Unfinished nursing care in intensive care units and the mediating role of the association between nurse working environment, and quality of care and nurses' wellbeing

Missed Intensive Nursing Care Scale: Results From an Italian Validation Study

BACKGROUND

Unfinished Nursing Care (UNC) refers to essential patient care that is postponed or neglected, significantly impacting outcomes such as increased morbidity, mortality and hospital-acquired infections. In Intensive Care Units (ICUs), the complexity of patient conditions results in higher UNC rates, particularly for basic care interventions. The Missed Intensive Nursing Care Scale (MINCS) assesses the frequency and types of missed care in these settings.

AIM

This study aimed to translate, culturally adapt and validate MINCS for use in the Italian ICU context, ensuring its psychometric robustness.

STUDY DESIGN

A methodological research for translation, cross-cultural adaptation and validation was conducted in two hospitals in north-eastern Italy, involving general, neurosurgical and cardiothoracic ICUs. The process included translation, back-translation, expert evaluation, pilot testing and psychometric analysis of MINCS-Italy (MINCS-IT) using Cronbach's alpha, Exploratory Factor Analysis (EFA) and Rasch analysis.

RESULTS

A total of 135 ICU nurses participated in the study, 76.3% were female, and an average ICU experience of 11.1 years. The final version of MINCS-IT contained 48 items, divided into three sections: demographics, elements of missed nursing care (34 items, α = 0.92), and reasons for missed care (14 items, α = 0.94). EFA revealed a five-factor structure for elements of missed care (53.2% variance explained) and a two-factor structure for reasons (64.9% variance explained). Rasch analysis supported item validity, except for one item ("Assessing patient nutritional status"), which showed suboptimal values.

CONCLUSIONS

The MINCS-IT is a reliable tool for assessing missed nursing care in Italian ICUs, addressing both fundamental and complex patient needs. Its comprehensive approach supports targeted interventions to improve care quality.

RELEVANCE TO CLINICAL PRACTISE

The MINCS-IT enables nurse managers to identify missed care patterns, fostering improvements in nursing practises and patient-family care outcomes, ultimately elevating ICU standards.

Analysis of the Prevalence of Missed Nursing Care Using Three Workload Assessment Methods: A Nationwide Cross-Sectional Study Among Intensive Care Nurses

BACKGROUND

Increased workload is associated with a higher prevalence of missed nursing care.

AIM

Describe the prevalence of missed care in intensive care units (ICUs) and identify the workload scale most strongly associated with this prevalence.

STUDY DESIGN

A cross-sectional survey was combined with a longitudinal study conducted in 2024, between 15 January and 15 April, in France to assess the workload. A total of 1271 nurses working in 61 ICUs completed the questionnaire one time per shift.

RESULTS

A total of 72.3% of nurses reported at least one missed care. The Nursing Activities Score provided the strongest association with the prevalence of missed care compared to patient-to-nurse ratio and the Practice Environment Scale of the Nursing Work Index.

CONCLUSION

The prevalence of missed care and nursing workload was high. Nurses tended to focus on direct patient care.

RELEVANCE TO CLINICAL PRACTICE

Continuously assessing the prevalence of missed care can be a valuable tool for managing workload in ICUs.

Workload assessment using the nursing activities score in intensive care units: Nationwide prospective observational study in France

BACKGROUND

Within French intensive care units (ICUs), patients are treated with two levels of care (intensive or intermediate) with different nurse-to-patient ratios legally defined.

OBJECTIVES

We aimed to compare the nursing workload associated with these two levels of care.

RESEARCH METHODOLOGY

A nationwide prospective observational study was conducted in France between April and July 2023. Each ICU was allowed to choose its own two-week period of data collection during which the Nursing Activities Score was collected by nurses at patients' bedside, during each shift. The Nursing Activities Score ranges from 20 to 177% and a 100% score represents a nurse per shift. The number of patients per nurse was collected and the Nursing Activities Score per nurse was assessed.

