Perspectives of Oncology Unit Nurse Managers on Missed Nursing Care: A Qualitative Study

Magnitude and reasons for missed nursing care among nurses working in South Gondar Zone public hospitals, Amhara regional state, Northcentral Ethiopia: institution-based cross-sectional study

BACKGROUND

Missed nursing care has become a global health concern because of its impact on patient safety and nursing care quality. It is a critical indicator of nursing care quality and adverse patient outcomes. However, data regarding the magnitude and reasons for missed nursing care is limited in the study area. This study aimed to determine the magnitude and reasons for missed nursing care among nurses working in South Gondar zone public hospitals.

METHODS

An institution-based cross-sectional study design was conducted among nurses working in South Gondar zone public hospitals from December 12, 2023, to January 20, 2024. The data was collected through self-administered MISSCARE survey tools. The collected data were entered into EpiData V.4.2 and then exported to SPSS V.25 for analysis. The statistical significance of the association between outcome variables and independent variables was declared at a P-value less than 5% (0.05) at 95% CI.

RESULT

The magnitude of missed nursing care in the study area was 51.7% (95% CI: 46.89-55.47%). Medications administered as ordered (69.8%), skin/wound care (69.8%), vital signs assessed as ordered and accordingly (68.8%), and IV/central line site care and assessments according to hospital policy (66.2%) were among the nursing care elements that were frequently missed. Material resource (76.7%), teamwork (69.1%), labor resource (65.5%), and communication (56.3%) were the main reasons for missed nursing care. Inadequate number of staff 2.9 (1.75, 4.75), training (CPD) in nursing care 1.9 (1.16, 3.14), equipment's not available 3.9 (2.16, 6.89), and medication were not available. 4.4 (2.48, 7.76) were associated with missed nursing care.

CONCLUSION

The proportion of commonly missed nursing care was high. After adjusting for demographic variables, labor resources, material resources, and communication were reasons for commonly missed nursing care. Increasing the number of nurses, investing in nurse training, working on equipment availability, and increasing medication availability could minimize frequent omissions of nursing care.

Missed nursing care and associated factors among nurses and midwives in maternity wards of Sidama region public hospitals, Ethiopia

BACKGROUND

Missed nursing care refers to any aspect of care performed by nursing staff that is omitted or significantly delayed. Even though the potential impact of missing nursing care on maternal and fetal outcomes is significant, there is currently limited evidence regarding the extent of this issue specifically within the maternity wards. Therefore, this study aimed to assess missed nursing care and associated factors in the maternity wards of public hospitals in the Sidama region, Ethiopia 2022.

METHODS

A hospital-based cross-sectional study was conducted among 361 nurses and midwives in maternity wards of Sidama region public hospitals from March 28 to April 26, 2022. Simple random sampling was used to select participants. The data was collected using the MISSCARE survey tool and analyzed with SPSS version 26. Simple linear and multiple linear regression analyses were used to identify the factors associated with missed nursing care.

RESULTS

The overall mean missed nursing care score was 67 out of 130 (95% CI: 65.92, 68.02) and the average score for each nursing intervention was 2.58 out of 5 (95% CI: 2.54, 2.62). The intention to leave the institution (β = 3.812, 95% CI: 2.285, 5.340) and increasing weekly work hours (β = 0.203, 95% CI: 0.134, 0.272) were factors positively associated with missed nursing care. However, increased work experience (β= -0.963, 95%CI: -1.475, -0.452) and job satisfaction (β= -4.976, 95%CI: -6.431, -3.522) were negatively associated with missed nursing care.

CONCLUSION

This study found that the level of missed nursing care was significant. Factors positively associated with missed nursing care included an intention to leave the institution and an increase in weekly work hours. In contrast, an increase in work experience and higher job satisfaction were negatively associated with missed nursing care.

Nurses' experiences and perceptions of unfinished nursing care: a qualitative systematic review protocol

OBJECTIVE

The aim of this review is to synthesize the findings of qualitative studies about the experiences and perceptions of nurses regarding unfinished nursing care.

INTRODUCTION

The issue of unfinished nursing care is a widespread challenge globally, causing detrimental effects to both patients and health care practitioners. Despite its prevalence, there is a dearth of qualitative evidence synthesis summarizing the reasons for unfinished nursing care, as well as the experiences of nurses.

