Interventions to prevent or reduce rationing or missed nursing care: A scoping review

The impact of proactive huddles and personal accountability on missed nursing care: A randomized controlled design

BACKGROUND

Evidence on effective interventions to reduce missed care is limited. While various strategies exist, proactive huddle intervention remains underexplored.

OBJECTIVES

This study aimed to develop, implement, and evaluate proactive huddles as an effective process to reduce missed care in nursing wards. A secondary objective was to investigate the moderating effect of personal nurse accountability on the relationship between proactive huddles and missed care.

METHODOLOGY

A randomized controlled study was conducted in a medium-sized hospital, involving 180 nurses across six internal and four surgical wards.

METHODS

Participants were randomly assigned to a 3-month intervention (n = 85) and control (n = 95) groups between March 2022 and May 2023. The intervention consisted of daily huddles, incorporating four key elements: status of tasks, potential delays, tasks that might not be completed, and assistance needed. The MISSCARE Survey (measured on three different occasions) and the 3D Accountability Questionnaire were assessed at baseline and immediately after the 3-month intervention.

RESULTS

A total of 602 huddles, each lasting about 5 minutes, were included. Gaps were identified in 69% of huddles, with 57% resolved. The intervention group showed reduced missed nursing care compared to the control, with effectiveness moderated by personal accountability-benefiting nurses with lower accountability more.

CONCLUSIONS

Huddles require minimal resource investment to reduce missed nursing care, especially for nurses with lower personal accountability. Making huddles a standard practice can improve nursing care quality.

PRACTICE IMPLICATIONS

Nursing managers are encouraged to support consistently implementing huddles in hospital settings.

Latent profile analysis of missed nursing care and their predictors among neuro-oncology nurses: a multicenter cross-sectional study

PURPOSE

To explore potential profile characteristics associated with neuro-oncology nurses' missed nursing care (MNC) and analyze differences in characteristics of neuro-oncology nurses across these profiles.

METHODS

A cross-sectional study design using convenience sampling involved 446 neuro-oncology nurses from ten Grade A oncology hospitals across six provinces in China, conducted from April to June 2024. The General Information Questionnaire, the Oncology Missed Nursing Care Self-Rating Scale, the Practice Environment Scale, and the Psychological Capital Scale were employed for data collection. Latent profile analysis was performed to identify MNC profiles, followed by multinomial logistic regression analysis to examine predictors of MNC.

RESULTS

The incidence of MNC among neuro-oncology nurses was found to be 36.4%. Three latent profiles were identified: "severe missed nursing care profile" (20.6%), "medium-risk missed nursing care profile" (51.3%), and 'low-risk missed nursing care profile' (28.1%). Compared with the "severe missed nursing care profile," neuro-oncology nurses with a technical secondary school or junior college education, who expressed job satisfaction, good self-confidence, and mental resilience were more likely to fall into the "medium-risk missed nursing care profile." Additionally, those aged 18-35 years were more likely to be categorized in the "low-risk missed nursing care profile," and nurses working in a positive nursing work environment were also more likely to belong to the "medium-risk" or "low-risk missed nursing care profiles."

CONCLUSION

There is notable heterogeneity in the levels of missed nursing care among neuro-oncology nurses. Nursing managers should prioritize addressing middle-risk missed nursing care and enhancing both the working environment and psychological support for neuro-oncology nurses. Tailored interventions based on the distribution of different profiles can improve nursing quality, increase job satisfaction, and enhance patient outcomes.

Rationing of nursing care in a developing country: A cross-sectional study

AIM

This study aimed to determine the effect of nurses' work environment, individual and work schedule features on the rationing of nursing care.

INTRODUCTION

Rationing of nursing care is a concern in healthcare settings worldwide, as it is associated with negative outcomes for both patients and nursing staff.

BACKGROUND

Little is known about the precursors of rationing of nursing care in developing countries.

METHODS

This descriptive, correlational and cross-sectional study was conducted with 405 nurses in Türkiye. Data were collected Nurse Information Form, Basel Extent of Rationing of Nursing Care-R and Nursing Work Index-The Practice Work Environment Scale. The study was reported following the STROBE and RANCARE guideline.

RESULTS

Nurses' mean rationing of nursing care score was 1.58 ± 0.59, and the mean work environment perception score was 2.58 ± 0.47, with no statistically significant relationship between the scale scores. However, working ward, working hours and working schedule significantly affected the total rationing of nursing care scores.

DISCUSSION

In this study, contrary to the literature, no relationship was found between the rationing of nursing care and the perception of the work environment. Supporting the literature, nurses' individual/work schedule features affected the rationing of nursing care.

CONCLUSION

Improving nurses' work schedule features and nurse staffing may help reduce the rationing of nursing care.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study emphasised the importance of nurses' work schedule features and nurse staffing in the rationing of nursing care. The data from this study can guide nurse managers in identifying factors related to work schedules that may affect the rationing of nursing care and strategies to follow to make the necessary improvements.

How Do Nurses Decide on Missed Nursing Care? A Grounded Theory Study of Grassroots Arrangement of Nursing Care

AIMS

To explore the complete decision-making process and action logic of nurses making autonomous decisions that result in missed nursing care.

BACKGROUND

The complex characteristics of patients in Intensive Care Units place higher demands on the allocation of nursing resources, as well as on the professional skills, resilience and ethics of nursing staff. Preventing missed nursing care is particularly crucial in Intensive Care Units.

DESIGN

A theory construction qualitative study using grounded theory.

METHODS

Semistructured face-to-face interviews were conducted with 20 nurses, including three head nurses and 17 bedside nurses. Head nurses provided insights into counselling and management practices.

RESULTS

The theoretical model of nurses' decision-making processes comprise four strategies: setting priorities, seeking help, delaying nursing care and omitting nursing care. The latter two constitute missed nursing care. Inadequate staffing, task urgency and negative emotions can lead to omitting nursing care.

CONCLUSIONS

This study proposes an original concept: grassroots arrangement of nursing care (GANC). Grassroots arrangement of nursing care includes the autonomous and adaptive decision-making process used by bedside nurses to optimise workflow in busy environments. It includes specific strategies and quality implications, enabling a nuanced balance between limited nursing resources, increasing patient needs and maintaining the best possible quality of care.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should consider the dual aspects of grassroots arrangement of nursing care, support nurses' grassroots autonomy and streamline decision-making processes.

