Aims
To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing.
Background
Research has ...established associations between nurse staffing levels and adverse patient outcomes including in‐hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy.
Design
Systematic review.
Data Sources
We searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles.
Review Methods
Two reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were ed on study design, missed care prevalence and measures of association. Synthesis was narrative.
Results
Eighteen studies gave subjective reports of missed care. Seventy‐five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care.
Conclusions
Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated.
Background
Missed nursing care is an error of omission defined as standard, required nursing care that is not completed or is seriously delayed. Study findings from around the world show that missed ...nursing care is a global concern.
Purpose
The purpose of this study was to compare reports of missed nursing care by two types of nurses – registered nurses and practical nurses – in acute care hospitals in Iceland. Former studies in the USA indicate a variance in reports of missed nursing care by staff with different roles.
Methods
This was a cross‐sectional descriptive study using the MISSCARE Survey‐Icelandic questionnaire for data collection. The questionnaire asks about the amount of missed nursing care on the unit for 24 nursing elements (Part A) and 17 reasons of care being missed (Part B). Participants were nursing staff from medical, surgical and intensive care units in all hospitals in Iceland.
Findings
A t‐test for independent groups showed a significant difference for the overall missed nursing care score (Part A) between registered nurses (M = 2.09, SD = 0.51) and practical nurses (M = 1.82, SD = 0.59) t(541) = 5.703, p < 0.001. A comparison of the overall mean score for reasons of missed nursing care (Part B) between registered nurses (M = 2.32, SD = 0.38) and practical nurses (M = 2.21, SD = 0.62) indicated a significant difference in their reporting t(299) = 2.210, p = 0.028. In spite of the overall significant difference in ratings of the elements and reasons for missed nursing care by registered nurses and practical nurses, a pattern is evident in the ranking of the elements of nursing care being missed and reasons.
Conclusions
The findings of this study point to the need to acknowledge certain aspects of missed nursing care and the different roles within nursing. They indicate a need to improve open, sincere and structured communication and mutual respect and trust within healthcare teams in Icelandic hospitals.
Background & Aim: Providing nursing care occurs through work methods that ensure the organization and implementation of care: the functional work method, the teamwork method, the individual work ...method, or the reference nurse work method. This study aims to identify work methods that nurses adopt in a Portuguese hospital. Methods & Materials: A cross-sectional study was conducted in a hospital in northern Portugal. A non-probabilistic convenience sampling technique was used, and 627 nurses were enrolled. Data were collected between March and April 2023 using the “Nurses’ Work Methods Assessment Scale.” The Statistical Package for the Social Sciences was used to perform descriptive and inferential statistics, using the Mann-Whitney, Kruskal-Wallis, and Spearman’s correlation tests. Results: The individual method predominated, followed by the functional and teamwork methods. A lower adherence to the nurse reference method was observed. The variable “work context” was the most significant for the four working methods. In the individual method, the frequency of the variable “condition in which the profession is practiced” was higher in specialist nurses and, particularly, rehabilitation nursing specialists. The frequency of using the individual method is also higher when nurses have a master’s degree and training in nursing care organization methodology. Conclusion: The highest frequencies of the individual method are related to the level of training, suggesting the influence of training in adopting working methods in clinical practice. Although the reference nurse method points to better satisfaction of clients’ needs, nursing practice environments sometimes have inadequate conditions for its operationalization.
This study will explore the effects of high-quality nursing care (HQNC) for patients with lung cancer (LC) during the perioperative period (PPP).
A literature search will be performed at Cochrane ...Library, MEDLINE, EMBASE, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure since its inception until October 1, 2019. All electronic databases will be searched with no restrictions of language and publication status. Two authors will perform study selection, data collection, and study quality assessment, respectively. We will use RevMan 5.3 software for statistical analysis.
This study will summarize the latest evidence on assessing the depression, anxiety, quality of life, and adverse events of HQNC in patients with LC during PPP.
The results of this study may provide helpful evidence of HQNC on psychological effects in patients with LC during PPP.
PROSPERO CRD42019155982.
Stroke is a significant problem, both clinical and social, leading to disability of the patient. Its occurrence is mainly influenced by modifiable and non-modifiable factors. The golden mean in ...diagnosis, and then in functioning in everyday life, is the time from the onset of the first symptoms of a stroke and the related method of treatment. Proper care for the patient in the acute phase of stroke is essential for continued functioning at home.
Background:
Previous research has linked missed nursing care to nurses’ work environment. Ethical climate is a part of work environment, but the relationship of missed care to different types of ...ethical climate is unknown.
Research objectives:
To describe the types of ethical climate in adult in-patient cancer care settings, and their relationship to missed nursing care.
Research design:
A descriptive correlation design was used. Data were collected using the Ethical Climate Questionnaire and the MISSCARE survey tool, and analyzed with descriptive statistics, Pearson’s correlation and analysis of variance.
Participants and research context:
All nurses from relevant units in the Republic of Cyprus were invited to participate.
Ethical considerations:
The research protocol has been approved according to national legislation, all licenses have been obtained, and respondents participated voluntarily after they have received all necessary information.
Findings:
Response rate was 91.8%. Five types identified were as follows: caring (M = 3.18, standard deviation = 1.39); law and code (M = 3.18, standard deviation = 0.96); rules (M = 3.17, standard deviation = 0.73); instrumental (M = 2.88, standard deviation = 1.34); and independence (M = 2.74, standard deviation = 0.94). Reported overall missed care (range: 1–5) was M = 2.51 (standard deviation = 0.90), and this was positively (p < 0.05) related to instrumental (r = 0.612) and independence (r = 0.461) types and negatively (p < 0.05) related to caring (r = −0.695), rules (r = −0.367), and law and code (r = −0.487).