INCLUSION CRITERIA

This review will include studies exploring registered nurses' and nurse managers' experiences and perceptions of unfinished nursing care, utilizing qualitative methods. Our approach to qualitative methodology will be unrestricted, allowing for various designs, such as phenomenology, ethnography, grounded theory, action research, and feminist research. Only articles published in English or Chinese from 2001 onward will be included.

METHODS

Our search will encompass the following electronic databases for published and unpublished literature: MEDLINE (PubMed), PsycINFO (APA PsycNET), CINAHL (EBSCOhost), Web of Science, Embase, ScienceDirect, ProQuest Dissertations and Theses, GreyNet International, Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Biomedicine Literature Database (CBM). To ensure thoroughness, manual searches of reference lists and citations of included studies will also be conducted. Two reviewers will extract relevant information, and quality validation will be conducted using the JBI critical appraisal checklist for qualitative research. Similar findings will be categorized through meta-aggregation to establish synthesized findings. Finally, each synthesized finding will be graded according to the JBI ConQual approach.

REVIEW REGISTRATION

PROSPERO CRD42022368041.

Why do nurses miss nursing care? A qualitative meta-synthesis

AIM

The aim of this qualitative meta-synthesis was to discover the factors impacting on missed nursing care of nurses through systematic thinking.

BACKGROUND

Although nurses are responsible for high-quality care, missed nursing care is common, endangering patient safety. Understanding of the causes related to missed nursing care could help nursing managers improve the quality of nursing care.

DESIGN

A qualitative meta-synthesis guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).

METHODS

As a method designed to contribute to knowledge development, meta-synthesis allows for integration of qualitative study findings using thematic synthesis. Six databases were searched up to October 2021; nine studies met the inclusion and quality assessment criteria and meta-synthesis were conducted.

RESULTS

Three themes related to the causes why nurses missed nursing care were found. The themes included intrinsic resources (professional and ethical values, ambiguous nurse role, prioritization, education system, and knowledge), system structure (staff and resources shortage, heavy workload but limited time, and organizational management failure), and social environment (communication, working relationship and skill mix, and inappropriate ward layout).

CONCLUSION

The phenomenon of missed nursing care is a global tissue, with variations in its elements but also notable similarities. Meta-synthesis provides evidence of intrinsic and extrinsic factors that contribute to missed nursing care.

RELEVANCE TO CLINICAL PRACTICE

Recognizing and understanding the causes of missed nursing care is essential for nursing managers to ensure patient safety and the provision of high-quality care.

Examining the Perspectives of Nurse Managers on Missed Nursing Care in Surgical Units

OBJECTIVE

To examine nurse managers' perspectives on missed nursing care (MNC) on surgical units.

BACKGROUND

The phenomenon of MNC is an important concern for nurse researchers. However, the reality of how it is experienced by clinical nurse managers is largely unexplored. Understanding nurse managers' experiences with MNC could help develop useful approaches to reducing levels of MNC.

METHODS

A descriptive qualitative study was conducted between December and June 2020, using face-to-face semistructured interviews with 10 nurse managers.

RESULTS

Five themes were identified: 1) awareness of MNC; 2) rationale for MNC; 3) consequences of MNC; 4) questions of reporting; and 5) management of MNC.

CONCLUSIONS

Nurse managers must use their positions and leadership skills to expect appropriate staffing approaches and material resources for surgical units, effective process for newly hired nurses, and the establishment of a reporting system for MNC to reduce the phenomenon in practice.

The frequency and reasons for missed nursing care in Australian perioperative nurses: A national survey

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.

Barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease in Iran: a descriptive qualitative study

OBJECTIVES

Chronic obstructive pulmonary disease is a chronic disease with numerous complications. Therefore, its effective management depends on home-based pulmonary rehabilitation. The effectiveness of home-based pulmonary rehabilitation programmes in turn depends on patient adherence to them. The aim of this study was to explore the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease.

DESIGN

Qualitative descriptive design.

SETTING

The lung care wards of Al-Zahra and Khorshid teaching hospitals and the comprehensive lung care clinic of Khorshid hospital, Isfahan, Iran.

PARTICIPANTS

Participants patients with chronic obstructive pulmonary disease (n=20), their family caregivers (n=15) and healthcare providers (n=14) recruited via purposive sampling.

