight and knowledge on out-of-hours emergency primary care nurses' experience of presenteeism in their workplace and their outlook on the impact they recognised the phenomenon to have on patient safety when caring for acute patients.

DESIGN

An explorative qualitative study.

SETTING

The study was conducted at three out-of-hours primary care facilities in southwest Norway.

PARTICIPANTS

A total of 10 female nurses were recruited as interviewees. Nurses providing direct patient care were included in the study.

RESULTS

The analysis resulted in four major themes: strong work ethics influence the decision to attend work unwell; work environment factors have a negative impact on nurses' health; nurses' awareness of consequences on the quality of care and patient safety and nurses make use of coping strategies when engaging in presenteeism.

CONCLUSION

Presenteeism is a common experience among nurses at out-of-hours emergency primary care clinics, with work-related stress being a significant contributing factor. Despite recognising a decrease in performance while engaging in presenteeism, nurses displayed adaptive behaviour. They were confident that their suboptimal health issues did not significantly impact patient safety while caring for acute patients. However, the true impact of presenteeism on patient safety in an out-of-hours emergency care setting remains uncertain due to the reliance on subjective reporting systems as quality indicators. More research is needed to understand the phenomenon and its implications on patient safety fully.

[The selection of patients in palliative care units, a necessary condition for maintaining care]

« Les humanités en santé : approches de terrain » sont coordonnées par Claire Crignon, professeure d’histoire et de philosophie des sciences à l’université de Lorraine, qui a créé le master « humanités biomédicales » à Sorbonne université.

Information technology use and tasks left undone by nursing staff: A qualitative analysis

Nursing staff perceive information technology (IT) as time-consuming and impinging on direct patient care time. Despite this, researchers have directed little attention toward the interplay between IT use and tasks left undone by nursing staff. In this paper, we analyze interview and focus group data on hospital nursing staff's experience working with IT to identify ways IT use interacts with tasks left undone. We found that tasks left undone by nursing staff can have IT-related antecedents and that IT-related tasks are also sometimes left undone. This analysis adds to the body of knowledge by showing that tasks related to the work environment and IT can be left undone and that nursing staff avoid certain IT-supported tasks because they do not know how to do them or why they ought to be done. These findings form the basis for our call for further research on the topic.

Greater nurse density correlates to higher level of population ageing globally, but is more prominent in developed countries

BACKGROUND

Representing over 50% of the healthcare workforce, nurses provide care to people at all ages. This study advances, at a population level, that high levels of nursing services, measured by nurse density may significantly promote population ageing measured by the percentage of a population over 65 years of age (65yo%).

METHODS

Population level data was examined to explore the correlation between nurse density and 65yo%. The confounding impacts on ageing such as the effects of economic affluence, physician density, fertility rate, obesity and urban advantages were also considered. Scatter plots, bivariate correlation, partial correlation and multiple linear regression analyses were performed for examining the correlations.

RESULTS

Nurse density correlated to 65yo%; this relationship was independent of other influences such as fertility rate, economic affluence, obesity prevalence, physician density and urban advantages. Second to fertility rate, nursing density had the greatest influence on 65yo%. The predicting and confounding variables explain 74.4% of the total 65yo% variance. The universal correlations identified in country groupings suggest that low nurse density may be a significant global concern.

CONCLUSIONS

While nurse density might contribute significantly to 65yo% globally, the effect was more prominent in developed countries. Ironically, countries with higher nurse densities and therefore greater levels of 65yo%, were countries with an increased need for more nursing staff. To highlight the profound implications for the role the nursing profession plays especially at a time of global nursing shortage, further study into the effects of long-run elasticity of nurse staffing level on population ageing may be needed. For instance, what percentage of nursing staff increase would be required to meet every 1% increase of an ageing population.

Patients' expectations of and experiences with psychosocial care needs in perioperative nursing: a descriptive study

BACKGROUND

Meeting inpatients' psychosocial care needs is essential for their wellbeing, recovery, and positive experiences. This study aimed to describe and compare surgical inpatients' subjective perceptions of the importance of fundamental psychosocial and overall care received.

METHODS

A descriptive study with a convenient sample was conducted from September 2019 to April 2020. A total of 194 surgical inpatients from Norway and Denmark answered a perioperative user participation questionnaire on the day of discharge. The questionnaire was previously face- and content validated. The questionnaire assessed patients' sociodemographic characteristics and four dimensions of fundamental care domains: Psychosocial, Relational, Physical, and System level. This study reports the results from the psychosocial domain. Descriptive statistics including frequencies, percentages, means, and standard deviations were used to analyze background information variables. The congruency between participants' expectations of and experiences with psychosocial care is presented.

