Omission of nursing care, professional practice environment and workload in intensive care units

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

OBJECTIVES

Unfinished care refers to the situation in which nurses are forced to delay or omit necessary nursing care. The objectives was: 1) to measure the prevalence of unfinished nursing care in intensive care units during the COVID-19 pandemic; 2) to examine whether unfinished nursing care has a mediating role in the relationship between nurse working environment and nurse-perceived quality of care and risk of burnout among nurses.

DESIGN

A national cross-sectional survey.

SETTING

Seventy-five intensive care units in Belgium (December 2021 to February 2022).

MAIN OUTCOME MEASURES

The Practice Environment Scale of the Nursing Work Index was used to measure the work environment. The perception of quality and safety of care was evaluated via a Likert-type scale. The risk of burnout was assessed using the Maslach Burnout Inventory scale.

RESULTS

A total of 2,183 nurse responses were included (response rate of 47.8%). Seventy-six percent of nurses reported at least one unfinished nursing care activity during their last shift. The staffing and resource adequacy subdimension of the Practice Environment Scale of the Nursing Work Index had the strongest correlation with unfinished nursing care. An increase in unfinished nursing care led to significantly lower perceived quality and safety of care and an increase in high risk of burnout. Unfinished nursing care appears to be a mediating factor for the association between staffing and resource adequacy and the quality and safety of care perceived by nurses and risk of burnout.

CONCLUSIONS

Unfinished nursing care, which is highly related to staffing and resource adequacy, is associated with increased odds of nurses being at risk of burnout and reporting a lower level of perceived quality of care.

IMPLICATIONS FOR CLINICAL PRACTICE

The monitoring of unfinished nursing care in the intensive care unit is an important early indicator of problems related to adequate staffing levels, the well-being of nurses, and the perceived quality of care.

Decoding Nursing Job Demands: A Multicenter Cross-Sectional Descriptive Study Assessing Nursing Workload in Hospital Medical-Surgical Wards

Background

Nursing workload is largely studied but poorly explored under physical, mental, and emotional dimensions. Currently, only a limited number of variables have been linked to nursing workload and work contexts.

Purpose

The study aimed to investigate whether it is feasible to identify variables that consistently correlate with nursing workload and others that are specific to the context.

Methods

We employed a descriptive correlational analysis and a cross-sectional design. Data were collected through a survey distributed to registered nurses working across Italy, at the conclusion of randomly assigned morning or afternoon shifts.

Results

We received 456 surveys from 195 shifts, collected from nurses in four public and two private hospitals. Commonly associated variables with nursing workload dimensions included patient complexity of care, admission/discharge or transfer, informing patients/relatives, contacting physicians, and unscheduled activities. Variables categorized as setting-specific were patient isolation and specialties, nurse-to-patient ratio, adequacy of staff in the shift, peer collaboration, healthcare documentation, educating others, and medical urgency.

Conclusions

In summary, certain variables consistently correlate with nursing workload across settings, while others are specific to the context of care. It is imperative for nurses and nurse managers to measure the nursing workload in various dimensions, enabling the prompt implementation of improvement actions.

A Cross-sectional Study Evaluating the Association Between the Nursing Practice Environment and Missed Nursing Care in Medical and Surgical Wards in Jordan

BACKGROUND

Missed nursing care can jeopardize the safety of patients. The practice environment contains various elements that may impact nursing staff's capability to provide appropriate care.

PURPOSE

To examine the association between the practice environment and missed nursing care in Jordanian hospitals.

METHODS

A cross-sectional design, including the MISSCARE survey and the Practice Environment Scale of the Nursing Work Index, was used for this study.

RESULTS

Data were gathered from 672 nurses working in 10 hospitals between March and July 2021. Findings revealed significant negative correlations between nurses' participation in hospital affairs ( r = -0.077, P = .046), nursing foundations for quality of care ( r = -0.139, P < .001), and missed nursing care.

CONCLUSION

Information from this study can help nursing leaders modify practice environment elements that impact missed nursing care occurrences, which will help improve the quality of care provided to patients.

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.

