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Fazio M, Jabbour E, Patel S, Bertelle V, Lapointe A, Lacroix G, Gravel S, Cabot M, Piedboeuf B, Beltempo M. Association of Shift-Level Organizational Factors with Nosocomial Infection in the Neonatal Intensive Care Unit. JOURNAL OF PEDIATRICS. CLINICAL PRACTICE 2024; 13:200112. [PMID: 38948384 PMCID: PMC11214522 DOI: 10.1016/j.jpedcp.2024.200112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 07/02/2024]
Abstract
Objective To evaluate the association between shift-level organizational data (unit occupancy, nursing overtime ratios [OTRs], and nursing provision ratios [NPRs]) with nosocomial infection (NI) among infants born very preterm in the neonatal intensive care unit (NICU). Study design This was a multicenter, retrospective cohort study, including 1921 infants 230/7-326/7 weeks of gestation admitted to 3 tertiary-level NICUs in Quebec between 2014 and 2018. Patient characteristics and outcomes (NIs) were obtained from the Canadian Neonatal Network database and linked to administrative data. For each shift, unit occupancy (occupied/total beds), OTR (nursing overtime hours/total nursing hours), and NPR (number of actual/number of recommended nurses) were calculated. Mixed-effect logistic regression models were used to calculate aOR for the association of organizational factors (mean over 3 days) with the risk of NI on the following day for each infant. Results Rate of NI was 11.5% (220/1921). Overall, median occupancy was 88.7% [IQR 81.0-94.6], OTR 4.4% [IQR 1.5-7.6], and NPR 101.1% [IQR 85.5-125.1]. A greater 3-day mean OTR was associated with greater odds of NI (aOR 1.08, 95% CI 1.02-1.15), a greater 3-day mean NPR was associated lower odds of NI (aOR 0.96, 95% CI 0.95-0.98), and occupancy was not associated with NI (aOR, 0.99, 95% CI 0.96-1.02). These findings were consistent across multiple sensitivity analyses. Conclusions Nursing overtime and nursing provision are associated with the adjusted odds of NI among infants born very preterm in the NICU. Further interventional research is needed to infer causality.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Quebec investigators of the Canadian Neonatal Network (CNN)∗
- McGill University, Montréal, QC, Canada
- Université de Sherbrooke, Sherbrooke, QC, Canada
- Université de Montréal, Montréal, QC, Canada
- Université Laval, Quebec, QC, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
- CHU de Québec, Québec, QC, Canada
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Rosenbaum KEF, Lasater KB, McHugh MD, Lake ET. Hospital Performance on Hospital Consumer Assessment of Healthcare Providers and System Ratings: Associations With Nursing Factors. Med Care 2024; 62:288-295. [PMID: 38579145 PMCID: PMC11141206 DOI: 10.1097/mlr.0000000000001966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To determine which hospital nursing resources (staffing, skill mix, nurse education, and nurse work environment) are most predictive of hospital Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) performance. BACKGROUND HCAHPS surveying is designed to quantify patient experience, a measure of patient-centered care. Hospitals are financially incentivized through the Centers for Medicare and Medicaid Services to achieve high HCAHPS ratings, but little is known about what modifiable hospital factors are associated with higher HCAHPS ratings. PATIENTS AND METHODS Secondary analysis of multiple linked data sources in 2016 providing information on hospital HCAHPS ratings, hospital nursing resources, and other hospital attributes (eg, size, teaching, and technology status). Five hundred forty non-federal adult acute care hospitals in California, Florida, New Jersey, and Pennsylvania, and 11,786 registered nurses working in those hospitals. Predictor variables included staffing (ie, patient-to-nurse ratio), skill mix (ie, the proportion of registered nurses to all nursing staff), nurse education (ie, percentage of nurses with a bachelor's degree or higher), and nurse work environment (ie, the quality of the environment in which nurses work). HCAHPS ratings were the outcome variable. RESULTS More favorable staffing, higher proportions of bachelor-educated nurses, and better work environments were associated with higher HCAHPS ratings. The work environment had the largest association with higher HCAHPS ratings, followed by nurse education, and then staffing. Superior staffing and work environments were associated with higher odds of a hospital being a "higher HCAHPS performer" compared with peer hospitals. CONCLUSION Improving nursing resources is a strategic organizational intervention likely to improve HCAHPS ratings.