RESULTS

The five main categories of the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease were patient-related barriers, caregivers' caregiving burden, limited support for patients, healthcare providers' limited professional competence and ineffective home-based pulmonary rehabilitation planning.

CONCLUSION

Different and complex factors related to patients, families and healthcare providers can affect adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease. Healthcare authorities can use the findings of this study to develop strategies to support patients with chronic obstructive pulmonary disease and their family caregivers and thereby reduce the physical and mental complications of Chronic obstructive pulmonary disease.

Missed Nursing Care, the Related Organizational Factors, and Strategies for Decreasing it from the Viewpoints of Nurses in University-Affiliated Hospitals of Birjand in 2019-2020

Background

For many reasons, some care services may be missed. This study was conducted to investigate missed care, the related factors, and solution for decreasing them.

Materials and Methods

A descriptive, cross-sectional study was performed on 122 nurses. A multi-part tool was used to gather information, which included demographic information, the Missing Nursing Care and Related Organizational Factors, and Missed Nursing Care Reduction Strategies Questionnaire. Descriptive and inferential statistical tests including ANOVA, independent t-test, and the Pearson correlation were used.

Results

The mean score (SD) of the Missing Nursing Care Questionnaire was 82.04 (8.50); thus, the amount of missed nursing care is very high. Additionally, the mean score (SD) of the Organizational Factors Questionnaire related to it was 30.98 (9.35). Considering the maximum score of the questionnaire (80), the role of organizational factors in the incidence of missing nursing care is relatively moderate. There was also a weak and inverse correlation between organizational factors and missed nursing care (r = -0.30, p < 0.01, df = 120). Based on the results, increasing the number of nurses and their level of knowledge has the greatest 67.21 (%) and least 34.42 (%) impact on reducing the incidence of missed nursing care.

Conclusions

According to the results, the prevalence of missed nursing care was high. However, the contribution of organizational factors to it is relatively little. This suggests that from the perspective of nurses, factors other than organizational factors related to the workplace can lead to missing care.

Comparison of patient classification systems for dimensioning nursing staff

OBJECTIVE

To compare nursing staff workload and dimensioning measured by two patient classification systems.

METHOD

Cross-sectional study, developed in a clinical inpatient unit of a large hospital in southern Brazil, between June and August 2022. Included patients (n = 260) were assessed through two different patient classification systems. The dimensioning calculation provided by the standard and descriptive statistics were applied.

RESULTS

Of the total number of patients, 1,248 classifications were performed with each of the classification systems. One of the instruments showed a concentration of demand for minimal care (54.5%) and the other for intermediate care (63.4%). The anticipation of required nursing hours was discrepant (235.58 and 298.16 hours), as well as the projected nursing staff, which was of 53 and 67 workers, respectively.

CONCLUSION

Measurement of workload and dimensioning were different when using two patient classification systems in the same sample. Additional accuracy studies shall be carried out.

Development and Validation of the Missed Nursing Care Tool for Pre-Operative Patients with Lung Cancer in China

Introduction

Current research suggests that missed nursing care is widespread in preoperative lung cancer patients in China, and preoperative airway management nursing care for lung cancer patients is not standardized. Missed nursing care for preoperative lung cancer patients, on the other hand, is rarely investigated, particularly from the patient's perspective. This study aimed to develop and validate the MISSCARE Survey for pre-operative patients with lung cancer in China.

Methods

This study generated the preliminary draft of the MISSCARE Survey - Lung Cancer Patient (MS-LCP) and tested its reliability and stability through three rounds of lung cancer resection (494, 50, and 309 cases, respectively). 20 patients and 6 experts determined the face and content validity. EFA and CFA assessed construct and convergent validity. Internal consistency, including Cronbach's alpha, Spearman-Brown reliability, and re-test reliability, was also examined.

Results

The scale contained 15 items, including specific care, communicative care, timely care, and basic care. KMO was 0.932 (> 0.6), and Bartlett's Test of Sphericity showed P = 0.000 (<0.05). The attribution factor's item loads ranged from 0.765 to 0.853, accounting for 82.20% of the variation. The scale's Cronbach's alpha, Spearman-Brown, and retest reliability were 0.945, 0.879, and 0.824. CFA showed goodness of fit (RMSEA = 0.021, χ²/df = 1.138, GFI = 0.900, AGFI = 0.945, CFI = 0.996, NFI = 0.967, IFI = 0.996). For each dimension, AVE ranged from 0.555 to 0.717 (>0.50) and CR from 0.861 to 0.904 (>0.70).

