Missed nursing care and its relationship with perceived ethical leadership

The association of teamwork and missed nursing care in acute care setting: A mixed-methods systematic review

AIM(S)

Teamwork among healthcare professionals is a key aspect of patient safety that influences the prevalence of missed nursing care. The association between teamwork and missed care in acute care hospitals is now well established in the literature. Therefore, this review aimed to synthesise the existing empirical evidence on the association between teamwork and missed care in the acute care setting.

DESIGN

A mixed-method systematic review study.

METHODS

The search was carried out in February 2023 in four scientific databases, PubMed, ProQuest, Web of Science and Scopus based on their institutional availability. The search produced 1542 studies. The method of thematic analysis was used in data synthesis.

RESULTS

A total of 18 studies were selected that revealed the relationship between teamwork and missed care. The teamwork score was weak to moderate but significantly associated with the overall score of missed care and was found to be a statistically significant predictor of missed care in an acute care setting. Additionally, teamwork represented an important reason for missed care, primarily in the context of poor communication, lack of trust and cooperation in the nursing team and lack of leadership.

CONCLUSION

The review findings contribute to a deeper understanding of the intricate dynamics between teamwork and missed care and provide valuable information to healthcare professionals and institutions looking to optimise teamwork and mitigate instances of missed care in the acute care setting.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Recognising how teamwork influences the occurrence of missed care, healthcare organisations can strategically implement targeted interventions to enhance collaboration, address communication gaps, foster trust, and provide effective leadership.

IMPACT

This review suggests that improving teamwork seems to be one of the most important strategies focused on mitigating missed care in acute care settings.

REPORTING METHOD

The reporting of this review followed the PRISMA 2020 checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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

OBJECTIVES

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

INTERVENTION

No intervention was needed in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

Unfinished nursing care reasons as perceived by nurses at different levels of Nursing Services: findings of a qualitative study

AIM

To investigate reasons for Unfinished Nursing Care across the whole levels of the nursing service as perceived by clinical nurses, ward managers and executive nurses.

BACKGROUND

Even though Unfinished Nursing Care has been considered an issue affected by the system, no studies to date have attempted to investigate reasons across the whole levels of the nursing service by involving clinical nurses, ward managers and executive nurses.

METHOD

A descriptive qualitative approach was performed in 2021 according to the COnsolidated criteria for REporting Qualitative research guidelines. A large public health care trust was approached, and a purposeful sample of clinical nurses, ward managers and executive nurses was invited to attend face-to-face or on-line interviews. Twenty-nine interviews were performed (nineteen clinical nurses, seven ward managers, three executive nurses) and transcribed verbatim: then, a content analysis was conducted by considering all narratives together followed by an analytic process to identify themes and subthemes at the clinical, ward manager and executive levels.

RESULTS

Reasons for Unfinished Nursing Care have emerged at five levels: System (e.g. poor support towards nursing care); Unit (e.g. ineffective models of nursing care delivery); Nurse Managers (e.g. inadequate nurse manager leadership); Nurses (e.g. weaknesses in education); and Patients (e.g. increased demand for patients' care).

CONCLUSION

The evidence available should be expanded to include also Unfinished Nursing Care reasons identified at the system and at the ward manager levels, that both can complete the perceptions of the clinical nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

The actors composing the nursing service perceive different reasons and therefore, should be involved in detecting and contrasting the Unfinished Nursing Care. The reasons applied or established at the upper level influence the bedside levels: therefore, strategies to prevent or minimize the Unfinished Nursing Care should be designed at multi-levels in a system-inclusive approach.