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Affiliation(s)
- Kathleen E. Fitzpatrick Rosenbaum
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- National Clinician Scholars Program, Yale University, New Haven, CT, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Yale New Haven Hospital, New Haven, CT, USA
- Yale School of Nursing, Yale University, New Haven CT, USA
| | - Karen B. Lasater
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Mathew D. McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Abere Y, Biresaw H, Misganaw M, Netsere B, Adal O. Missed nursing care and its associated factors in public hospitals of Bahir Dar City, Northwest Ethiopia: a cross-sectional study. BMJ Open 2024; 14:e081647. [PMID: 38626963 PMCID: PMC11029394 DOI: 10.1136/bmjopen-2023-081647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The aim of this study was to investigate the prevalence of missed nursing care and its associated factors among public hospitals in Bahir Dar City, Northwest Ethiopia. DESIGN An institution-based cross-sectional study was conducted among 369 randomly selected nurses. SETTING The study was conducted in primary and secondary-level public hospitals in Bahir Dar City. PARTICIPANTS Nurses who had worked in hospitals in Bahir Dar City were included. INTERVENTION No intervention was needed in this study. PRIMARY AND SECONDARY OUTCOME MEASURES A binary logistic regression model was used for statistical analysis. Statistical significance of the association between outcome variables and independent variables was declared at a p value of <0.05 with a 95% CI. RESULTS The prevalence of missed nursing care in this study was 46.3% (95% CI: 41.7% to 50.9%). The activities most frequently missed were physical examination (56.4%), patient discharge planning and teaching (50.9%), providing emotional support to the patient and family (50.8%), monitoring input and output (50.2%), assisting with patient ambulation (48.5%) and documentation (48%). Factors associated with missed nursing care include: male professionals (adjusted OR (AOR): 2.9, 95% CI: 1.8 to 4.8), those who had not received on-the-job training (AOR: 2.2, 95% CI: 1.4 to 3.6), those who worked full 24-hour shifts (AOR: 3.7, 95% CI: 2.0 to 6.5), those who were dissatisfied with the level of teamwork (AOR: 4.6, 95% CI: 2.8 to 7.6) and those who had an intention to leave the nursing profession (AOR: 1.8, 95% CI: 1.1 to 2.9). These factors were statistically associated with missed nursing care. CONCLUSION A significant proportion of nurses missed essential nursing care activities. Efforts should be made to enhance training, improve teamwork among nurses, provide stability and adjust work shifts to mitigate this issue.
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Affiliation(s)
- Yirgalem Abere
- Adult Health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Henok Biresaw
- Adult Health Nursing, Bahir Dar University, Bahir Dar, Ethiopia
| | | | | | - Ousman Adal
- Emergency and critical care nursing, Bahir Dar University, Bahir Dar, Ethiopia
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4
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Gahramani S, Mahmoudi M, Nouri, Valiee S. Factors associated with the quality of dying and death and missed nursing care. Int J Palliat Nurs 2024; 30:190-198. [PMID: 38630644 DOI: 10.12968/ijpn.2024.30.4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Patients in intensive care units need full nursing care due to the high mortality rate. However, some aspects of nursing care can be forgotten. AIMS To investigate the quality of death and dying and its association with aspects of missed nursing care, alongside the overall perception of nurses in intensive care units about factors associated with missed nursing care. METHODS This cross-sectional study used a census sampling method of 105 nurses working in intensive care units. In order to collect data, the Quality of Dying and Death Questionnaire (QODD), missed nursing care (MISSCARE survey) and factors associated with missed nursing care questionnaire were used. Data analysis was performed by using SPSS 16. FINDINGS The quality of death and dying, as perceived by nurses, was found to be lower than the average (Range score: 0 to 100). The range of missed nursing care was average (Range of score: 24 to 96) and the most noticeable reason for this missed nursing care was the shortage of nursing staff. CONCLUSION Managers should ensure that nurses provide complete nursing care for terminally ill patients in intensive care units and eliminate factors that lead to aspects of nursing care being missed, such as staffing levels, material resources and communication between staff members.
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Affiliation(s)
- Shahin Gahramani
- Students Research Committee, Kurdistan University of Medical Sciences, Iran
| | - Mokhtar Mahmoudi
- Assistant Professor, Clinical Care Research Center, Kurdistan University of Medical Sciences, Iran
| | - Nouri
- Associate Professor, Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Iran
| | - Sina Valiee
- Professor, Clinical Care Research Center; Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Iran
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Clark RRS, Peele ME, Mason A, Lake ET. Effects of Nurse Staffing on Missed Breastfeeding Support in Maternity Units With Different Nurse Work Environments. J Perinat Neonatal Nurs 2024; 38:158-166. [PMID: 38758272 DOI: 10.1097/jpn.0000000000000824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
PURPOSE To examine the effect of nurse staffing in varying work environments on missed breastfeeding teaching and support in inpatient maternity units in the United States. BACKGROUND Breast milk is the optimal food for newborns. Teaching and supporting women in breastfeeding are primarily a nurse's responsibility. Better maternity nurse staffing (fewer patients per nurse) is associated with less missed breastfeeding teaching and support and increased rates of breastfeeding. We examined the extent to which the nursing work environment, staffing, and nurse education were associated with missed breastfeeding care and how the work environment and staffing interacted to impact missed breastfeeding care. METHODS In this cross-sectional study using the 2015 National Database of Nursing Quality Indicator survey, maternity nurses in hospitals in 48 states and the District of Columbia responded about their workplace and breastfeeding care. Clustered logistic regression models with interactions were used to estimate the effects of the nursing work environment and staffing on missed breastfeeding care. RESULTS There were 19 486 registered nurses in 444 hospitals. Nearly 3 in 10 (28.2%) nurses reported missing breastfeeding care. In adjusted models, an additional patient per nurse was associated with a 39% increased odds of missed breastfeeding care. Furthermore, 1 standard deviation decrease in the work environment was associated with a 65% increased odds of missed breastfeeding care. In an interaction model, staffing only had a significant impact on missed breastfeeding care in poor work environments. CONCLUSIONS We found that the work environment is more fundamental than staffing for ensuring that not only breastfeeding care is not missed but also breastfeeding care is sensitive to nurse staffing. Improvements to the work environment support the provision of breastfeeding care. IMPLICATIONS FOR RESEARCH AND PRACTICE Both nurse staffing and the work environment are important for improving breastfeeding rates, but the work environment is foundational.
