Commonly missed nursing cares in the obstetrics and gynecologic wards of Tigray general hospitals; Northern Ethiopia

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.

Explaining the barriers and facilitators of the accreditation process in maternity departments

BACKGROUND

Accreditation is an important tool to ensure the quality of health services in health systems. Many studies have been conducted on the quality of accreditation in general and intensive care settings from the perspective of clinical nurses and nursing managers, but the barriers and facilitators of accreditation in maternity departments have not been studied. This study aims to explain the experiences and perspectives of midwives on implementing the accreditation process in the maternity department.

METHODS

This qualitative conventional content analysis research was conducted in 2024 in Qom, Iran. Twelve midwives from the maternity departments of two referral hospitals were purposefully chosen. The data were collected through in-depth semi-structured interviews. Data analysis was performed using Graneheim and Lundman's approach.

RESULTS

Three categories were extracted for accreditation barriers: Management barriers with subcategories of "The lack of cultural structure, Shortage of personnel, Not entering gynecologists into the accreditation process, Non-effective management", Administrative barriers with subcategories of "Paperwork and a lot of incoming information, Time-consuming and consuming tasks of accreditation, The dilemma between accreditation indicators and hospital standards, Imbalance between shift work activities, and participation in the process of accreditation, and Personal barriers with subcategories of " Paperwork and a lot of incoming information, Head midwife's stress and concern for accreditation, Inappropriate staff attitude toward accreditation, Reducing the motivation in the midwife, Midwife feel forced to do accreditation, Resistance to change. Two categories were extracted for accreditation facilitators: Actual facilitators with subcategories of" The availability of in-service training courses, Determining the errors and clarification activities with documentation, Clinical midwifes' involvement in decisions of the accreditation, Risk reduction, and job security "and Potential facilitators with subcategories of "Hope for a better future with the accreditation process, Satisfaction of the accreditation, transparency, Emphasis on efficiency and effectiveness".

CONCLUSIONS

Barriers to completing accreditation are multidimensional. The lack of proper management to create a cultural structure, to involve members of the treatment team, to solve the lack of staff, conflict between hospital standards and accreditation standards, frequent manual documentation, lack of anxiety control and promotion of motivation are some of the barriers to completing accreditation. Having multiple in-service courses related to accreditation and categorized errors and emphasizing effectiveness is a facilitator of accreditation completion. Considering the importance of the mother and newborn, health managers should adopt short and long-term management policies in the maternity departments to improve the facilitating factors and remove the barriers. To control the erosiveness of the accreditation process, the high-level managers of the hospitals should teach midwives effective management methods, and the active participation of gynecologists, increase motivation with financial and administrative incentives, involve more midwives in committees, and increase the personnel involved in the accreditation process. The middle managers of the hospital should also coordinate and balance the number of clinical shifts with the number of shifts in the accreditation process team. Planning in-service training to explain and inform about how to accurately complete accreditation standards and classification activities to reduce work errors.

Missed nursing care and associated factors among nurses at University of Gondar Comprehensive Specialized Hospital, Ethiopia, 2022

The issue of missed nursing care is a problem that affects the overall quality of nursing care in hospitals around the world. However, there is limited research about it in Ethiopia. This study assessed missed nursing care and factors among nurses. An institutional-based cross-sectional study was conducted among 485 nurses at the University of Gondar Specialized Hospital. The data were collected from May 15 to June 15, 2022 using a self-administered questionnaire. A simple random sampling technique was used to select study participants. The data was entered to EPI DATA version 4.6 and exported to SPSS version 23 for analysis. Descriptive statistics were computed, and a summative score of missed nursing care was calculated. Then, multiple linear regression analysis was used to identify the factors. A P-value of 0.05 was used to declare significant level. In this study, missed nursing care was 62.5% (95% CI 60.98-64.02). Documentation, vital signs assessment, intravenous care, and assessment as per hospital policy and patient education were the most frequently missed nursing care. Being single in marital status (B = -4.609, P = 0.004), adequacy of nursing staff (B = -2.458, P = 0.003), satisfaction with income (B = -8.753, P = 0.007), working in medical unit (B = -5.708, P = 0.002) and working in both day and night shift (B = 1.731, P = 0.027) were statistically associated factors. More than half of the participants missed basic nursing care. Most of the identified factors correlated with missed nursing care negatively. Efforts should be done to enhance communication between health team members, assign a manageable number of patients per nurse, and adjust shifts and units.

