Missed nursing care as experienced by undergraduate nursing students

Missed nursing care and its associated factors among nursing students: A cross-sectional study

BACKGROUND

Nursing students are often curious about the match between their theoretical knowledge and the nursing care they observe during their clinical practices. Discrepancies between them can lead to instances where nursing care is omitted. If this omission is frequent, students may perceive it as a norm. Assessing missed nursing care among nursing students can provide input to improve clinical education and quality of nursing care. However, there is a lack of research on missed nursing care among nursing students in Ethiopia.

OBJECTIVE

To assess missed nursing care and its associated factors among nursing students in Ethiopia.

METHODS

A cross-sectional study was conducted from April 7 to June 22, 2024, at two universities in Ethiopia. Nursing students who had completed at least one clinical placement were included. Convenience sampling was used to recruit 358 participants. A validated 'Unfinished Nursing Care Survey for Students (UNCS4S)' scale was used to measure missed nursing care. Data were analysed using SPSS version 29 software. Multiple linear regression analysis was used to identify factors associated with missed nursing care at a P value of ≤0.05.

RESULTS

The average score of missed nursing care was 3.03 [95 % CI: 2.98; 3.08]. Teaching patients (Mean = 3.71, 3.58; 3.83 CI), providing personal hygiene (Mean = 3.70, 3.57; 3.83 CI), and emotional support (Mean = 3.62, 3.51; 3.73 CI) were most frequently missed. Lack of collaboration among nurses (β = 2.165, 1.040; 3.29 CI), inadequate number of nurses (β = 3.166, 0.711; 5.621 CI), insufficient supervision of tasks (β = 1.344, 0.453; 2.236 CI), inaccurate initial priority setting (β = 1.043, 0.107; 1.979 CI), and inadequate nursing care model (β = 1.211, 0.160; 2.261 CI) were factors associated with missed nursing care.

CONCLUSIONS

Nursing students reported a high level of missed nursing care. Hospital administrators should address nursing staff shortages, strengthen teamwork among nurses, and improve supervision of nursing tasks to mitigate missed nursing care and improve patient safety. There is a need to review whether existing nursing curricula sufficiently integrate missed nursing care and its potential impacts to enhance students' awareness and preparedness for their future practices. Future qualitative research is needed to explore students' personal experiences with missed care and reactions when they observe it and explore its impacts on their education and attitudes toward nursing.

Changes in the Pre- and Postpandemic Unfinished Nursing Care Occurrence and Reasons as Perceived by Italian Nursing Students: A Secondary Analysis

Missed care, a phenomenon born in the United States more than 30 years ago and currently called unfinished nursing care (UNC), has been compared in pre- and postpandemic to detect changes in the trends as perceived by nurses. However, no studies have compared the perceptions of nursing students before and after these challenging times. The aim of this study was to compare pre- and postpandemic UNC occurrence and the reasons for it as perceived by Italian nursing students during their clinical rotations. A secondary analysis of data collected in 2018 (prepandemic) and 2023 (postpandemic) was conducted and here reported according to STROBE guidelines. The Unfinished Nursing Care Survey for Students (UNCS4S), measuring 22 expected interventions (from 22 [never] to 110 [always left unfinished]) and 18 possible reasons for it (from 18 [nonsignificant] to 90 [very significant]), was administered. The UNCS4S total scores of 231 (prepandemic) and 352 (postpandemic) students were 39.80 (CI 95% 37.06-42.54) and 50.89 (CI 95% 47.66-54.12), respectively (p ≤ 0.001). No significant differences between groups emerged for reasons (47.91, CI 95% 45.10-50.71 vs. 45.92, CI 95% 43.91-47.93, respectively; p = 0.257). Postpandemic students perceived a higher occurrence of UNC but with similar reasons to those reported before the pandemic.

Nursing Students' Operating Room Experiences: A Qualitative Metasynthesis

PURPOSE

This study was conducted to analyze the findings of qualitative studies about nursing students' experiences with operating room (OR) practices. There is a need to conduct metasynthesis studies to highlight the overarching dimensions of nursing students' experiences in the OR learning environment, identify and summarize key elements, draw attention to the professional implications of the experience, and then help define the future research agenda. This original study is the first metasynthesis of qualitative studies focusing on nursing students' OR practice experiences.