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Affiliation(s)
- Rebecca R S Clark
- Author Affiliations: Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia (Drs Clark and Lake and Ms Mason); Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania (Drs Clark and Lake and Ms Mason); Demography Department, University of Pennsylvania School of Arts and Sciences, Philadelphia (Dr Peele); and Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia (Dr Clark
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Gillespie BM, Harbeck E, Chaboyer W. The frequency and reasons for missed nursing care in Australian perioperative nurses: A national survey. J Clin Nurs 2024. [PMID: 38380764 DOI: 10.1111/jocn.17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/17/2024] [Accepted: 02/11/2024] [Indexed: 02/22/2024]
Abstract
AIM To describe Australian perioperative nurses' reported frequency and reasons for missed nursing care in the operating room. DESIGN Cross-sectional online survey conducted in March-April 2022. METHODS A census of Australian perioperative nurses who were members of a national professional body were invited to complete a survey that focussed on their reported frequency of missed nursing care and the reasons for missed nursing care in the operating room using the MISSCare Survey OR. RESULTS In all, 612 perioperative nurses completed the survey. The perioperative and intraoperative nursing care tasks reported as most frequently missed included time-intensive tasks and communication with multiple surgical team members present. The most frequently reported reasons for missed care were staffing-related (e.g. staff number, skill mix, fatigue and complacency) and affected teamwork. There were no significant differences in the frequency of missed care based on perioperative nurse roles. However, there were statistically significant differences between nurse management, circulating/instrument nurses and recovery room nurses in reasons for missed care. CONCLUSIONS Much of the missed care that occurs in the operating room is related to communication practices and processes, which has implications for patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Understanding the types of nursing care tasks being missed and the reasons for this missed care in the operating room may offer nurse managers deeper insights into potential strategies to address this situation. REPORTING METHOD Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Brigid M Gillespie
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Griffith University, Goldcoast, Queensland, Australia
- School of Nursing & Midwifery, Griffith University, Goldcoast, Queensland, Australia
- Gold Coast Health Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Goldcoast, Queensland, Australia
| | - Emma Harbeck
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Griffith University, Goldcoast, Queensland, Australia
| | - Wendy Chaboyer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Griffith University, Goldcoast, Queensland, Australia
- School of Nursing & Midwifery, Griffith University, Goldcoast, Queensland, Australia
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7
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Ding S, Wang X, Wang Q, Shen J, Xie H, Fu X, Liao L, Chen J, Zhu L, Huang J, Yang S, Huang X, Zhang Y. Translation and psychometric testing of the Chinese version of the Perinatal Missed Care Survey. Int J Nurs Sci 2024; 11:106-112. [PMID: 38352293 PMCID: PMC10859582 DOI: 10.1016/j.ijnss.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/05/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Objective This study aimed to translate and evaluate the psychometric properties of the Perinatal Missed Care Survey in China. Methods The Perinatal Missed Care Survey was translated according to the guidelines of the cross-cultural debugging scale recommended by the American Academy of Orthopaedic Surgeons Evidence-Based Medicine Committee, including forward translation, back translation, cultural adaption, and content validation, and its Chinese version was used in a cross-sectional study conducted from February to April in 2023. A total of 491 midwives from 14 different level hospitals in southwest China were recruited through a convenience sampling method. The discrimination ability of the items was tested through item analysis, and construct validity was assessed through exploratory factory and confirmatory factor analyses. The content validity index and Cronbach's α coefficients evaluated content validity and reliability, respectively. Results The Chinese version's item-total correlation coefficients ranged from 0.641 to 0.866 in part A and from 0.644 to 0.819 in part B (P < 0.001). Parts A and B's scale-level content validity indexes were 0.95, and the item-level content validity indexes were from 0.86 to 1.00. The three common factors of part A (necessary care, basic care, and postnatal care) and part B (communication, labor resources, and material resources) were extracted, accounting for 70.186% and 71.984% of the total variance, respectively. Confirmatory factor analysis indicated that the good fit of the three-factor models was acceptable. The Cronbach's α coefficients were 0.968 (part A) and 0.940 (part B). Conclusion The Chinese version of the Perinatal Missed Care Survey is a reliable and valid instrument for assessing nursing care missed by midwives during labor and birth and the reasons it was missed. Studies with large sample sizes are needed to verify the instrument's applicability in China.