Magnitude and reasons for missed nursing care among nurses working in South Gondar Zone public hospitals, Amhara regional state, Northcentral Ethiopia: institution-based cross-sectional study

BACKGROUND

Missed nursing care has become a global health concern because of its impact on patient safety and nursing care quality. It is a critical indicator of nursing care quality and adverse patient outcomes. However, data regarding the magnitude and reasons for missed nursing care is limited in the study area. This study aimed to determine the magnitude and reasons for missed nursing care among nurses working in South Gondar zone public hospitals.

METHODS

An institution-based cross-sectional study design was conducted among nurses working in South Gondar zone public hospitals from December 12, 2023, to January 20, 2024. The data was collected through self-administered MISSCARE survey tools. The collected data were entered into EpiData V.4.2 and then exported to SPSS V.25 for analysis. The statistical significance of the association between outcome variables and independent variables was declared at a P-value less than 5% (0.05) at 95% CI.

RESULT

The magnitude of missed nursing care in the study area was 51.7% (95% CI: 46.89-55.47%). Medications administered as ordered (69.8%), skin/wound care (69.8%), vital signs assessed as ordered and accordingly (68.8%), and IV/central line site care and assessments according to hospital policy (66.2%) were among the nursing care elements that were frequently missed. Material resource (76.7%), teamwork (69.1%), labor resource (65.5%), and communication (56.3%) were the main reasons for missed nursing care. Inadequate number of staff 2.9 (1.75, 4.75), training (CPD) in nursing care 1.9 (1.16, 3.14), equipment's not available 3.9 (2.16, 6.89), and medication were not available. 4.4 (2.48, 7.76) were associated with missed nursing care.

CONCLUSION

The proportion of commonly missed nursing care was high. After adjusting for demographic variables, labor resources, material resources, and communication were reasons for commonly missed nursing care. Increasing the number of nurses, investing in nurse training, working on equipment availability, and increasing medication availability could minimize frequent omissions of nursing care.

Understanding the Experiences of Nurses' Work: Development and Psychometric Evaluation of an End of Shift Survey

AIM

To explore and validate an end of shift survey with a low response burden, practical application and generated evidence of related associations between workload, quality of work and patient care, missed care and job satisfaction.

DESIGN

A retrospective cross-sectional survey of the experiences of nursing staff.

METHODS

Data were collected from 265 nurses who responded to a questionnaire at the end of their shift in 2022. Exploratory factor analysis was undertaken using IBM SPSS v.27 and confirmatory factor analysis was undertaken using IBM AMOS v27. Hypotheses testing was undertaken using IBM SPSS v.27 using multiple regression analyses.

RESULTS

All of the hypotheses were supported. There was a negative association between workload and quality of work and job satisfaction. Quality of work was negatively associated with workload and missed care and positively associated with job satisfaction. The association between missed care and job satisfaction was negative.

CONCLUSION

The EOSS is a valid and reliable tool with a low response burden. The tool supports previous research which demonstrated there is a negative relationship between level of workload and shift type with satisfaction, quality of work and potentially nurse retention.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

In the context of a global nursing shortage nursing leaders must ensure that care we provide is of the highest quality. We must take every action to address high workload to reduce the risk that fundamental care is not sacrificed, job satisfaction is improved and nurses remain in the profession. The EOSS gives nurse leaders a reliable, practical, consistent, applied tool that will better enable associations to be observed between resource configuration, workload and critical impacts on nursing and patient care.