RESULTS

The inpatients expected (and experienced) the healthcare personnel to treat them with respect and dignity, and to be involved and informed throughout their perioperative care. The average ratings regarding these aspects of psychosocial care needs were 72.1-93.8%. There was congruency between patients' perceptions of the subjective importance (SI) of psychosocial fundamental care and their perceived reality (PR) of care. Congruency between high SI and high PR ranged from 59.1 to 92.2%, and congruency between low SI and low PR ranged from 0 to 6.6%. Incongruency between SI and PR varied between 5.9 and 39.6% and was mainly related to higher PR than SI. We found no association between education level, sex, length of stay, age, and patient expectations of or experiences with psychosocial care needs.

CONCLUSIONS

Surgical inpatients in Norway and Denmark experience respectful and dignified treatment, and they feel involved and informed in their perioperative care. It is important to include patient perspectives in further research to avoid missed care and disconnection between what patients prefer and what healthcare personnel plan to do. Understanding patient preferences might also lead to less stress and workload for healthcare personnel.

Original Research: Nurse-Reported Missed Care and Its Association with Staff Demographics and the Work Environment

BACKGROUND

Nurses have primary responsibility for many of the care processes and interventions intended to improve patients' health during hospital stays. Accordingly, missed nursing care can negatively impact patient safety and lead to negative clinical outcomes. Missed nursing care is standard care that is not completed, incomplete, or seriously delayed.

PURPOSE

There is scant literature on nurse-reported missed care (NRMC) in Singapore. Identifying the prevalence of, types of, and reasons for missed care, including staff-related factors, is imperative to understanding the implications of missed care and identifying opportunities for improvement.

METHODS

Ours is a correlation study of NRMC using convenience sampling. Nurses working on all inpatient units in an acute care hospital in Singapore were recruited to complete the MISSCARE survey, a quantitative tool measuring missed nursing care and the reasons for it. Descriptive statistics was applied to analyze demographics, types of NRMC, and reasons for NRMC. The Pearson χ2 test was used to analyze the correlation between demographics and satisfaction variables and NRMC.

RESULTS

A total of 314 participants out of 1,944 eligible nurses (response rate, 16%) were recruited. The most commonly reported missed care activities were setting up meals for patients who can feed themselves (87.3%), ambulation (70.1%), attending interdisciplinary conferences (64.3%), providing emotional support to patients and/or family (58%), and turning patients every two hours (56.7%). The most cited reasons for missed care were inadequate number of staff (84.4%), caregiver not in unit or unavailable (76.1%), heavy admission and discharge activity (75.5%), urgent patient situations (74.2%), and unexpected rise in patient volume and/or acuity (73.2%). Younger age, greater experience in role and current unit, inadequate staffing and teamwork, low satisfaction with current role and with being a nurse, and planning to leave the current position were factors significantly associated with greater levels of missed care.

CONCLUSION

This study demonstrated evidence of NRMC and its associated factors within the local setting. In addition to expanding nursing resources, analyzing nursing work processes, providing support for younger nurses, and improving nursing satisfaction are possible mitigating factors in preventing missed care. Strategies targeting workforce and resource management, greater support for new and younger nurses, and job satisfaction should be considered to address missed care.

How well do nurses know their patients? Agreement between patients' degree-of-worry and nurses' estimation of patients' degree-of-worry-An observational study

AIM

To assess the agreement between patients' self-reported degree-of-worry (DOW) and nurses' evaluation of patients' DOW.

DESIGN

An observational cohort study with patients and their primary nurses.

METHODS

Between 22 February and 27 March 2021, data collection among patients and their nurses in an emergency department was carried out. Patients ≥18 years, cognitively intact and Danish or English speaking were eligible to participate. Nurses regardless of seniority and gender were eligible for participation. The single-item degree-of-worry measure, 'how worried are you about the condition you are here today on a scale from 1 to 10, where 1 is minimally worried and 10 is maximum worried' as well as information on gender, age, co-morbidity, triage level and medical reason for encounter was collected from patients. The corresponding nurses were asked; 'how worried do you think your patient is about the condition he/she is there today on a scale from 1 to 10, where 1 is minimally worried and 10 is maximum worried?' Nurses also supplied data on gender, age, seniority as a Registered Nurse and in the ED. Agreement between patients' self-reported degree-of-worry and nurses' evaluation of patients' degree-of-worry was assessed with weighted Cohen's Kappa.