Conclusion

The MS-LCP was reliable and valid in this study, making it appropriate for the Chinese lung cancer patient population. This tool is more objective in its presentation of missed nursing care, assisting nursing staff in optimizing nursing procedures before surgery, increasing the implementation of higher-quality tumor care, and promoting the recovery of lung cancer surgery patients.

Nursing in oncology ward with intertwined roles: a focused ethnography

BACKGROUND

Characteristics of nursing care in the oncology ward depend on this ward's specific context. This study aimed to investigate the nursing care in the oncology ward regarding the culture of this ward.

METHODS

This qualitative study was conducted in an oncology ward using a focused ethnographic approach. The whole nursing team of the selected ward (N = 16) participated in the study through purposeful sampling. Three methods of observation, interview, and field documents were used for data collection. Data were analyzed by Spradley's (1980) ethnographic method.

RESULTS

'Nursing in the oncology ward with intertwined roles' emerged as the main theme. This theme included the following subthemes: 'Robin Hood nurse,' 'a secretive nurse,' 'a negligent nurse,' 'a snitching nurse,' 'a complaining nurse,' 'an apathetic senior nurse,' 'a stigmatized training nurse,' 'a brazen-bodied nurse,' 'a compassionate nurse,' 'a moonlighting nurse,' and 'a drug bartender.'

CONCLUSION

This study provided a deep cultural insight into nursing care in the oncology ward, considering the particular culture of this ward and emphasizing the nurses' intertwined roles. These roles are on a spectrum, with positive roles, such as compassion, on one side and negative roles, such as negligence, on the other. The results of this study can be provided to nursing managers; therefore, by being aware of nurses' roles considering the specific subculture of the oncology ward, they can provide psychological interventions to improve the mental health of reluctant and complaining nurses and ethics-based training for secretive, negligent, and snitching nurses to provide quality care to the patient.

Nurse managers' support of fundamental care in the hospital setting. An interpretive description of nurse managers' experiences across Australia, Denmark, and New Zealand

AIMS

To explore the role of ward-based nurse managers in supporting nurses to undertake high-quality fundamental care.

DESIGN

A qualitative study guided by the principles of interpretive description. Reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ).

METHODS

Nurse managers in three urban, publicly funded hospitals in Australia, Denmark and New Zealand, were invited to participate in group interviews to discuss how they support fundamental care in their clinical areas. Six group interviews were conducted between February 2017 and March 2020 involving 31 participants.

RESULTS

Six interrelated themes were identified: Difficulty expressing how to support the nurse-patient relationship; Establishing expectations for care delivery without clear strategies for how this can be achieved; Role modelling desired behaviours; Significance of being present to support care quality; The importance of engaging and supporting staff in their work; and Recognizing the challenges of prioritizing care needs.

CONCLUSION

This study indicates that nurse managers are not universally clear in explaining how they support their staff to provide fundamental care. If fundamental care is not clearly understood and communicated in the nursing team, then there are risks that fundamental care will not be prioritized, with potential negative consequences for patient care. Nurse managers may benefit from additional resources and guidance to help them to support fundamental care delivery in their clinical areas.

IMPACT

Previous research exploring fundamental care and missed care highlights the importance of the role of the nurse manager in influencing nursing care. This study demonstrates that though nurse managers have a passion for supporting their staff to deliver fundamental care, clear strategies to achieve this are not always evident. This study suggests that scholarship around leadership to promote and facilitate fundamental care is crucial to improving nursing practice and patient outcomes.

Explanation of factors forming missed nursing care during the COVID-19 pandemic: A qualitative study

Background

Providing nursing care to patients with COVID-19 has put additional pressure on nurses, making it challenging to meet several care requirements. This situation has caused parts of nursing care to be missed, potentially reducing the quality of nursing care and threatening patient safety. Therefore, the present study aimed at explaining the factors forming missed nursing care during the COVID-19 pandemic from the perspective of nurses.