REPORTING METHOD

We have adhered to the relevant EQUATOR guidelines using the STROBE reporting method.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

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.

The Relationship Between Moral Sensitivity, Missed Nursing Care and Moral Distress Among New Nurses: A Cross-Sectional Study

Moral sensitivity, missed nursing care and moral distress among healthcare professionals have received considerable attention in recent years. These factors represent important healthcare challenges for new nurses (graduation to 2 years of work experience). However, studies on the relationships among these variables in the context of new nurses in China remain lacking.

AIMS

To explore the relationships among moral sensitivity, missed nursing care and moral distress in the context of new nurses in China.

RESEARCH DESIGN

A cross-sectional descriptive survey was conducted.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 228 new nurses were recruited from three tertiary hospitals in Qingdao, Shandong Province, China. Participants provided their sociodemographic and professional information and completed the Chinese Moral Sensitivity Questionnaire-Revised Version, the Chinese Missed Nursing Care Survey Version and the Chinese Moral Distress Scale-Revised Version. The data were analysed using Spearman's correlation analysis and multiple linear regression analysis.

RESULTS

The means and standard errors of moral sensitivity, missed nursing care and moral distress were 40.71 (0.39), 9.82 (0.78) and 34.87 (2.41), respectively. The variable of missed nursing care exhibited a significant negative relationship with moral sensitivity and a significant positive relationship with moral distress. Regression analysis revealed that the main factors influencing new nurses' moral distress were educational background, nature of job, current unit, frequency of night shifts and the dimensions of moral strength and responsibility. These factors can explain 14.9% of the total variation.

CONCLUSION

The findings revealed that higher rates of missed nursing care were associated with lower moral sensitivity and greater moral distress among new nurses. Therefore, developing interventions to reduce missed nursing care may be a promising strategy for improving moral sensitivity and preventing moral distress among new nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

In hospitals, moral distress can be improved by focusing on modifiable factors such as staffing resources, leading to better promoting new nurses' health and improving the quality of care. This study can highlight practices accounting for moral sensitivity and missed nursing care in nursing research and training programmes.

REPORTING METHOD

Strengthening the reporting of observational studies in epidemiology (STROBE) statement.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Missed nursing care and its associated factors in public hospitals of Bahir Dar City, Northwest Ethiopia: a cross-sectional study

OBJECTIVES

The aim of this study was to investigate the prevalence of missed nursing care and its associated factors among public hospitals in Bahir Dar City, Northwest Ethiopia.

DESIGN

An institution-based cross-sectional study was conducted among 369 randomly selected nurses.

SETTING

The study was conducted in primary and secondary-level public hospitals in Bahir Dar City.

PARTICIPANTS

Nurses who had worked in hospitals in Bahir Dar City were included.

INTERVENTION

No intervention was needed in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

A binary logistic regression model was used for statistical analysis. Statistical significance of the association between outcome variables and independent variables was declared at a p value of <0.05 with a 95% CI.

RESULTS

The prevalence of missed nursing care in this study was 46.3% (95% CI: 41.7% to 50.9%). The activities most frequently missed were physical examination (56.4%), patient discharge planning and teaching (50.9%), providing emotional support to the patient and family (50.8%), monitoring input and output (50.2%), assisting with patient ambulation (48.5%) and documentation (48%). Factors associated with missed nursing care include: male professionals (adjusted OR (AOR): 2.9, 95% CI: 1.8 to 4.8), those who had not received on-the-job training (AOR: 2.2, 95% CI: 1.4 to 3.6), those who worked full 24-hour shifts (AOR: 3.7, 95% CI: 2.0 to 6.5), those who were dissatisfied with the level of teamwork (AOR: 4.6, 95% CI: 2.8 to 7.6) and those who had an intention to leave the nursing profession (AOR: 1.8, 95% CI: 1.1 to 2.9). These factors were statistically associated with missed nursing care.

