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.

Using Multiple Logistic Regression to Determine Factors Affecting Delaying Hospital Arrival of Patients with Acute Ischemic Stroke

Background

Early treatment of ischemic stroke patients who arrive at the hospital ≤4.5 hours after the onset of symptoms with recombinant tissue plasminogen activator is more beneficial and very important.

Objective

This study is aimed to investigate the factors delaying the hospital arrival of patients with acute ischemic stroke by using multiple logistic regression analysis.

Methods and Materials

This descriptive cross-sectional study was done on patients diagnosed with acute ischemic stroke who were referred to Ardabil city Training and Research hospital at 2018. All patients and/or patient relatives were interviewed and data were collected through a checklist including demographic and clinical data of patients to explore the involved factors delaying hospital arrival of patients and then analyzed using multiple logistic regression analysis.

Results

Of all included patients, only 25.3% arrived at the hospital in ≤ 4.5 hours. By using multivariate logistic regression analysis, living in cities (P = 0.007), cigarette consumption (P = 0.032), having valvular heart disease (P = 0.008), and gender (P = 0.049) were factors associated with an early arrival to the hospital.

Conclusions

Results showed that most of the patients had a considerable delay in arriving at the hospital in ≤ 4.5 hours. Thus, providing health promotion strategies to improve society awareness of early symptoms of stroke, training of local physicians about the importance of early arrival of stroke patients, and more extended ambulance services in all cities and rural areas are necessary for better management of acute stroke patients in this area.

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.

Evaluation of the influential factors on the mortality of patients with acute myocardial infarction

Introduction: Death caused by myocardial infarction (MI) usually occurs during the first hours after the onset of symptoms. Therefore, to manage, treat and decrease the mortality rate of these patients, early hospital admission is important. Objectives: We aimed to investigate the impact of the influential factors on mortality of patients with MI. Patients and Methods: In this case-control study, MI patients who were referred to the Ardabil Alavi Hospital, Ardabil university of medical sciences, Ardabil, Iran between April 2017 and April 2018 were included. The patients that had died due to MI were considered as the case group (n=27) and 27 matched patients that had died due to other causes were selected as the control group. Linear logistic regression was employed to analyze the data. Results: The mean age of the patients in the case group was significantly higher than in the control group (75.1±11.7 versus 63.;1±11.6, P=0.001). The history of non-cardiac diseases in the case group (44.4%) was significantly higher than in the control group (7.4%; P=0.002). The number of PCIs (percutaneous coronary interventions) that were conducted in the case group (40.7%) was significantly lower than in the control group (74.1%; p=0.013). The time distance between hospital admission and PCI performance in the case group (110.9 minutes) was significantly higher than in the control group (56 minutes; P=0.001). However, the mean of delay time from the onset of symptoms to hospital admission (the patient delay) and from hospital admission to receiving treatment (the health system delay) was similar between the two groups. Conclusion: This study showed that the number of performed PCIs, history of non-cardiac disorders and the interval between the onset of symptoms and PCI performance are significantly associated with the morality of MI patients.

Comparison of the effect of teaching Bundle Branch Block of electrocardiogram through storytelling and lecture on learning and satisfaction of nursing students: A quasi-experimental study

AIM

In this study, we taught learners the interpretation of the bundle branch block in two ways of storytelling and usual lecture, then compare the effect of these two methods on the level of learning and satisfaction. Storytelling can lead to deep learning, promoted critical thinking of students and enhanced clinical skills. It is an effective teaching method engaging nursing and midwifery students in clinical education.

DESIGN

A quasi-experimental study.

METHODS

We conducted this study in the training hospital, Ardabil, Iran, from 2019 to 2020. We selected 70 nursing students of semesters 6th and 7th through convenience sampling then allocated them randomly into two groups of intervention (n = 40) and control (n = 30). We taught the same topics to the intervention group via the storytelling method and the control group via lecturing. Data collection tools included a standard questionnaire of satisfaction with the teaching method and learning how to interpret an electrocardiogram. Data were analyzed using chi-square and independent t-tests. The significance level was considered less than 0.05.

RESULTS

Students in the control group had a higher mean score of satisfaction with the teaching method (30.00 ± 2.00) than students in the intervention group (29.00 ± 3.00). Also, There was no significant difference between the two groups regarding learning quality (P = 0.20).

CONCLUSION

Both methods of storytelling and lecturing were effective in increasing students' satisfaction. However, the liking of the teaching method, learning in a short time and high motivation for learning in the intervention group were higher. It is suggested to teach electrocardiogram interpretation to nursing students first through lecturing and then stabilize the concepts in their minds through storytelling.