Methods

This qualitative study was conducted using a conventional content analysis approach in Iran, 2020-2021. Data were collected from in-depth, semi-structured interviews with 14 nurses based on purposive sampling. Data analysis was performed simultaneously with data collection. Graneheim and Lundman's approach was used for data analysis, and MAXQDA software was used for data management. After transcribing the recorded interviews, to achieve the accuracy and validity of the study, the criteria proposed by Lincoln and Guba were considered and used.

Results

A total of 14 nurses with a mean age and standard deviation of 31.85 ± 4.95 and working in the COVID-19 wards participated in the study. The acquired data were categorized into four main categories: care-related factors, disease-related factors, patient-related factors, and organization-related factors. The category "care-related factors" comprised uncertainty in care, PPE-related limitations, attrition from care, and futile care. The category "disease-related factors" consisted of the extension of symptoms, unpredictable peaks of the disease, and restriction on the presence of patients' companions. The category "patient-related factors" included comorbidities, elderly patients, and deterioration of infected patients. Ultimately, the category "organization-related factors" consisted of restrictions on equipment supply, lack of human resources, weaknesses in teamwork, and an unsupportive work environment.

Conclusion

The results of this study showed that several reasons including factors related to care, patient, disease, and organization cause missed nursing care. By modifying the related affecting factors and considering the effective mechanisms to minimize missed nursing care, it is possible to provide better services.

Ability of Emotional Regulation and Control as a Stress Predictor in Healthcare Professionals

Emotional Regulation and Control implies a person’s ability to respond to stressful demands and emotional experiences in a socially acceptable and adaptive way. The aim of this cross-sectional study was to examine the contribution of the ability of emotional regulation and control in the prediction of workplace stress in healthcare professionals. The study included 203 healthcare professionals employed at a hospital in the Republic of Croatia. Data were collected using two validated questionnaires: Questionnaire on Workplace Stressors for Hospital Professionals and Emotional Regulation and Control Questionnaire (ERC). Most respondents (64%) experienced stress in Workplace Organization and Financial Issues factor, while 52.7% experienced stress in Public Criticism factor. The respondents assessed their ability of emotional regulation and control to be low (mean = 55; range = 20−100). The level of experienced stress was significantly higher if the ability of emotional regulation and control was low (Spearman’s Rho = 0.308; p < 0.001). The multivariate regression model (11.2% explained variances; p = 0.001) indicated a greater possibility of severe stress in respondents who have stronger Memory of Emotionally Saturated Content (odds ratio = 1.18; 95% CI = 1.07−1.30). The results of this study signify the need to establish effective institutional support aimed at objectifying stress and strengthening emotional intelligence and empathy in healthcare professionals.

Data-driven clinical improvement: Oncology nurse leaders' perceptions and experiences of organisational data reports

AIM

To elicit oncology nurse leaders' perceptions and experiences of accessing, using and interpreting report data at the unit level, and their suggestions for future reports.

BACKGROUND

Nurse leaders are expected to use data reports for decisions about unit-level operations, yet data may be inaccessible, unavailable and lack relevance for improving patient care and unit-level outcomes.

METHODS

A purposeful sampling was used to recruit 12 unit-level nurse leaders. Qualitative data were collected through semi-structured interviews and analysed using thematic content analysis.

RESULTS

Consistent themes included the lack of accurate, useful and meaningful data specifically related to patient care. Accessibility Challenges, Limits to Applicability and Suggestions for Improvement were the main themes.

CONCLUSION

Nurse leaders require real-time data to effectively implement clinical interventions and practice changes for improving unit-level patient care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders emphasized that their insight into the development of customizable reports is crucial for obtaining meaningful data relevant to the varied unit-level health care setting. Reports targeting unit-level outcomes would provide meaningful data to facilitate clinical improvement where patient care is provided. Improved reports increase the likelihood of their use and the potential for enhancing the quality and safe care outcomes.

Nurses' Perceived Challenges in the Management of Hospitalized Cancer Patients in a Comprehensive Cancer Center in Southeastern Nigeria

OBJECTIVE

Nurses' challenges in poor-resource countries like Nigeria have been understudied. This study determined nurses' perceived challenges in management of hospitalized cancer patients in a comprehensive cancer center in southeast of Nigeria.

METHODS

The descriptive study included 133 registered nurses working in medical-surgical and oncology wards.  A 37-item questionnaire included seven (7) questions on socioeconomic, 16 questions related to nurse's knowledge, and 14 questions related to cancer treatment and the hospital facility.  A significant challenge was defined as a mean score of more than 3 in a Likert scale 5 points.