RESULTS

One hundred and five ICUs participated. Overall, 21,665 measurements of Nursing Activities Score per patient and 9,885 Nursing Activities Score per nurse were collected. ICUs were composed by 2083 beds distributed into 1520 (73 %) intensive care beds and 563 (27 %) intermediate care beds. Among the participating units, 93 (89 %) of the teams worked in 2 shifts. Median [p25-p75] Nursing Activities Score per adult patient was 61 % [49-80] for intensive care patients and 47 % [38-61] for intermediate care patients (p < 0.001). Median Nursing Activities Score per nurse for adult population was 127 % [92-167], 143 % [92-198], and 164 % [126-213] for nurses only providing intensive care, only intermediate care or both levels of care, respectively (p < 0.001). A Nursing Activities Score per nurse value >100 % was observed in 71.4 %.

CONCLUSIONS

Nurses' workload was high in the ICU, especially when providing intermediate or mixed levels of care.

IMPLICATIONS FOR PRACTICE

In order to reduce nurses' workload, a review of the nurse-to-patient ratios is expected. Physically separating the two levels of care may be a valuable option.

Job satisfaction, work environment, and burnout as predictors of missed nursing care in pediatric units: A descriptive cross-sectional study

PURPOSE

To examine the frequency and predictors of missed nursing care in pediatric units.

DESIGN AND METHODS

This study with a descriptive cross-sectional design was conducted in the pediatric clinics of two public university hospitals in Türkiye. The convenience sampling method was employed, including all nurses working in pediatric units, with a total of 123 nurses participating. Data were collected face-to-face from May to October 2023 using a sociodemographic and job-related characteristics form, the Practice Environment Scale of the Nursing Work Index (PES-NWI), the Maslach Burnout Inventory (MBI), and missed nursing care activity questions. The data were analyzed using descriptive statistics and logistic regression analysis.

RESULTS

The most frequently missed care activities were found to be skin care (45.5 %), educating patients and families (40.7 %), and preparing patients and families for discharge (37.4 %). Predictors of missed nursing care were nurses' educational level, high nurse-to-patient ratios, low job satisfaction, enough opportunity to discuss patient care issues with other nurses, nursing foundations for quality of care, nurse manager's ability, leadership, and support for nurses, staffing and resource adequacy, and collegial nurse-physician relations, emotional exhaustion and personal accomplishment.

CONCLUSIONS

This study revealed that the most frequently missed care activities among nurses were related to skin care, education, and discharge preparation. Understanding the underlying causes is essential for reducing the rate of missed care.

PRACTICE IMPLICATIONS

To reduce the frequency of missed care, it is necessary to improve the work environment and make institutional investments in nursing, enabling nurses to effectively fulfill their duties.

The role of nurses' adherence to clinical safety guidelines in linking nurse practice environment to missed nursing care

INTRODUCTION

While the nurse practice environment's vital role in shaping patient care outcomes is well established, the precise mechanisms through which it influences missed nursing care remain unexplored. Hence, this study examined the mediating role of adherence to clinical safety guidelines in the relationship between the nurse practice environment and missed nursing care.

METHODS

This descriptive, cross-sectional study involved 1237 nurses from 11 governorates in the Sultanate of Oman. Data were collected using three standardized scales: the Patient Safety Adherence Scale, the Practice Environment Scale of the Nursing Work Index, and the Missed Nursing Care Scale.

RESULTS

A favorable nurse practice environment was associated with higher adherence to clinical safety guidelines (β = 2.492, p < 0.001) and a lower frequency of missed nursing care (β = -0.2919, p = 0.015). Adherence to clinical safety guidelines partially mediated the relationship between the nurse practice environment and missed nursing care (β = -0.055, p < 0.001).

CONCLUSION

Enhancing the nurse practice environment plays a crucial role in improving nurses' adherence to clinical safety guidelines, which in turn reduces compromised nursing care.

CLINICAL RELEVANCE

Healthcare administrators and policymakers should prioritize improving working conditions to enhance nurses' adherence to clinical safety guidelines, thereby minimizing the occurrence of missed care and improving overall patient outcomes.

Association of Burnout and Intention-To-Leave the Job With Objective Nursing Workload and Nursing Working Environment: A Cross-Sectional Study Among Intensive Care Nurses

AIM

The objectives of this study were to determine the prevalence of burnout risk and intention-to-leave among intensive care unit (ICU) nurses and analyse the association of these with workload and work environment.

DESIGN

A cross-sectional survey of nurses working in ICUs was conducted in France between 15 January 2024 and 15 April 2024 alongside a longitudinal assessment of workload during the same period.