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Affiliation(s)
- Shenglan Ding
- Birth Room, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Wang
- Department of Nursing, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qingxia Wang
- Birth Room, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Shen
- Birth Room, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Huili Xie
- Birth Room, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiujuan Fu
- Birth Room, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Luxi Liao
- Birth Room, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiaojiao Chen
- Department of Medical Imaging, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lian Zhu
- School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jing Huang
- School of Nursing, Peking University, Beijing, China
| | - Siyuan Yang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiuhua Huang
- Surgery Intensive Care Unit, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yilan Zhang
- Birth Room, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Albsoul RA, Alshyyab MA, Albayyari RY, Alselaibi DH, Flefil SA, Jardaneh LH, Dababseh SYF, Al Odat BA, Alkubaisi FA, AlKhawaldeh MH, FitzGerald G. Qualitative evaluation of missed nursing care in neonatal intensive care units in a teaching hospital in Jordan. J Pediatr Nurs 2023; 73:e277-e284. [PMID: 37788945 DOI: 10.1016/j.pedn.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Missed nursing care (MNC) is a worldwide patient safety issue. However, little is known about MNC in neonatal intensive care units (NICU). The aim of this paper is to explore the elements and factors influencing the occurrence of MNC in the NICU in a teaching hospital in Amman, Jordan. DESIGN AND METHODS The study used a qualitative descriptive design. Semi-structured interviews were conducted with NICU nurses. Purposeful sampling was used to select the participants and data collection was performed in the period August 2022 to September 2022. Data were analyzed using thematic analysis. RESULTS The participants included 15 female nurses. The majority of the participants held a bachelor's degree in nursing. Five themes emerged from the analysis of data namely: (1) Conceptualizations of MNC (2) Missed care elements in the NICU (3) Reasons behind MNC in the NICU (4) Consequences of MNC and (5) Strategies to reduce the occurrence of MNC. Feeding,changing diapers, monitoring vital signs, and medication administrationwere identified as missed care elements in the NICU. CONCLUSIONS The findings of this research may inform the development of interventions that may reduce missed care incidents in the NICU. PRACTICE IMPLICATIONS Addressing staff shortages and the provision of necessary materials and equipment appear to be the key factors that may reduce the frequency of MNC. Thus, enhancing patient safety and quality healthcare in this challenging healthcare environment.
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Affiliation(s)
- Rania Ali Albsoul
- Healthcare management, Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Muhammad Ahmed Alshyyab
- Health Services Management, Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | | | | | | | | | | | | | | | | | - Gerard FitzGerald
- Public Health, School of Public Health and Social Work, QUT, Brisbane, Victoria Park Road, Kelvin Grove, QLD 4059, Australia.
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Alsalem N, Rashid FA, Aljarudi S, Al Bazroun MI, Almatrouk RM, Alharbi FM, Al Mansour L, Abuzaid NB. Exploring Missed Nursing Care in the NICU: Perspectives of NICU Nurses in Saudi Arabia's Eastern Health Cluster. Pediatr Rep 2023; 15:571-581. [PMID: 37873798 PMCID: PMC10594518 DOI: 10.3390/pediatric15040052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/25/2023] Open
Abstract
(1) Background: Missed nursing care, an omission error characterized by delayed or omitted nursing interventions, poses significant risks to patients' safety and quality of car.; (2) Methods: This is a quantitative cross-sectional study on 151 nurses who work in NICUs in three main networks in the Eastern Health Province, Saudi Arabia: Dammam (n = 84), Qatif (n = 53), and Jubail (n = 14). The study uses a self-reported questionnaire (MISSCARE) and applies the 5-point Likert Scale. Statistical analysis data were analyzed using SPSS version 23.0. (3) Results: The primary reasons for missed care were shortage of nursing staff and unbalanced patient assignments. Missed nursing care negatively affects job satisfaction and was positively correlated with nurses' intentions to quit their jobs. Inadequate equipment, supplies, and breakdowns in communication between nurses and other healthcare professionals were also significant factors contributing to missed care. (4) Conclusions: Missed nursing care is associated with overwork, nursing shortages, and lower job satisfaction, impacting the quality of care provided in the NICU. Improving working conditions, nurse staffing, and patient assignment planning should be prioritized to address this issue effectively.
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Affiliation(s)
- Nasreen Alsalem
- Maternity and Children Hospital, Dammam 32253, Saudi Arabia; (F.A.R.); (S.A.); (R.M.A.); (F.M.A.); (N.B.A.)
| | - Fatima Abu Rashid
- Maternity and Children Hospital, Dammam 32253, Saudi Arabia; (F.A.R.); (S.A.); (R.M.A.); (F.M.A.); (N.B.A.)
| | - Saleh Aljarudi
- Maternity and Children Hospital, Dammam 32253, Saudi Arabia; (F.A.R.); (S.A.); (R.M.A.); (F.M.A.); (N.B.A.)
| | | | - Roqayah Mirza Almatrouk
- Maternity and Children Hospital, Dammam 32253, Saudi Arabia; (F.A.R.); (S.A.); (R.M.A.); (F.M.A.); (N.B.A.)
| | - Fatimah M. Alharbi
- Maternity and Children Hospital, Dammam 32253, Saudi Arabia; (F.A.R.); (S.A.); (R.M.A.); (F.M.A.); (N.B.A.)
| | | | - Nahid Baker Abuzaid
- Maternity and Children Hospital, Dammam 32253, Saudi Arabia; (F.A.R.); (S.A.); (R.M.A.); (F.M.A.); (N.B.A.)