DESIGN

A qualitative metasynthesis.

METHODS

This metasynthesis study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and registered with PROSPERO (International prospective register of systematic reviews) (CRD42021252129). This metasynthesis consists of qualitative studies that included themes, were conducted with nursing students with OR experience, and were published in English between December 2000 and June 2022. Data were analyzed using the two-step metasynthesis procedures proposed by Sandelowski and Barroso.

FINDINGS

This metasynthesis study was carried out by analyzing 12 qualitative studies that met the inclusion criteria, reflected the results of a total of 244 nursing students, and were conducted in 7 different countries. As a result of the analysis of the studies, two main themes and seven subthemes were determined about the OR experiences of nursing students. The main themes of the study included (1) the OR environment and (2) professionalism and career choices.

CONCLUSIONS

The synthesis of studies in this research revealed nursing students' OR experiences and provided evidence about the association between these experiences and their professionalism and career goals. The research drew attention to the limitations and facilitators of the OR learning environment for nursing students and provided guidance for a positive interactive learning environment.

Unfinished nursing care occurrence, priority order and reasons as perceived by nursing students: An international study

AIM

The study aimed to measure and compare differences (a) in the unfinished nursing care interventions overall and the order in which they are left unfinished; and (b) in the underline reasons, as perceived by Italian, Slovak and Turkish nursing students.

BACKGROUND

In recent years, in the nursing education context a novel line of research in the field of unfinished nursing care as those interventions required by patients, but omitted or delayed, has emerged. However, no studies have been conducted at the international level.

DESIGN

An international, comparative cross-sectional study was performed in 2022-2023 and reported here according to Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

METHODS

A multinational research network was formed with a convenient sample of 13 universities and 60 campuses (4595 students). The Unfinished Nursing Care Survey for Students (UNCS4S) was administered. A total of 1850 students participated.

RESULTS

According to the UNCS4S total score, Italians reported an average 50.9 out of 110 unfinished nursing care interventions (CI95 % 47.6-54.1), Slovakians 54.9 (CI95 % 53.7-56.1) and Turkish students 50.4 (CI95 % 49.2-51.5) (p<0.001). Some interventions were reported more often as unfinished across countries as supervising the task assigned to the nursing aides, going to the patient without being called, spending the required time with the patient and their caregivers and emotionally supporting patients and their caregivers. In terms of reasons, total scores were statistically different across countries (Italy: 45.92 out of 90, CI95 % 43.91-47.9; Slovakia: 62, CI95 % 61.02-62.98; Türkiye: 72.29, CI95 % 71.13-73.45; p<0.001); however, at the factor level, communication issues, lack of material resources and issues in supervision of nursing aides were reported in all countries as the most important reasons of the unfinished nursing care.

CONCLUSIONS

Students learn to shape and set priorities early in their nursing careers with similar order in what to leave unfinished as first, despite the different educational structures, care cultures and healthcare systems. Among the unfinished nursing care reasons perceived, the most influential were similar across countries, suggesting common areas for improvement. How to better prepare students to be resilient and capable of managing the challenges posed by unfinished nursing care episodes due to the lack of resources and communications issues should be considered as a priority by nurse educators.

Missed nursing care among nursing students: A scoping review

BACKGROUND

Nursing students report facing inconsistencies between theoretical knowledge and actualities of clinical practice, and research indicates they witness missed nursing care during clinical practice. Understanding nursing students' experiences can inform improved clinical learning environments and enhance patient care quality. Recently, research has focused on students' views regarding missed care, yet comprehensive understandings of this phenomenon are lacking.

OBJECTIVE

This review explored what is known about missed nursing care from perspectives of nursing students.

DESIGN

A scoping review according to Arksey and O'Malley's framework and Joanna Briggs Institute methodology was undertaken.

DATA SOURCES

Key databases were searched, including Medline, Embase, CINAHL, Scopus, ProQuest, PsycINFO and Web of Science in August 2023.

REVIEW METHODS

The review included qualitative, quantitative, and structured literature reviews published in English between 2006 and 2023. Inclusion and exclusion criteria and keywords guided the search. Data screening and extraction were independently performed by two reviewers. Included studies were analysed using descriptive statistics and narrative synthesis. Findings are reported in accordance with the PRISMA-ScR.