Discussion:
The reported levels of missed care and the types of ethical climates present similarities and differences with the relevant literature. All types of ethical climate were related to the reported missed care.
Conclusion:
Efforts to reduce the influence of instrumental and independence types and fostering caring, law and code, and rules types might decrease missed nursing care. However, more robust evidence is needed.
To explore nurses' perspectives regarding the decision-making processes that lead to missed nursing care and to identify the personal and contextual attributes involved in these processes.
A ...qualitative study was undertaken between April - October 2018.
A total of 28 registered nurses working in different wards in hospital settings participated in nine focus groups with semi-structured interviews. An interview guide encouraged nurses to share perceptions of missed care and the personal and contextual attributes shaping their decision-making.
Content analysis revealed three themes related to nurses' decision-making processes for whether to omit or delay care. First, nurses emphasized the role of nurses' agency, suggesting explicit or implicit rationing of care, regardless of scarce resources. Second, nurses distinguished between two modes of thinking that they labelled "automated thinking," activated in routine situations and "effortful thinking," initiated in more novel situations. Finally, nurses identified situational factors triggering fluctuations in their awareness such as task type, difficult patients and the presence of relatives and the head nurse.
Nurses are aware of the processes guiding a decision to omit or delay care. They pointed to patient, nurse and ward conditions that serve as cues in their decision whether to miss care. Identifying these cues supports Hammond's cognitive continuum theory of decision-making and may serve in the development of training programmes for nurses aimed at limiting the phenomenon.
The study addressed missed nursing care through a decision-making lens. The findings pointed to nurses' agency as shaping decisions about whether to miss care and identified the personal and contextual cues that guide nurses' decisions. These findings call for organizational training programmes encouraging nurses to identify barriers and facilitators of missed nursing care and how to overcome them.
Aims and objectives
Systematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes.
Background
A considerable body of evidence supports the ...hypothesis that lower levels of registered nurses on duty increase the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear.
Design
Systematic review.
Methods
We searched Medline (via Ovid), CINAHL (EBSCOhost) and Scopus for studies examining the association of missed nursing care and at least one patient outcome. Studies regarding registered nurses, healthcare assistants/support workers/nurses’ aides were retained. Only adult settings were included. Because of the nature of the review, qualitative studies, editorials, letters and commentaries were excluded. PRISMA guidelines were followed in reporting the review.
Results
Fourteen studies reported associations between missed care and patient outcomes. Some studies were secondary analyses of a large parent study. Most of the studies used nurse or patient reports to capture outcomes, with some using administrative data. Four studies found significantly decreased patient satisfaction associated with missed care. Seven studies reported associations with one or more patient outcomes including medication errors, urinary tract infections, patient falls, pressure ulcers, critical incidents, quality of care and patient readmissions. Three studies investigated whether there was a link between missed care and mortality and from these results no clear associations emerged.
Conclusions
The review shows the modest evidence base of studies exploring missed care and patient outcomes generated mostly from nurse and patient self‐reported data. To support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes as a result of missed care, more research that uses objective staffing and outcome measures is required.
Relevance to clinical practice
Although nurses may exercise judgements in rationing care in the face of pressure, there are nonetheless adverse consequences for patients (ranging from poor experience of care to increased risk of infection, readmissions and complications due to critical incidents from undetected physiological deterioration). Hospitals should pay attention to nurses’ reports of missed care and consider routine monitoring as a quality and safety indicator.
İntramusküler enjeksiyon çeşitli komplikasyonların gelişmesine neden olan önemli bir hemşirelik uygulamasıdır. Bu komplikasyonların önlenmesi için göz önünde bulundurulması gereken birçok faktör ...vardır. Gordon’un Fonksiyonel Sağlık Örüntüleri Modeli, bireylerin gereksinimlerini 11 fonksiyonel alanda ele alarak bireylere kapsamlı bakım verilmesini ve bütüncül olarak değerlendirilmesini sağlamaktadır. Bu olgu sunumunda dorsagluteal bölgeden intramusküler enjeksiyon yapılması nedeni ile komplikasyon gelişen hastanın Gordon’un Fonksiyonel Sağlık Örüntüleri Modeline göre hemşirelik bakımı yer almaktadır. Olgunun verileri, hasta bakımı sırasında yapılan gözlemler ve hasta ile yapılan görüşmelerden elde edilerek toplanmış, modele göre bakım içeriği planlanmış, uygulanmış ve değerlendirilmiştir.
•Patients fundamental care needs is of risk of being missed in the Emergency Departments.•One cause for Missed Nursing Care is a high patient input leading to a nurse-to-patient imbalance.•Missed ...nursing care likely have consequences for the quality of care and patient safety in Emergency departments.
Patient safety is a global health priority. Errors of omission, such as missed nursing care in hospitals, are frequent and may lead to adverse events. Emergency departments (ED) are especially vulnerable to patient safety errors, and the significance missed nursing care has in this context is not as well known as in other contexts.
The aim of this scoping review was to summarize and disseminate research about missed nursing care in the context of EDs.
A scoping review following the framework suggested by Arksey and O’Malley was used to (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; (5) collate, summarize, and report the results; and (6) consultation.
In total, 20 themes were derived from the 55 included studies. Missed or delayed assessments or other fundamental care were examples of missed nursing care characteristics. EDs not staffed or dimensioned in relation to the patient load were identified as a cause of missed nursing care in most included studies. Clinical deteriorations and medication errors were described in the included studies in relation to patient safety and quality of care deficiencies. Registered nurses also expressed that missed nursing care was undignified and unsafe.
The findings from this scoping review indicate that patients’ fundamental needs are not met in the ED, mainly because of the patient load and how the ED is designed. According to registered nurses, missed nursing care is perceived as undignified and unsafe.
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