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10
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Lake ET, Staiger D, Smith JG, Rogowski JA. The Association of Missed Nursing Care With Very Low Birthweight Infant Outcomes. Med Care Res Rev 2023; 80:293-302. [PMID: 36692294 PMCID: PMC10121798 DOI: 10.1177/10775587221150950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study is the first to look at the association between missed nursing care and mortality, morbidity, and length of stay (LOS) for VLBW infants in a U.S. NICU sample. We used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. The 190 sample hospitals were from 19 states in all regions. Missed clinical nursing care was significantly associated with higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage. With further research, these results may motivate the development of interventions to reduce missed clinical nursing care in the NICU.
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Affiliation(s)
- Eileen T. Lake
- University of Pennsylvania School of Nursing, Philadelphia, USA
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11
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Brandon D, McGrath JM. Missed Caregiving: A Call to Action for Health System Leadership. Adv Neonatal Care 2022; 22:379-380. [PMID: 36044755 DOI: 10.1097/anc.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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12
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Bagnasco A, Rossi S, Dasso N, Catania G, Zanini M, Aleo G, Scelsi S, Petralia P, Watson R, Sasso L. Exploring Care Left Undone in Pediatric Nursing. J Patient Saf 2022; 18:e903-e911. [PMID: 35617633 DOI: 10.1097/pts.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to investigate the association between nursing care left undone in pediatrics and factors related to nursing staff characteristics and work environment. METHODS The data of the present study were extracted from our RN4CAST@IT-Ped database, a cross-sectional observational study, which included 13 hospitals belonging to the Italian Association of Paediatric Hospitals. Through convenience sampling, nurses and pediatric nurses providing direct care in routine pediatric wards were enrolled in the study. Data aggregated by clinical care area were analyzed, through descriptive and inferential statistics methods using IBM SPSS 22.0 software. RESULTS We collected data from 399 pediatric nurses working in surgical wards, 1208 in medical wards, and 631 in critical care units. Some of the investigated factors have shown an association with the risk of omitting essential nursing activities, like health care judged of poor quality, patient safety judged as poor, and nurses' intention-to-leave the job. For every nursing activity under investigation, we found some significant statistical associations. CONCLUSIONS Our results are consistent with the international literature showing that nurses miss some activities more frequently. Understanding the associations underpinning care left undone could be a starting point for the implementation of patient-centered care and the improvement of the quality and safety of care in pediatric settings, as well as the work environment.
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Affiliation(s)
| | - Silvia Rossi
- From the Department of Health Sciences, University of Genoa
| | | | | | - Milko Zanini
- From the Department of Health Sciences, University of Genoa
| | - Giuseppe Aleo
- From the Department of Health Sciences, University of Genoa
| | | | | | - Roger Watson
- Faculty of Health and Social Care, University of Hull, Hull, England, United Kingdom
| | - Loredana Sasso
- From the Department of Health Sciences, University of Genoa
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Abstract
ABSTRACT The challenge of nurse staffing is amplified in the acute care neonatal intensive care unit (NICU) setting, where a wide range of highly variable factors affect staffing. A comprehensive overview of infant factors (severity, intensity), nurse factors (education, experience, preferences, team dynamics), and unit factors (structure, layout, shift length, care model) influencing pre-shift NICU staffing is presented, along with how intra-shift variability of these and other factors must be accounted for to maintain effective and efficient assignments. There is opportunity to improve workload estimations and acuity measures for pre-shift staffing using technology and predictive analytics. Nurse staffing decisions affected by intra-shift factor variability can be enhanced using novel care models that decentralize decision-making. Improving NICU staffing requires a deliberate, systematic, data-driven approach, with commitment from nurses, resources from the management team, and an institutional culture prioritizing patient safety.