RESULTS

Of the 5873 articles identified, nine were included in the review. Studies were conducted in seven countries. Themes in students' perceptions included negligence of patients' rights and dignity, living in limbo, and pragmatic acceptance. Reasons for missed care included ineffective teamwork, lack of interest in caring, and inefficient leadership. Missed nursing care adversely affected patient health, hindered student learning and professional growth. Strategies for improvement included enhancing teamwork, enforcing ethical issues, increasing supervision, and creating commitment to work.

CONCLUSION

Missed nursing care affects patient safety and education of nursing students. Incorporating practical training modules into curricula, establishing preceptorship programs, and incorporating ethics education into clinical practice are crucial to address missed nursing care. Further research in diverse settings is warranted.

Nursing students' perceptions of unfinished nursing care: A cross-sectional study

AIM

To investigate the prevalence, patterns and reasons for unfinished nursing care as perceived by nursing students.

BACKGROUND

Unfinished nursing care (UNC) is a frequently observed phenomenon in the acute care setting. To date, studies have focused primarily on the perspective of nurses or patients, but another important perspective is that of nursing students who provide nursing care in all healthcare settings.

DESIGN

A descriptive cross-sectional study.

METHODS

The study included 738 undergraduate nursing students from nine Slovak universities. Data were collected between September 2022 and February 2023 using the Slovak version of the Unfinished Nursing Care Survey tool (UNCS). Data were analyzed using descriptive and inferential statistics.

RESULTS

The mean composite score of UNCS was 2.48 (SD=0.68). In general, 100% of nursing students reported that nurses missed at least one or more nursing care activities during their last clinical placement. The average number of missed nursing care activities was 11.2 per nurse as perceived by nursing students during their last clinical placement. Nursing students reported that the most frequently omitted nursing care activity was spending time with patients and their caregivers (3.15 ± 1.11; 92.9%). The most frequently reported reason for UNC was an inadequate number of nurses on the ward (4.31 ± 1.01; 98.1%). In the study, reported UNC could be predicted by previous experience in healthcare, previous clinical rotation, number of patients per shift, perceived staff adequacy and outcome expectations (p <0.05).

CONCLUSIONS

The findings reveal that UNC is a widespread phenomenon and all nursing students report this phenomenon during their clinical placements. Spending time with patients and their caregivers emerged as the most frequently omitted nursing care activity, highlighting the importance of patient-centered care. The primary reason cited for UNC was an inadequate number of nurses, highlighting staffing issues as a significant contributing factor. These findings emphasize the need for targeted interventions to address staff shortages and improve nursing education to prepare students to address UNC in their future practice.

Exploring unfinished nursing care among nursing students: a discussion paper

BACKGROUND

In line with the impetus traceable among the nursing staff, studies regarding the perception of Unfinished Care among students have increased in recent years as also recommended by some policy documents in the consideration that, as future members of the staff, they are expected to raise concerns about failures in the standards of care. However, no discussion of their methodological requirements has been provided to date. The aim of this study is to debate Unfinished Care explorations among nursing students and developing recommendations.

METHODS

A Rapid Review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, followed by a scientific discussion based on empirical evidence that emerged from the review combined with expert knowledge. Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were searched up to May 2022.

RESULTS

In the last five years, seven studies have been conducted by researchers affiliated at the university level, involving from 18 to 737 undergraduate students across Europe. By critically analysing their key aspects, there are derived some recommendations in conducting investigations in this field as, (a) the hidden meaning of Unfinished Care investigations among students by also deciding which concept is mostly appropriate to investigate; (b) the need of establishing alliances with the clinical settings in order to involve them in such explorations; (c) more complex research methods capable of exploring this issue among students by promoting learning outcomes and not only a simple data collection; and (e) the influences of these explorations on students' wellbeing, as well as on ethical implications and that regarding the relationship between the healthcare services and the universities.

CONCLUSION

Policymakers consider students to be key informants of the quality of nursing care issues witnessed during their clinical placements. The related emerging line of research is intriguing because of the underlying methodological, ethical and system complexities that need to be addressed according to some considerations.