REPORTING METHOD

This study follows the Consolidated Criteria for Reporting Qualitative Studies (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring the nexus between the standardized nursing terminologies and the unfinished nursing care phenomenon: An empty systematic review

PURPOSE

To identify and synthesize evidence regarding the documented relationship between the standardized nursing terminologies and the unfinished nursing care phenomenon.

DATA SOURCES

A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature Complete databases were last consulted on November 27, 2023. The review included primary quantitative studies that reported an association between recognized standardized nursing terminologies and unfinished nursing care. Two researchers completedtitle and abstract and full-text screening.

DATA SYNTHESIS

Our search identified 149 citations. A full-text review of one paper was undertaken. No studies met our inclusion criteria. We report an empty review.

CONCLUSIONS

Standardized nursing terminologies and Unfinished Care are two sides of the same coin: despite their potential commonalities, no studies have documented their potential links. Digital systems, such as electronic health records and decision support systems, could foster this linkage.

IMPLICATIONS FOR NURSING PRACTICE

This review suggests that linking the conceptual frameworks can promote the diffusion of standardized nursing terminologies in clinical practice and increase accuracy in the measurement of Unfinished Care. This synergy could promote the contribution of nursing knowledge to patient care, nursing visibility, and be beneficial to clinical nurses, managers, and healthcare systems to international level.

"A little bit more challenging, but more rewarding": Medical-surgical nurses' perspectives on caring for adults with intellectual disabilities

Background: Despite their central role in hospital care, little research has explored medical-surgical nurses' perspectives on the rewarding aspects of and significant influences on caring for adults with intellectual disabilities, even though they are key to understanding this population's inequitable hospital outcomes. Methods: A qualitative descriptive design was used, and interviews were conducted with 13 medical-surgical nurses from the United States. Manifest content analysis was used to analyze the interview transcripts and categorize findings. Results: Five categories of significant influences: Preparedness to Care for People with Intellectual Disabilities, Communication, Caregiver Involvement, Ethical Concerns, and Context of Care, and four categories of rewards: Connecting, Making a Difference, Enjoyment, and Learning Opportunity, were revealed. Conclusion: Medical-surgical nurses derive meaning from connecting with and making a difference in the lives of hospitalized adults with intellectual disabilities, but face barriers to providing high-quality nursing care, resulting in dehumanized, delayed, or missed 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.

How Shift Nurses' Presenteeism is Related to Insomnia and Care Left Undone: A Cross-Sectional Study Using Generalised Structural Equation Modelling

AIM

To examine the association between nurses' insomnia, presenteeism and care left undone and explore the mediating effect of presenteeism on the relationship between insomnia and care left undone among nurses in acute care hospitals, applying a dynamic model of presenteeism and absenteeism.

DESIGN

A cross-sectional design.

METHODS

A secondary data analysis was conducted using online survey data collected in January 2023. Participants were 1154 registered nurses who provided direct nursing care to patients in tertiary or general hospitals (hospitals with 300 or more beds) in South Korea. Poisson regression analysis was used to examine the association between nurses' insomnia, presenteeism and care left undone. Generalised structural equation modelling was performed to examine the mediating effect of presenteeism on the relationship between insomnia and care left undone.

RESULTS

The prevalence of insomnia was 15.3%. More than half of the participants (63.7%) reported experiencing presenteeism in the past 4 weeks. All reported at least one nursing care left undone during their last shift. Insomnia and presenteeism were positively associated with care left undone, and presenteeism mediated the relationship between insomnia and care left undone among nurses in acute care hospitals.

CONCLUSION

Nurses experienced insomnia and presenteeism, related to higher rates of care left undone. Nurses' insomnia had a direct effect on care left undone and an indirect effect through presenteeism.

IMPLICATIONS FOR THE PROFESSION

Nurse managers and administrators need to make greater efforts to reduce insomnia and presenteeism among nurses, thereby reducing care left undone and improving patient safety in acute care settings.

IMPACT

Nurse managers and administrators should consider proactive interventions to address nurses' insomnia and foster a workplace with healthy systems and culture to reduce sleep disturbance and presenteeism, which can effectively decrease care left undone.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Investigating the relationship between missed/rationed nursing care and organizational commitment in Iranian nurses

BACKGROUND AND OBJECTIVE

The primary objective of the nursing profession is to provide comprehensive and appropriate nursing care that meets the individual needs of patients. However, instances of missed/rationed nursing care can jeopardize the delivery of complete and safe healthcare, potentially putting patients' lives at risk. The level of organizational commitment demonstrated by nurses is likely to impact various personnel and organizational factors. Therefore, this study aims to predict instances of missed/rationed nursing care by examining the influence of organizational commitment.

METHOD

This descriptive and cross-sectional study will be conducted in 2023. Three hundred nurses working in general and intensive critical care units at Tehran University of Medical Sciences hospitals were randomly selected. Data collection included Allen and Mayer's organizational commitment questionnaires, Kalish's missed care questionnaire, and demographic variables. A multiple linear regression model was used to analyze the prediction of missed care by commitment and other variables. The relationship between these variables was also explored using SPSS version 26 software.

FINDINGS

Half of the nurses reported occasionally missing nursing care. Moreover, more than half of the nurses reported moderate organizational commitment in all dimensions. The most significant reasons identified by nurses for missed care were financial resources, human resources, and communication (p < 0.001). There was a significant relationship between missed/rationed nursing care and organizational commitment (p = 0.042). In the multiple regression equation, a significant portion of missed care due to commitment was predicted when considering demographic variables (p < 0.001).

CONCLUSION

By understanding the relationship between organizational commitment and missed care, and identifying the factors contributing to missed/rationed care, managers can improve the efficiency of human resources and allocate appropriate financial resources. Establishing effective communication with employees can also enhance their commitment to addressing neglected care, ultimately reducing instances of oversight.

The association of teamwork and missed nursing care in acute care setting: A mixed-methods systematic review

AIM(S)

Teamwork among healthcare professionals is a key aspect of patient safety that influences the prevalence of missed nursing care. The association between teamwork and missed care in acute care hospitals is now well established in the literature. Therefore, this review aimed to synthesise the existing empirical evidence on the association between teamwork and missed care in the acute care setting.