RESULTS

A total of 194 patient-nurse pairs were included for analysis. The agreement between patients' DOW and nurses' evaluation of patients' DOW categorised as DOWlow , DOWmiddle and DOWhigh was in total agreement in n = 85 pairs (43.8%) of the ratings, which corresponds to a weighted Cohen's Kappa of 0.19 (0.08-0.30; p < 0.001).

CONCLUSION

Nurses estimate of their patients' DOW was in very poor agreement. This indicates that nurses are not able to assess the patient's DOW to a satisfactory level. This result is troubling as it may have serious consequences for patient care as it indicates that the nurses do not know their patients' perspectives.

Bedside nurses' perspective on the Fundamentals of Care framework and its application in clinical practice: A multi-site focus group interview study

BACKGROUND

A changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives.

OBJECTIVE

To describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice.

DESIGN

A descriptive qualitative design informed by the Fundamentals of Care framework.

SETTING(S)

The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019.

PARTICIPANTS

A total sample of 53 registered nurses working at the bedside participated. Participants had a wide variety of clinical experience and represented a range of different nursing practice areas.

METHODS

Twelve focus group interviews were used to collect data and analysed with a deductive content analysis approach.

RESULTS

Bedside nurses perceived that the Fundamentals of Care framework was adequate, easy to understand and recognised as representative for the core of nursing care. The definition for fundamental care covered many aspects of nursing care, but was also perceived as too general and too idealistic in relation to the registered nurses' work. The participants recognised the elements within the framework, but appeared not to be using this to articulate their practice. Three main categories emerged for implications for clinical practice; guiding reflection on one's work; ensuring person-centred fundamental care and reinforcing nursing leadership.

CONCLUSIONS

The Fundamentals of Care framework is perceived by bedside nurses as a modern framework describing the core of nursing. The framework was recognised as having clinical relevance and provides bedside nurses with a common language to articulate the complexity of nursing practice. This knowledge is crucial for bedside nurses both in clinical practice and in leadership roles to be able to speak up for the need to integrate all dimensions of care to achieve person-centred fundamental care. Various activities for reflection, person-centred care and leadership to apply the framework in clinical practice were presented, together with minor suggestions for development of the framework.

TWEETABLE ABSTRACT

Bedside nurses recognise their clinical practice within the Fundamentals of Care framework, showing the core of modern nursing.

Cultural adaptation of the revised Basel Instrument for Rationing of Care to the Turkish context: a study of validity and reliability

Background

Studies have shown that nurses do not complete one or more necessary nursing care elements in their last shift due to lack of time. The Basel Extent of Rationing Nursing Care (BERNCA) instrument is one of the most used scales to measure the rationing of nursing care.

Aim

This study is aimed to culturally adapt the revised BERNCA (BERNCA-R) instrument to the Turkish language and to test its validity and reliability.

Methods

A cross-sectional and methodological study was used. The instrument was adapted in three stages: translation and adaptation, content validity testing and validity and reliability. Data were obtained from 350 nurses working in two public acute care hospitals in Turkey, between September 2019 and January 2020. The descriptive statistics, content validity index, exploratory and confirmatory factor analyses, Cronbach's α, Guttman split-half and inter-item reliability analyses were performed for the analysis of the data.

Results

The Turkish version of the BERNCA-R instrument with a 27-item and three-subscales (monitoring, daily care and needs and psychosocial care) structure was found to have acceptable and good fit indices.

Conclusion

The Turkish version of the BERNCA-R instrument is valid and reliable tool to measure rationing of nursing care.

Nursing Practice Variations in Pain Management in Older Adults With Dementia Admitted to an Acute Geriatrics Unit During the COVID-19 Pandemic

The current retrospective descriptive study evaluated nursing practice variations on pain management in older adults with dementia admitted to an acute geriatrics unit (AGU) before (2018) and during (2021) the coronavirus disease 2019 (COVID-19) pandemic. Data were gathered from electronic health records. Pain intensity was evaluated a median of 1.9 times per day of stay in the pre-COVID-19 sample, whereas in the COVID-19 sample, the median was 0.7 times per day of stay. Median number of analgesic administrations per day of stay and mean percentage of clinical care records that mentioned pain were higher in patients admitted during the pandemic. Variations in nursing care organization in the AGU due to the COVID-19 pandemic had an impact on the patterns of pain management nursing practice in older adults with dementia. [Research in Gerontological Nursing, 16(4), 173-182.].

Missed nursing care in emergency departments: A scoping review

BACKGROUND

Patient safety is a global health priority. Errors of omission, such as missed nursing care in hospitals, are frequent and may lead to adverse events. Emergency departments (ED) are especially vulnerable to patient safety errors, and the significance missed nursing care has in this context is not as well known as in other contexts.