CONCLUSION

A significant proportion of nurses missed essential nursing care activities. Efforts should be made to enhance training, improve teamwork among nurses, provide stability and adjust work shifts to mitigate this issue.

Why do nurses miss nursing care? A qualitative meta-synthesis

AIM

The aim of this qualitative meta-synthesis was to discover the factors impacting on missed nursing care of nurses through systematic thinking.

BACKGROUND

Although nurses are responsible for high-quality care, missed nursing care is common, endangering patient safety. Understanding of the causes related to missed nursing care could help nursing managers improve the quality of nursing care.

DESIGN

A qualitative meta-synthesis guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).

METHODS

As a method designed to contribute to knowledge development, meta-synthesis allows for integration of qualitative study findings using thematic synthesis. Six databases were searched up to October 2021; nine studies met the inclusion and quality assessment criteria and meta-synthesis were conducted.

RESULTS

Three themes related to the causes why nurses missed nursing care were found. The themes included intrinsic resources (professional and ethical values, ambiguous nurse role, prioritization, education system, and knowledge), system structure (staff and resources shortage, heavy workload but limited time, and organizational management failure), and social environment (communication, working relationship and skill mix, and inappropriate ward layout).

CONCLUSION

The phenomenon of missed nursing care is a global tissue, with variations in its elements but also notable similarities. Meta-synthesis provides evidence of intrinsic and extrinsic factors that contribute to missed nursing care.

RELEVANCE TO CLINICAL PRACTICE

Recognizing and understanding the causes of missed nursing care is essential for nursing managers to ensure patient safety and the provision of high-quality care.

Translation and psychometric testing of the Chinese version of the Perinatal Missed Care Survey

Objective

This study aimed to translate and evaluate the psychometric properties of the Perinatal Missed Care Survey in China.

Methods

The Perinatal Missed Care Survey was translated according to the guidelines of the cross-cultural debugging scale recommended by the American Academy of Orthopaedic Surgeons Evidence-Based Medicine Committee, including forward translation, back translation, cultural adaption, and content validation, and its Chinese version was used in a cross-sectional study conducted from February to April in 2023. A total of 491 midwives from 14 different level hospitals in southwest China were recruited through a convenience sampling method. The discrimination ability of the items was tested through item analysis, and construct validity was assessed through exploratory factory and confirmatory factor analyses. The content validity index and Cronbach's α coefficients evaluated content validity and reliability, respectively.

Results

The Chinese version's item-total correlation coefficients ranged from 0.641 to 0.866 in part A and from 0.644 to 0.819 in part B (P < 0.001). Parts A and B's scale-level content validity indexes were 0.95, and the item-level content validity indexes were from 0.86 to 1.00. The three common factors of part A (necessary care, basic care, and postnatal care) and part B (communication, labor resources, and material resources) were extracted, accounting for 70.186% and 71.984% of the total variance, respectively. Confirmatory factor analysis indicated that the good fit of the three-factor models was acceptable. The Cronbach's α coefficients were 0.968 (part A) and 0.940 (part B).

Conclusion

The Chinese version of the Perinatal Missed Care Survey is a reliable and valid instrument for assessing nursing care missed by midwives during labor and birth and the reasons it was missed. Studies with large sample sizes are needed to verify the instrument's applicability in China.

Linking Patient Safety Climate With Missed Nursing Care in Labor and Delivery Units: Findings From the LaborRNs Survey

OBJECTIVE

This study aimed to explore the association of nurses' perceptions of patient safety climate with missed nursing care in labor and delivery (L&D) units.

METHODS

We recruited nurse respondents via email distribution of an electronic survey between February 2018 and July 2019. Hospitals with L&D units were recruited from states with projected availability of 2018 state inpatient data in the United States. Measures included the Safety Attitudes Questionnaire Safety Climate Subscale and the Perinatal Missed Care Survey. We estimated the relationship between safety climate and missed care using Kruskal-Wallis tests and mixed-effects linear regression.