DESIGN

A mixed-method systematic review study.

METHODS

The search was carried out in February 2023 in four scientific databases, PubMed, ProQuest, Web of Science and Scopus based on their institutional availability. The search produced 1542 studies. The method of thematic analysis was used in data synthesis.

RESULTS

A total of 18 studies were selected that revealed the relationship between teamwork and missed care. The teamwork score was weak to moderate but significantly associated with the overall score of missed care and was found to be a statistically significant predictor of missed care in an acute care setting. Additionally, teamwork represented an important reason for missed care, primarily in the context of poor communication, lack of trust and cooperation in the nursing team and lack of leadership.

CONCLUSION

The review findings contribute to a deeper understanding of the intricate dynamics between teamwork and missed care and provide valuable information to healthcare professionals and institutions looking to optimise teamwork and mitigate instances of missed care in the acute care setting.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Recognising how teamwork influences the occurrence of missed care, healthcare organisations can strategically implement targeted interventions to enhance collaboration, address communication gaps, foster trust, and provide effective leadership.

IMPACT

This review suggests that improving teamwork seems to be one of the most important strategies focused on mitigating missed care in acute care settings.

REPORTING METHOD

The reporting of this review followed the PRISMA 2020 checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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.

Unmet care needs in psychiatric healthcare context: A systematized literature review

WHAT IS KNOWN ON THE SUBJECT

Missed, rationed or unfinished nursing care represents a global problem that jeopardizes the provision of quality and safe care. This phenomenon is frequently observed in adult, paediatric and child healthcare facilities and various care units.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

The findings of this review contribute valuable information to inform evidence-based practices, foster organizational improvements and ultimately optimize the overall quality of care in psychiatric healthcare settings. In addition, the review illuminates the far-reaching consequences of care on both patient and nurse outcomes, emphasizing the urgent need for tailored strategies to mitigate these effects.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Based on the synthesis of the literature, a thorough and continuous assessment of patient care needs in the physical, psychological and social domains is needed, primarily utilizing standardized instruments designed for psychiatric settings to ensure a comprehensive understanding of unmet needs. Based on identified unmet needs, nurses should develop individualized care plans and tailor interventions to address them. In addition, nurse managers must adopt and implement regular monitoring mechanisms to track the prevalence of unmet care needs and at the same time establish reporting systems that capture the proportion of unmet needs, allowing timely interventions and adjustments to care delivery. Lastly, nurse managers must not only emphasize the importance of ethical care practices and dignity-focused interventions but also educate healthcare providers, especially nurses, on the potential threats to patient dignity arising from unmet care needs.

ABSTRACT

INTRODUCTION: Despite frequent observations of unmet care needs in acute care adult settings, there are a limited number of studies that focus on investigating this phenomenon in the psychiatric setting.

AIM

To synthesize the existing empirical research on unmet care needs in psychiatric healthcare settings.

METHODS

The search was carried out in August 2023 in four scientific databases, PubMed, ProQuest, Web of Science and OVID Nursing, based on their institutional availability. The search produced 1129 studies. The search and retrieval process reflected the recommendations of the Preferred Reporting Items for systematic reviews and meta-analyses.

RESULTS

This review included 14 studies investigating unmet care needs in the psychiatric healthcare setting. Unmet care needs included three domains: physical, psychological and social. The analysis of the factors revealed factors related to the characteristics of the organization, nurse and patient.

DISCUSSION

The classification of unmet needs provides a comprehensive understanding of the various challenges facing people in psychiatric healthcare settings.

IMPLICATION FOR PRACTICE

Identified factors that influence the occurrence of unmet care needs will help prevent the occurrence of unmet care needs and timely assessment. The resolution of needs helps to achieve patient and nurse outcomes, increase the quality of care provided and patient satisfaction in a psychiatric healthcare setting.

The relevance of the contribution of psychoneuroendocrinoimmunology and psychology of reasoning and decision making to nursing science: A discursive paper

AIM

Patients' death or adverse events appear to be associated with poor healthcare decision-making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem-related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision-making (PRDM) to support a new nursing theoretical frame.

DESIGN

Discursive paper.

METHOD

This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections.

CONCLUSION

Nursing recognizes the patient-nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections.

IMPACT ON NURSING PRACTICE

A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement in the design or writing of this discursive article.

The relationship between nurses' moral competency and missed nursing care: a descriptive-correlational study

BACKGROUND

When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections, increased mortality rates, and poor prognosis. Moral competence is crucial for clinical nurses as it guarantees high-quality patient care in nursing practice. Thus, this study aimed to investigate the correlation between moral competencies and MNC among nurses.

METHODS

This study was conducted with a descriptive-correlational design. The participants in the study were nurses who were currently enrolled at Shahid Beheshti University of Medical Sciences. In order to recruit nurses for the study, a convenience sampling method was implemented. The study tools were completed by a total of two hundred nurses. Research tools included a demographic questionnaire, the Moral Competence of Clinical Nurses Questionnaire, and the Kalisch and Williams Missed Nursing Care (MISSCARE) survey.

ETHICAL CONSIDERATION

This study was approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences.

RESULTS

The mean scores of moral competencies and MNC were 151.83 ± 12.60 and 42.71 ± 9.38, respectively. In other words, descriptive statistics showed that the moral competence score was more than 75%, and the MNC score was less than 50%. Also, there was a significant negative correlation between the total scores of moral competencies and MNC (r = -0.38, p < 0.001), indicating that more moral competence was correlated with lower levels of MNC.

CONCLUSION

The study revealed a negative correlation between nurses' moral competence and MNC, suggesting that enhancing moral competence could reduce MNC. To reduce MNC occurrences, hospitals, and organizations should prioritize moral competency, according to our research.

Digital health intervention on patient safety for children and parents: A scoping review

AIM

To explore digital health interventions on patient safety for children and their parents.

DESIGN

A scoping review.

METHODS

The PCC 'Participants, Concepts, and Contexts' guided the selection of studies that focused on children under 19 years of age or their parents, patient safety interventions for children, and digital health technology for patient safety interventions. This study was conducted using the Arksey and O'Malley framework's five steps. We reported the review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist.