AIM

The aim of this scoping review was to summarize and disseminate research about missed nursing care in the context of EDs.

METHOD

A scoping review following the framework suggested by Arksey and O'Malley was used to (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; (5) collate, summarize, and report the results; and (6) consultation.

RESULTS

In total, 20 themes were derived from the 55 included studies. Missed or delayed assessments or other fundamental care were examples of missed nursing care characteristics. EDs not staffed or dimensioned in relation to the patient load were identified as a cause of missed nursing care in most included studies. Clinical deteriorations and medication errors were described in the included studies in relation to patient safety and quality of care deficiencies. Registered nurses also expressed that missed nursing care was undignified and unsafe.

CONCLUSION

The findings from this scoping review indicate that patients' fundamental needs are not met in the ED, mainly because of the patient load and how the ED is designed. According to registered nurses, missed nursing care is perceived as undignified and unsafe.

Mobile Dressing Trolleys Improve Satisfaction and Logistics on Pediatric Surgery Wards

BACKGROUND

Evidence-based data on the effect of dressing trolleys on children's postoperative recovery are not available. The aim of this study was to evaluate a specific pediatric surgical dressing trolley on patient and caregiver satisfaction, as well as temporal and logistical aspects of the dressing change procedures.

METHODS

In a prospective observational non-randomized study, a total of 100 dressing changes were observed before (group 1) and after (group 2) the introduction of a pediatric surgical dressing trolley and the satisfaction, time and logistical factors were recorded on site.

RESULTS

The median preparation time, the duration of the dressing change and the total time decreased significantly from group 1 to group 2 by 1:11 min (p < 0.001); 1:56 min (p = 0.05) and 5:09 min (p = 0.001), respectively. The patient's room was left significantly less often in group 2 to retrieve missing bandages. The median satisfaction of the medical staff increased by 12% in group 2 (p < 0.001). The satisfaction of the parents increased by 2.5% in group 2 (p = 0.042), and that of the nursing staff increased by 9.25% in group 2 (p = 0.015).

CONCLUSIONS

Our results demonstrate the positive effects of a dressing trolley for pediatric surgical dressing changes by minimizing postoperative handling and manipulation of the child. It improves time and logistical factors as well as the satisfaction of those involved, which may lead to a faster recovery.

Administrative burden in Swiss nursing homes and its association with care workers' outcomes-a multicenter cross-sectional study

BACKGROUND

Care workers in nursing homes often perform tasks that are rather related to organizational or management activities than 'direct patient care'. 'Indirect care activities', such as documentation or other administrative tasks are often considered by care workers as a burden, as they increase overall workload and keep them away from caring for residents. So far, there is little investigation into what kind of administrative tasks are being performed in nursing homes, by which type of care workers, and to which extent, nor how administrative burden is associated with care workers' outcomes.

PURPOSE

The objective of this study was to describe care workers' administrative burden in Swiss nursing homes and to explore the association with four care worker outcomes (i.e., job dissatisfaction, emotional exhaustion, intention to leave the current job and the profession).

METHODS

This multicenter cross-sectional study used survey data from the Swiss Nursing Homes Human Resources Project 2018. It included a convenience sample of 118 nursing homes and 2'207 care workers (i.e., registered nurses, licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the administrative tasks and burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics.

RESULTS

Overall, 73.9% (n = 1'561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n = 787) reporting to spend 2 h or more during a "normal" day performing administrative tasks. Ratings for administrative burden ranged from 42.6% (n = 884; ordering supplies and managing stocks) to 75.3% (n = 1'621; filling out the resident's health record). One out of four care workers (25.5%, n = 561) intended to leave the profession, whereby care workers reporting higher administrative task burden (OR = 1.24; 95%CI: 1.02-1.50) were more likely to intend to leave the profession.

CONCLUSION

This study provides first insights on care workers' administrative burden in nursing homes. By limiting care workers' burdensome administrative tasks and/or shifting such tasks from higher to lower educated care workers or administrative personnel when appropriate, nursing home managers could reduce care workers' workload and improve their job satisfaction and retention in the profession.

Patient Outcomes and Hospital Nurses’ Workload: A Cross-Sectional Observational Study in Slovenian Hospitals Using the RN4CAST Survey

Introduction

Higher nursing workload increases the odds of patient deaths, as the work environment has a significant effect on patient outcomes. The aim of the study was to explore the relation between patient outcomes and nurses’ working conditions in hospitals.