RESULTS

The analytic sample included 3429 L&D registered nurses from 253 hospitals (response rate, 35%). A majority of respondents (65.7%) reported a perception of good safety climate in their units, with a mean score of 4.12 (±0.73) out of 5. The mean number of aspects of care occasionally, frequently, or always missed on respondents' units was 11.04 (±6.99) out of 25. χ2 Tests showed that six mostly commonly missed aspects of care (e.g., timely documentation) and three reasons for missed care (communications, material resources, and labor resources) were associated with safety climate groups ( P < 0.001). The adjusted mixed-effects model identified a significant association between better nurse-perceived safety climate and less missed care ( β = -2.65; 95% confidence interval, -2.97 to -2.34; P < 0.001) after controlling for years of experience and highest nursing education.

CONCLUSIONS

Our findings suggest that improving safety climate-for example, through better teamwork and communication-may improve nursing care quality during labor and birth through decreasing missed nursing care. Conversely, it is also possible that strategies to reduce missed care-such as staffing improvements-may improve safety climate.

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.

Proper partograph utilization among skilled birth attendants in Hawassa city public health facilities, Sidama region, Ethiopia, in 2021

Abnormalities of labor are the major causes of maternal and fetal mortality and morbidity. Proper partograph utilization is a key intervention to detect labor abnormalities and subsequent initiation of management. Although a great deals of studies were conducted about partograph utilization, they have failed to explore some critical factors which correlate with correct filling of partograph so far. To assess magnitude and factors associated with proper partograph recording among skilled delivery attendants in public health facilities of Hawassa city, Sidama Ethiopia, in 2021. An institution based cross-sectional study was conducted to assess proper partograph filling practice among skilled delivery providers of public health facilities of Hawassa city, Sidama region, Ethiopia from November to December 15, in 2021. Data were collected using self-administered questionnaire, and client chart review. Data were entered, cleaned, and analyzed using SPSS software. Binary and multivariate logistic regression analysis was used to show association between outcome and explanatory variables. Multi-collinearity test was done using VIF. Adjusted Odds Ratio with 95% CI and p value less than 0.05 was taken as cuff of value for statistically significant value at final model. Out of 405 study participants, only 370 study subjects have provided full response for questions making a response rate of 91.4% in this study. The reason of non-responders was evaluated as not related with the issue of the outcome variable. The mean age of study subjects was 28 ± 3.9 years. Magnitude of proper partograph utilization was found to be58.4% (95% CI, 55.8-60.9%) among skilled delivery attendants in this study. Factors associated with partograph uptake were: On job training (AOR = 1.9, 95% CI: (1.1, 3.2), good knowledge (AOR = 3.1, 95% CI: (1.8, 5.3) and supportive supervision (AOR = 4.5, 95% CI, 2.5, 7.9), client took Uterotonics (AOR = 2.3, 95% CI: 1.4, 3.9), and day time admission (AOR = 3.5, 95% CI, 1.9-6.4). These factors were associated positively with proper partograph utilization. In conclusion, magnitude of proper partograph utilization was found to be lower than magnitude of WHO threshold. Hence, on job training should be enhanced about proper partograph utilization. Furthermore, monitoring, supervision and strengthening the human resource of delivery process would be mandatory by managers of delivery units.

Nurse-Reported Staffing Guidelines and Exclusive Breast Milk Feeding

BACKGROUND

Nursing care is essential to overall quality of healthcare experienced by patients and families-especially during childbearing. However, evidence regarding quality of nursing care during labor and birth is lacking, and established nurse-sensitive outcome indicators have limited applicability to maternity care. Nurse-sensitive outcomes need to be established for maternity care, and prior research suggests that the initiation of human milk feeding during childbirth hospitalization is a potentially nurse-sensitive outcome.

OBJECTIVE

The aim of this study was to determine the relationship between nurse-reported staffing, missed nursing care during labor and birth, and exclusive breast milk feeding during childbirth hospitalization as a nurse-sensitive outcome.