RESULTS

Challenges included a shortage of nurses (inadequate numbers of skilled nurses in oncology and other wards with mean±sd score (4.73±0.58), lack of continuing education  on current trends in the management of cancer (4.03±0.45), and lack of oncology trained nursing experts for job mentoring (4.24±0.77). Others were managing patients facing chemotherapy related side-effects (3.06±2.12), high cost of treatment borne by cancer patients (4.41±0.68) and exorbitant hospital bills (4.72±0.48), non-availability of drugs (4.09±0.87) and institutional policy bottlenecks affecting subsidizing treatment costs (4.09±0.84). Cancer care affected mainly by inadequate and functional equipment (4.24±0.55), and with no staff remuneration (4.53± 0.85).

CONCLUSION

Nurses' Perceived Challenges were related to professional, institutional, and those related to patient.

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.

Explaining the experiences of nurses regarding strategies to prevent missed nursing care: A Qualitative Study

AIM

To describe the experiences of nurses regarding strategies to prevent missed nursing care.

BACKGROUND

One of the global challenges is missed nursing care, which includes missed or delayed care. This problem puts patients' clinical outcome at risk, so understanding nurses' experiences of how to prevent or reduce it can help the healthcare policymakers.

METHOD

In this qualitative descriptive study, 14 nurses were selected by purposive sampling. In-depth semi-structured interviews were conducted to collect data. The Graneheim and Lundman's approach of qualitative content analysis was used for data analysis. MAXQDA (version 10) software was used for data management.

RESULTS

The extracted codes were summarized into seven categories and one theme. The categories included "empowering nurses", "manpower supply", "supervision", "specializing the activities", "providing resources and facilities", "encouraging teamwork", and "resolving dissatisfaction. " The main theme was " missed nursing care prevention strategies".

CONCLUSION

The frequency of missed nursing care can be reduced or prevented using management strategies such as paying attention to nurses 'empowerment, increasing nurses' job satisfaction, normalizing nurses' salaries, providing equipment and facilities, and monitoring nurses' performance. Experimental studies are recommended to evaluate the effectiveness of these strategies. Implications for nursing management Nursing managers can take steps such as workplace improvement, reducing nurses' workload, and empowering nurses to reduce or eliminate missed care.

Causes of Missed Nursing Care During COVID-19 Pandemic: A Qualitative Study in Iran

Background

The unpredictable and variable nature of COVID-19 and the lack of healthcare resources has led to inadequate care for patients. This study aimed to explain the causes of missed nursing care during the COVID-19 pandemic from the perspective of Iranian nurses.

Method

This qualitative study was conducted using semi-structured interviews with 14 nurses caring for patients with COVID-19 in three hospitals in Iran. Sampling was performed by the purposive method. Data were analyzed using the conventional content analysis method. The interviews were first recorded and transcribed, and then the data were analyzed using the Elo and Kyngas method. Data management was done with MAXQDA software version 10. To achieve trustworthiness, the criteria presented by Lincoln and Guba were used.

Findings

A total of 14 nurses participated in the study. The mean age of participants was 31.85 ± 4.95 years, and the mean number of years of work experience was 7.71 ± 4.44. Eleven participants were women. Among all participants, nine had a bachelor's degree and five had a master's degree. Four nurses had fixed shifts, while ten nurses had rotating shifts. The causes of missed nursing care were categorized into 4 groups. The category “unfulfilled care” comprised the reasons for forgetting care, neglecting care, arbitrary elimination of care, and compulsory elimination of care. The category of “care at improper time” consisted of interference of the care in patients' daily activities and interference with other healthcare providers' activities. The “incomplete cares” category comprised failure to complete the care period in hospital, interruption in care, and discontinuance of care after patient discharge. The last category, “incorrect care,” consisted of providing care regardless of the nursing process, providing care by unqualified professionals, and providing trial-and-error care.

Conclusion

This study illustrates an understanding of the causes of missed nursing care during the COVID-19 pandemic from the perspective of nurses. The increasing demand for care caused by the pandemic and problems in the work environment has led to the failure of nurses to provide complete, correct care and sometimes miss parts of care to patients. Therefore, nursing policymakers and managers should develop and implement appropriate care protocols and instructions to minimize missed nursing care.