Methods

Administrative data on discharges of surgical patients for the year 2019 in eight general hospitals and two university medical centres in Slovenia were collected to determine in-hospital mortality within 30 days of admission. The RN4CAST survey questionnaire was used to gather data from nurses in these hospitals, with 1,010 nurses participating. Data was collected at the beginning of 2020. The number of nurses per shift and the nurse-to-patient ratio per shift were calculated. Univariate, bivariate and multivariate statistical methods were used to analyse the data.

Results

The 30-day in-hospital mortality for surgical patients was 1.00% in the hospitals sampled and ranged from 0.27% to 1.62%. The odds ratio for staffing suggests that each increase of one patient per RN is associated with a 6% increase in the likelihood of a patient dying within 30 days of admission. The mean patient-to-RN ratio was 15.56 (SD=2.50) and varied from 10.29 to 19.39. Four of the 13 tasks checked were not performed on patients during the last shift.

Conclusion

The results are not encouraging, with an extremely critical shortage of RNs and thus a high RN workload. The number of patients per RN is the highest in Europe and also higher than in some non-European countries, and represents an extreme risk to the quality of nursing and healthcare as a whole. The recommendation for acute non-emergency internal medicine and surgery departments is four patients per RN per shift.

Validation Study of the Revised Spirituality and Spiritual Care Rating Scale (SSCRS): A Cross-Sectional Survey in Poland

Introduction

The use of a validated scale, Spirituality and Spiritual Care Rating Scale (SSCRS) to measure nurses' perceptions of spirituality and spiritual care.

Aim

The purpose of this study was to analyse selected psychometric properties of the Polish version of the SSCRS, among them the applicability of the dimensions of spiritual care in nursing, ie, spirituality, spiritual care, religiosity and personalized care, to Polish conditions.

Methods

Poland-wide multicentre study with a cross-sectional validation design. The study was conducted between March and June 2019. Seven Polish Nursing Faculties accepted the invitation to participate in the study. A representative sample of 853 nurses enrolled in MSc (postgraduate) programs in nursing participated. After translation and cultural adaption of the SSCRS, the instrument underwent a full psychometric evaluation of its construct validity using (exploratory and confirmatory factor analysis), internal consistency (Cronbach's alpha and correlation analysis), reliability (test-retest analysis), known-group validity (Student's t-test) analysis.

Results

The exploratory and confirmatory factor analysis demonstrated that the Polish version of the SSCRS was a three-factor model with "Activity-centred spiritual care" (9 items), "Emotional support-centred spiritual care" (5 items) and "Religiosity" (3 items) domains. The Cronbach's alpha coefficient for the whole scale was 0.902, and the alpha values for the individual domains were 0.898, 0.873 and 0.563, respectively. The three domains mentioned above seemed to provide a comprehensive understanding of spiritual care perceived subjectively by Polish MSc in nursing students.

Conclusion

This study demonstrated a substantial degree of similarity in the selected psychometric characteristics of the Polish version of SSCRS and the original scale.

Influence of the Team Effectiveness of Nursing Units on Nursing Care Left Undone and Nurse-Reported Quality of Care

The aim of this study was to identify the influence of nursing unit team effectiveness on nursing care left undone and nurse-reported quality of care. This was a cross-sectional study with a sample of 230 nurses working at general hospitals in South Korea. Data were collected in January 2023 using an online questionnaire. Nursing unit team effectiveness was measured, consisting of the following sub-scales: leadership of the head nurse, cohesion, job satisfaction, competency of nurses, work productivity, and coordination. Multiple regression analyses were used to assess relationships between nursing unit team effectiveness and nursing care left undone and nursing-reported quality of care. Among these sub-domains, the study found that the higher the coordination (β = -0.22, p < 0.001), the significantly lower the nursing care left undone. The higher the competency of nurses (β = 0.26, p < 0.001) and work productivity (β = 0.20, p < 0.001), the higher the nurse-reported quality of care. In addition, nursing care left undone had a negative effect on nurse-reported quality of care (β = -0.15, p < 0.001). Therefore, nursing managers should make efforts to manage team effectiveness in nursing units to improve nurse-reported quality of care.

Nurse Staffing Level, Length of Work Experience, and Risk of Health Care-Associated Infections Among Hospital Patients: A Prospective Record Linkage Study

BACKGROUND

Nurse understaffing may have several adverse consequences for patients in hospitals, such as health care-associated infections (HAIs), but there is little longitudinal evidence available on staffing levels and HAIs with consideration of incubation times to confirm this. Using daily longitudinal data, we analyzed temporal associations between nurse understaffing and limited work experience, and the risk of HAIs.