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Examining the reasons for missed nursing care from the viewpoints of nurses in public, private, and university hospitals in Jordan: A cross-sectional research. Collegian 2022. [DOI: 10.1016/j.colegn.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Standards for Professional Registered Nurse Staffing for Perinatal Units. Nurs Womens Health 2022; 26:e1-e94. [PMID: 35750618 DOI: 10.1016/j.nwh.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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16
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Standards for Professional Registered Nurse Staffing for Perinatal Units. J Obstet Gynecol Neonatal Nurs 2022; 51:e5-e98. [PMID: 35738987 DOI: 10.1016/j.jogn.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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17
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Clark RRS, Peele ME, Lake ET. Nursing Resources by Type of Maternity Unit Across Regions of the United States. J Obstet Gynecol Neonatal Nurs 2022; 51:290-301. [PMID: 35278349 PMCID: PMC9086175 DOI: 10.1016/j.jogn.2022.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine variation in nursing resources across three different types of maternity units in five regions of the United States. DESIGN Cross-sectional descriptive. SETTING Maternity units in hospitals in 48 states and the District of Columbia that participated in the 2016 National Database of Nursing Quality Indicator survey. PARTICIPANTS Staff nurses (N = 19,486) who worked in 707 maternity units. METHODS We conducted a secondary analysis of survey data examining nursing resources (work environment, staffing, education, specialty certification) by type of maternity unit, including labor and delivery, labor/delivery/recovery/postpartum, and postpartum. We used descriptive statistics and analysis of variance. RESULTS Participants worked in 707 units (269 labor and delivery units, 164 labor/delivery/recovery/postpartum units, and 274 postpartum units) in 444 hospitals. The work environment was not significantly different across unit types (mean = 2.89-2.94, p = .27). Staffing, education, and specialty certification varied significantly across the unit types (p ≤ .001). In terms of staffing, postpartum units had, on average, almost twice the number of patients per nurse as labor and delivery units (7.51 patients/nurse vs. 4.01 patients/nurse, p ≤ .001) and 1.5 times more patients than labor/delivery/recovery/postpartum units (5.04 patients/nurse vs. 4.01 patients/nurse, p ≤ .001). CONCLUSION Nursing resources varied significantly across types of maternity units and regions of the United States. This variation suggests that improving nursing resources may be a system-level target for improving maternity care in the United States.
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18
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Kim S, Chae SM. Missed nursing care and its influencing factors among neonatal intensive care unit nurses in South Korea: a descriptive study. CHILD HEALTH NURSING RESEARCH 2022; 28:142-153. [PMID: 35538726 PMCID: PMC9091770 DOI: 10.4094/chnr.2022.28.2.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Preventing missed care is important in neonatal intensive care units (NICUs) due to neonates’ vulnerabilities. This study examined missed care and its influencing factors among NICU nurses. Methods Missed care among 120 Korean NICU nurses was measured using a cross-culturally adapted online questionnaire. The frequency of missed care for 32 nursing activities and the significance of 23 reasons for missed care were collected. Results All participants had missed at least 1 activity, missing on average 19.35 activities during a typical work-day. The most common missed item was “provide developmental care for the baby”. The most common reason for missed care was “emergency within the unit or deterioration of one of the assigned patients”. The final regression model explained 9.6% of variance in missed care. The average daily number of assigned patients receiving inotropes or sedation over the last month influenced the total number of missed care items. Conclusion Missed care was affected by nurses’ workload related to the number of patients taking medication. Frequently missed activities, especially those related to developmental care, require patience and time, conflicting with safety prioritization and inadequate working conditions. NICU nurses’ working conditions should be improved to ensure adequate time for nursing activities.
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Affiliation(s)
- Soohyun Kim
- Registered Nurse, Seoul National University Hospital, Seoul, Korea
| | - Sun-Mi Chae
- Professor, College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
- Corresponding author Sun-Mi Chae College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea TEL: +82-2-740-8816 FAX: +82-2-766-1852 E-MAIL:
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19
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Janatolmakan M, Khatony A. Explaining the consequences of missed nursing care from the perspective of nurses: a qualitative descriptive study in Iran. BMC Nurs 2022; 21:59. [PMID: 35287687 PMCID: PMC8918588 DOI: 10.1186/s12912-022-00839-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Missed nursing care is a global challenge that can have many consequences. Knowing the experiences of clinical nurses can be helpful. Therefore, this study was conducted to explain the experiences of Iranian nurses regarding the consequences of missed nursing care. Methods This qualitative descriptive study was conducted with a content analysis approach. Sampling was done by the purposeful sampling method and continued until data saturation. Data were collected by in-depth semi-structured interviews. Data were analyzed using qualitative content analysis and Graneheim and Lundman’s method. MAXQDA version 10 software was used for data management. Results The participants included 14 nurses with a mean age of 38.7 ± 7.7 years. The data were classified into three categories: patient-related outcomes, nurse-related outcomes, and organization-related outcomes. These categories included nine subcategories entitled "moral distress", "job dissatisfaction", " decreased quality of nursing care "," patient dissatisfaction ","adverse events"," absenteeism ","intention to leave and subsequent turnover", "decreased hospital credit", and "increased hospital costs". Conclusion Missed nursing care can have adverse consequences for the patients, nurses, and organizations. Therefore, it is necessary to adopt management strategies such as providing sufficient manpower and increasing nurses' job satisfaction to reduce the amount of missed nursing care. Further studies are needed to explain the predictors of the missed nursing care consequences.
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Affiliation(s)
- Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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20
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Baernholdt M, Jones TL, Anusiewicz CV, Campbell CM, Montgomery A, Patrician PA. Development and Testing of the Quality Improvement Self-efficacy Inventory. West J Nurs Res 2022; 44:159-168. [PMID: 33745388 PMCID: PMC8450303 DOI: 10.1177/0193945921994158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses (N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses' ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses' knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies.