Carga laboral de profesionales de enfermería en Unidad de Cuidado Intensivo según Nursing Activities Score

Highlights: La NAS es una herramienta que toma relevancia al momento de evaluar la carga de trabajo de los profesionales de enfermería. Se evidencia que el personal de enfermería está expuesto a altas cargas de trabajo que, en la mayoría de casos, supera lo sugerido por Consejos y Asociaciones de enfermería. Algunos factores que pueden afectar la carga de trabajo son el tipo de turnos de trabajo, sexo del profesional, tipo de UCI, el número de pacientes a cargo, entre otros. Es necesario evaluar la implementación de la NAS en distintos tipos de servicios para entender la situación y trabajo actual de los profesionales de enfermería. Introducción: Nursing Activities Score ha sido utilizada como un instrumento principalmente en la Unidad de Cuidados Intensivos para medir las actividades de enfermería, siendo esta la unidad que maneja pacientes de mayor complejidad para el cuidado. Objetivo: establecer la carga de trabajo, evaluada por Nursing Activities Score, y factores relacionados a la misma en Unidades de Cuidado Intensivo. Metodología: Revisión cualitativa tipo scoping Review, utilizando el método PRISMA. Búsqueda en las bases de datos CINAHL, LILACS, SCOPUS, SCIENCE DIRECT, SCIELO y PUBMED. Resultados: La muestra final se compone de 87 textos, que van desde el año 2007 hasta 2021. Se clasificaron en cinco categorías: Carga de trabajo en UCI, comparación entre unidades, carga de trabajo relacionada al personal de enfermería, carga de trabajo relacionada a las características de los pacientes y consecuencias de la carga de trabajo. Discusión: La revisión revela una carga de trabajo mayor al 50% en la mayoría de los estudios, esto debido a diferentes factores: principalmente las características particulares de los pacientes, no se observó una diferencia significativa entre unidades generales y especializadas, las cargas de trabajo elevadas suponen un factor de riesgo para la ocurrencia de eventos adversos. Conclusiones: Los resultados de esta revisión permiten evidenciar que el personal de enfermería está expuesto constantemente a altas cargas de trabajo. Esta carga de trabajo puede verse influenciada o influenciar diversos factores, como lo son las características de los pacientes a quienes se brinda atención o puede afectar positiva o negativamente la calidad de la atención de enfermería. Como citar este artículo: Cruz López Laura Nathalie, Quintero Osorio Jenny Fernanda, Melo Roa Juan David, Henao Castaño Ángela María. Carga laboral de profesionales de enfermería en Unidad de Cuidado Intensivo según Nursing Activities Score. Revista Cuidarte. 2023;14(1):e2680. http://dx.doi.org/10.15649/cuidarte.2680

Explanation of factors forming missed nursing care during the COVID-19 pandemic: A qualitative study

Background

Providing nursing care to patients with COVID-19 has put additional pressure on nurses, making it challenging to meet several care requirements. This situation has caused parts of nursing care to be missed, potentially reducing the quality of nursing care and threatening patient safety. Therefore, the present study aimed at explaining the factors forming missed nursing care during the COVID-19 pandemic from the perspective of nurses.

Methods

This qualitative study was conducted using a conventional content analysis approach in Iran, 2020-2021. Data were collected from in-depth, semi-structured interviews with 14 nurses based on purposive sampling. Data analysis was performed simultaneously with data collection. Graneheim and Lundman's approach was used for data analysis, and MAXQDA software was used for data management. After transcribing the recorded interviews, to achieve the accuracy and validity of the study, the criteria proposed by Lincoln and Guba were considered and used.

Results

A total of 14 nurses with a mean age and standard deviation of 31.85 ± 4.95 and working in the COVID-19 wards participated in the study. The acquired data were categorized into four main categories: care-related factors, disease-related factors, patient-related factors, and organization-related factors. The category "care-related factors" comprised uncertainty in care, PPE-related limitations, attrition from care, and futile care. The category "disease-related factors" consisted of the extension of symptoms, unpredictable peaks of the disease, and restriction on the presence of patients' companions. The category "patient-related factors" included comorbidities, elderly patients, and deterioration of infected patients. Ultimately, the category "organization-related factors" consisted of restrictions on equipment supply, lack of human resources, weaknesses in teamwork, and an unsupportive work environment.