METHODS

The study was based on administrative data of 40 units and 261,067 inpatient periods for a hospital district in Finland in 2013-2019. Survival analyses with moving time windows were used to examine the association of nurse understaffing and limited work experience with the risk of an HAI 2 days after exposure, adjusting for individual risk factors. We reported hazard ratios (HRs) with 95% CIs.

RESULTS

Neither nurse understaffing nor limited work experience were associated with the overall risk of HAIs. The results were inconsistent across staffing measures and types of HAIs, and many of the associations were weak. Regarding specific HAI types, 1-day exposure to low proportion of nurses with >3 years of in-hospital experience and low proportion of nurses more than 25 years old were associated with increased risk of bloodstream infections (HR=1.30; 95% CI: 1.04-1.62 and HR=1.40; 95% CI: 1.07-1.83). Two-day exposure to low nursing hours relative to target hours was associated with an increased risk of surgical-site infections (HR=2.64, 95% CI: 1.66-4.20).

CONCLUSIONS

Data from time-varying analyses suggest that nursing staff shortages and limited work experience do not always increase the risk of HAI among patients.

The associations of psychological burnout and time factors on medication errors in rotating shift nurses in Korea: A cross sectional descriptive study

AIM

To describe the associations of psychological burnout and time factors on hospital nurses' medication errors.

DESIGN

A cross-sectional survey design was used.

METHODS

A structured questionnaire pertaining to psychological burnout, time factors and medication error was administered to 200 bedside nurses working at two tertiary university hospitals in Korea. The associations between the psychological burnout, time factor and medication error were analysed with the zero-inflated negative binomial regression for over-dispersed and over-abundant zeros count data.

RESULTS

Higher psychological burnout, shorter meal time during duty and longer weekly overtime were associated with an increased likelihood of medication error of nurses working in tertiary university hospitals. For medication safety, nurse managers should provide appropriate administrative support to nurses to cope with psychological burnout of nurses. Work time management should also be considered as human factors to satisfy the needs of nurses, such as securing meal times and maintaining a low level of weekly overtime.

[Pathway Analysis on the Effects of Nursing Informatics Competency, Nursing Care Left Undone, and Nurse Reported Quality of Care on Nursing Productivity among Clinical Nurses]

PURPOSE

Nursing informatics competency is used to manage and improve the delivery of safe, high-quality, and efficient healthcare services in accordance with best practices and professional and regulatory standards. This study examined the relationship between nursing informatics competency (NIC), nursing care left undone, and nurse reported quality of care (NQoC) and nursing productivity. A path model for their effects on nursing productivity among clinical nurses was also established.

METHODS

Data were collected using structured questionnaires answered by 192 nurses working in a tertiary hospital located in J city, Korea, and analyzed using SPSS/WIN 23.0 and AMOS 21.0 program.

RESULTS

The fit indices of the alternative path model satisfied recommended levels χ² = .11 (p = .741), normed χ² (χ²/df) = .11, SRMR = .01, RMSEA = .00, GFI = 1.00, NFI = 1.00, AIC = 18.11. Among the variables, NIC (β = .44, p < .001), NQoC (β = .35, p < .001) had a direct effect on nursing productivity. Due to the mediating effect of NQoC on the relationship between NIC and nursing productivity, the effect size was .14 (95% CI .08~.24). Meanwhile, nursing care left undone through NQoC in the relationship between NIC and nursing productivity, has a significant mediation effect (estimate .01, 95% CI .00~.03). The explanatory power of variables was 44.0%.

CONCLUSION

Education and training for enhancing NIC should be provided to improve nursing productivity, quality of care and to reduce missed nursing care. Furthermore, monitoring the quality of nursing care and using it as a productivity index is essential.

The characteristics and factors associated with omitted nursing care in the intensive care unit: A cross-sectional study

INTRODUCTION

Prior research showed that work environment features in acute care settings influence nurses' capacity to provide care and impacts patient outcomes (e.g., falls). However, little is known about this phenomenon in the intensive care unit. The objectives of this study were to describe the characteristics of omitted nursing care, and to examine the associations between work environment features, omitted nursing care and nurse-reported outcomes in the intensive care unit.

METHODS

An electronic cross-sectional correlational study was conducted in the province of Quebec, Canada. Over September 2021, nurses were asked to complete the Healthy Work Environment Assessment Tool (HWEAT), the Intensive Care Unit Omitted Nursing Care instrument (ICU-ONC) and to report their perceptions of nurse-reported outcomes (e.g., quality of care). The associations between these variables were estimated using multivariable cluster-robust regression models, adjusted for nurse and hospital characteristics.