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Affiliation(s)
| | - Terry L. Jones
- Virginia Commonwealth University, Richmond, VA, United States
| | - Colleen V. Anusiewicz
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Aoyjai Montgomery
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Patricia A. Patrician
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
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21
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Bartmess M, Myers CR, Thomas SP. Nurse staffing legislation: Empirical evidence and policy analysis. Nurs Forum 2021; 56:660-675. [PMID: 33982311 DOI: 10.1111/nuf.12594] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/21/2021] [Accepted: 04/29/2021] [Indexed: 12/31/2022]
Abstract
Unsafe nurse staffing conditions in hospitals have been shown to increase the risk of adverse patient events, including mortality. Consequently, United States and international professional nursing organizations often advocate for safer staffing conditions. There are a variety of factors to consider when staffing nurses for patient safety, such as the number of patients per nurse, nurse preparation, patient acuity, and nurse autonomy. The complex issue of staffing nurses often is compounded by cost issues and can become politicized. When nurse organizations' recommendations for safe staffing measures are disregarded by hospital administrations, nurse lobbyists and interest groups often pursue legislative action to protect patients and nurses from unsafe staffing conditions. This article presents a narrative review of safe nurse staffing factors and an analysis of nurse staffing legislation. Using a patient-centric lens, three state-level nurse staffing policies (mandated nurse-to-patient ratios, public reporting of staffing plans, and nurse staffing committees) were evaluated by empirical evidence, cost to hospitals and state governments, political feasibility, and potential to affect patient populations. Although nurse staffing policy analysis can be conducted in several ways, it is crucial that nurses consider empirical evidence related to staffing policies as well as evaluations of implemented policies and political influences.
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Affiliation(s)
- Marissa Bartmess
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
| | - Carole R Myers
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
| | - Sandra P Thomas
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
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22
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Bagnasco A, Catania G, Zanini M, Dasso N, Rossi S, Aleo G, Timmins F, Sermeus W, Aiken LH, Sasso L. Are data on missed nursing care useful for nursing leaders? The RN4CAST@IT cross-sectional study. J Nurs Manag 2020; 28:2136-2145. [PMID: 32881131 DOI: 10.1111/jonm.13139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/04/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
AIM To describe nurses' reported missed nursing care activities among hospitalized adult patients medical and surgical wards and explore gaps in service provision. BACKGROUND In 2015, Italy replicated the RN4CAST study, which heralded the exposition of missed care as an international phenomenon. In Italy, nurse-patient workload is high, with high levels of burnout and dissatisfaction reported, all factors associated with missed care. METHODS A cross-sectional study (n = 3,590) was conducted using the 13-item online Task Left Undone Tool aimed at collecting data on missed nursing care. RESULTS The frequency of omission of activities ranged between 7% and 50%. There were significant differences between morning, afternoon and night shifts and the various clinical settings. Oral care was the most frequently missed care activity. CONCLUSIONS This study takes step forward in identifying and reducing missed care on medical and surgical wards, both in Italy and also internationally, which needs to take into account the specific organisational characteristics of each setting. IMPLICATIONS FOR NURSING MANAGEMENT Although more essential activities are missed less frequently, much is known about the relational deficits such as information giving, education, communication and discharge advice, which managers ought to spearhead through local initiatives to improve these practices.
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Affiliation(s)
- Annamaria Bagnasco
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Gianluca Catania
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Milko Zanini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Nicoletta Dasso
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Silvia Rossi
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Giuseppe Aleo
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Fiona Timmins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Walter Sermeus
- Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Loredana Sasso
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
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23
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Yen PY, Pearl N, Jethro C, Cooney E, McNeil B, Chen L, Lopetegui M, Maddox TM, Schallom M. Nurses' Stress Associated with Nursing Activities and Electronic Health Records: Data Triangulation from Continuous Stress Monitoring, Perceived Workload, and a Time Motion Study. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2020; 2019:952-961. [PMID: 32308892 PMCID: PMC7153131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As health IT has become overloaded with patient information, provider burnout and stress has accelerated. Studies have shown that EHR usage leads to heightened cognitive workload for nurses, and increases in cognitive workload can result in stronger feelings of exhaustion and burnout. We conducted a time motion study in an oncology division to examine the relationships between nurses' perceived workload, stress measured by blood pulse wave (BPw), and their time spent on nursing activities, and to identify stress associated with EHR use. We had a total of 33 observations from 7 nurses. We found that EHR-related stress is associated with nurses' perceived physical demand and frustration. We also found that nurses' perceived workload is a strong predictor of nurses' stress as well as how they spent time with their patients. They also experienced higher perceived mental demand, physical demand, and temporal demand when they were assigned to more patients, regardless of patient acuity. Our study presents a unique data triangulation approach from continuous stress monitoring, perceived workload, and a time motion study.