Conclusion

The results of this study showed that several reasons including factors related to care, patient, disease, and organization cause missed nursing care. By modifying the related affecting factors and considering the effective mechanisms to minimize missed nursing care, it is possible to provide better services.

Evaluation of the relationship between individual workload perception and compliance with isolation measures of emergency and critical care nurses

BACKGROUND

As a result of the coronavirus 2019 (COVID-19) pandemic, compliance with isolation measures has become challenging.

OBJECTIVE

To evaluate the individual workload perception and compliance with isolation measures of nurses working in the emergency service and critical care unit during the COVID-19 outbreak.

METHODS

This descriptive correlational study was carried out in the emergency service and critical care unit of a public hospital between April 20 and May 20, 2021. A total of 153 nurses working in the emergency service and critical care unit who agreed to participate in the study were included in the study.

RESULTS

Nurses from a state hospital's emergency department and critical care unit (n = 153) were included in the study sample. The impression of overall individual workload by nurses and compliance with isolation (r = 0.153; p <  0.05) had a positive, weak, and significant relationship. The Isolation Measures Compliance Scale resulted in a mean score of 70.70±5.35. The mean score on the Individual Workload Scale for nurses was moderate (3.22±0.54).

CONCLUSION

The low perception of individual workload of nurses working in the emergency service and critical care unit during the COVID-19 pandemic increased the compliance with isolation measures.

Nursing practice environment and missed care at highly specialised hospitals in Mexico: A cross-sectional observational study

BACKGROUND

The influence of the work environment on missed care and service quality has been well documented. However, available evidence concerning this relationship comes mostly from developed countries. Few studies have been conducted in low- or middle-income countries. We assessed the relationship between the work environment and missed nursing care in highly specialised hospitals in Mexico.

METHODS

We conducted an observational cross-sectional study with data collected from January 2019 to February 2020 in 11 highly specialised hospitals (n = 510 nurses). We estimated missed nursing care utilising the MISSCARE questionnaire and used the Practice Environment Scale-Nursing Work Index instrument to assess the work environment. After describing the main attributes of the study sample according to the type of work environment, we constructed five adjusted fractional regression models, the first concerning the overall index of missed care, and the others pertaining to its various dimensions.

RESULTS

The sample analysed was balanced as regards adjustment variables according to the type of work environment. The adjusted estimates confirmed an inverse relationship between the missed care index and enjoying an enhanced, or favourable, work environment. Overall, the difference was 9 percentage points (pp); however, by dimension of missed care, the major differences between enhanced and attenuated, or unfavourable, work environments were registered for basic care, followed by patient education and discharge planning (4pp) and individual needs (8pp).

CONCLUSIONS

The work environment determines the frequency of missed nursing care, both overall and by dimension. Nursing managers need to create short- and mid-term strategies favouring positive work environments in order to improve working conditions for nursing professionals.

Combination Relationship between Features of Person-Centered Care and Patient Safety Activities of Nurses Working in Small-Medium-Sized Hospitals: A Cross-Sectional Study

Perceived safety culture and nursing work environment are considered important prerequisites for a patient safety activity. Patient safety is also associated with person-centered care; however, few studies apply the person-centered care framework which includes staff attributes and care environment. This study aimed to examine the canonical correlations of person-centered care factors, including professional self-concept, patient safety culture, nursing work environment, and patient safety activities of nurses working in small-medium-sized hospitals. A cross-sectional survey was used. Participants included 171 nurses from seven small-medium-sized hospitals in Busan metropolitan city, in Korea. Data were analyzed using descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's correlation coefficients, and canonical correlations. Two significant canonical variates were found. First, better professional self-concept, a positive patient safety culture, and better nursing work environment were associated with better patient safety care activities. Second, a negative patient safety culture and healthy nursing work environment were associated with a lack of communication between medical staff. Person-centered framework factors such as staff attributes and care environment were positively associated with patient safety activities. Based on the results, nurses in small-medium-sized hospitals should be highly aware of their professional self-concept. Moreover, nurses should be equipped with psychological safety and a healthy work environment to enhance patient safety activities.