METHODS

2018 Joint Commission PC-05 Exclusive Breast Milk Feeding rates were linked to survey data from labor nurses who worked in a selected sample of hospitals with both PC-05 data and valid 2018 American Hospital Association Annual Survey data. Nurse-reported staffing was measured as the perceived compliance with Association of Women's Health, Obstetric and Neonatal Nurses staffing guidelines by the labor and delivery unit. Data from the nurse survey were aggregated to the hospital level. Bivariate linear regression was used to determine associations between nurse and hospital characteristics and exclusive breast milk feeding rates. Generalized structural equation modeling was used to model relationships between nurse-reported staffing, nurse-reported missed care, and exclusive breast milk feeding at the hospital level.

RESULTS

The sample included 184 hospitals in 29 states and 2,691 labor nurses who worked day, night, or evening shifts. Bivariate analyses demonstrated a positive association between nurse-reported staffing and exclusive breast milk feeding and a negative association between missed nursing care and exclusive breast milk feeding. In structural equation models controlling for covariates, missed skin-to-skin mother-baby care and missed breastfeeding within 1 hour of birth mediated the relationship between nurse-reported staffing and exclusive breast milk feeding rates.

DISCUSSION

This study provides evidence that hospitals' nurse-reported compliance with Association of Women's Health, Obstetric and Neonatal Nurses staffing guidelines predicts hospital-exclusive breast milk feeding rates and that the rates are a nurse-sensitive outcome.

Determinants of missed nursing care in Jordanian hospitals during COVID-19 pandemic

AIM

The aim of the study was to examine the effect of perceived organizational support, accountability and nurses' characteristics on missed nursing care under the impact of COVID-19.

DESIGN

A cross-sectional design was used to describe and predict nurses' characteristics.

METHODS

A sample of 536 Registered Nurses participated in the study from eight hospitals in different health sectors in Jordan (three public hospitals, three private hospitals and two teaching hospitals).

RESULTS

Communication problems had the highest impact on missed nursing care, compared with labour resources and material resources reasons. Higher patient: nurse ratio aggravated by COVID-19 pandemic, years of experience, satisfaction with the income, perception of accountability and organizational support were among the factors associated with the levels of 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.

The Factor Associated with Missed Nursing Care in Hospital: A Systematic Review

Background:  Patient safety is a major concern in the healthcare industry worldwide. Increasing patient safety is critical for avoiding negative outcomes in nursing care and achieving goals at the desired level of quality. One of the indicators of this quality care given to patient is known as missed care. Aim: Aims of this study to explore the factors influencing missed care in order to improve the quality of nursing care. Methods: This study is a systematic review that explores the factors influencing missed nursing care in hospitals. Meanwhile, the literature search was carried out in the CINAHL Pubmed, Ebsco, Science Direct, Proquest, Willey, Sage from 2017 to 2021. Results: The results from six databases (n=3702) were sorted into 22 collected articles which include 18 quantitative, 2 qualitative, and 2 mixed methods. These findings highlighted three factors that influence missed nursing care: a lack of staffing, nurse competency, and the working environment. Conclusion: The factors that  contribute with missed nursing care in hospitals include lack of nurse staff, competency, and work environment. As a result, the nursing manager's critical role is to create adequate nursing staff, improve their competency, and foster a positive work environment. Keywords: missed nursing care, lack of staffing, nurse competency,  working environment

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 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).

Midwifery and nurse staffing of inpatient maternity services - A systematic scoping review of associations with outcomes and quality of care

OBJECTIVE

To undertake a scoping literature review of studies examining the quantitative association between staffing levels and outcomes for mothers, neonates, and staff. The purpose was to understand the strength of the available evidence, the direction of effects, and to highlight gaps for future research.

DATA SOURCES

Systematic searches were conducted in Medline (Ovid), Embase (Ovid), CINAHL (EBCSCO), Cochrane Library, TRIP, Web of Science and Scopus.