RESULTS

A total of 493 nurses from 42 distinct hospitals participated to this study. On average, nurses felt that their work environment was acceptable, and that the quality and safety of patient care was good. Basic care activities (e.g., mobilisation) were most frequently reported as omitted as opposed to those related to surveillance and medical interventions. In multivariable analyses, higher work environment scores were associated with reduced omitted nursing care scores (p < 0.001) and better ratings for nurse-reported outcomes (p < 0.001). Also, higher omitted nursing care scores were associated with more negative perceptions about the quality and safety of care (p < 0.001).

CONCLUSION

Our study portrays the characteristics and some factors associated with omitted nursing care in the intensive care unit. Further research should determine whether intensive care nurses' reports of organisational features and omitted nursing care are associated with objectively captured patient outcomes.

The Impact of Sociodemographic Factors on the Rationing of Nursing Care in Urology Wards

BACKGROUND

The problem of care rationing is widespread all over the world and results from many factors affecting nurses. These factors may result from the environment in which the nurses work, e.g., the atmosphere at work, or may not be related to work, e.g., place of residence. The aim of this study was to examine the impact of sociodemographic factors (place of residence, satisfaction with the financial situation, number of forms of postgraduate education, work system, number of patients per nurse, number of diseases) on care rationing, job satisfaction and quality of nursing care.

METHODS

The study is a cross-sectional study which includes 130 nurses from all over Poland who work in urology wards. The criteria for inclusion were consent to the examination, practicing the profession of a nurse, work in the urology department and work experience of at least 6 months, regardless of the number of hours worked (full-time/part-time). The study was conducted using the standardized PIRNCA (Perceived Implicit Rationing of Nursing Care) questionnaire.

RESULTS

The average rationing nursing care was 1.11/3 points which means nursing care was rarely rationed. The average job satisfaction was 5.95/10 points, and the assessment of the quality of patient care was 6.88/10 points, which means a medium level of the job satisfaction and the quality of patient care. The rationing of care was affected by the number of nurse illnesses; job satisfaction was influenced by the place of residence and satisfaction with the financial situation, while the quality of care was not influenced by any of the analyzed factors.

CONCLUSIONS

The result of care rationing is at a similar level as the results in Poland and abroad. Despite the rare rationing of care, employers should take corrective action, especially in terms of increasing the staff and health prevention of nurses.

Doživljanje neizvedene zdravstvene nege pri medicinskih sestrah

Uvod: Stiske zaradi zdravstvene nege, ki ostaja zaradi različnih razlogov neizvedena, so pri medicinskih sestrah pogosto spregledane in neprepoznane. Namen integrativnega pregleda literature je pregledati najnovejše raziskave, ki opisujejo, kako se neizvedena zdravstvena nega izraža na duševnem počutju medicinskih sester.Metode: Uporabili smo integrativni pregled literature, izveden v skladu s PRISMA smernicami v podatkovnih bazah PubMed, CINAHL, Wiley, COBISS.SI in Google Učenjak. Potek iskanja in analize literature je prikazan s pomočjo PRISMA diagrama. Zadetke smo razvrstili glede na raven dokazov. Uporabili smo tematsko analizo vsebine.Rezultati: Skupaj je bilo identificiranih 175 in v končno analizo vključenih 11 virov. Identificirano je bilo 96 kod združenih v 4 kategorije: (1) Telesno, duševno in čustveno počutje, (2) Moralno etične dileme, (3) Sprejemanje odločitev pri delu – prilagajanje, (4) Poklicne in osebne vrednote.Diskusija in zaključek: Neizvedena zdravstvena nega je za medicinske sestre pomemben izvor stisk in stresa, saj zaradi neizvajanja vseh potrebnih aktivnosti v zdravstveni negi prihajajo v neskladje s svojimi osebnimi in poklicnimi vrednotami. Naši rezultati dodajajo vsebinski kontekst in boljše razumevanje posledic neizvedene zdravstvene nege pri medicinskih sestrah. Vsakodnevno odločanje, katere aktivnosti bo potrebno izpustiti, vpliva ne samo na slabše počutje, nezadovoljstvo in izgorelost, ampak celo na zapuščanje delovnih mest in poklica.

Unfinished nursing care in nursing homes

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.

It's a hard process - Nursing students' lived experiences leading to dropping out of their education; a qualitative study

BACKGROUND

Dropout from nursing education is a serious problem worldwide. Student nurse attrition has a profound effect not only on the nursing profession and patient care, but also on the students themselves. Dropout is recognized as a complex phenomenon that has multiple causes. A more detailed and nuanced understanding of the complexity behind dropout is needed if we are to retain more nursing students.

AIM

To explore the students' experiences and considerations before dropping out and their reflections after dropping out to gain a deeper understanding of the factors that prompted them to leave their nursing education.