DATA SOURCES

PubMed, CINAHL, Embase, Web of Science, and Cochrane were searched for articles published up to November 2022.

RESULTS

A total of 13 articles were included and categorized according to the following criteria to describe the results: intervention characteristics, type of digital technology, and outcome characteristics. Regarding intervention characteristics, we identified two categories, prevention and risk management. Additionally, we identified four types of digital technology, mobile applications, web-based technologies, computer kiosks and electronic health records. Finally, in studies focussing on child safety, parental safety behaviours were used to assess injury risk or detect changes related to prevention.

CONCLUSION

Patient safety interventions provided through appropriate digital technologies should be developed to enhance continuum of care for children from hospitalization to home after discharge.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Digital health interventions can bolster the role of healthcare providers in patient safety in and out of hospitals, thus improving children's safety and quality of care.

IMPACT

What problem did the study address? Although the various advantages of digital health technology have been demonstrated, the potential role of digital technology in patient safety interventions for children has not been explored. What were the main finding? Preventive patient safety interventions and risk management for children have been developed. Where and on whom will the research have an impact? Digital health interventions on patient safety can improve children's safety and quality of care by promoting non-face-to-face engagement of children and parents after discharge and expanding healthcare providers' roles.

TRIAL AND PROTOCOL REGISTRATION

Registered on the Open Science Framework (https://osf.io/dkvst).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

"The supreme discipline of Nursing"-A qualitative content analysis of nurses' opinions on caring for people eighty years of age and older

Introduction

Nurses often experience stress and feel under time pressure when working with older people, increasing their job dissatisfaction. Especially people 80 years of age and older often require more complex and a greater measure of care, as the risk of care dependency is higher in this age group. This study was conducted to collect nurses' experiences and opinions regarding the care of people 80 years of age and older, as well as to learn more about how nurses perceive this care.

Method

We analysed narratives collected in an Austrian nationwide, cross-sectional online study to investigate nurses' attitudes towards people 80 years of age and older and their perceptions regarding their care (N = 1197). Data were collected from May-October 2021 by using a convenience sampling method. In total, 149 participants filled in the free text field; these texts were analysed using a qualitative content analysis method.

Results

Three main themes emerged from the analysis of the nurses' narratives: (1) 'opinions on people in need of care', (2) 'reputation of nursing profession', and (3) 'criticism of current nursing practice'. Most narratives were assigned to the subthemes 'positive opinions on nursing', 'ideal image of nursing', and 'shortage of staff'.

Conclusion

Nurses considered their work with people aged 80 years and older to be meaningful and important, but they criticised working conditions which need to be improved. This could be achieved by offering further education and increasing nursing staff. Further research is needed to investigate nurses' needs and wishes regarding the care of people aged 80 years and older.

Factors of Missed Nursing Care in Intensive Care Units: Palestinian Perspective

Maintaining a high standard of nursing care is imperative for ensuring patient safety. Several factors significantly impact the provision of nursing care, including work environment resources, personnel coordination, work systems, and head nurse leadership. In addition, each nurse's clinical and academic career also plays a role in shaping the quality of care provided to patients. This article reports results of a cross-sectional study aimed to identify the different types of missed nursing care and the factors that contribute to them, as perceived by nurses, and second, to investigate how nurses' characteristics may relate to the occurrence of missed nursing care. Data for this study were obtained through a self-administered questionnaire that was distributed to participants working in an intensive care unit. The study included a final sample size of 176 participants, all of whom worked in intensive care unit hospitals located in the north region of Palestine. The study found that handwashing, setting up meals for patients who feed themselves, discharge planning, and response to a call light were the most frequently missed nursing care activities. The primary factors identified as reasons for missed nursing care were inadequate availability of labor and material resources, along with communication issues. Efforts to address these identified issues can potentially lead to improved quality of nursing care in intensive care units.

Professional engagement: Connecting self-efficacy to actual turnover among hospital nurses

AIMS

To examine how nurses' self-efficacy impacts professional engagement (professional opportunities exploration and workplace improvement participation), nurses' turnover intention and further on actual turnover.

BACKGROUND

The problem of nursing shortage has become a common global issue. Nurses' self-efficacy could reduce nurses' turnover intention. However, whether professional engagement could connect nurses' self-efficacy and their actual turnover remains unknown.

DESIGN

This study adopts a three-wave follow-up design.

METHODS

This study uses proportionate random sampling to survey nurses in a large medical centre in Taiwan. Totally, 417 participants were enrolled from December 2021 to January 2022 (first wave) and followed up from February 2022 to March 2022 (second wave). The data of nurses' actual turnover (or not) were traced in May 2022 (third wave). STROBE statement was chosen as the EQUATOR checklist.

RESULTS

Self-efficacy was positively linked to outcome expectation, which is positively linked to professional opportunities exploration. Self-efficacy was positively linked to career interest and workplace improvement participation. Professional engagement was negatively linked to nurses' intention to leave the target hospital, which was positively linked to actual turnover.

CONCLUSION

This study uniquely finds that professional engagement is the key to the mechanism underlying the influence of nurse' self-efficacy on their actual turnover.

IMPACT

Our findings impact nursing management that professional engagement is as well important as nurses' self-efficacy, with an aim to maintain the professional nursing workforce.

PATIENT OR PUBLIC CONTRIBUTION

Nurses complete the questionnaires, return them to the investigators and permit investigators to check their personnel data.

Research on missed nursing care during the COVID-19 pandemic: A scoping review

BACKGROUND

Missed nursing care is defined as care that is delayed, partially completed, or not completed at all. The scenario created by the COVID-19 pandemic may have influenced multifactorial determinants related to the care environment, nursing processes, internal processes, and decision-making processes, increasing missed nursing care.

AIM

This scoping review aimed to establish the quantity and type of research undertaken on missed nursing care during the COVID-19 pandemic.

METHODS

This review was conducted following the Joanna Briggs Institute methodology for scoping reviews. We searched CINAHL, MEDLINE, Scopus, two national and regional databases, two dissertations and theses databases, a gray literature database, two study registers, and a search engine from November 1, 2019, to March 23, 2023. We included quantitative, qualitative, and mixed studies carried out in all healthcare settings that examined missed nursing care during the COVID-19 pandemic. Language restrictions were not applied. Two independent reviewers conducted study selection and data extraction. Disagreements between the reviewers were resolved through discussion or with an additional reviewer.