Explaining the experience of nurses on missed nursing care: A qualitative descriptive study in Iran

BACKGROUND

Missed nursing care is a new concept that refers to the care that has been omitted or delayed. Due to the importance of the perceived experiences of nurses, this study was conducted to explain the experiences of Iranian nurses regarding the types of and reasons for missed nursing care.

METHODS

In this qualitative descriptive study, face-to-face and semi-structured interviews were used to collect data. The participants were selected by purposive sampling method. The extracted codes were organized into twelve subcategories and consolidated into six categories. 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 types of missed nursing care were expressed in the form of three categories, including "failure to pay attention to all patient needs", "non-observance of hygienic principles", and "non-observance of patient-related safety standards". The reasons for missed nursing care were also explained in three categories, including "nurse-related reasons", "facility-related reasons", and "management-related reasons". The subcategories related to these categories included nursing shortage, nurses' dissatisfaction, lack of teamwork spirit, inadequate clinical competence, personal problems, lack of facilities and equipment, old and defective equipment, and inefficient management.

CONCLUSION

Missed nursing care has many types and causes. This problem can be reduced by taking measures such as empowering nurses, regulating the selection of nursing managers, providing sufficient manpower, providing resources and facilities, eliminating the causes of nurses' dissatisfaction, and encouraging team spirit. Future studies are suggested to investigate the effect of intervention measures on the frequency of missed nursing care.

Factors Contributing to Rationed Nursing Care in the Slovak Republic-A Secondary Analysis of Quantitative Data

Rationed nursing care is a significant problem in healthcare facilities worldwide. Awareness of contributing factors to rationed care might support the development and implementation of strategies for reducing this phenomenon from clinical practice. The study examined the association between selected hospital, unit, and staff variables and the prevalence of rationed nursing care. Secondary analysis of cross-sectional data collected between December 2017 and July 2018 from 895 registered nurses in seven acute care hospitals in the Slovak Republic was performed. Data were collected using the questionnaire Perceived Implicit Rationing of Nursing and analyzed by descriptive and inferential statistics in the statistical program SPSS 25.0. Statistically significant associations were found between rationed nursing care and unit type, education, shift type, nurses' experience in the current unit, overtime hours, missed shifts, intention to leave the position, perceived staff adequacy, quality of patient care, and job satisfaction. Differences in rating rationed nursing care, quality of patient care, and job satisfaction were identified based on hospital type. Together with top hospital management, nurse managers should develop targeted interventions focusing on mitigating rationed nursing care from the clinical practice with a focus placed on university hospitals. Quality and safe care might be ensured through constant monitoring of the quality of patient care and job satisfaction of nurses as these factors significantly predicted the estimates of rationed nursing care.

Razões correlacionadas a omissão de cuidados de enfermagem

RESUMO Objetivo: Avaliar as razões correlacionadas à omissão de cuidados de enfermagem em um hospital universitário. Método: Delineamento transversal analítico, desenvolvido em um hospital universitário do Nordeste do Brasil, nos meses de janeiro a fevereiro de 2020. A população do estudo compreendeu enfermeiros e técnicos de enfermagem que atuavam na assistência direta ao paciente. Aplicou-se a versão brasileira do Missed Nursing Care Survey em uma amostra por conveniência composta por 227 participantes (79 enfermeiros e 148 técnicos de enfermagem). Foram calculadas estatísticas uni e bivariadas no software Statistical Package for social Science, versão 26.0. Resultados: O cuidado de enfermagem mais omitido foi deambulação três vezes por dia ou conforme prescrito (70,9%). A razão mais prevalente foi aumento inesperado do volume e/ou gravidade dos pacientes da unidade (93,0%). Foram verificadas correlações positivas, embora fracas, entre a omissão de cuidados geral, bem como por nível de prioridade, e razões de omissão atribuídas pelos enfermeiros e técnicos de enfermagem (p < 0,05). Conclusão O estudo evidenciou que a omissão de cuidados de enfermagem abrangeu todas as cinco dimensões do instrumento correlacionados principalmente aos recursos laborais e materiais.