METHODS

ICU nurse workload was assessed using the Nursing Activities Score (NAS). The risk of burnout was assessed using the Maslach Burnout Inventory scale and intention-to-leave the hospital was assessed with a binary question. A total of 1271 nurses working in 61 intensive care units completed the questionnaire and 14,134 NAS per patient and 1885 NAS per nurse were included in the study.

RESULTS

The median overall of burnout by hospital site was 64.7% [P25: 53.3-P75: 72.7] for the broad definition and a median of 20.7% [13.3-27.3] of ICU nurses reported an intent-to-leave their job. The median overall NAS score per nurse was 135.9% [121.4-156.9] and the prevalence of NAS scores exceeding 100% per nurse was 73.9% [62.8-80.3]. A significant association was found between nurses working in an ICU with a better work environment and all dimensions of burnout as well as the intention-to-leave the job. A prevalence in the hospital site of NAS scores exceeding 100% per nurse below the median was associated with a lower burnout (OR = 0.69, 95% CI: 0.50-0.88 for broad definition) and intention-to-leave the job (OR = 0.68, 95% CI: 0.50-0.92).

CONCLUSION

This study found significant associations between burnout and the intention to leave the job for nurses in ICUs, mainly due to a better work environment and, to a lesser extent, a lower workload for nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

In an era of nurse shortages and absenteeism, it is crucial for institutions to retain their nursing staff. Our results should encourage hospital managers to take action to improve the ICU work environment and keep ICU workloads manageable to decrease burnout and the intention-to-leave the job among ICU nurses.

REPORTING METHOD

This article follows the STROBE guidelines for the reporting of cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A Salutogenic Perspective on Critical Care Nurse's Experiences of Supervising Nurses Without Training in Intensive Care: To Comprehend, Manage, and Feel Meaning During a Crisis

Introduction: Using the COVID-19 pandemic as an example of a national and international crisis, it has been possible to show how critical care nurses (CCNs) were affected by their work situation with impact on health and wellbeing. This study sought out to investigate how CCNs stress was affected and to provide some answers as to how to react and organize care in a future crisis. The specific focus was CCNs' stressors related supervision of nurses untrained in intensive care and how these were handled in a salutogenic perspective. Aim: The aim of this study was to analyze CCNs' experiences of supervision of nurses without training in intensive care during the COVID-19 pandemic, and to analyze these experiences with the help of the salutogenic concept sense of coherence. Materials and Methods: The phenomena under study were explored during the years of 2021-2022 through in-depth interviews and interpreted using deductive content analysis. Results: By analyzing CCNs experiences of supervising nurses without training in intensive care with the lens of sense of coherence, it was possible to show in what way these concepts influenced how to cope with the demanding situation. Sense of coherence was influenced by the inevitable prioritization of patient care and nursing interventions. This prioritization caused moral distress, but was also enhanced or decreased by CCNs sense of coherence. Conclusion: When recruiting and introducing new personnel in a future crisis to any field of healthcare, but particularly to the intensive care, we would, on the basis of these findings, suggest that well-established plans are vital for how to move personnel throughout the organization, and for how to introduce the field of intensive care. Plans for how to model care with the help of RNs without specialist training should be put in place. A communication plan for the organization is also of importance to enhance transparency.

The Health Narratives Research Group (HeNReG): A self-direction process offered to help decrease burnout in public health nurse practitioners

Founded in accordance with 19th century sex roles and public health concerns, nursing evolved as other-directed, dependent on physician-focused diagnosis, prescription decisions, and public health advancements. The result of this other direction is that public health nurse practitioners have endured significant workplace stress resulting in burnout, especially during COVID-19. To help decrease their burnout, nurses require development of self-direction. The Health Narratives Research Group (HeNReG) has the potential to reduce burnout in nurse practitioners by encouraging the development of self-direction. The HeNReG process is presented through historically analyzed documents regarding reducing burnout in health researchers by developing self-direction including: (1) three years of archived year-end feedback results provided by participants, (2) archived participant responses to specific HeNReG-related writing prompts, and (3) a comparison of HeNReG results with the outcomes of resilience programs. The conclusion-the HeNReG offers an effective option for reducing burnout in health researchers that has the potential to decrease nurse practitioner burnout in a way that resilience programs do not. Tailoring the HeNReG process to public health nurses is discussed, inviting future research for reducing burnout in public health nurses.