RESULTS

We included 25 studies with different designs, the most common being acute care cross-sectional survey designs. Studies focused on determining the frequency and reasons for missed nursing care and its influence on nurses and organizational outcomes.

LINKING EVIDENCE TO ACTION

Missed nursing care studies during the COVID-19 pandemic were essentially nurses-based prevalence surveys. There is an urgent need to advance the design and development of longitudinal and intervention studies, as well as to broaden the focus of research beyond acute care. Further research is needed to determine the impact of missed nursing care on nursing-sensitive outcomes and from the patient's perspective.

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.

Missed Nursing Care in Medical and Surgical Wards in Jordan: A Cross-Sectional Study

Missed nursing care is a multifaceted patient safety issue receiving increased attention among healthcare scholars worldwide. There is limited research on missed nursing care in the Jordanian healthcare context. The current study sought to examine the perceptions of Jordanian nurses toward the amount and types of missed nursing care in medical and surgical wards. We also examined the differences in missed care items between public, private, and university hospitals in Jordan. This was a cross-sectional study using the MISSCARE Survey tool. Data collection spanned 4 months between March and July 2021. The final study sample consisted of 672 registered nurses employed in five public, three private, and two university hospitals in Jordan. Data were analyzed using descriptive statistics, Analysis of variance, and Pearson correlation coefficent test. Of the 672 registered nurses who participated, the majority were females (n = 421; 62.6%). Most participants held a bachelor's degree in nursing (n = 577; 85.9%). The three most common missed nursing activities in the participating hospitals were: ambulation, oral care, and emotional support. Nurses working in public hospitals reported the highest missed nursing care. The age and number of patients under care significantly correlated with missed nursing care. The findings could help nursing managers develop plans to reduce missed nursing care in their healthcare institutions.

Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review

BACKGROUND

Missed nursing care undermines nursing standards of care and minimising this phenomenon is crucial to maintaining adequate patient safety and the quality of patient care. The concept is a neglected aspect of human resource for health thinking, and it remains understudied in low-income and middle-income country (LMIC) settings which have 90% of the global nursing workforce shortages. Our objective in this review was to document the prevalence of missed nursing care in LMIC, identify the categories of nursing care that are most missed and summarise the reasons for this.

METHODS

We conducted a systematic review searching Medline, Embase, Global Health, WHO Global index medicus and CINAHL from their inception up until August 2021. Publications were included if they were conducted in an LMIC and reported on any combination of categories, reasons and factors associated with missed nursing care within in-patient settings. We assessed the quality of studies using the Newcastle Ottawa Scale.

RESULTS

Thirty-one studies met our inclusion criteria. These studies were mainly cross-sectional, from upper middle-income settings and mostly relied on nurses' self-report of missed nursing care. The measurement tools used, and their reporting were inconsistent across the literature. Nursing care most frequently missed were non-clinical nursing activities including those of comfort and communication. Inadequate personnel numbers were the most important reasons given for missed care.

CONCLUSIONS

Missed nursing care is reported for all key nursing task areas threatening care quality and safety. Data suggest nurses prioritise technical activities with more non-clinical activities missed, this undermines holistic nursing care. Improving staffing levels seems a key intervention potentially including sharing of less skilled activities. More research on missed nursing care and interventions to tackle it to improve quality and safety is needed in LMIC. PROSPERO registration number: CRD42021286897.

Eat Walk Engage: Enabling acute care teams to deliver consistent fundamentals of care for older people

AIMS

Fundamentals of care are particularly important for older people in acute inpatient settings, who are at increased risk of serious hospital-associated complications like delirium and functional decline. These complications occur due to interactions between clinical complexity and the complex processes and context of hospital care and can be reduced by consistent attention to the fundamentals of care. This paper aims to illustrate of how multi-level nursing leadership of fundamentals of care can be supported to emerge within complex multidisciplinary delivery systems in acute care.

DESIGN

Discussion paper informed by clinical and organizational experience of a multidisciplinary leadership team and complexity leadership theory.

DATA SOURCES

We provide a series of vignettes as practical illustrations of a successful multidisciplinary improvement program called Eat Walk Engage which supports the delivery of better care for older inpatients, significantly reducing delirium. We argue that taking a broader complexity-based approach including collaborative multidisciplinary engagement, iterative and integrated interventions and appropriate knowledge translation frameworks can enable emergent leadership by nurses at all levels.

IMPLICATIONS FOR NURSING

This promising approach to improving care for older patients requires organizational support for facilitation and reflective practice, and for meaningful data to support change. Our discussion challenges nursing leaders to support the time, agency and connections their nursing staff need in order to emerge as local leaders in fundamental care.

CONCLUSION

The debate around scope and responsibilities for fundamentals of care in hospital care has important practical implications for conceptualizing leadership and accountability for improvement.

IMPACT

Our discussion illustrates how a structured multidisciplinary approach that acknowledges and navigates complexity can empower nurses to lead and improve outcomes of older patients in acute care.

Toward understanding nurses' decisions whether to miss care: A discrete choice experiment

BACKGROUND

Studies of missed nursing care suggest that it results from ward-level, patient-related, and task-type factors, while nurses' decision-making style was scarcely studied. Studying the effect of nurses' decision-preference structures, namely a pattern of joint ward and patient factors, on missed care may also contribute to understanding the phenomenon.

OBJECTIVES

To examine the relationships between decision-preference structures and missed care and the moderating effects of decision-making styles and task type in these links.

DESIGN

A discrete choice experiment with a between- and within-participants design.

PARTICIPANTS

A sample of 387 registered nurses working in acute medical surgical wards in Israel.

METHODS

Based on the protocol for discrete choice experiments, a survey was developed to assess the decision-preference structure, considering five factors: overload, presence of head nurse, clinical complexity, difficult patient, and presence of relatives. Participants were randomly assigned to four task-type conditions and completed a survey regarding their task. Decision-making style was assessed using a validated questionnaire.