Reasons correlated with omission of nursing care

ABSTRACT Objective: To evaluate the reasons correlated with the omission of nursing care in a university hospital. Method: Analytical cross-sectional design, developed in a university hospital in Northeast Brazil, from January to February 2020. The study population consisted of nurses and nursing technicians who worked in direct patient care. The Brazilian version of the Missed Nursing Care Survey was applied in a convenience sample consisting of 227 participants (79 nurses and 148 nursing technicians). Univariate and bivariate statistics were calculated in the software Statistical Package for Social Science, version 26.0. Results: The most omitted nursing care was walking three times a day or as prescribed (70.9%). The most prevalent reason was an unexpected increase in the volume and/or severity of patients in the unit (93.0%). Positive, albeit weak, correlations were found between overall care omission, as well as omissions by priority level, and reasons for omission given by nurses and nursing technicians (p < 0.05). Conclusion: The study showed that the omission of nursing care covered all five dimensions of the instrument, mainly correlated with labor and material resources.

Factors affecting missed nursing care in hospitalized frail older adults in the medical wards: a qualitative study

BACKGROUND

Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units.

METHODS

This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba.

RESULTS

In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as "age-unfriendly structure," "inefficient care," and "frailty of older adults" could increase the risk of MNC. In addition, factors such as "support capabilities" and "ethical and legal requirements" will moderate MNC.

CONCLUSIONS

Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.

The relationship between organizational communication and missed nursing care in oncology wards in Taiwan

Aim

Unfavourable communication increases missed nursing care. Oncology wards have more communication complexity than general wards; therefore, creating a positive communication environment is important for ensuring quality care. This study aimed to understand the relationship between organizational communication satisfaction and missed nursing care in Taiwan.

Design

This cross‐sectional study was performed to measure organizational communication satisfaction and missed nursing care in six oncology wards at a stand‐alone cancer centre hospital in Taipei, Taiwan in December, 2018.

Methods

The study collected data using the Communication Satisfaction Questionnaire and the MISSCARE survey. The data were analysed using descriptive statistics, t test, analysis of variance and Pearson product–moment correlation analysis in December 16, 2018.

Results

A total of 111 questionnaires were collected, and the response rate was 92.5%. The study showed that nurses tended to miss nursing care when they were dissatisfied with the unit's manpower status organizational communication environment, horizontal and diagonal communication and informal communication.

Systematic review of missed nursing care or nursing care left undone

Comprehensive nursing cares are important to provide total healthcare for the patient. However, there are miss nursing cares that nurses left to be done. This research is aim to discover the varieties of missed nursing care and to understand their possible impacts on nurses and patients. A systematic review was utilized. Data were collected from six databases: ScienceDirect, ProQuest, Scopus, SAGE, PubMed, and Wiley, from 2015 to 2019. Search results from the six databases (n=2934) sorted into 18 collected articles emphasized on three categories: missed nursing care, influencing factors, and impact of nursing care. The factors of missed nursing care are nurses' perception on patient safety, self-accountability, etc. The possible effects are patient and nurse satisfactions decline, and cost swell. Planning, intervention, and documentation are notoriously often missed by nurses. The reasons behind this issue are nurses' characteristics, HR problems, communication, workspace, and manager influence. These will have a great impact on patient satisfaction and nurse job satisfaction. Therefore, the role of nursing managers is large in improving missed nursing care.

Exploring the Lived Experience of Missed Nursing Care in Postgraduate Nursing Students in Iran

BACKGROUND

Missed care is a global phenomenon, which can include many clinical conditions that threaten the patients' safety in all countries and cultures, and also indicates the quality of nursing care. The nursing students' awareness and understanding of missed nursing care is of great importance. The current study aims to explore the lived experience of postgraduate nursing students in missed care.

METHODS

The current qualitative study was performed based on the interpretive phenomenological approach in Tehran, Iran, in February to December 2019. A total of 10 master's degree nursing students were selected through purposive sampling. A total of 10 semi-structured individual interviews were used to collect the data. The trail version of MAXQDA-10 software was used for coding. All interviews were recorded and codified, and the main themes were extracted from them using Dicklemann et al.'s (1989) analytical method.

RESULTS

Two main themes, five sub-themes, and 31 meaning units were obtained. The main themes included: "unfulfilled care" and "living in limbo".

CONCLUSION

Missed care, as unfulfilled care, is accompanied with living in limbo for nursing students, and this condition is influenced by organizational and personal factors. It seems that managers can prevent missed nursing care by supervising nursing care, reducing the nurses' workload, creating a sense of commitment to work, and enforcing ethical issues among nurses.