Value of Intensive Nursing Detail Management in Intensive Care Unit Nursing

Objective

To evaluate the value of intensive nursing detail management in intensive care unit (ICU) nursing.

Methods

In this prospective study, 100 ICU patients in Shiyan Maternal and Child Health Hospital between January 2019 and March 2020 were assessed for eligibility and recruited. They were concurrently randomly assigned (1 : 1) to receive either conventional nursing (control group) or intensive nursing detail management (study group). The clinical endpoint was the nursing efficiency.

Results

Intensive nursing detail management was associated with significantly higher scores in basic nursing, quality of nursing, and quality of management versus conventional nursing (P < 0.05). Intensive nursing detail management resulted in a significantly higher adequate nursing rate (96.00%) versus conventional nursing (74.00%) (P < 0.05). The patients given intensive nursing detail management had a shorter hospital stay versus those receiving conventional nursing (P < 0.05). Intensive nursing detail management was associated with a higher nursing satisfaction rate (74.00%) versus conventional nursing (70.00%) (P < 0.05).

Conclusion

Intensive nursing detail management is effective and safe in ICU nursing, so it is worthy of clinical application.

Causes of Missed Nursing Care During COVID-19 Pandemic: A Qualitative Study in Iran

Background

The unpredictable and variable nature of COVID-19 and the lack of healthcare resources has led to inadequate care for patients. This study aimed to explain the causes of missed nursing care during the COVID-19 pandemic from the perspective of Iranian nurses.

Method

This qualitative study was conducted using semi-structured interviews with 14 nurses caring for patients with COVID-19 in three hospitals in Iran. Sampling was performed by the purposive method. Data were analyzed using the conventional content analysis method. The interviews were first recorded and transcribed, and then the data were analyzed using the Elo and Kyngas method. Data management was done with MAXQDA software version 10. To achieve trustworthiness, the criteria presented by Lincoln and Guba were used.

Findings

A total of 14 nurses participated in the study. The mean age of participants was 31.85 ± 4.95 years, and the mean number of years of work experience was 7.71 ± 4.44. Eleven participants were women. Among all participants, nine had a bachelor's degree and five had a master's degree. Four nurses had fixed shifts, while ten nurses had rotating shifts. The causes of missed nursing care were categorized into 4 groups. The category “unfulfilled care” comprised the reasons for forgetting care, neglecting care, arbitrary elimination of care, and compulsory elimination of care. The category of “care at improper time” consisted of interference of the care in patients' daily activities and interference with other healthcare providers' activities. The “incomplete cares” category comprised failure to complete the care period in hospital, interruption in care, and discontinuance of care after patient discharge. The last category, “incorrect care,” consisted of providing care regardless of the nursing process, providing care by unqualified professionals, and providing trial-and-error care.

Conclusion

This study illustrates an understanding of the causes of missed nursing care during the COVID-19 pandemic from the perspective of nurses. The increasing demand for care caused by the pandemic and problems in the work environment has led to the failure of nurses to provide complete, correct care and sometimes miss parts of care to patients. Therefore, nursing policymakers and managers should develop and implement appropriate care protocols and instructions to minimize missed nursing care.

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

Background:  Missed nursing care (care left undone or task incompletion) is viewed as an important early predictor of adverse patient care outcomes and is a useful indicator to determine the quality of patient care. Available systematic reviews on missed nursing care are based mainly on primary studies from developed countries, and there is limited evidence on missed nursing care from low-middle income countries (LMICs). We propose conducting a systematic review to identify the magnitude of missed nursing care and document factors and reasons associated with this phenomenon in LMIC settings. Methods and analysis:  This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). We will conduct literature searching across the Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, from inception to 2021. Two independent reviewers will conduct searches and data abstraction, and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be determined using the Newcastle-Ottawa Scale (NOS). Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals PROSPERO registration number: CRD42021286897 (27 th October 2021).