STUDY SELECTION AND REVIEW METHODS

To be eligible, staffing levels had to be quantified for in-patient settings, such as ante-natal, labour/delivery or post-natal care. Staff groups included midwives, nurse midwives or equivalent, and assistant staff working under the supervision of professionals. Studies of the quality of care, patient outcomes and staff outcomes were included from all countries. All quantitative designs were included, including controlled trials, time series, cross-sectional, cohort studies and case controlled studies. Data were extracted and sources of bias identified by considering the study design, measurement of exposure and outcomes, and risk adjustment. Studies were grouped by outcome noting the direction and significance of effects.

RESULTS

The search yielded a total of 3280 records and 21 studies were included in this review originating from ten countries. There were three randomised controlled trials, eleven cohort studies, one case control study and six cross sectional studies. Seventeen were multicentre studies and nine of them had over 30,000 participants. Reduced incidence of epidural use, augmentation, perineal damage at birth, postpartum haemorrhage, maternal readmission, and neonatal resuscitation were associated with increased midwifery staff. Few studies have suggested a negative impact of increasing staffing rates, although a number of studies have found no significant differences in outcomes. Impact on the mode of birth was unclear. Increasing midwifery assistants was not associated with improved patient outcomes. No studies were found on the impact of low staffing levels for the midwifery workforce.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Although there is some evidence that higher midwifery staffing is associated with improved outcomes, current research is insufficient to inform service planning. Studies mainly reported outcomes relating to labour, highlighting a gap in research evidence for the antenatal and postnatal periods. Further studies are needed to assess the costs and consequences of variations in maternity staffing, including the deployment of maternity assistants and other staff groups.

Patient safety culture, missed Nursing care and its reasons in Obstetrics

Objective:

to assess the correlations between the patient safety culture, the missed Nursing care, and the reasons for the omission in the obstetric area.

Method:

a cross-sectional study, conducted in 2019, with 62 Nursing professionals working in the obstetric area of a teaching hospital in southern Brazil. The MISSCARE-Brasil and Hospital Survey on Patient Safety Culture instruments were used. The data were analyzed using descriptive statistics, means comparison test and Spearman correlation.

Results:

the overall mean of positive answers for the safety culture was 34.9 (± 17.4). The care of assessing the vital signs and monitoring capillary blood glucose were the most prioritized, with airway aspiration and oral hygiene being the most overlooked. The main reasons for the omissions refer to labor resources and to inadequate staffing. A significant and inversely proportional correlation was found between the patient safety culture and overlooked nursing care (r=-0.393).

Conclusion:

the safety culture of the obstetric area was assessed as fragile by the Nursing professionals. The more the safety culture is strengthened and the greater investment in labor and human resources, the less care is overlooked.

The role of teamwork in the implicit rationing of nursing care: A systematic mixed-methods review

AIM

To systematically evaluate the role of teamwork in implicit rationing care and how to improve teamwork.

BACKGROUND

The implicit rationing of nursing leads to adverse effects for both patients and nurses. Therefore, how to reduce it has attracted increasing research attention. How teamwork may be an important factor in reducing implicit rationing care has become a focus of research.

METHODS

Data between May 2000 and May 2020 were collected from five databases. The study was guided by the framework of a mixed studies review.

RESULTS

Seventeen studies were chosen for review regarding efficient teamwork to reduce implicit rationing care. The following seven subthemes with positive effects that improve teamwork and reduce implicit rationing care were formed: (a) improving knowledge and skills; (b) promoting effective communication; (c) building mutual trust; (d) reducing turnover intention; (e) reasonable staffing; (f) division of responsibilities; and (g) cultivating team consciousness.

CONCLUSIONS

Teamwork can decrease implicit care and is influenced by many factors, but the intervention is singular. In the future, teamwork can be further improved to reduce implicit care.

IMPLICATIONS FOR NURSING MANAGEMENT

With more intervention research in the future, leadership and team-oriented roles can be used to complete all the care needed.