RESULTS

Extensive workload (b = -0.46; p = 0.001), difficult patient (b = -0.20; p = 0.001), and patient clinical complexity (b = -0.10; p = 0.006) were negatively linked to the probability of missed care. The interaction between workload and task type (b = 0.252; p = 0.017) indicated that the probability of missed care under extensive compared with regular workload was lowest for developing a discharge plan and highest for providing emotional support. The interaction of patient complexity and task type (b = 0.230; p = 0.013) indicated that the probability of missed care in developing a discharge plan and medication administration was lower for patients having high compared with low clinical complexity. The interaction between difficult patient and task type (b = -0.219; p = 0.044) indicated that the probability of missed care in emotional support, developing a discharge plan, and patient's mobility was lower for difficult than for non-difficult patients. Finally, the interaction between workload and decision-making style (b = -0.48; p = 0.001) indicated that the probability of missed care under heavy compared with regular workloads was lower for the dual-preference or the dominantly intuitive styles.

CONCLUSIONS

This design enabled examining the prioritizing processes nurses use when deciding about whether to miss care. The likelihood of missing more in structured tasks is lower under a heavy overload and when patients appear difficult or clinically complex. Dual-preference styles or dominantly intuitive styles are more suitable for the routine high workload.

Validation of the Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care, a Swedish version

AIM

The aim of the study was to translate, adapt and validate the instrument Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care for use in the Swedish community health care context.

DESIGN

A cross-sectional study. Data were collected from October 2019 to January 2020, and the questionnaire was sent to Registered Nurses, Enrolled Nurses and assistant nurses.

METHODS

The study was performed in four phases: (1) translation, (2) adaptation of the Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care to the Swedish context, (3) content validity testing, and (4) evaluation of psychometric properties. The collected data resulted in 611 responses. Explorative factor analysis was performed to explore the interrelationship, and Cronbach's alpha was used to evaluate the internal consistency.

RESULTS

Explorative factor analysis presented six factors/subscales: (1) fundamental care, (2) timely needed-based care, (3) dignity and support, (4) ensuring respectful treatment, (5) social activities, and (6) documentation, planning and reporting. The Cronbach's alpha for the components showed values between 0.7 and 0.9.

CONCLUSION

The analyses indicate an instrument to be usable for Enrolled Nurses and nurse assistants in community health care. Additional tests, can contribute to refining the content of the items and further test reliability and validity of the instrument.

NO PATIENT OR PUBLIC CONTRIBUTION

As this is a study of translation and validation of the instrument Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care.

An Overview of Missed Nursing Care and Its Predictors in Saudi Arabia: A Cross-Sectional Study

Background

Nursing care is holistic, and missing any aspect of care can be critical to patients' health. However, due to the complex and intense nature of the nursing practice, nurses have to unintentionally prioritize some activities, forcing them to omit some aspects of nursing care.

Aim

To explore the dimensions of missed nursing care and its predictors within the Saudi Arabian healthcare system.

Methods

Quantitative, cross-sectional study used the MISSCARE survey by utilizing nonprobability convenience sampling to collect the data of 604 staff nurses working in inpatient wards in Jazan, Saudi Arabia.

Results

The overall mean of missed nursing care is (m = 1.37, SD = 0.45). Missed nursing care activities were mostly failure to attend interdisciplinary care conferences (m = 1.66, SD = 0.96) and patient ambulation thrice a day (m = 1.63, SD = 0.97). Missed nursing care was mainly caused by human resource shortage (m = 3.53, SD = 0.88). Missed nursing care is predicted by the turnover intention (B = 2.380, t = 3.829, p < 001) and job satisfaction (B = −0.864, t = −4.788, p < 001).

Conclusion

Although missed nursing care is evident in Saudi Arabia, it is significantly lower than the international rates, and it is mainly caused by labor resource shortage which directly influences nurses' job satisfaction and intention to leave. Optimizing the recruitment process, resource allocation and effective nurses' retention programs are proposed solutions that may be beneficial to mitigate missed nursing care.

Exploring the role of communication in missed nursing care: A systematic review

AIMS

To systematically review the literature on relationships between communication issues and missed nursing care.

DESIGN

Systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement.

DATA SOURCES

EMBASE, Web of Science, CINAHL, PubMed and Cochrane databases were comprehensively searched from inception to December 2021.

REVIEW METHODS

Screening, data extraction and initial quality assessment were conducted independently by two reviewers. The JBI quality assessment tool was used for study appraisal and the certainty of evidence was assessed using the five Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Discrepancies were settled by consulting a third researcher.

RESULTS

A total of 18 articles were included. Missed nursing care was common and the status of communication was not optimistic in clinical. Nurses' sociodemographic characteristics and work environment both influenced missed nursing care and communication. Intrateam communication included three parts: doctors-nurses communication, nurses-nurses communication and nurses-patients communication, poor intrateam communication could contribute to missed nursing care. There was an interaction between missed nursing care and communication.

CONCLUSION

Promoting efficient intrateam communication, to acknowledge the importance of communication factors in reducing the incidence of missed nursing care in clinics is required. Future research can explore the impact of the internal dimension of communication on missed nursing care and consider interventions aimed at nurses' effective communication.

IMPACT

What problem did the study address? This study offers new evidence that the impact of intrateam communication on missed nursing care. What were the main findings? Effective intrateam communication can reduce the incidence of missed nursing care, there is mutual influence between communication and missed nursing care. Where and on whom will the research have an impact? Policymakers can provide positive interventions on communication problems in different populations (e.g. nurses-patients, nurses-nurses and doctors-nurses) to provide high-quality patient care.

Missed nursing care in highly specialized hospitals: A Mexican case study

OBJECTIVE

To assess the status of missed nursing care and the reasons for its occurrence in a highly specialised public hospital in Mexico.

MATERIALS AND METHODS

An observational cross-sectional analysis with data collected from January to June 2019 at the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra in Mexico City. We assessed missed care and its causes by conducting the MISSCARE survey among 116 nursing professionals selected from a population of 162 nurses. This work presents the estimated rates of missed care-overall and broken down into its four dimensions-as well as the reasons for its occurrence, namely limited labour resources, inadequate material resources and communication problems among work teams.

RESULTS

The overall score for missed care was 16% (95% CI: 11.84%-20.15%), with the following rates by dimension: 19.48% for basic care, 14.66% for individual needs, 6.47% for patient education and discharge planning, and 4.31% for continuous patient assessment. The main reason cited for missed care was inadequate material resources, followed by limited labour resources and communication problems among work teams.