Razões correlacionadas a omissão de cuidados de enfermagem

RESUMO Objetivo: Avaliar as razões correlacionadas à omissão de cuidados de enfermagem em um hospital universitário. Método: Delineamento transversal analítico, desenvolvido em um hospital universitário do Nordeste do Brasil, nos meses de janeiro a fevereiro de 2020. A população do estudo compreendeu enfermeiros e técnicos de enfermagem que atuavam na assistência direta ao paciente. Aplicou-se a versão brasileira do Missed Nursing Care Survey em uma amostra por conveniência composta por 227 participantes (79 enfermeiros e 148 técnicos de enfermagem). Foram calculadas estatísticas uni e bivariadas no software Statistical Package for social Science, versão 26.0. Resultados: O cuidado de enfermagem mais omitido foi deambulação três vezes por dia ou conforme prescrito (70,9%). A razão mais prevalente foi aumento inesperado do volume e/ou gravidade dos pacientes da unidade (93,0%). Foram verificadas correlações positivas, embora fracas, entre a omissão de cuidados geral, bem como por nível de prioridade, e razões de omissão atribuídas pelos enfermeiros e técnicos de enfermagem (p < 0,05). Conclusão O estudo evidenciou que a omissão de cuidados de enfermagem abrangeu todas as cinco dimensões do instrumento correlacionados principalmente aos recursos laborais e materiais.

Reasons correlated with omission of nursing care

ABSTRACT Objective: To evaluate the reasons correlated with the omission of nursing care in a university hospital. Method: Analytical cross-sectional design, developed in a university hospital in Northeast Brazil, from January to February 2020. The study population consisted of nurses and nursing technicians who worked in direct patient care. The Brazilian version of the Missed Nursing Care Survey was applied in a convenience sample consisting of 227 participants (79 nurses and 148 nursing technicians). Univariate and bivariate statistics were calculated in the software Statistical Package for Social Science, version 26.0. Results: The most omitted nursing care was walking three times a day or as prescribed (70.9%). The most prevalent reason was an unexpected increase in the volume and/or severity of patients in the unit (93.0%). Positive, albeit weak, correlations were found between overall care omission, as well as omissions by priority level, and reasons for omission given by nurses and nursing technicians (p < 0.05). Conclusion: The study showed that the omission of nursing care covered all five dimensions of the instrument, mainly correlated with labor and material resources.

Round multiprofissional com checklist: associação com a melhoria na segurança do paciente em terapia intensiva

RESUMO Objetivo Verificar a associação entre round multiprofissional com uso de checklist e práticas de segurança do paciente por profissionais de saúde de uma unidade de terapia intensiva. Método Estudo de método misto, delineado pela abordagem sequencial explanatória, realizado em um hospital do sul do Brasil. Os dados quantitativos foram analisados por meio de regressão de Poisson e os dados qualitativos, pela análise de conteúdo. Fez-se a análise integrada por meio da combinação explicada/conectada. Resultados No período pós-implementação dos rounds com uso sistemático de checklist houve melhora significativa da profilaxia de tromboembolia venosa, sedação leve, redução dos dias de uso de ventilação mecânica, cateter venoso central e de sonda vesical de demora. Conclusão O round multiprofissional com uso sistemático de checklist, associado com a melhoria nas práticas de segurança do paciente, foi considerado como uma estratégia que assegura melhores cuidados em terapia intensiva e favorece a satisfação no trabalho.

Multiprofessional round with checklist: association with the improvement in patient safety in intensive care

ABSTRACT Objective To verify the association between a multiprofessional round with the use of checklists and patient safety practices by health professionals in an intensive care unit. Method Mixed-method study, delineated by the sequential explanatory approach, conducted in a hospital in southern Brazil. Quantitative data were analyzed using Poisson regression, and qualitative data, using content analysis. The integrated analysis was performed through the explained/connected combination. Results In the post-implementation period of the rounds with systematic use of the checklist, there was a significant improvement in the prophylaxis of venous thromboembolism, light sedation, reduction in the days of use of mechanical ventilation, central venous catheter and indwelling urinary catheter. Conclusion The multiprofessional round with the systematic use of checklist, associated with the improvement in patient safety practices, was considered as a strategy that ensures better care in intensive care and favors job satisfaction.