DESIGN/METHOD

A qualitative explorative design inspired by Gadamer's philosophical hermeneutics was used to explore the students' lived experiences and considerations concerning dropping out. Qualitative telephone interviews were conducted on 15 nursing students.

RESULTS

The analysis revealed three main themes that disclosed and elucidated the nursing students' reasons for dropping out: (i) Resources to make a difference and help others; (ii) Clinical practice was more demanding than expected; (iii) The learning environment was important - the social environment was essential.

CONCLUSION

The students encountered a lack of support to deal with the difficult emotions that arose when witnessing serious illness and death. They expressed feeling overwhelmed by their vulnerability and called for support to develop resilience. The social environment and a sense of belonging to the nursing profession were cited by students as being essential to this support.

Fundamental Care's state of knowledge around the world: Where are we now? A scoping review

AIMS

To investigate and describe the current state of knowledge about Fundamental Care in terms of population, contexts, concepts and gaps.

DESIGN

A scoping review.

DATA SOURCES

CINAHL, Medline, PsycINFO and EMBASE databases were searched in April 2021 for eligible literature, published from January 2010, onwards.

REVIEW METHODS

This scoping review was built around the recommendations of Peters et al. (2020 version). Two researchers conducted the literature search, and three researchers independently screened the titles and abstracts of the retrieved studies' data, using the eligibility criteria and the review questions as a guide.

RESULTS

The search yielded 763 records, of which 107 were included. Results are presented under seven subheadings: (a) Countries and Continents, (b) Context, (c) Research Design, (d) Publishing/Journal, (e) Participants and Population, (f) Keywords and (g) Fundamental of Care Framework and Practice Process. All the retrieved articles describe the current state of knowledge about Fundamental Care in terms of population, contexts, concepts and gaps.

CONCLUSION

This scoping review highlighted the elevated number of articles that have been published since the beginning of the work on Fundamental Care, 10 years ago. The included articles are related to different dimensions of research, practice and teaching and to the Fundamentals of Nursing Care, but also to nursing theory. Finally, most of the articles had a nursing focus.

IMPACT

The results of this scoping review allow us to highlight the work from the past 10 years. This may be of interest to learn more about the research surrounding Fundamental Care. This scoping review allows us to better target the theoretical and empirical developments to focus on in the coming years.

Toward understanding nurses' decisions whether to miss care: A discrete choice experiment

BACKGROUND

Studies of missed nursing care suggest that it results from ward-level, patient-related, and task-type factors, while nurses' decision-making style was scarcely studied. Studying the effect of nurses' decision-preference structures, namely a pattern of joint ward and patient factors, on missed care may also contribute to understanding the phenomenon.

OBJECTIVES

To examine the relationships between decision-preference structures and missed care and the moderating effects of decision-making styles and task type in these links.

DESIGN

A discrete choice experiment with a between- and within-participants design.

PARTICIPANTS

A sample of 387 registered nurses working in acute medical surgical wards in Israel.

METHODS

Based on the protocol for discrete choice experiments, a survey was developed to assess the decision-preference structure, considering five factors: overload, presence of head nurse, clinical complexity, difficult patient, and presence of relatives. Participants were randomly assigned to four task-type conditions and completed a survey regarding their task. Decision-making style was assessed using a validated questionnaire.

RESULTS

Extensive workload (b = -0.46; p = 0.001), difficult patient (b = -0.20; p = 0.001), and patient clinical complexity (b = -0.10; p = 0.006) were negatively linked to the probability of missed care. The interaction between workload and task type (b = 0.252; p = 0.017) indicated that the probability of missed care under extensive compared with regular workload was lowest for developing a discharge plan and highest for providing emotional support. The interaction of patient complexity and task type (b = 0.230; p = 0.013) indicated that the probability of missed care in developing a discharge plan and medication administration was lower for patients having high compared with low clinical complexity. The interaction between difficult patient and task type (b = -0.219; p = 0.044) indicated that the probability of missed care in emotional support, developing a discharge plan, and patient's mobility was lower for difficult than for non-difficult patients. Finally, the interaction between workload and decision-making style (b = -0.48; p = 0.001) indicated that the probability of missed care under heavy compared with regular workloads was lower for the dual-preference or the dominantly intuitive styles.

CONCLUSIONS

This design enabled examining the prioritizing processes nurses use when deciding about whether to miss care. The likelihood of missing more in structured tasks is lower under a heavy overload and when patients appear difficult or clinically complex. Dual-preference styles or dominantly intuitive styles are more suitable for the routine high workload.