CONCLUSION

Basic care and individual needs interventions were the most frequently omitted services, primarily because of inadequate material resources, limited labour resources and communication problems among work teams. An increase in the frequency of missed care can be expected in light of the high demand for health services, particularly as regards labour and material resources, imposed by the SARS-CoV-2 pandemic.

Antecedents of unfinished nursing care: a systematic review of the literature

BACKGROUND

Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date.

METHODS

A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach.

RESULTS

Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability).

CONCLUSIONS

At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.

A systematic review: Unfinished nursing care and the impact on the nurse outcomes of job satisfaction, burnout, intention-to-leave and turnover

AIM

To investigate the association of unfinished nursing care on nurse outcomes.

DESIGN

Systematic review in line with National Institute for Health and Care Excellence guideline.

DATA SOURCES

CINAHL, the Cochrane Library, Embase, Medline, ProQuest and Scopus databases were searched up until April 2020.

REVIEW METHODS

Two independent reviewers conducted each stage of the review process: screening eligibility, quality appraisal using Mixed Methods Appraisal Tool; and data extraction. Narrative synthesis compared measurements and outcomes.

RESULTS

Nine hospital studies were included, and all but one were cross-sectional multicentre studies with a variety of sampling sizes (136-4169 nurses). Studies had low internal validity implying a high risk of bias. There was also a high potential for bias due to non-response. Only one study explicitly sought to examine nurse outcomes as a primary dependent variable, as most included nurse outcomes as mediating variables. Of the available data, unfinished nursing care was associated with: reduced job satisfaction (5/7 studies); burnout (1/3); and intention-to-leave (2/2). No association was found with turnover (2/2).

CONCLUSION

Unfinished nursing care remains a plausible mediator of negative nurse outcomes, but research is limited to single-country studies and self-reported outcome measures. Given challenges in the sector for nurse satisfaction, recruitment and retention, future research needs to focus on nurse outcomes as a specific aim of inquiry in relation to unfinished nursing care.

IMPACT

Unfinished nursing care has previously been demonstrated to be associated with staffing, education and work environments, with negative associations with patient outcomes (patient satisfaction, medication errors, infections, incidents and readmissions). This study offers new evidence that the impact of unfinished nursing care on nurses is under investigated. Policymakers can prioritize the funding of robust observational studies and quasi-experimental studies with a primary aim to understand the impact of unfinished nursing care on nurse outcomes to better inform health workforce sustainability.

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.

Applicability of the interventions recommended for patients at risk or with delirium in medical and post-acute settings: a systematic review and a Nominal Group Technique study

BACKGROUND

Delirium is a common condition during hospitalisation that should be prevented and treated. Several recommendations have been established to date, whereas few studies have investigated their applicability in daily practice for medical and post-acute settings.

AIM

The aim of this research exercise was to emerge the applicability of the interventions recommended by studies in the daily care of patients at risk or with delirium cared in medical and post-acute settings.

METHODS

The study was organised in three phases. A systematic literature review according to Centre for Reviews and Dissemination was conducted (January-February 2021). Cochrane Library, Pubmed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Psychological Information Database, and the Joanna Briggs Institute databases were searched. Primary and secondary studies were evaluated in their methodological quality with the Standard Quality Assessment Criteria, the Critical Appraisal Skills Programme, and the Appraisal of Guidelines for Research & Evaluation. Then, the interventions identified were assessed in their applicability using the Nominal Group Technique who ranked their judgement on a four-point Likert scale from 1 (totally inapplicable) to 4 (totally applicable). Qualitative feedbacks were also considered, and a validation of the final list was performed by the Nominal Group.

RESULTS

A total of 12 studies were included producing a list of 96 interventions categorised into four macro-areas (prevention, non-pharmacological, communication and pharmacological management). The Nominal Group identified 51 interventions (average score > 3.5) as applicable in medical and post-acute settings. Then, through a process of re-reading, and revising according to the comments provided by the Nominal Group, a list of 35 interventions out of the initial 96 were judged as applicable.

CONCLUSION

Applicability should be assessed with experts in the field to understand the involved factors. One-third of interventions have been judged as applicable in the Italian context; the nurses' expertise, the work environment features, and the time required for each intervention in a high workload setting may prevent the full applicability of the interventions recommended by the literature.

Explaining the consequences of missed nursing care from the perspective of nurses: a qualitative descriptive study in Iran

Background

Missed nursing care is a global challenge that can have many consequences. Knowing the experiences of clinical nurses can be helpful. Therefore, this study was conducted to explain the experiences of Iranian nurses regarding the consequences of missed nursing care.

Methods

This qualitative descriptive study was conducted with a content analysis approach. Sampling was done by the purposeful sampling method and continued until data saturation. Data were collected by in-depth semi-structured interviews. Data were analyzed using qualitative content analysis and Graneheim and Lundman’s method. 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 data were classified into three categories: patient-related outcomes, nurse-related outcomes, and organization-related outcomes. These categories included nine subcategories entitled "moral distress", "job dissatisfaction", " decreased quality of nursing care "," patient dissatisfaction ","adverse events"," absenteeism ","intention to leave and subsequent turnover", "decreased hospital credit", and "increased hospital costs".

Conclusion

Missed nursing care can have adverse consequences for the patients, nurses, and organizations. Therefore, it is necessary to adopt management strategies such as providing sufficient manpower and increasing nurses' job satisfaction to reduce the amount of missed nursing care. Further studies are needed to explain the predictors of the missed nursing care consequences.

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 associated with missed nursing care and nurse-assessed quality of care during the COVID-19 pandemic

BACKGROUND

The coronavirus outbreak has brought unprecedented pressures to many health care systems worldwide, potentially compromising nursing care delivery and overall health care services.

AIMS

This study identified factors that contributed to missed nursing care and nurse-assessed quality of care during the coronavirus pandemic.

METHODS

This study employed a cross-sectional research design using an online survey. Survey respondents were 295 frontline nurses from the Central Region of the Philippines.

RESULTS

Missed care occurred at a low level, with "adequate patient surveillance" as the most often missed nursing care activity. Hospital facility size, nurse staffing levels, and patient safety culture predicted missed nursing care. Personal protective equipment adequacy, nurse staffing levels, and patient safety culture were identified as predictors of quality of care.