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Affiliation(s)
- Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing, Barnes-Jewish College, BJC HealthCare, St. Louis, MO, USA
| | - Nicole Pearl
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
| | - Cierra Jethro
- Goldfarb School of Nursing, Barnes-Jewish College, BJC HealthCare, St. Louis, MO, USA
| | - Emily Cooney
- Goldfarb School of Nursing, Barnes-Jewish College, BJC HealthCare, St. Louis, MO, USA
| | - Brittany McNeil
- Goldfarb School of Nursing, Barnes-Jewish College, BJC HealthCare, St. Louis, MO, USA
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Marcelo Lopetegui
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Thomas M Maddox
- Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St. Louis, MO, USA
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
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Smith JG, Rogowski JA, Lake ET. Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care. J Nurs Manag 2020; 28:1940-1947. [PMID: 31891425 DOI: 10.1111/jonm.12943] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/20/2019] [Accepted: 12/28/2019] [Indexed: 12/01/2022]
Abstract
AIM(S) To determine relationships among missed nursing care, job enjoyment and intention to leave for neonatal nurses. BACKGROUND Being unable to provide required nursing care to infants could contribute to poorer neonatal nurse job outcomes, which may exacerbate staffing challenges. Little evidence exists about how missed nursing care relates to neonatal nurse job outcomes. METHOD(S) The design was cross-sectional. Secondary data from the 2016 National Database of Nursing Quality Indicators Registered Nurse Survey were used, which included nurse ratings of job enjoyment, intention to leave and missed nursing care. American Hospital Association data from 2016 were used to describe hospitals. Linear and logistic regressions were calculated. RESULTS There were 5,824 neonatal nurses. Mean nurse job enjoyment was 4.26 out of 6 (SD = 0.97). On average, 15% of nurses intended to leave their position. Each one unit increase in missed nursing care was associated with a 0.26 decrease in job enjoyment and a 29% increased odds of intention to leave after controlling for nursing and hospital characteristics. CONCLUSIONS Missed nursing care can influence nurse job enjoyment and intention to leave in neonatal care units. IMPLICATIONS FOR NURSING MANAGEMENT Neonatal nurse managers should address missed nursing care to improve neonatal nurse job outcomes.
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Affiliation(s)
- Jessica G Smith
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Jeannette A Rogowski
- Department of Health Policy and Administration, The Pennsylvania State University, State College, PA, USA
| | - Eileen T Lake
- Nursing and Sociology, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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25
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Lake ET, Smith JG, Staiger DO, Hatfield LA, Cramer E, Kalisch BJ, Rogowski JA. Parent Satisfaction With Care and Treatment Relates to Missed Nursing Care in Neonatal Intensive Care Units. Front Pediatr 2020; 8:74. [PMID: 32257979 PMCID: PMC7093579 DOI: 10.3389/fped.2020.00074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The satisfaction of parents of infants in neonatal intensive care is important to parent-infant bonding and parents' ability to care for their baby, including after discharge. Given the principal caregiver role of nurses in this setting, parent satisfaction is influenced by high quality nursing care. Nursing care that is required but missed, such as counseling and support, might influence parent satisfaction. How missed nursing care relates to parent satisfaction is unknown. Objective: To describe the satisfaction of parents of infants in neonatal intensive care and to determine how satisfaction relates to missed nursing care in a sample of USA nursing units. Methods: The design was cross-sectional and correlational. Thirty neonatal intensive care units that participate in the National Database of Nursing Quality Indicators were recruited. To maximize sample variation in missed care, the highest and lowest quartile hospitals on missed nursing care, measured by nurse survey, were eligible. Ten parents of infants who were to be discharged were recruited from each site to complete a survey. Parent satisfaction was measured by the EMPATHIC-38 instrument, comprising five subscales: information, care and treatment, organization, parental participation, and professional attitude, and a total satisfaction score. Multivariate regression models were estimated. Results: Parent satisfaction was high (5.70 out of 6.00). The prevalence of missed care was 25 and 51% for low and high missed care units, respectively, and 40% for all units. On average, nurses missed 1.06 care activities; in the low and high missed care units the averages were 0.46 and 1.32. Over 10% of nurses missed activities that involved the parent, e.g., teaching, helping breastfeeding mothers, and preparing families for discharge. One standard deviation decrease in missed care activities at the unit level was associated with a 0.08-point increase in parent satisfaction with care and treatment (p = 0.01). Conclusion: Parents in USA neonatal intensive care units are highly satisfied. Neonatal intensive care nurses routinely miss care. Parent satisfaction with care and treatment is related to missed nursing care. Nursing care that is missed relates primarily to the care of the baby by the parents, which could have long term health and developmental consequences.
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Affiliation(s)
- Eileen T Lake
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Jessica G Smith
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Douglas O Staiger
- Department of Economics, Dartmouth College, Hanover, NH, United States
| | - Linda A Hatfield
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Emily Cramer
- School of Nursing, University of Kansas, Kansas City, KS, United States
| | - Beatrice J Kalisch
- College of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jeannette A Rogowski
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, United States
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