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

Background:  Missed nursing care (care left undone or task incompletion) is viewed as an important early predictor of adverse patient care outcomes and is a useful indicator to determine the quality of patient care. Available systematic reviews on missed nursing care are based mainly on primary studies from developed countries, and there is limited evidence on missed nursing care from low-middle income countries (LMICs). We propose conducting a systematic review to identify the magnitude of missed nursing care and document factors and reasons associated with this phenomenon in LMIC settings. Methods and analysis:  This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). We will conduct literature searching across the Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, from inception to 2021. Two independent reviewers will conduct searches and data abstraction, and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be determined using the Newcastle-Ottawa Scale (NOS). Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals PROSPERO registration number: CRD42021286897 (27 th October 2021).

Missed nursing care in hospital environments during the COVID-19 pandemic

BACKGROUND

Studies performed in Central European countries showed a high prevalence of missed nursing care in various clinical settings before the COVID-19 pandemic.

AIMS

The aim of the study was to investigate which domains of the work environment were significant predictors of missed nursing care activities in Czech hospitals during the COVID-19 pandemic.

METHODS

A cross-sectional study was used. The RANCARE guideline and STROBE checklist were followed for reporting in the study. The sample consisted of 371 nurses from four acute care hospitals. The MISSCARE Survey and the Practice Environment Scale of the Nursing Work Index questionnaires were used to collect data. The data were analyzed using multiple linear and logistic regression analyses.

RESULTS

Nurses reporting unfavorable environments consistently describe a higher frequency of episodes of missed care. Prevalence estimates of missed care in Czech acute care hospitals during the COVID-19 pandemic was predicted from the overtime work, the nurses' perception of the "Nursing foundations for the quality of care," and their satisfaction with their current position.

CONCLUSIONS

Missed nursing care could be mitigated by improving the nurses' work environment. Domains of the nurse work environment are known as structural modifiable factors and their refinement could be a cornerstone for interventions to reduce the prevalence of missed nursing care.

IMPLICATIONS FOR NURSING POLICY

Monitoring the conditions and aspects of the nurse work environment in hospitals and considering nurses' concerns about the work environment on an ongoing basis are important strategies for nurse supervision as well as for policymakers.

Nursing physical workload and mental workload in intensive care units: Are they related?

AIM

In order to ensure patient safety and quality of care, it is important to consider factors which may impact on nursing workloads. This study aimed to investigate the simultaneous physical and mental workload and any relationships between these concepts on nurses working in intensive care units.

DESIGN

A cross-sectional design was undertaken.

METHOD

Participants were nurses (N = 105) recruited from six adult intensive care units which met the inclusion criteria. Nursing Activities Score (NAS) to measure physical workload and NASA Task Load Index (NASA-TLX) to measure mental workload were used. Data were collected for each participating nurse in three shifts (morning, evening and night). Data were analysed using bivariate correlation and multivariable linear regression analysis.

RESULTS

The mean (SD) of nurses' physical and mental workload was 72.84% (22.07%) and 70.21 (12.36), respectively. A significant relationship between physical and mental workload (p <.001) was identified.

Nurse work environment and its impact on reasons for missed care, safety climate, and job satisfaction: A cross-sectional study

AIM

To describe the nurse work environment and its relation to reasons for missed nursing care, safety climate, and job satisfaction.

DESIGN

This was a cross-sectional study.

METHODS

Two hundred and nineteen nursing professionals by a convenience sample from two teaching hospitals between April 2017 and October 2017. The variables nurse work environment, reasons for missed nursing care, safety climate, and job satisfaction were collected by measuring instruments, and a descriptive, correlation, and comparative analyses were performed.

RESULTS

The nurse work environment was classified as mixed, with three subscales of the instrument resulting in scores that represented a better nurse work environment, namely: nursing foundations for quality care; collegial nurse-physician relations; and nurse manager ability, leadership, and support. The most frequent reasons for missed care were related to labour and material resources. A better work environment was associated with a high level of work satisfaction, better perception of the safety climate, and fewer reasons for missed care.

CONCLUSION

Better nurse work environments can contribute to improving nurses' perception of job satisfaction and the safety climate, and to reducing reasons for missed care.

IMPACT

Authentic leadership in the nurse work environment has implications in terms of reducing the reasons for missed nursing care, improving the perception of the safety climate, and job satisfaction. Nurse managers should evaluate the nurse work environment and missed nursing care as an important predictors of the quality of patient care.