CONCLUSION

Frontline nurses tended to miss clinical aspects of nursing care during the pandemic. Modifying elements of the work environment, including nurse staffing levels, safety culture, and adequacy of protective equipment, may reduce care compromise and improve the quality of nursing care.

IMPLICATIONS FOR NURSING MANAGEMENT

By addressing the identified predictors, nurse managers could effectively develop appropriate interventions to support the professional role of nurses and ensure the delivery of complete, safe, and quality nursing care during the pandemic.

Linking nurse practice environment, safety climate and job dimensions to missed nursing care

AIM

This study examined the aspects of the nurse practice environment and patient safety climate and the various job dimensions that contribute to the occurrence of missed nursing care.

BACKGROUND

Missed nursing care is a crucial healthcare concern that poses significant threats to patient safety. The available literature on missed nursing care is confined to high-resource nations, where hospital policies, mechanisms and processes to support professional nursing practice are well established.

METHODS

This is a multi-centre, cross-sectional study, using self-report scales, which involves 624 clinical nurses in selected hospitals in the Philippines.

RESULTS

Patient safety climate (β = -0.148, p = 0.001), decision authority (β = -0.101, p = 0.018) and staffing/resource adequacy (β = -0.086, p = 0.014) significantly predicted missed nursing care. Nurse, unit and hospital variables were not related with missed nursing care.

DISCUSSION

Nurses who perceived greater decision authority, positive safety climate and adequate staffing/resources were less likely to miss or omit patient care activities.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

Institutional measures to foster decision authority in nurses, improve safety climate and address staffing/resource issues can be a viable solution to reduce the occurrence of missed nursing care.

Rationing of Nursing Care on Example of Selected Health Care Facility

Contemporary health determinants require nurses to develop new competencies and skills while performing complex tasks in all forms of health care. The problem of rationing of care is present all over the world and usually occurs when available resources are too low to provide adequate care to all patients. The most common reasons for loss of care are shortages of nurses, use of modern treatment methods, increased demand for care by a large number of patients, and greater knowledge of patients about their rights. A questionnaire survey was conducted among 295 nurses employed in hospital wards. The survey was conducted from September to December 2020 using the standardized BERNCA (The Basel Extent of Rationing of Nursing Care) questionnaire to measure the level of rationing of nursing care. The research was hampered by the sanitation regime associated with the SARS CoV-2 pandemic. Nursing care rationing is dependent on seniority and place of work. The mean total BERNCA score of the degree of rationing of nursing care was 2.58 ± 0.96 on a scale of 0 to 4 (where 0 means "no need for it" and 4 means "often". The median score was 2.69. The higher frequency of rationing nursing care was characteristic of those working on surgical wards. The mean score obtained by them was 2.72 ± 0.86, with the median equal to 2.88. In the case of nurses employed in non-surgical wards, the scores were 2.08 ± 1.07 and 2.28, respectively. Rationing of nursing care is dependent on seniority and work location, with a higher degree of rationing of care occurring in surgical units.

Missed nursing care as experienced by undergraduate nursing students

Background: In clinical settings where missed nursing care prevails, nursing students' instructions, supervision and the joint reflection on clinical practice with mentors are also affected and nursing students become involved in dealing with missed nursing care.

AIM

To explore the experience of missed nursing care in clinical placements, its meaning for nursing students, and actions they considered or took.

METHODS

Qualitative study based on a content analysis of nursing students' written reports. Nursing students in three universities in Germany with experience of at least one clinical practice placement were invited to participate. Online, they answered three open questions concerning missed nursing care focusing on: (1) experiences of the phenomenon, (2) its meaning and (3) actions that had been considered or taken when dealing with missed nursing care. A content analysis was performed.

RESULTS

The recruitment criteria were met by 69 nursing students. Four main themes and 20 sub-themes were identified. The reports covered all forms of missed nursing care. Becoming involved led to intrapersonal conflicts and, feelings of powerlessness but also to learning opportunities. It challenged professional and ethical standards. Students identified a broad spectrum of actions to answer the challenge.

CONCLUSION

Dealing with missed nursing care creates opportunities and challenges for nursing students. To build up a well-trained and sustainable nursing workforce, learning environments for nursing students must reflect the challenges and counteract deficits.

Systematic review of interventions targeting fundamental care to reduce hospital-associated decline in older patients

AIMS

To examine the effectiveness of targeted nursing interventions on mobilization, nutrition and cognitive engagement to reduce functional and hospital-associated decline (HAD) in older patients.

DESIGN

Systematic review of experimental studies using randomized and quasi-experimental designs.

DATA SOURCES

We searched electronic databases CINAHL, MEDLINE, EMBASE, Cochrane library, google scholar and BMJ quality reports from January 2009 to February 2020.

REVIEW METHODS

We reviewed intervention studies that targeted ward nursing teams to increase mobilization, nutrition or cognitive engagement of older adults. Inclusion criteria included older patients, acute care (medical, surgical and older adult wards) and reporting patient level outcomes. Quality appraisal included the Joanna Briggs Critical Appraisal Checklist for Quasi-Experimental Studies.

RESULTS

From 1729 papers, 18 studies using quasi-experimental and pre-post designs were selected. Study heterogeneity necessitated a narrative synthesis. The quality of evidence was low to moderate. All studies used multicomponent strategies, and 10 studies used evidence translation frameworks to align interventions to local barriers. Overall, 74% (n = 14) of studies reported a significant improvement in the stated primary outcome. Eight studies reported a significant increase in mobilization (e.g., sitting in a chair or walking), and four reported improved functional outcomes. Five studies improved nutrition outcomes (e.g., protein or energy intake), and three studies reported a significant reduction in delirium.

CONCLUSION

Acknowledging methodological limitations, the evidence indicates that nursing teams using evidence-translation frameworks can improve mobilization, nutrition and cognitive engagement in acute care settings. Future research requires higher-quality pragmatic trial designs, standardized outcomes, staff co-designed interventions, evidence-translation frameworks and patient engagement to make more confident inference about effectiveness.

IMPACT

Nursing teams with the support of hospital management have to address ward and system barriers to prioritize fundamental care to improve patient outcomes. There is sufficient evidence on multicomponent interventions and implementation strategies to inform nurse-led quality improvement.